hit

I was running last week in West Philly and a lady almost hit me with her car.

It was one of those situations where she was stopping. She was almost or already at a complete stop at the white line on the street. So I started crossing.

I was literally right in front of her when she hit the accelerator. If she'd been trying to hit me, she couldn't have timed it better.

So, I screeched, "Jesus Christ!" and skittered out of the way barely fast enough.

Then I screamed some obscenities about her driving, and how she should pay better attention.

Then I ran away.

I was relaying this story to a friend of mine, and she said that when that sort of thing happened to her, her reaction was to run away in terror without saying anything. She said she WISHED she had the gumption to scream obscenities.

I pointed out that it was probably better not to be a screamer. That one day I'd probably get shot. On the other hand, at times like that I'm not sure I could do differently if I tried either.

Address

Had another drs appt this week with a new dr. They gave me a form to verify that my information was correct, and I noticed that they'd spelled my street wrong.

So I corrected them.

And what happened? The admin told me that the lab where I have to go get blood work done might give me trouble because of the change. And it was in this you're-causing-trouble tone of voice.

I kind of thought this was asinine. Put the freaking change into the system, woman!! You f-ed up the data entry! YOU deal with it!

This should not be my problem.

What I said was, "Well if they (or you) are interested in getting paid, it would be helpful if the bills were addressed to the right address so that I will receive them. Don't you think?"

I realize that front desk staff at drs offices are paid horribly poorly, but really. Don't they want the bills to go to the right place? Sheesh.

Freaking morons.

Sacrifice

There's a post over at MiM today about what women need to do to be successful. the big takeaways I got were:

1. In men, success and likeability are positively correlated. In women, negatively. You need to attribute your success to yourself even if you risk not being liked. Takeaway: Your real friends will like you and support you through your successes and failures even if they are a little jealous too sometimes.

2. Choose your spouse wisely. If your husband works too, he should be sharing responsibilities at home in an equitable fashion. Takeaway: Ask your husband for the help you need. If you are in the dating stage, ask your bf/gf. If they are put out by the request, it is a sign. They are not going to change, and you should take that under advisement.

3. If you want to have a family, try not to start checking out of work mentally before you even have children. Takeaway: Do what you do full throttle until you want to do something different. Then do that full throttle instead.

Then she asks us, the readers, to talk about how we've shortchanged ourselves.

So, here it is: I shortchanged myself by not realizing that I was smart enough to do med school pre-reqs and get As in them during college.

I shortchanged myself by allowing my fear of math keep me from higher level math and science classes in college, even though I almost always got As in those classes.

I shortchanged myself by not looking into how to get involved in research when I realized that health services research was really what I wanted to do -- the year after I graduated from college.

I shortchanged myself by dating a guy for three years that I knew was completely wrong for me (we would NEVER have been equal partners) because I was afraid of being alone.

I shortchanged myself in my current program during my first year when I allowed my default mentor (that I was initially assigned, not my current one) to pressure me into working for him even though I wasn't interested in his research. I shortchanged myself by not asserting that I wanted to talk to other investigators, and that I needed some sort of introduction before I emailed them so that they would know that my inquiries were legitimate.

But I do a lot of things right as well.

I try to say thank you when I receive a complement.

I work my ass off to get my work done, even though I don't know if / when we will have kids.

I picked an awesome husband who loves to clean, but mostly who loves to see me happy.

I am trying to apologize less. For everything.

I have accepted that some people will not like who I am no matter what I do (unless I fail), and have decided that this is their problem. I try not to obsess over this.

I try to be kind and encouraging to my female friends who doubt themselves and make self deprecating remarks.

I try to realize that other peoples' successes are not personal failings (though this is hard sometimes, especially when things aren't going as well as I want them to).

I try tame the inner green monster when I meet women who are more successful than I am. This is also not always easy. :-)

I am getting better at identifying and articulating my needs in my program in a constructive fashion that gets me what I need and makes other people happy.

Anyway, I encourage you to read the full post, as this hardly does it justice. Since the other author wanted to know how you've shortchanged yourselves, *I* want to hear from you the things you've done right.

The Benjamins

Apparently, a lot of people think that doctors go into medicine for the money. I don't know about you, but it seems like an awful lot of training to do that, especially with the erosion of physician salaries for the past 20 years or so, and continued erosion likely. Most if not all of my classmates could have made a lot more money if they'd become consultants or i-bankers or lawyers. They went into medicine mostly a) because it's cool (it really is amazing what doctors do), and b) because they want to help people.

I can't say that money had *nothing* to do with my decision to go to medical school, however. My dream job when I started this thing was to be a physician scientist. I had a mentor whom I really admired, and I wanted a career just like his.

But, the fact that I can always be a full time doctor as a fall back career is definitely a plus! One, it turns out I like patient care -- or have thus far in my training. Two, job security is HUGE to me. Having lost my job before, and seeing how the economy just sucks right now, knowing that I will (most likely) always be able to support myself, always (most likely) be able to get health insurance, was huge to me. Even if I don't get my dream of being a physician scientist (which I have a great shot at), I have this great fall back. That's something that would have been a lot more elusive had I gone to PhD-only school.

There's also the MD-PhD aspect of things. I am going to graduate debt free at the end of all of this. Now, if you do the math including opportunity costs, interest, etc. MD PhD is not a good investment. But I had some savings from working prior to med school, and there is no doubt that med school tuition would have cleaned that out, not to mention leaving me with 200K of debt. It's nice knowing that I can always walk away debt free if I want or have to. Having a pair of golden handcuffs sucks.

So if I'm totally honest with myself, yeah, money did have something to do with me becoming a doctor. Mostly I really wanted this career, but these other issues were definitely important too.

