A Glorious Return

I just read that my last post was published in October of 2014.

There are many excuses for this:

1. My trusty aging Mac wasn't keeping up with the new OS and turning it on, much less typing a post, took ages. I knew I either needed moar RAM or a whole new Mac. With resident-level resources, this took awhile to accumulate appropriate funds to do the necessary task. And usually by the time I had accumulated necessary funds, something more pressing would come up and I would blow the cash on that instead.

2. While I've logged many interesting encounters and have many stories to tell about the last 15 months, I've actually been quite occupied actually living a rich and active lifestyle, and have largely failed in documenting it. I don't even Instagram. Or Tweet. My Facebooking has fallen off sharply.

3. I just haven't cared. All of my give-a-fuck funds were being spent on keeping my actual life together and moving along. I had reached a point where I finally just couldn't be bothered with narrating it to +/- who knows how many people actually read it.  When I'm not working, I've been trying to be outside to exercise. Or I've been binging on Netflix/HBO.  I haven't really written anything in the last 15 months, not even longhand. Except hospital documentation. Which I'm tired of.

There are others, but most indirectly refer back to #3. As I have entered a new phase of life, I am trying to return to my previous discipline of writing periodically, to assemble some testament to my travels and doings and thoughts. To exercise this part of my brain that actually writes for the story, not to cover my medical/legal ass.

And what is this new phase? I entered it on December 2nd, which is one of the Match Days (yeah, remember those? I am finally vindicated). Well, I will complete the dreaded Internal Medicine Residency training in about 6 months. At that time, I will leave my tiny job at the tiny community hospital that pays tiny money, move out of my tiny house and drive my tiny car to Albuquerque, NM, where I will start a two-year endocrinology fellowship at the not-tiny University of New Mexico. So stay tuned for all the emotional spectra that I anticipate will accompany this process.

Oh, and I plan to acquire a new tiny corgi during my tenure in the American Southwest. Accepting recommendations for his/her title and name.

Sweet, Sweet Freedom

The internet is recently awash in articles and blogs about women's Childless By Choice lifestyles--and it's about effing time.

I Don't Have Children and I'm Happy About It. Can You Handle That? - 08/28/2014
Silly Things People Have Said to Me When I Tell Them I'm Not Having Kids - 10/21/2013
Why is Being Childless By Choice Still an Issue? - 10/01/2014
What it Really Feels Like to Be a Childfree Woman - 08/16/2014

Those of you Constant Readers who know me well, or who have read my book, know that I chose a childless life long ago. At least, a biological child. I have a number of logical, medical and philosophical reasons for choosing this, but have lacked the ability to truly, indefinitely, make it my choice.

Echoing the messages I've read in articles that outline similar choices, I'll re-state it here: Long ago (like, in my early teen years) I acknowledged a desire for complete reproductive freedom. Of course, at that age no one took me seriously. In my early 20s, the viewpoints had remained unchanged. I was met with frequent--nay, constant--rebuttals à la "You'll grow out of it," or "God wants you to have children" or "You can't possibly know how much you're missing out on." Sure, I can accept that third one, I guess. There are plenty of things I didn't know were kick-ass until I tried them, but in this case for me the risks were not worth the potential benefit.

But here's the really important thing: I was not going to change my mind.

Finally starting in my mid 20s, I began asking doctors about sterilization. No one would listen to me. They continued to dispense The Pill, send me on my way, and say, "We'll see you when you're ready to have babies." I was irritable. I knew the failure rates of alternative forms of contraception. They made me paranoid. How many women had I met over the years who ended up with a "Woops! Uh, I'm a mom now." I did not want that for me. And the consequence was that this was a stressor present at every sexual encounter, in some form. It makes you tired. It makes you less interested in your sexuality.

Then I went to medical school and my paranoia blossomed. The major lesson I learned in my ob/gyn training was that 1) most women really have NO actual idea how their body really works and 2) about 50% of all pregnancies in this country are accidents.

