First Bloom!

I guess it is true that crocus blooms first. I was pleased to see this in my backyard today. I planted a large assortment of bulbs and perennials this past fall and am curious to see just what actually grows. There's a good variety of stems poking through the bark in the flower bed up front, too. No starts of leaves on the trees just yet.

It is blindingly sunny today. The last couple of days of rain have finally melted away the last stubborn piles of ice. I think I'll go for a walk and get my fill of vitamin D, and then do a little bit of housework drudgery before I head off to work.

Making Mountains Out of Mole Hills

Yes, it is really almost 2 am.

I just got home... from work.

How is it that pimples can just show up out of nowhere? There you are, minding your own beeswax, when you glance in the mirror and there appears to be a huge appendage struggling to grow out of your face? No warning, just out of nowhere. It is just like those crazy mushrooms that magically show up in your yard in the the morning.

How is it fair that I can have pimples and little crinkles around my eyes at the same time? It seems like I should have at least been granted a decade or so of perfect skin before the wrinkles started in.

Pretty, Pretty Princess

On Thursday night I played poker (Texas Hold 'Em, tournament-style) with some of the co-workers. I came in second.

On Friday and Saturday, I spent several hours sticking scalpels into various pockets of pus on multiple patients and sewing up assorted lacerations. (The butt abscess patient actually thanked us with a gift basket of snacks!)

Yesterday, my attempt at running was ruined by a sinus headache. With every step, it felt like the Keebler elves were inside my head pounding at my frontal sinus with their mini-hammers.

Tonight I am working. Before I do, I am going to go blow my poker winnings on a pedicure.

Whew!

Work went ok last night. One of my attendings was talking to me about how she had a similar setup during her intern year, and spent almost the entire year out of the department before she finally came back. She said that she used to get sick before every shift. That made me feel a lot better, as much of the time I make myself sick with worry.

My shift ended at midnight, but I didn't get home until after 3 am. One of my patients had a posterior shoulder dislocation, which is kind of unusual, so I decided to stay late and help try to get it back in. We were unsuccessful even after sedating him, but apparently the orthopedics team got it on the second try because when I checked his file before I dictated his chart today, there were new x-rays showing it back in place.

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Today I just had to go in to the simulation lab for a few hours. I suppose that the sim lab is the only objective way of comparing resident knowledge as all of our interactions are recorded and then we get debriefed afterwards. We're participating in a study to see how the lab simulates real stressors, so when we do our scenarios we have to wear these backpacks with several leads attached that monitor our respiratory rates, heart rates, armpit temperatures (!), and then we have to spit into test tubes before and after each scenario to see if our stress hormone levels are changing. Mine today was pretty challenging. The mannequins are fairly realistic... they can be hooked up to monitors, have heart and lung sounds, etc. There's a couple people behind a mirror that can change the programming in response to the medications we give. My patient was programmed to die regardless of what I did, but I did manage to respond to the scenario correctly. I think I may have even redeemed myself a little in the eyes of the attending that runs the cases.

I would say that I am normally a pretty independent person, but every now and then it is nice to be told that you are doing a good job. There are so many variables in residency that it is hard to know if you are actually at the level you are supposed to be at. And, while it is almost all on-the-job training, a lot of times there is no feedback until you do something different than the way your supervisor would have done it. I haven't really gotten chewed out by anyone, but it sometimes seems like the pats on the back are few and far between.

I read somewhere recently that for every negative comment a person receives, it can take about twenty positive comments to repair those hurt feelings. I don't think that I tend to criticize others a whole lot, but I definitely don't compliment them as much as I should either.

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This afternoon, I put on my iPod, listened to Norah Jones, and walked along a frozen lake for about an hour. It was cold, but I was fine as long as I didn't dawdle. There were almost perfectly round mirrors of silver water in areas that were melting along the lake's surface. It just seemed kind of random how certain patches were melting ahead of others. The circles were almost all about the same size, too. The trees are still just skeletons standing around in awkward nakedness, but along the water's edge Canadian geese were happily rooting around in the half-covered grass, finding some sort of new life to munch on.