I wonder if that makes me a wicked evil greedy person? Personally, I think it makes me a responsible and practical person. Thoughts?

computer

So I just got off the phone with a nice man in the Philippines about the computer. For the $300+ three year warranty that I was required to buy since I bought at the campus bookstore, I am getting a technician to come to my house to install:

1) A new motherboard
2) A new hard drive
3) A new fan

On either Friday or Monday.

It's like I'm getting a whole new computer! In two days!

Craziness.

Normally, I would consider such a warranty to be a rip off. However in this case it appears to have paid off.

Whew!

Here's crossing my fingers to make sure everything works the first time, and that we don't have to repeat this process x10 until I get a functioning machine again.

hard

Woohoo!! Hard drive failure.

Gonna be a fun next couple of days

Don't you love how they've made a $1000 computer disposable? The last one I had failed within the year. It's "fixed" now, but probably only because I never use it. The one before? Failed after 1 year as well. This one I've had 18 months.

Pieces of shit, I am telling you.

parenting

Today while I was draining the Boo in the park next to my house, 4 boys -- they were probably about 10 -- decided it would be fun to rush up to me and my dog as a group to try and scare us.

Then as I walked away, they threw a nerf football at us. They missed.

Miss Boo was very well behaved all things considered. She showed mild interest in the ball, and then peed.

The adult who was "supervising" them asked me, "Did they just throw that at you?"

I said, "I think so." I just wanted to get out of there.

Then I heard him ask the boys if they had done that.

The boys told him that the ball wasn't theirs, which he reported back to me.

I suppose I should be happy that it wasn't EXACTLY a bald face lie. Maybe the ball really wasn't theirs.

Children can be turds sometimes, but adults can be total suckers too.

Dog etiquette

Walking Miss. Ferocious in the park today, I came across a moron woman who had her two dogs off leash. She saw me and the Boo coming, and immediately freaked out, yelling at her dogs to come, and frantically rushing to snap the leashes back on.

Not sure if this is because the Boo is a pit, or because her dogs are reactive, but in any case, the Boo is definitely not the only pit who goes to that park (in fact, the majority of dogs taken to that park are pits -- I do live near the ghetto after all), and if your dogs are reactive, then WTF are you doing letting them off leash anyway?

The Boo was interested in them, but overall very well behaved. We have made great strides since Control Unleashed class this spring, and she can now be within 30 feet of another dog without lunging and acting nuts-o (usually). I carry a bag of treats and a clicker attached to my keys when we go for walks so I can reinforce calm behavior around other dogs. It doesn't always work -- sometimes I have to drag her away -- but it usually does, and things are so so so much better than they were before.

It probably helps that it's 100 degrees out too. :-)

She can even go poo in the park if there is another dog present. This may not seem like much to you, but I can tell you that to me it has been a minor miracle. Like I said, baby steps.

Anyway, As we got a little closer, the big fluffy white dog that the lady had started lunging and barking in the direction of the Boo (who remained very composed, for her). And the lady started telling, "NO! NO! BAD! SIT! NO! SIT! BAD!" (yank yank yank) at her dog.

I've noticed that when your dog acts up, it is actually expected that you will a) yell at your dog, or b) beat your dog for the delectation of the observers. Depends a bit on the audience. If you call your dog, and use the clicker and praise and treat it when it doesn't react or when it calms down, people tend to look at you funny. Some probably think you're nuts. Others think you're a shitty dog owner.

ANYway.

I feel I've learned a lot about dogs this past year, and I definitely have a lot more to learn. Still, it makes me sad that people beat their dogs when they're bad and expect them to understand what they did wrong.

Long term to do

I know many of you find my to do lists boring, but I wanted to post this one to show what kinds of activities your typical Epi PhD partakes in. If there is such a thing as a typical Epi PhD.... but I digress.

So right now I've been studying for my qualifications exams, which will be in mid-August. I have a LOT of crap to go over for this. The exam will consist of a four hour epi exam, a four hour biostats exam, and I have to write a grant in 7 days. I don't mind the exam parts of this, but the grant part is going to SU-UCK! Bye bye a whole week of my life!

I've also been consulting on this project for one of the fellows that is related to some of the stuff I wrote my grant about. The idea was synergy. I'd help him design the study,et it off the ground, etc., and he'd get the assistance he needs to do his project and graduate. It's been about 5 hours per week of my time. He's great to work with, which is a giant plus.

Then there's this paper. Since my program really wants me to graduate in 4 years (since nobody has any $ these days), they are permitting me to use a paper that I've been working on pre-quals for my dissertation. And the paper is almost done!! I just need to run the final models (with multiple hierarchical random intercepts instead of just one -- which takes freaking forever) and get my mentor to sign off on it.

So after the quals I'm going to a wedding, and then to Italy to see my in-laws. Hopefully the weather around Cortina will cooperate and we will get to go RV-ing there for a few days.

Than I come back. I have to hit the ground running when I get here because then I have SO MUCH TO DO.

1. Get consulting project launched
2. Get my related project launched (I many need to do an IRB amendment for this too.... we'll see)
3. Do revisions on paper (assuming it got submitted before I left) and resubmit as necessary (lather rinse repeat on that one)
4. Start working on protocol for oral candidacy exam. I need to design two more projects for this, one of which is a survival analysis which I don't know how to do yet. All this before a committee meeting in October (hopefully).
5. I'd really like to do my oral defense by December or at absolute latest early January, so that is going to take a lot of time.
6. Oh yeah, finish writing this OTHER manuscript that I've been working on for a while on residency work hours reform.
7. Take survival analysis class.

It seems like so much. And it all really really needs to get done by January. It's going to be a crazy next 6 months. But for now: quals. That needs to be my (almost) sole focus. Argh! If only I remembered more about poisson regression I'd be feeling so much better about this right now!