By this time I was about 30, and had kept asking my doctors for a Final Solution. I continued to be rebuffed, if not by the physician then by the insurance company whose policy stated that they would not endorse "any form of elective sterilization." My irritability became fury.

PEOPLE. I HAVE NOT, AND WILL NOT, CHANGE MY MIND. WHY WON'T YOU HELP ME?

It was clear that the world at large cared more about my right to reproduce than my decision whether it was right for me to reproduce. I tried--and subsequently failed--the alternatives: NuvaRing, Mirena, Skyla. It was a 1 1/2 year long hell of mood swings, pelvic pain and inflammatory acne. Of cervical dilatory procedures and bad periods.

Then came Essure. An in-office procedure that permanently places a nickel coil in each fallopian tube and induces inflammatory response such that the body will close off the tube as it encapsulates the foreign body. It was relatively cheap. Paid for by most insurances. And usually produced the same level of reliability as tubal ligation, without surgery. I almost pulled the trigger--until I read about the FDA re-investigation of this device, and concluded that I didn't want anything with  such potential for going bad on me later.

Now 33 years old, I went back to the ob/gyn, again, and this time we talked ligation (BTL for short). New data has been accumulating that salpingectomy (a sectioning and removal of the entire tube) is becoming the standard of care, because it allows for pathology review of the tissue. I found this to be highly valuable, since I'd been irradiated and treated with adjuvant chemotherapies. If the data was showing that ovarian cancers are actually first starting in the tubes, and being at higher risk than the average bear, this would allow for direct visualization of both structures AND a pathologist's review? I'd just hit pay-dirt.

We extensively reviewed surgical and anesthetic planning with the priority being preservation of the remaining kidney/ureter. My surgeon brought in an additional surgeon to first assist--a gyn specialist who only does high risk pelvic procedures--since I'd already had open abdominal surgery as a kid, and we were expecting it to look like an adhesion-bomb went off in there. My friends still tried to talk me out of it. My parents (at the same instant) said, "I can't believe this!/Yeah, I saw this coming." I couldn't wait.

Pre-Op Anticipation

One laparoscopic bilateral salpingectomy later, I am now fully recovered, have a completely clean path report (rejoice!), and they say that the abdomen/pelvis looked "pristine" during the procedure.

Every freakin' day I enjoy the security and freedom of knowing that I will never have a "Woops!"

Shootin' The Curl

Note: This is not me.

When in Rome, you know?

I've lived in coastal SoCal now for about 16 months, and just in the last few I have grown discontent with merely walking on the beach.

Trusty colleague Dr. O.P. has helped me embark on a series of aquatic adventures. I have thus discovered the joy of sea kayaking (which is markedly different from--and more fun than--the sea kayaking I did up in Seattle), sailing, and surfing.

Kind of.

I didn't initially *really* want to surf, citing my disinterest in being victimized by either sharks or jellies, but he lured me into the breakers, protected by full wetsuit and astride a beginner's foam longboard. We chose Seal Beach for our inaugural trip to Shoot the Curl because the waves break close to shore, so there would be less paddling required. I was fine with this, as the closest I've ever come to Catching a Mad Swell to this point had been my adventures in boogie boarding last summer.

It's cumbersome to negotiate a huge solid sail through the whitewater, and terrifying to see the swells rise up above your head and have to plunge through them without flipping over.

But then you get past the breakers and all is quiet, cool and comfortable--except for the occasional dead fish floating by, or a nearby streak attack by a pelican on the hunt.

I'll sum this first trip to the surf as follows: I spent a lot of time upside-down in the water, and it took 2 days to really get all the sand out of my assorted nooks and crannies. Did I stand up? Neg. But I did learn to control and balance the board...mostly.

Also: this thing happened on the same day we were out Ripping Some Primo Pounders.

But then I also ate shit hard enough on a few of those attempts that I screwed up my right shoulder for a week. Turns out that dressing one's self or driving a manual transmission is almost wholly dependent on the function of one's dominant shoulder. Big time suck.