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Oh, and I almost forgot: "The Phoenix" matched at her first-choice program! She's going to be an awesome pediatrician!

Performance Anxiety

Tonight I go back to the department. I am extremely anxious about it. I have finally finished all of my off-service rotations and now will be in either the Adult or Pediatric Emergency Department for the rest of the year. I really like our attendings and our residents, so it will be good to be around some familiar faces. However, at the same time, now I will be around long enough for them to figure out just how dumb I am. What if I hate it? So far this year, I have been flying under the radar. I have had good evaluations and no incidents with administration. In many ways, I kind of feel like the invisible intern. While my colleagues have been having confrontations with the staff, most of them don't even know who I am! I guess I will just have to step it up a notch. Maybe the desire to not look like a complete idiot will be a better motivator to keep up with my reading.

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In other news, my younger brother was in a car accident over the weekend. He has about 6 months left in Kenya as part of his Peace Corps mission. Apparently two jeeps were passing each other on a mountain curve and his got knocked hard enough to roll it over twice. Luckily he was on the inside part, so they didn't roll down the side of the mountain. He ended up needing some x-rays and stitches and now has to take HIV prophylaxis meds for the next month as they weren't sure that all of the blood on his face was his. Between this and losing 40 pounds that he didn't have to spare from bacterial dysentery, he has had quite an adventure over there. He's done some good things too, like constructing a subterranean dam, solar-powered water heaters, and is trying to get a windmill project off the ground before he leaves. I am sure it is an environmental engineer's paradise, but I can't wait to see him. At least now he probably won't be such a picky eater.

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As for running, I did 6 miles on Saturday, and rewarded myself with ice cream on Sunday.

Alone in the Crowd

Last night I went out again with the coworkers. We started out late, so I figured there couldn't possibly be too much trouble as there wasn't enough time for people to get too intoxicated. Boy, was I wrong: they just drank faster! To make a long story short, the same girl ended up needing to sleep over at someone's house, but this time I made sure that it wasn't at my place.

There seems to be some sort of lack of distinction with them between the terms single and desperate. They seemed like they were bound and determined to shove me off on any nearby guy. First, there was a creepy flight attendant that didn't get my sense of humor. Then there was a guy that was extremely good-looking, but totally plastered. He was literally using the barstool and myself as crutches to keep from falling on the floor.

The other unfortunate thing about my coworkers is that they get really LOUD when they're drinking. They kept suggesting that I leave with this guy as he was, "like, totally hot." Unfortunately, drunk guy picked up on this and asked if he could come over. I said "no", and then as the bar was closing he kept just standing there like I was going to change my mind. Finally, he left and I got chastized for being too picky and was told that I was never going to meet anyone if I didn't "hook-up" with them, and that I could get to know him later! They all kept looking at me like I was crazy when I said that I don't believe in taking random strangers home.

Besides, I figure that if he wanted to get to know me at all, then he would have asked for my phone number or given me his. Clearly, he was just looking for someone to spend the night with.

I talked this over with my friend today and fortunately she agreed that sleeping with people is not a good way to get to know them. I thought that this was somewhat backwards, but last night I was clearly in the minority. Maybe I am just more conservative, but I don't get why these girls have such low standards. I don't know why there is such a disparity between myself and them as to what is appropriate behavior, but it is not something I am going to compromise on. Maybe I should just stop going out to bars with them, and only join them for activities that have an actual purpose, like dinner, poker, or bowling.

New Mileage

Yesterday, during my long run I did 5.25 miles! I am still going with the run-walk method, but I haven't been at it regularly enough to see if I am making better progress. Otherwise, the weekend was pretty uneventful. I watched a movie at a friend's house, and did catch-up housework here. It turned out that I didn't get a single page on Friday night! Today I was supposed to attempt cross-country skiing or snowshoeing with some friends, but the weather did not cooperative. There is still quite a bit of snow lying around, but water is running steadily down the streets.