1/2 way to boiling

Today it's supposed to be 103 degrees, not counting the horrible humidity that comes with it. My friend still wants to drag me to this unconditioned warehouse in the suburbs to do dog agility tonight. I think she's insane.

Luca pointed out last night that we're halfway to the boiling point. I think that means staying inside is the right thing to do.

Miss Boo will thank me.

Lab

I had a bunch of blood drawn yesterday. When I was there, the phlebotomist wondered out loud why a particular test hadn't been included in the stack 'o slips I'd given her. I said, that's odd, I thought it was, and together we looked through the stack and found the slip for the test she was talking about.

Later that day I received a call from the dr. She was very concerned that I hadn't gotten that particular lab drawn. I told her I had. That I'd brought in the slips, and the phlebotomist and I had gone through them SPECIFICALLY looking for that lab. And we'd found it.

She said, "It's ok, I'm sure you just forgot to bring in the slip. You can come in again tomorrow and have it drawn then."

I said, "No, the phlebotomist and I specifically went through the stack of slips looking for that one lab, and we found it. It was there."

The doctor said, "It's ok, I'm sure you just forgot to bring in the slip. You can come in again tomorrow and have it drawn then."

GRRRRRR.......

I let it go and remained pleasant. I know how proud you must all be of me.

And yes, the doctor emphasized 5 or 6 times how important it was that I make the extra trip, even as I repeatedly told her that I didn't mind. I really hate being nagged. I'm trying to be a good patient here, guys. Stop annoying the crap out of me!

I let that go too.

The thing is, I actually didn't mind having to come in to have my blood redrawn, as tried to convey repeatedly, even though it is 100,000,000 degrees out today, and I should be studying. However, can someone explain to me why this HAD to be made into my fault? Even though I'm sure that the lab probably just lost that particular tube?

I mean it's not exactly farfetched. Labs / phleb/ whoevertheheckitis lose this sort of thing all the time. I swear when I was doing my sub-i, any given day at least one of my the 5,000,000,000 labs for my patients would get lost and would have to be redrawn. It's not like I was blaming her phlebotomist or anyone in particular.

Sometimes, it's really annoying being a patient.

Don't get me wrong I really do like this dr in every other way. More than most other drs I've met EVER. So I probably shouldn't complain about this little thing. Still it really did get under my skin. And yes, she knows I'm a med student. Hm. On second thought perhaps that's why she assumed it was my fault.... or at least made my try to eat the responsibility for the f-up.

Ha. Awesome.

Woo!

The Institute of Medicine has recommended that birth control be covered at 100% as a preventive care measure. This pleases me.

A few years ago, one of my 22 year old classmates informed me that birth control had ALWAYS been covered by insurance, and she couldn't understand why I felt a co-pay of $15 wasn't that big a deal.

It's so interesting how quickly things are forgotten. Birth control was most certainly NOT covered by most private insurances when I went on it at 18. In fact, the first time it was ever covered by an insurance plan of mine was when I was 22. That just happened to be the year that Pfizer came out with Viagra.

Coincidence? I don't think so.

I continue to find it amusing that in 1995, OCPs not covered by insurance cost $15. And in 2010, OCPs covered by insurance cost almost the same amount. Hm.

I still don't think $15/month is a lot to pay for birth control, and it does still irritate me when my friends, usually over some expensive dinner, whine about how poor they are, and how they can't possibly afford their OCPs. I mean really, people. Come on.

Still, we have way too many unplanned pregnancies in this country, and if free OCPs, even to bougie med students whose parents are bankrolling their tuition, will prevent some of those, I think it's worth doing. We might even help some women who could actually use the help in the process.

Early, for now

I had to get up early for a drs appt this AM. (I know, I could be GETTING READY rather than blogging, right?)

Anyway, in PhD-land, I've been able to sleep to the luxurious hour of 7 most mornings. Sometimes, I even get up as late as (wait for it) 7:30!

I know, sounds amazing doesn't it.

Getting up at 6 isn't such a big deal though, especially when it's going to be so freaking hot out later today.

For Princess Boo, however, 6AM is a very big deal. On mornings where I get up earlier than usual, it takes her SEVERAL more minutes to drag her doggie carcass out of bed. And then she'll stand at the top of the stairs watching me eat breakfast, as if to say, "Mommy, can't we just go back to bed, PLEASE!!!!"

This morning, she staggered down the stairs like a drunk sailor, climbed up on the couch, lay down on my feet, passed out, and promptly started snoring.

Turns out, she's less of a morning doggie than I am a morning person.

Poor Miss Boo! Your life is so hard.

One of those days

This morning I got up early and went for a run. It was one of those days where I felt awesome. You know how some days you have to drag yourself out the door, and every step you take you're counting down to when you can stop? Well today made all of those days completely worth it.

I did 2.8 miles without stopping, without slowing down on the hills. Even though I was breathing hard, it felt good. It's not much, but it's a lot compared to where I was a month ago.

Come to think of it, that makes sense. It usually takes a month or so for exercise to stop feeling like crap. Good to see that I'm on schedule!

Luca and I went climbing yesterday also. It was also great! I went up 2 5.5s that I struggled up two weeks ago with ease. Then we did some 5.6s and 5.7s. I almost did the 5.6 on the first try. The 5.7s make me stop and rest. I can't quite hold my static positions on the holds long enough to think about what I'm supposed to be doing with my body. And I actually do have to think, whereas with the lower rated climbs you can just go. I prefer the thinking.

I'm finding that I can stick on more difficult holds too, which is encouraging. At first I was like, "There is no way I'm going to be able to hold onto this," but this week, it started just happening. You trust that you'll be able to do it, and your hand stays. Matched a foot on a hold that I was using with my hand. I know, it's nothing really. But a month ago I couldn't do that either. It's very satisfying.