I'll leave you with this selfie of me trying on a neoprene spring suit today. I made myself a deal: once I can routinely stand up and control the board, I'll be in the market for my very own fun-board.

This is me. YOU'RE WELCOME. 

One Year Later

I can scarcely believe that it was fully a year ago that I endured the Horror that was Match Week--and its aftermath. So much work (and extra work), time, money and travel that culminated in...absolutely nothing. I relied on a few close friends, Ambien and (a metric ton) of beta blockers to get through those ensuing weeks.

I should have bought stock in Kleenex.

And then I was scooped up by then-Pacific Hospital of Long Beach now College Medical Center/Molina Healthcare's family medicine residency and I put down roots in the LBC. 

And lemme tell ya, living here is, shall we say, the tits.

Of all the places I've lived over the years (and I include my vagrant 4th year of medical school in this), Long Beach is by far the best and most livable. It is retardedly expensive, but it's sunny and 75 pretty much every day. I really, really enjoy my colleagues and the cooperative environment we cultivate for ourselves. I don't need a gym membership (which is good because I can't afford one anyway), because I exercise at the beach every day. I don't require an air conditioner, and this winter I never had to turn on my heat. There are 5 airports within an hour (one within 15 minutes) of my house that will take me anywhere and everywhere. The food scene is highly varied and awesome, and I never have to plan my life around weather--unless I need sunscreen.

Most importantly, RDJ lives nearby.

Yeah you do.

And so you can understand the gamut of my emotions when after I had decided I would try again with this Match business and failed--again. I depleted my savings account, spent my vacation days to go on interviews, and withstood the agony of the unending wait...for nothing. So on the one hand, there are all of the aforementioned things that I love about this little urban paradise. On the other hand, I will never go into gyn/onc, and I will never be in charge of an O.R.

And that creates, shall we say, a dissonance. 

Night Time Love (Spelled H-A-T-E)

Shut it Oreos. I'll be El Triste if I feel like it.

I'm about to enter the fourth of four weeks on the Night Block. I and my senior resident manage the medical/surgical/ICU wards overnight, arrange all incoming admissions through the ER and respond to any Code Blues and Rapid Responses--including on the locked psychiatric ward. I spent the latter Advent season and the 12 days of Christmas doing such. It was my first Christmas truly away from family and friends. The first of many, I'm guessing.

I'm so over it.

Weeks 1 and 2 were no big deal. By mid-week 3 I began to feel an urge to RedRum. Now into week 4 I am...shall we say, irritable. If the morning marine layer isn't too bad, I can catch a glimpse of the sun on my commute home. Otherwise, my life is dark--well...fluorescently lit, I suppose. I have been maintaining my vampire life on the weekends, to minimize the stress associated with this schedule. So here I sit, 2:00am, trying to keep busy until I can Go To Ground in 5 hours.

Its' hard to keep busy. It's lonely. Everyone else I know is asleep. The only places that are open right now are bars and 24hr fitness (neither of which I care to explore). I've caught up on a lot--like, a lot--of TV.

But I long for morning jogs. For having coffee with friends on the weekend. For museums and shopping and scenic drives.

A very good and respected friend of mine recently [and somewhat strongly] admonished me to get back out there and re-assess the dating scene, of which I have been historically apathetic. Since I know he pays attention and I respect his opinions, I dutifully attempted such. Thus far, it's unremarkable. I have been met with messages from men on the other side of globe (why?), men who are wayyy too young for me (not quite ready to Cougar, sorry), and--my favorite--men who are strongly pursuant to achieving a date, who then stand me up. So in short, I would describe this experience en toto as "underwhelming." I talked to said Friend on the phone today about the latter, scoffing, "This is all your fault. I'm going to turn off my account again." I mean seriously, sometimes lonely can be bad but at least it is bereft of these ridiculous highs and lows. He made me promise to give it an extra 2 weeks after completing Night Block, citing my current circumstantial and unfocused hatred. I tried to talk him down to 1 week. "Nope." Fine.