And Now for Something a Bit More Whiny

He leaned over the counter this morning, making small talk while writing a quick progress note. Around his wrist was a white rubber bracelet, of the type popularized by Lance Armstrong and his Livestrong cancer awareness effort. The last three letters read -T-H-Y. He was clever enough, so I asked him what it said. He hesitated a little and then turned it around a bit so that I could read: A-P-A-T-H-Y. He told me that he has another one at home that says DESPAIR. I know this was just a sarcastic, and somewhat thoughtless response to all of the trend following bracelet-wearers.

However, the bracelet kind of stuck in the back of my head all day. It didn't really help matters that the reason that he was checking up on our patient this morning was that he had accidently overdosed one of her meds yesterday. If I were in his position, I don't think I would want to be seen with that around my wrist.

Then I started thinking about what my bracelet would say if I was to describe how I felt in one word.

TIRED?

WORRIED?

FRUSTRATED?

LONELY?

USELESS?

Schedule-wise this has been a more relaxed week for me. I have been working out more regularly, and even reading a little every night. And yet I just feel like a mess. I don't know what I am accomplishing here. I kind of feel like I am in a pit with steep, muddy walls that I can't climb out of.

If I had my pick, I would want my bracelet to say CONTENT or more simply LOVED, but those seem to be feelings well out of my grasp right now.

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I am on home call right now. It's hard not to just sit there and stare at my pager, willing it not to go off. It is annoying that the key to sleeping tonight is directly related to a 1" x 2" x 0.5" electronic device. I HATE THAT THING. A person with a good attitude would be grateful for being able to spend a call night at home, but unfortunately I am not in that state of mind... yet.

This evening, I watched "An Inconvenient Truth". It was pretty good, and I think that I may have learned a thing or two. I did not realize that Al Gore was such an idealist. I used to be like that. I guess maybe I just need a little refill on my supply of hope.

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P.S. "Match Day" for medical students entering residency programs this July is coming up next week on the 15th. Please keep "The Phoenix" in your thoughts and prayers.

The Face of Evil

Photo by Rick Leche, who has some amazing wildlife shots on www.flickr.com

Sometmes You Feel Like a Nut

I was all set for an uneventful evening. It is 7 degrees outside right now and may hit 20 below with the windchill overnight. I figured it was a good night to just go home after work and stay there. The house has been a little chilly, so I decided that tonight would be a good night to get the fireplace going. I heard a few noises from my fireplace and thought maybe a bird was messing around with the chimney cap as it didn't really seem all that loud.

The fire had been going for about an hour when I noticed a small stick fall into the flames. I didn't really think too much about it. I went on with my cleaning when I hear this loud thud against the fireplace screen.

I looked down, right into a pair of beady black eyes.

THERE WAS A FREAKIN' SQUIRREL IN MY FIREPLACE!

This squirrel was jet black, and huge! He was almost the size of a cat, and surely up to no good!

To be honest, my first instinct was to ram the screen flush against the fireplace and force the thing back up the chimney or to a firey death. I am not very proud that I had that thought, but I didn't know how to easily catch the stupid varmint. Then I started picturing a blazing squirrel screaming its final breaths and decided I had to let the thing out.

It scurried up my bookshelf and then behind the couch.

I tried to herd it towards the door, but it started up the stairs. I chased it back down and then managed to prop open my side door. I tried again to herd the squirrel out, but rather than going down the stairs and out the door, the thing went into my kitchen and started running all over my countertop, climbing the cabinets, and dancing on the kitchen table just long enough to throw all the placemats on the floor! I looked for a broom, but all I could find was a Swiffer Sweeper to swing at the thing. It ran back into the living room and I opened the front door as well. At this point, I think I was yelling obscenities involving the squirrel committing lecherous acts with someone's mother. (Keep in mind that my doors are wide open for the neighbors to hear all of this.)

It suddenly dawned on me that I definitely did not want the thing on the second floor, particularly in my bedroom, so I ran upstairs and closed all the doors. By then the first floor was chilly, and I couldn't find Mr. Squirrel anywhere.