And then we saw this guy go up a 5.11 so smoothly it looked totally effortless. It was really beautiful to watch. Maybe some day..... haha.

Today will be another push up day. I have a big jump in my difficulty level this week. I have to do 10,12,7,7,9, which seems like a lot more than I had to do last week. Hopefully I will make it!

You don't know what it's like

For some reason today, I was riding along in the car with Luca, and I remembered an email I got from a friend of mine a few weeks back. She's a new mom, and it was one of those you-can't-possibly-understand emails that people with children send to people without.

In any event, she told me that she really wanted to quit her job and stay home with her baby (this is what I couldn't possibly understand since I am not a mother). But she didn't because she was afraid people would think she was stupid.

Thinking about that in the car today, it just made me sad. *I* would never think she was stupid. She could never work another day in her life and I wouldn't think that, and I doubt that anyone who knows her would think that either. And for the record, I think she's a wonderful mommy, and also wonderful at her job. She can do whatever she wants, as far as I'm concerned, as long as it makes her happy.

It made me sad because it made me realize the extent to which we do things with our lives that make us unhappy in order to please some invisible other. It's sad because we should be doing what makes us and our families the happiest, the best off. Who cares what the rest of the world -- who doesn't even know us -- thinks? Maybe it's also partly these tacit expectations we've placed upon ourselves as we've grown up. Maybe my friend subconsciously doesn't think highly of the intellect of the stereotypical SAHM, and that feeds into it too.

Obviously I am not immune to this sort of thinking. I see myself as "hard core" and part of what I find appealing about surgery, and other specialties like it, is that it's as hard core as it gets.

But, as C made me realize in a post she recently wrote, I don't actually like standing in an 8 hour surgery. And while I suppose that I could choose a specialty that had shorter ones, I think I'm still going to have the same issue. It's a bad sign when I start watching the clock compulsively, even if I can get myself to wait for over 2 hours in between peeks.

I basically like running around all day like a chicken with my head cut off. None of this sitting still BS. I like to use my brain and my powers of negotiation. Not my hands so much. And I don't give a crap about gadgets.

And then there's psychiatry. I really liked psych, but I have a complex from majoring in sociology and feeling like people don't take me seriously already. And there are plenty of people who don't think psychiatrists are "real" doctors. Which is bullshit, but there it is. And for the record, I can't think of a single internist who knows crap about psychiatry, even though they think they do, so it's not like it's so easy to be a good psychiatrist. And I'm probably NOT going to be a psychiatrist, but it's because I love the rest of medicine more than I love psychiatric problems.

So I guess the point of this post is this: listen to your inner voice and try as best as you can to tune out the expectations of others. And also if your personal expectations for yourself aren't making you happy anymore? Listen to that. And if some jerk thinks worse of you for making a decision that benefits you and your family? F-them. They weren't worth your time anyway.

Why do they put nails in coffins?

To keep the oncolgists from giving more chemo.



I've only had the pleasure of seeing a case like this once, but I'm sure the best is yet to come.

helicopter

A police helicopter has been circling the neighborhood for the past 20 minutes. I wonder where the shooting occurred.

Ah, the sounds of West Philadelphia.

17

One month from today, I have the first of my quals.

I did 17 push-ups consecutively last night. Two weeks ago when I started this program I could only do 3.

My PI is in the MICU for the next two weeks (hopefully) buying me a little time before I have to send him my manuscript, since I know he won't have time to read it. I'm still going to try to get it out to him this weekend. We'll see if that actually happens.

Bonus: No meetings for 2 weeks = more time to study!

On the agenda for today:
- meet with project manager to discuss variables for consulting project I'm working on
- finish reading about linear regression
- read through paper 1x trying to refine and cut
- Gordis problems (as many as possible)
- send a variety of emails pertaining to consultation project

Between now and next Tuesday I'd also like to:
- make presentation for Tues night chalk talk (and make it somehow interesting to basic science people -- this is NOT going to be easy)
- keep refining paper
- Gordis problems finished by Tuesday
- read about logistic regression
- make cheat sheet for how to do Gordis problems

I'd also like to climbing this weekend. AND go dress shopping for this wedding I'm going to in August. Did I mention how much I hate shopping? Well, I do.

Also in the next week or so will be a number of drs appointments, though OF COURSE I don't know when these are going to happen yet. Oh joy.

And at some time, I have to go to the kitchen cabinet store so I can get gouged get a quote on cabinets for our kitchen so we can see if it's worth remodeling. I am beginning to think that maybe we should just replace the counter tops and sink.... but we'll see. Not terribly interested in dropping 10K at the moment.

Ah stress.

Well, I'll just think about the push ups and try to ignore the rest of it for a little while yet this morning while I walk the dog.

Some days it's just good to be alive

Today the weather is so beautiful! It's about 87 and sunny, and practically no humidity.

We had the cement contractors come and re-do our sidewalk this morning. It looks great. Now I get to sit outside in the beautiful weather guarding the wet cement from the juvenile delinquents who live in our neighborhood.

I brought a chair out, and my netbook, and I've been studying stats for about an hour so far. I also got to finish my delicious salad from The Greek Lady that I had yesterday for dinner too. My neighbor recommended it to me. She's such an awesome neighbor. It's just one other way that she makes my life better.

I also got to have a little contractor eye candy. After I showered this morning, I looked out the window and had the privilege of viewing 3 tanned muscular 20 something contractor youths as they laid the cement for my sidewalk.

Some days it's good to be alive.

Sporotrix?

I love it when the NYT has their Think like a Dr. column. See if you can figure this one out! The NYT usually posts answers within a few days.

I guessed sprotrichosis. It's usually chronic, but I'm wondering if he had a particularly acute onset because of lymph node removal. In any case, you definitely can get skin findings like he had, and also have neurological symptoms.