The things you do for your pals.

 But the light at the end of the tunnel is growing: Friday after the Morning Report, I am headed directly to Palm Desert to spend the weekend with Oregon friends and be reborn unto daylight. It was right about a year ago that I was living out there for a rotation; it'll be nice to visit.

Post-Call Thoughts

At Pacific Hospital, we are obsessed with boats.

I just finished a month on the internal medicine wards. Had my first patient die. I am clueless as to what happened. He was doing fine and we discharged him back to his nursing home and the next morning I get a text from my attending saying, "Mr. Q expired this AM after an arrest; Weird, huh?" Did not see that coming.

More boats in the stairwells.

One of the best things about working in IM is all of the demented patients. Usually they like you. Usually they cheerfully endure all the crap we do to them. When they have agitation a little haldol goes a long way. And then sometimes this happens: 

Our hospital is obsessed with testing its fire alarm system, and one night, about 2 am, they tested it (WHY? Why do that to sick people in the middle of the night??). All of the bells start going off and Ms. M, a very elderly and very demented gal was sure she had won big in Vegas. She could be heard  shouting from her room, "I won! I won! Give me my money!" And she continued thus until the test was over.

More boats in the chart room.

and also secret chart room cookie stash

But Ka is a wheel, it's only purpose is to turn, and I definitely appreciate the irony of my position now. I remember my days of incarceration in the hospital and being irritable when the doctors would come in at the crack of dawn, poke me awake, and ask how I'd been sleeping. Now, I'm doing that to people even before the crack of dawn. Sorry guys.

A glimpse into the top-secret residents' call room.

complete with computer...

and bed--I'll give you ONE guess as to why I never sleep there

Here's a rundown of a day in the life of IM:

Hours are long on the medicine wards. I show up at 5am to review the overnight admissions and examine all the patients assigned to my team (anywhere from 4 to 12 people), check everyone's vitals, make sure the labs are ordered, and begin documenting the daily progress notes. Then at 7am it's Morning Report, where we dissect an interesting case from the previous night and go over the assessment and plans in minute detail. By 8am it's bedside rounds with the attending physicians as they trickle through. I usually had 3 at any time to juggle. 10:30am and it's back to the medical library for table rounds where we discuss our cases as a team with our program director and fine-tune the plans. Then it's back to the floor until 12:30pm when it's lunch-time lecture. The rest of the afternoon is spent reviewing the day's test results for all the patients on my team, doing procedures, and planning for the next day. All the hours spent on the floor are constantly punctuated by pages from nurses, nutritionists, case managers, radiology, pharmacy, etc. with questions or to address patient complaints. You may also do new admissions, unless you have reached your patient cap (12). At 5pm we sign out the entire patient census to 2 residents who cover the calls until the night team shows and takes over. From that time to anywhere from 7:30pm to mayben 9:30pm I spend dictating discharge summaries, finishing progress notes or catching the last couple of attendings for bedside rounds. If I should get home by 8, I have enough time to shove some food in my face, shower and go to bed if I hope to be conscious at work the next day.

3am face.

On weekends we share call, two of us on for the day shift and two on overnight. I'm amazed at how well I tolerate overnight call. It's because of my two superpowers (to review that is 1. not sleeping at night and 2. the ability to feed in record amounts of time). But I tend to hit the wall between 3 and 4 am. I'm sure my world-record feeding ability will come back to haunt me later in life (helloo lazy lower esophageal sphincter => GERD => Barrett's Esophagus => adenocarcinoma).

With the dawn comes my reprieve!

Buh. I made the mistake of sleeping this morning for a few hours and now I feel terrible. I shoulda just stayed up until my normal bed time.

Goodbye for now IM. I'll see you in a month.

And now for a relaxing, board-study-filled rotation on OB/GYN. I am back among my people.