I turned off the stereo so that his claws on my hardwood floors would betray him, but I couldn't get him to come out of his hiding place, no matter how hard I stomped. I shut all of the outside doors and decided to "phone a friend" as apparently squirrel-herding is not my specialty. Luckily one of my buddies was just coming off shift. After much convincing that I wasn't making this crap up, he agreed to come over and help me chase the thing out. Being a typical guy, he kept asking me if I had a shotgun. By the time he had arrived, I had built a wall out of my ottoman and couch cushions to direct the squirrel in the right direction.

When my buddy arrived, he pointed out some tracks by my side door. As I hadn't actually seen the squirrel escape, I made him stay until we had searched under all of the heavy furniture and had given each room a brief once-over. After he got home, he called said something about seeing the trail of tracks lead from my door to the tree out front. I guess that should be somewhat reassuring, but I'm still planning on sleeping with the covers up tight by my neck tonight.

It could have gone much worse. I could have had a squirrel running around catching everything on fire. It is somewhat funny for this to happen this week when I'm just starting my rotation in the burn unit. Early this winter I had the chimney inspected. The guy was supposed to come back out and replace the chimney cap as he said that the kind that I have attracts squirrels. I guess he really knows what he's talking about. I also guess I won't be having any more fires going until that cap is replaced! I am sure it will be months before my buddy lets me live tonight down. Right now, I am anxiously waiting for the fire to finally die down so I can seal that damper up tight!

A Few Steps Forward

All truly great thoughts are conceived by walking.
- Friedrich Nietzsche

I wanted to clear my head today, so I went for a walk. Just around the neighborhood, nowhere special. The clouds taunted me-- first with big, fluffly "lake effect" snow, and then with stinging sleet. I don't know that any "great thoughts" came to mind, but afterwards I did feel a little better.

During medical school, I somehow befriended a gruff, older classmate. She had been forced to retire from her career by an injury, and made the unlikely choice to relocate from Maui to the dusty, polluted desert to attend medical school. She was quite a character, and I think I learned a lot from her during our few years together.

One of the things that she liked to do was walk early in the morning before class. A few times she actually convinced me to meet her at 6 am and accompany her on a two-mile walk from our apartment complex. It wasn't much, just a short trail along the edge of a wash behind the same stucco houses that pop up in crops all over that city.

She was a big believer in taking care of one's self emotionally as well as physically. I believe she'll make one wickedly-awesome psychiatrist. One of the things that she shared with me was that she used to walk along the beach of the North Shore every morning, and that walking Skunk Creek (I am not making that name up!) by our school was the best she could do to replicate that. Getting outside and away from everything else helped her to calm down enough so that she was better prepared to deal with the rest of the day. I'm hoping to transition to running outside when the weather's better because while I can blow off steam at the gym, it is not exactly a relaxing escape. And, while I try to relax when I am home, often I can't seem to get my mind off all of the things that I should be doing. Maybe adding a few evening walks a week will help.

Last Call

The weather has been crazy lately. On Friday morning I nearly fell in my own driveway as the snow had melted on Thursday and re-frozen overnight. I was on call on Friday, and today the temperature was almost 40, so again, there was much melting. I went to the gym for a quick run, and less than an hour after I returned home, it started snowing again!

Last night was somewhat of a milestone as it was my last 24-hour shift of the year. Apparently, I have one weekend of home call coming up, in which they can page me at any time and I have to go in if they need me. Many of the other interns have had weekends free of interruption with this arrangement, so I'm hoping for the best.

I will be meeting up with one of my friends and her kids in a few weeks, but otherwise no vacation until June. Hopefully, my motivation will return again once I get back in the department. I just have no desire to do anything right now. I don't feel like I learned very much during my time on the pediatrics floor. With the quick turnaround, constantly flipping patients, and constantly revolving community pediatricians there just wasn't any continuity of care. Towards the end, I did end up with some more normal cases, but the amount of social work issues that came up was just staggering. I don't know how pediatricians do it. Between the neglect, physical abuse, and poor decision-making skills of many of my patients' parents, I think I would end up on anti-depressants if I did this full-time.

Otherwise it was a day of napping, TV watching, and wallpaper attacking. And just a tip: if you're scoring wallpaper and using a chemical spray to help remove it, it also helps to sponge it down with hot water before scraping.