Lower on my list would be other types of vasculitis. I wondered if they tested him for HBV/HCV or ANCA.

I actually kind of love vasculitis. Not to wish on anyone, obviously, but it's one of those diseases I had no idea even existed before med school, and I think the variety of them are really interesting.

Push ups

Yesterday was another push-up day. I did 5,7,5,5,10.

For the next set (tomorrow) I'm supposed to do a test: how many in a row can I do without stopping.

I lifted today. As per MSO's suggestion, I experimented with doing fewer reps at the heavier weights for the pull up / dip machine. I'm finding dips are easier than pull ups. Maybe it's because of all those push ups I'm doing? Anyway, today I started with 10 dips / 10 pull ups at 60 lbs counterbalance. Then I went to 5/5 at 40 lbs. Then I went to 4/4 at 30lbs. The last pull-up was really difficult and I think I can say with certainty that I did that exercise until muscle failure. Yay?

No dead lifts (very scary) but I did try some wall sits. Those were hard enough.

AND! My running was spectacular. Well, it felt pretty crappy, but I felt like I'd accomplished something when I was done. I did 10 min at 6mph, followed by 3 intervals. The first interval was 600m 1/3 at 7.5mph, 2/3 at 7mph. The second was 400m at 7mph. And the third was 400m 1/2 at 7 and 1/2 at 6.5. All this (with warm up and cool down and rest in between) added up to a total of 2.75 miles and a little over 30 minutes. I was very pleased with myself.

*****

Today I agreed to give a chalk talk to the other MD-PhDs in my class next Tuesday night. I figured WTH, it's free dinner, and I already basically have the paper written, how hard would it be to put together 20 slides for a quickie talk? Haha. As if I don't have anything better to do.

But, I figured it would be nice to see my classmates, since I only see them approximately once every 12 months. And I could always use practice presenting my work. Hopefully they won't all fall asleep during the talk.

*****

Quals studying is..... going. I feel like I am learning a lot. But I also feel like I have a ways to go. Fortunately there's still more than a month left until the exam. I will be fine I'm sure. I just can't wait until they're over.

*****

Unless I decide to subject myself to doctoral seminar again (please god no!!!), I will not have class the first part of this fall semester. You have no idea how pleased this makes me. Of course, instead I will be doing the following:

1) Preparing for my oral candidacy exam / next committee meeting
2) Starting my methods papers (yes, there will be two of them)
3) Getting a prospective data collection study off the ground. I am getting consulting credit for this since I'm helping one of the MSCE students with the design and implementation of this study. I like him, and he's very pleasant to work with. The only problem is that he's not at all interested in research, and I'm worried that I'm going to end up doing the bulk of the work. That would suck.

I want to try to TA fall semester too, but it may not happen. It depends on whether or not the powers that be are interested in allowing me and my other MD-PhD compatriot to TA the med students in med school epi. Oh joy oh rapture. How fun it will be to be forced to teach the med students in their least favorite course EVER. Haha.

Attractive and Charming

Teamwork and personality screening tests to pass are some of the newest requirements for some med schools, according to the NYT.

My thoughts?

THANK GOD I never have to go through the med school application process EVER AGAIN.

I suppose this is meant to weed out the few "bad apples" that slip through in any given class, but it probably won't. Just as students can study for the MCAT and get a high GPA, they can study how to ace these tests as well. It's just another bonus for the test-prep industry.

As for the comments on the article (see the well blog).... there weren't many yet, but there was one comment that everyone loves a pretty girl and a handsome man in a suit. And you know what? It's true. I'm hard pressed to think of a single physically unattractive female in my med school class (though none who were dangerously hot either...). The one or two students who were obese were incredibly brilliant students (to make up for it? WTF.). There were a few less attractive males (I guess THAT'S ok), but the male students who were especially handsome seemed to do better than the other students on, well, everything.

Now, I'm all for teamwork, and creating doctors who aren't jerks. But is this really going to do that?

I guess it's no different in any other field. It just frightens me a little that these tests are one step closer to formalizing the process of picking an "attractive and charming" med student rather than one who might actually be good with patients. Do we really need to make med students any more homogeneous than they already are?

Climb

Luca and I climbed again today, and today this was the first time that I could go up a bunch of overhang-y 5.5s and not feel like I was going to die when I finished them. Apparently my conditioning is paying off somewhat, which is really satisfying!

I also did a 5.6 clean that I *almost* could do last week, and made it all the way up a 5.7, but not cleanly. Of course in the process I banged the crap out of my knee (because I am a giant klutz) and thought I was going to puke/pass-out from pain. It's still a little sore now, but I iced it and took some ibuprofen and hopefully the bruise that comes out tomorrow won't make my entire knee completely purple.

Note: these skills on these higher graded climbs did NOT translate into being able to to other 5.6s and 5.7s. I like that the higher rated climbs are a little more technical with actual moves you have to do rather than just brute force yank yourself up the wall, but I hate slope-y holds! Ah well, it's getting there.

Luca also had a good day. He is getting stronger too, though I think sometimes he is frustrated that he's not improving as fast as he wants.

Other observation: the gym is a TOTAL meat market. Not sure how I didn't notice before, but yeah. I got hit on by the lady at the front desk AND by some guy on the way to the bathroom. Honestly, it was pretty flattering, since this almost never happens to me these days, well... ever. I even bragged about it to Luca.

:-)

What! I'm allowed to feel pretty every so often, aren't I?

By the end of the day, my lats weren't as sore as usual, but the tendons in my fingers were beginning to get ouchy. It's probably good we stopped when we did.