Constant Readers are Weird

Pie Heaven has 10 official followers, but I know the audience is larger than that, thanks to FB and G+.

But you people are kinda messed up. You like to read stuff that I didn't expect.

I love that Blogger tracks the traffic by post, by geographic region, by browser, and a billion other things that I don't actually care about, and it tells me how many hits I've gotten per post. Someone in Russia routinely reads. Australia too. As of yet I have not penetrated Europe, Africa, Asia or the rest of the Americas. Patience...

I'd say that on average, any given post gets somewhere between 35-40 hits. Last fall we broke a record when I got over 50 hits on my post about the anti-nicotine policy for employees at Sparrow Hospital in Lansing, MI.

This surprised me. And I thought the numbers wouldn't ascend higher than that.

My post about encountering death on the wards was also abnormally high yield, as was "Post-Its or Breast...I Can't Tell." But then a couple months ago I posted about my horrifying and awful Match experience and you people ate that shit up. 75 hits last I checked. A new record. It's follow-up "I'm a Real Doctor Now," did very well, but didn't come close to breaking that record. Somehow, the most recent "Emergency Panties" did nearly as well (wtf?? that one wasn't very good at all). And then one of my all-time favorites and best works to date on this project "And Now For a Funerary Gala" failed to achieve a response that was beyond average.

Duly noted. You guys dig drama and suffering. I will henceforth let the tragedies flow.

Emergency Panties

I'll just tell you straight off that the title of this blog is probably the most exciting part of it. Too bad for you.

But Emergency Panties are real.

These are them.

 And I had to use mine the other day.

So back at the beginning of 3rd year med school I acquired miscellaneous toiletries and garments that I kept in the boot of Skate. I did this because our administration spent a week prior to rotations chiding us about how we will be tried before the dreaded Student Performance Committee (imagine Harry Potter's Disciplinary Hearing at the Ministry of Magic) for any number of unwitting sins. But they particularly emphasized the punishment if they should ever hear about us using a hospitals' scrubs or other personal care products. We were responsible for providing our own scrubs and other products, should we find ourselves on some 30-hour shift or something.

Pretty sure no wise wizards would come to my aid at the SPC.

Not being particularly inclined to having to defend myself in front of WU's version of the Wizengamot, I collected deodorant, a hairbrush, and two pairs each of socks and panties in my kit. I figured these items would almost guarantee that I could get through any clinical situation at a moment's notice and still offend the fewest possible people with my unwashed self.

So those items remained untouched in their bag in the boot of my car until last week. I called upon the Emergency Panties, not because I was stuck in the hospital for a particularly long and shower-free shift, but because I'd had so many shifts in a row that prevented me from either doing laundry myself or dropping it off anywhere to be done for me. I'd made a point of amassing a ridiculous count of panties in anticipation of this problem, and still my shifts outlasted them.

If you prefer math:

n  >  x

Where n is defined as the # shifts and x is the # of panties

Emergency panties got me through the last two shifts until I could obtain quarters to do my laundry.

Thank you, Emergency Panties, your service is appreciated.

I'm a Real Doctor Now

Primed and ready for day 1 of residency.

No longer "Almost." Guess I need a new Blogger handle.

I am 2 weeks into residency, which has me assigned to the "surgery" department. I don't know if it's the feast or famine feature of hospital census, or if it's a feature of this particular department, but I have only participated in 3 or 4 surgeries. I'm busy all day, doing consults, caring for post-op patients, etc., but in terms of learning surgery? Yeah not really. The powers that be also decided that the surgical department is "too sensitive" to grant badge access to the residents, so any time I need in there I have to wait for someone to buzz me in. And I've had several occasions where I need in there after hours or on a holiday and of course no staff is around TO buzz me in. It miffs me.

But aside from such idiosyncrasies of the workplace, I'm doing all right. I really love my fellow interns. Not a single douche bag among us! Moreover, all patients have been accounted for, are alive and able bodied. I'm halfway through the dreaded month of July without killing or maiming someone by some sin of oversight or omission.