I also think it may be time to buy my own harness. I had a wonderful Arc'Teryx harness from 12 years ago, and it was so so comfy. Unfortunately, I don't trust a 12 year old harness, and I noticed online that it would cost $140 to replace it. INSANE!! There are other harnesses that are cheaper, but my experience is that the cheap-o harnesses pinch in the crotch and shift around more than I'd like.

Anyone have any recommendations on this?

****

And now I'm busy studying for my quals. Or, I was anyway, until I got distracted by writing this post.

:-)

Happy rest of the weekend!

Push up day #4

Set 1 - 5
Set 2 - 6
Set 3 - 4
Set 4 - 4
Set 5(max) - 10

Each time I get to my max set I think, "Dammit! Why'd I have to do 10 that time before? That means I have to 10 again now." And then I grind them out. It wasn't as hard today as it was two days ago, at least.

I've decided to try to increase my running intensity as well. Running on the treadmill has historically been death for me. I can do about 10 minutes before I can't stand it anymore, so I've been gradually increasing to my goal of 10 consecutive minutes at 10 min mile pace. Today was the first day I did the whole mile!

I've decided to try adding some intervals after that. I'm much more a speed girl than an endurance girl anyway, and it's so much easier to push myself for 2-3 minutes hard, and then walk. Walking on the treadmill's never been a problem for me! :-)

So today I added a "fast" 400 after my 10 min mile. I did 50% at 7mph, and 50% at 7.5mph, which is roughly 8 minute mile pace. Whew! It was tough. At least I feel like I'm making progress though. Two weeks ago I couldn't even run ONE mile at 10 min mile pace. Now I can! Maybe next week I'll try adding an additional repeat of the 400. I figure if I build up slowly, I'll be less likely to burn out.

We'll see.

And then I lifted. I decided to change things up a bit with my lifting routine. My friend PS told me that she does the dip / pull-up machine, so last week I gave it a try. I've been counter-balancing my weight by 60 lbs. This week I decided that what I really care about is getting stronger, not doing more reps. So now I do one set of 10 dips and 10 pull ups at 60lbs, and then I reduced the counter-balance to 40 lbs and did 5 dips and 5 pull-ups at the heavier weight.

I found that I was able to complete them. It wasn't easy, but it wasn't as hard as I thought it would be. My goal is to be able to do them without any counter-balance at all, but I'm not sure how to work up to that. Should I build the reps and then when I'm able to do 10 go back to 5 at a 10 lbs less counter-balance? Or, since 5 isn't so terrible now, should I do 5 at 40 lbs, and then try to do as many as I can at 30 lbs?

Anyone with weightlifting experience, please weigh in! I'm afraid I'm a bit of a girl with respect to all of this stuff.

After I do the dips/pull-ups, I've been doing a bunch of lat pulldowns and seated rows. I've been doing 3x10 of each, and have been able to steadily increase weight on them since I started. Not sure if I'm making it too easy on myself, but I'm improving, so the plan seems to be working.

I will say this, when I lift heavier weights, I find I breathe harder. I don't grunt I promise! But I can totally see how a grunt could potentially slip out. Haha. I also think I prefer the "hard-core" weight room to the less hard-core weight room upstairs. In the "hard-core" room, all the sweaty guys basically ignore me. There's no staring at one another, like what happens in the upstairs room. I guess I just don't like being watched.

Anyway, LIVS mentioned she does dead lifts. Anyone know what those are? What are they for? How do you do them? Suppose I were to want to try one, how do you start? Do I need a spotter? They sound serious.

Climbing culture

Maybe it's an east coast thing, but I never really noticed this before when I climbed in Chicago. But people here check each other out at the gym. There's a TON of posturing, and the climbing gym is no exception. To avoid this, Luca and I try to go early when there are other couples who also suck at climbing, and fewer people who are just there to show off. Last week there was a couple climbing there in their late 40s (I think). I'd be thrilled if I could be just like them when we get to be their age.

Around 12 last week the competi-freaks arrived. They piled their bags in the middle of the gym floor, and then talked extensively and loudly about the ratings of the various climbs they had recently completed. Then they'd alternate between doing huge numbers of push-ups and talking about what 5.9 they were going to lead.

They did this for a good 30 minutes without actually going up ANY route. Luca and I found this highly amusing to say the least.

Then Luca told me that it was an interesting contrast to the climbing culture he grew up with in Italy, where to warm up they'd smoke a cigarette. And when they got to the top they'd drink some wine.

And while the thought of smoking or consuming wine at the same time as I exercise makes me feel vaguely sick to my stomach, I still think I prefer that life philosophy.

******

Push up challenge day 3:
Set1 - 4
Set2 - 6
Set3 - 4
Set4 - 4
Set5(max) - 10

Even though I only did one pushup more than last time, it was hard! This was the hardest it's been to date. And my arms hurt today. I'm just going to tell myself that it's because I lifted on Tuesday, even though I specifically excluded chest. I'll do a light swim today and then lift again tomorrow. Hopefully it will be a little bit easier!

First Triathlon

Before I turned 23, I had exactly zero experience with endurance sports. I'd played a little water polo in high school (badly), and run the 400 my junior and senior year, and done about 8 months of climbing after I finished college before I switched to a job that wasn't near a gym. But other than that, zilch.

I remember back when I was 20 running on a treadmill for the first time wondering how anyone could actually run for a whole hour continuously. Ok? I was not an endurance athlete.

So, at the end of 2000, I started dating the boat anchor, who was really really into triathlon. And, because he wanted me thin (which I found out later), he encouraged me to take up the sport as well.

I remember being very reluctant. I was totally not interested in spending $1000 on a bike that I might never ride again. I also couldn't imagine myself exercising for that long. Ever.

I reluctantly signed up for my first race in August of 2001: The Nike Women's Sprint Triathlon in Manteo IL I think it was.

I trained all summer for it. Actually, my main race of the year was going to be Mrs. T's (now the Chicago Triathlon) where I was doing Olympic distance, and this was to see how the whole thing worked, but I was still nervous.

And the race went really well! I came out fast on the swim (I've always been a strong swimmer -- relative to other triathletes, but not to actual swimmers), had a good bike, and finished solid on the run. It was of course over 90 degrees when I finished, and I've never been good in the heat, but I was overall thrilled with my performance. I'd come in under 1:30:00. Yay me!

So anyway, as I was collecting my gear in the transition area after the race was over, I ran into my friend Amanda. This had also been her first race, and we were both all giddy, the way everyone seems to get after these things, and talked about how we did. I don't think I ever mentioned a time, but I did say I'd done better than I thought and I was so pleased with my performance. She was happy too.

And then one of her other friends, who was someone I'd never met before, inserted herself in between us with her back to me. She started talking about she and my friend had really accomplished something because not six months prior, THEY had both given birth. How the achievements of all the other younger, skinnier women who hadn't recently given birth (giving me a dirty look in the process) were nothing compared with what they had accomplished. How everything was so easy for skinny single women without children, and that we had nothing to feel proud of, unlike them.

At some point I attempted to say something supportive about her accomplishment, but all I got was a scathing glare, an eye roll, and then she pretended I hadn't spoken at all.

I wanted to punch her in the face. I won't say she took away ALL my satisfaction from completing the race, but she took away at least 50% of it.

I'd like to say that this was the only time in the 13 races that I ultimately completed that this ever happened, but unfortunately it wasn't. Almost every race, something like this would happen. It's one of the reasons I ultimately quit the sport. There are enough jerks that it took all the fun out of it. All it takes is one or two careless comments ("Oh, you're HAPPY with that time? Ok. Congrats I guess.") and it takes the fun away.

I bring this up because one of the barriers to starting an exercise program is fear of failure. Fear of looking stupid. Fear of losing. Bitches like the one at this race embody that fear. Part of being an adult is realizing that you can't win at everything, but part of being an adult is also learning what's important and what isn't. And, really? Triathlons are hobbies. If it's not fun then what's the point? It's about improving yourSELF. Not about beating the skinny 24 year old who'd never run farther than 3 miles in her life before she signed up for this.

I realize that I am a competitive person. Competition drives me to a certain extent. I know I am not alone in this. But when you make comments that intentionally undercut another person's accomplishments, you are really small. And you have just lost the race.

Stung by a bee

When I was on a rotation a few years back, I remember getting lectured by a resident about how I should never tell a patient that getting a shot of lidocaine before getting stitched up was like, "Being stung by a bee."

His rationale was that it was annoying and patronizing.

I had only been parroting what I'd heard EVERY OTHER RESIDENT AND ATTENDING say for the past 11 months, but whatever. I bit my tongue.

Now that I am in the unique position of a) having received a shot of lidocaine, and b) having been stung by a bee, both in the past two weeks, I feel I am -- at last -- qualified to comment on the matter.

And all I have to say is this: getting stung by a bee is way worse.

The lidocaine? The needle goes in and out, and you are loaded up with something that stops you from feeling pain. Generally, unless you are stupid enough to watch as the needle goes in, you may barely even notice it.

And then? You are numb.

A bee sting is way way different. First, you may not even know it's a bee that's causing the sudden sharp pain wherever it is. It may feel like, for instance, you stepped on a burr. Then, as you look to inspect said area of pain to remove said burr, you will see a wiggling fuzzy buzzing thing dangling from wherever it stung you and realize that it is NOT a burr, but a bee.

With any luck it will be something relatively innocuous like a bumble bee, but if your life sucks it could be a yellow jacket or hornet.

Then you will try to flick said insect from your stung appendage, hopefully without falling over onto your ass. You will shriek like a baby girl because you have a general phobia of bees, and you will hop precariously on one foot to the nearest bench, dragging your very confused / concerned dog along behind you. Then you will extract the stinger.

Only then will your appendage really start to hurt. Unlike lidocaine, which actually TAKES PAIN AWAY, a bee sting gets worse before it gets better.

Hopefully you're not allergic, in which case you will proceed directly to your epi pen and/or to the nearest ED. As long as you're not, you will finish walking your dog, limping along pathetically for the next mile or so, freaking out anytime a bumble bee flies into your path as you pass by about 100 gardens that are full of bees along the way.

Not that this has ever happened to me.


Anyway, in short: Never tell your patient that getting a shot of lidocaine is like a bee sting because it's not. Getting stung by a bee is worse. Worse by a lot.

Autism

There's a study that just came out that showed a link between taking SSRIs during pregnancy and the development of autism in future offspring. The conclusion was that SSRIs taken during pregnancy CAUSE autism. Gah!

I haven't read the methods section in detail yet, but based on what I have read, I came up with a couple of other alternative explanations. It's worth pointing out that this was a retrospective case control study using medical records. They compared the SSRI taking habits of mothers who had given birth to a child with ASD to the SSRI taking habits of control mothers who had given birth to children who did not develop ASD.

Thing is, there are at least a couple of alternative explanations:

1. Mothers who take SSRIs for depression are more likely to have children with autism later because the depression causes the autism somehow in utero.

2. Mothers who take SSRIs for depression are more likely to have children with autism later because they behave differently towards their children.

3. Mothers who take SSRIs for depression are current seekers of psychiatric care, and are more likely to seek psychiatric diagnoses for their children than mothers who do not take SSRIs for depression, and therefore their children are more likely to receive a diagnosis of autism.

I particularly like #3, and think it's at least as plausible as what the authors concluded. Particularly since this was an observational study rather than a trial.
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They appear to have done a sub-analysis looking only at mothers who had documented mental illness in the chart. It's fair to ask whether mothers with depression not taking SSRIs are going to have depression documented in the chart as consistently as mothers with depression taking SSRIs. Still, no increase in risk was found in this group, but they were probably underpowered to detect a difference.