And what is with the doctors always wanting to work before dawn? What IS that? Why can't we have swing-shift medicine? Roll in at noonish...work 12-15 hours...I am much more amenable to that than this 5am business. If you are on my FB you've already heard my scheme for a clinic called "How 'Bout I Just Swing By Later" healthcare. It's gold. AND a recent medscape article suggests that I would have large demand, as many people don't want to take time off work to go to a doctor anyway. After-hours genius!

I also am already sick with some kind of wheezy, hacking tracheobronchitis. FTS.

But I am not quite out of med-student mode yet. That behavior which has been ground into me for years to always say "yes" to a request, regardless of what it is, when it happens or how long it will take. Case in point I volunteered for extra work yesterday so I could learn about lumbar pain. And as I heard myself saying yes to the request, my occipital brain was back there going, What is wrong with you, asshat? STOP TALKING. You ask when did this extra work happen? At 5am, of course, when else?

I gotta stop doing that shit.

And now I leave you with a classic northside Long Beach observation.

Sage wisdom in the patient parking lot...duly noted.

The Denzel Phenomenon

This post has been on my list of things to do for some time, and I figured that since I'm down to the last few days of freedom that it's now or never. By this time next week, immersed as I will be in the onslaught of the internship year, I may well have lost my will to live, let alone blog.

For years social scientists has posited that symmetry is beauty to humans. Studies that blended faces showed that subjects counted the most symmetric faces to be the most attractive.

You don't have to look far to find supporting evidence. It is rare to find an asymmetric A-lister, either in face or in body. Rarer still is an asymmetric model.

Megan Fox--pretty danged symmetric in face and body...

Rock stars? Well, one only must look at Mick Jagger to understand that symmetry apparently need not apply--these guys ooze the sex appeal no matter how icky they look. A separate set of studies will be needed to understand this particular phenomenon.

Mick wtf??

OK actually Slash is pretty symmetric. Still grosses me out though.

GAH. Steven Tyler no thanks.

I take this a step further by suggesting that there are two types of beauty. The first is beauty that actually speaks to you on a visceral level. For me that would be the RDJ's of the world. I am not responsible for my own actions should I find myself in their presence. The second type of beauty, and which I posit for your consideration now, is what I have termed The Denzel Phenomenon, and I mean those individuals in whom I can appreciate and acknowledge objective beauty, but it's beauty nonetheless that leaves my soul empty and my interest at zero.

How did I name it thus? I chose an individual who is widely acknowledged to be attractive by women the world over. Someone in whom I can assess corporeal features, note how much symmetry he possesses, as well as his other characteristics that are would-be attractive (i.e., height, tone of voice, presence, etc.), acknowledge that they are all positive and yet know that these things are only strictly scientific. They mean nothing to me personally.

Young Denzel. Meh.

For instance, insofar as I find all those who fit the RDJ Profile to be intriguing, I conversely happen to find the, say, Brad Pitt Profiles to be not-intriguing. Similarly, it is my nature to be uncompelled by other races. With only two exceptions to date, I have not found myself in the least bit attracted to men of African-American, Indian, Asian, etc. descents. I have no specific reasons to cite for this, but it is empirically true. Wait, does this make me some kind of...cellular racist?? (FYI, just Googled "cellular racism" and found this blog)

This is the guy who played Dr. Suresh on "Heroes."
Symmetric. Olive-skinned. Accent. Good hair.
Do not care.

And I rejoice that my theory has become conversational, as last week I was driving around with colleague Almost-Dr. Casey, discussing the finer points of attraction. He commented that "Brad Pitt, now he's a looker."
Me: "Eh. Take it or leave it."
Him: "Whaaaa? Come on. Even I'd hit that."
Me: *shrug*
Him: "But he's a Denzel, though, right?"
Me: "Oh yeah. Totally."

Nope, I got nothin'. Totes a Denzel.