Coming up with a study design that simultaneously solves all these problems is a bit of a challenge. Any suggestions?


Citation here. It's a credible journal. You can't get to the full text article this way, but if you have access to the medical literature via other mechanisms, you can use this citation to get you there via pubmed.

Push

Today was another push-up morning. It was tough. Yesterday, Luca and I went climbing, which probably violates this whole "rest" thing that we're supposed to be doing in between push-ups days.

The climbing was awesome. We made it up a couple of overhang-y 5.5s and finally found a piece of wall that was actually vertical and did a 5.6 and attempted a 5.7. The 5.7 I think may happen next week. It was a little too fingery-y for me, but it was the kind of route I remember really enjoying when I used to climb 12 years ago.

I've never been a big fan of the overhang. I'm the kind of person muscle just melts off of, and though people always say, "Oh it's because you don't know how to use your body when you do the overhang," those same people are the ones who are triangularly shaped because their lats are so overdeveloped. I'll get stronger, I know, but in the meantime, give me a fingery-y technical vertical climb ANY DAY.

Interestingly, my deltoids are sore today. Not sure what that's about, but whatever.

My push up set was as follows:

Set 1: 4
Set 2: 5
Set 3: 4
Set 4: 4
Set 5 (max): I did 10! I was really excited about this. It was hard, but it felt good when I was done.

Luca did 8,8,6,6,7. I'm glad I have a partner to do this with, though he bitches and moans about it the whole time. His chest and abs are already getting more defined. He looks hot!

Cookies

Last night, I decided to make chocolate chip cookies, to be eaten with vanilla ice cream as ice cream sandwiches for some guests we're having over. In the process, I asked Luca to get some parchment paper and put it on some baking sheets.

Well, instead of parchment paper, he used wax paper, and this wasn't noticed until smoke started coming out of the oven. Really noxious smelling smoke I might add.

He wanted to try to save the batch, but it was beyond saving. I was really irritated with him. Was what I'd asked really that difficult? Do I really have to micromanage EVERYTHING he does or just do it myself? It makes me feel like such a nag.

He told me that I could just make another batch. I said that we were out of chocolate chips so NO I could not make another batch. He'd have to go to the grocery store and make the batch himself, since I was not doing it again. He said, "Well, I don't know how to do it?" And I replied, "It's called following a recipe, hon. What do you think the netbook is doing in the kitchen."

Once he finished stomping around angrily when I told him we'd have to start over, he bit the bullet and went to the grocery store while I watered the garden. I was still steaming. It took everything I had not to yell at him -- both for f-ing up with the wax paper and for stomping around.

Then he came back and made a batch of cookies himself.

Good boy.

He brought them out and gave them to the neighbors who had been playing soccer in the street. The gobbled them down and told him what a wonderful cook he was. Then they told me how lucky I was to have a husband that would do something so nice for me.

Haha.

If only they knew.

I could only wonder whether he'd have gotten the same compliments about me if *I* had been the one to bring out the cookies, or if that would be expected since all girls like to bake.

:-P

They were good cookies though.

Thanks for fixing your screw-up, sweetie, and only stomping around about it for a little while. I guess I am lucky afterall.

Housekeeper

Regular readers may recall how several months ago, I was raving about wonderful it was to have a housekeeper.

Well, we no longer have a housekeeper.

Why? Because the housekeeper needed us to be home so that we could keep the dog away from them while they cleaned. And they were never on time and always rescheduling. And Luca would literally NEVER pick up his shit before they arrived, leaving me running around the house like a crazy person picking up every time they came.

So basically, each time they came, it was $150 and 3 hours of my time at a minimum. And I would have to go down to the basement, where there are no outlets and no furniture suitable for working at, and wait while the cleaners cleaned. Which always felt like FOR. EVER. And sometimes was actually forever. I know this, because my computer battery would run out.

I also sort of felt like the cleaners thought I was some bougie bitch who didn't have a job or kids, and just couldn't be bothered to clean the house myself. I may be projecting, though honestly, in my experience, if people have the opportunity to think badly of someone else for any reason at all, many will seize upon it. Not that I should care, but it still bothered me.

This was exacerbated by the fact that when they would have to cancel and reschedule, they would want to know if I was available the next day. I wanted to tell them, "Look, it took me two weeks to find a time that would work with my schedule. NO I cannot just drop everything and stay home tomorrow so that you can clean then instead of today."

I didn't object to the work they did. I didn't even mind them in other respects. I just felt like between the 3 hours of my time, the $150 every month, the pain in the ass it was to schedule, that Luca and I could clean our own damn house once a month.

One day, I'm sure we'll go back to having a cleaner. It just isn't going to be now.

Actually

Over the past week it's happened twice: I've given a compliment to someone by saying, "Thank you so much for your feedback, it's actually been very very helpful."

And twice the person has said, "What do you mean 'actually'? Are you surprised?"

I'd always thought the tone (appreciative) conveyed my gratitude and sincerity, but maybe not? Then, maybe they're just pulling my leg, and I don't know how to take it. But ever since all of the communication issues I had with my mentor this last year came to a head, I've been a little hypersensitive about things like this.

Since GOD KNOWS when the switch is going to flip, and Hades will reemerge to ruin my life for another year.

I wish these things didn't worry me, and that I could blow off these comments, but I just can't.

Maybe they're trying to kid with me. I wonder what would happen next time if I said, "Surprised? Well naturally! I was expecting to be sobbing when I finished reading your comments, but that didn't happen. ACTUALLY."

Somehow I am guessing the kidding's only permitted in one direction though.

Hee.