Piffle

Call of the Sirens (Part VIII)

2008-08-19T11:56:00.003-04:00

Our scene: A darkened patient room in a large urban teaching hospital. Not particularly nice but not grim, either. Think tan vinyl flooring and grey laminate counters, but cleanish. The time? Between 5 and 6 am. There is a human-shaped lump on the bed under the beige hospital bed spread, breathing rhythmically in a narcotic-induced sleep. A lone figure in pea-green scrubs and short medical student white coat, pockets bulging with assorted paraphernalia, stethoscope draped 'round the neck, silently creeps in, making no sound, holding her breath. In one fluid movement, she pops one end of the stethoscope into her ears and snakes the other end under the covers and onto the patient's upper abdomen (the 'epigastrium', for those who enjoy such jargon). Holding it there for a brief 3 seconds, she then withdraws from whence she comes, out the doorway, to join the other identically attired members of her surgical team, 6 in all, 2 with short med student coats, 4 with long housestaff coats (2 interns, 1 junior resident, 1 chief resident). In terse whisper, the interloper imparts the following, "No complaints. Dressing intact. Breath sounds clear. Cardiac--regular rate and rhythm, no murmurs. Bowel sounds present." One of the members of the team quickly scribbles her words into the patient's chart. Another scribbles some orders and puts it with the rest of the team's charts on the rolling chart rack. On to the next room, where the performance is repeated with little-to-no variation.

Thus are pre-rounds on the surgical team.

Heaven on a scalpel.

Rules:

Always round before the patient is awake and family members are present. Talking to patients and especially family, wastes time. The nurses can read your note and take care of all that touchy-feely bullshit.
Always have the lightest team member examine the patient, the better to creep in and out without waking anyone. (See above)
Placing the stethoscope in one place allows you to (theoretically) examine all 3 organ systems (lungs, heart, gut) without all that needless mucking about that internists are so fond of, placing their stethoscopes here and there around the torso.
All this stealth is vital for the team to have rounded on all the inpatients ahead of time in order to be in the operating room by 7 am sharp: gloved, gowned, scrubbed, surgical instruments in hand, attending pimping away. ("So. Dr Piffle. What is the order in which one encounters the vessels that supply the GI tract coming off the aorta, in descending order and is each anterior or posterior to their corresponding venous counterparts?" "Errrrrrrrrrrrrrr....")

Ah. The surgical rotation, where one learns the 4 cardinal universal rules of surgery:

Trust no one.
Eat when you can, sleep when you can, pee when you can.
The esophagus is not your friend.
Don't fuck with the pancreas.

Contrast these with the 4 rules of internal medicine, as told to me by a rather cool attending:

Medicine is not a science, it is an art based on science.
There are at least 2 ways to do everything.
Every patient is an n=1.
If you're not having fun, something's wrong.

Taking #4 up there: see, the thing about surgery, is that it is fucking fun and really simple. Not the surgeries themselves, but the approach to medicine. You are congratulated for the shortness of your notes and your ability to turf (transfer the care of) any patient who is not in need of surgery right now, to a non-surgical service. You don't have to waste time on all this differential diagnosis stuff. Who the hell cares why Mrs Jones is demented, all you care about is if Mrs Jones is a surgical candidate. If not, turf her.

Turf her good.

(An aside-- that's one thing that reallyreally bugs me about all these medical shows. See, there are strongly delineated lines between medicine and surgery, especially in a teaching hospital. Surgeons operate and do the post-operative (including the surgical intensive care unit) care. They do not have anything to do with medical issues. They don't manage the insulin. They do manage the pain meds. The patient with some sort of unknown fever, unless there's an obvious surgical source, would never be admitted to a surgical service. The patient would be admitted to medicine, perhaps with a surgical consult as to whether or not surgery might be indicated, but NEVER to a surgical team. Also? There are distinct surgical sub-specialities. Don't mix general surgery with orthopedics, ob/gyn, ENT, urology. They do not generally cross specialities. A general surgeon won't be operating on a deviated nasal septum. Nor will that surgeon be fixing a heart or doing neurosurgery. And vice versa. Pediatric surgeons generally don't operate on adults and vice versa. Got it? Rigidly defined roles. There are exceptions but they don't practice in large teaching hospitals.)

I also adored the surgeries, themselves. All that glamorous, sterile attire. The appropriate etiquette. How to scrub--start by cleaning under the fingernails with the enclosed nail pick, then lather up with the sponge side, then scrub 10 times each part of each finger, then the backs of the hands then the palms, rinse with the hands up, letting the water drip down the arms and not off the fingers. How to move through a sterile field. How to change positions with a colleague at the table-- the one closest to the head turns out of place, rotating back-to-back, and turning around again to face the table. How to stand--arms crossed, hands under armpits or hands held in front of the chest. Never below the waist. Below the waist is not part of the sterile field. Neither is the back nor above the shoulders. How to gown and glove oneself (although the surgical circulating nurses will often do the honors of assisting with the donning of gown and gloves) while maintaining sterility. One does NOT break the sterile field or one will find oneself in small pieces in several parking lot dumpsters.

How not to pee for hours and hours on end. Drinking fluids is to be carefully timed. It's OK to have some coffee up until, say 6 am, but not later, unless it's a short case. Some cases go 12-14 hours.

How to stand so as to try to diminish the pain in your legs, your back, your arms. How to ignore the hunger. The fatigue. How not to look weak. How to bond with your team.

That last one was key, I've no illusions. I adored surgery because of my team. The Chief Resident was an amazing woman who actually enjoyed teaching and let her students do lots. The Jr resident was a middle aged guy who had been a cardiothoracic surgeon in his Eastern European country before he immigrated and had to do all his training all over, again. So he was very happy to have the students do procedures. As he was so qualified, our team would sometimes have 2 suites going at once, with the Chief, an intern and a student in one room and the Jr resident with the other intern and student in the second room, the attending wandering about between the two and the lounge. What's not to love?

And so, why the hell didn't you become a surgeon, m'dear?

Ah. First, because I knew my personality, and while I loved it, I knew I didn't have the soul of a surgeon. I don't like crises. You can't get away from the crashing, life-and-death, what-the-hell-are-you-going-to-do-right-this-minute-Doctor-this-person-is-dying stuff, but it's so much more common in surgery. The tools I have as an internist are the drugs, the endotracheal tube and ventilator, the cardioversion paddles, the labs and scans and the consultants. Not quite in the same league as what the surgeon faces with someone who's bleeding out.

Also, most surgeons are assholes. It's true. I've known lots of wonderful surgeons, but most are not. I'm not fond of assholes.

And finally, Charles would have divorced me, I'm sure. The residency is brutal, lasting 7-10 years for general surgery, depending on the program. Call is usually every other night. The off call days run 14-16 hours. It's the speciality that brought us the phrase "The problem with only being on call every other night is that you miss 1/2 the good cases." That in itself was enough to bring me to my senses and to make me an internist, with my drugs and scans and long, involved differential diagnoses. And to care why the hell Mrs. Jones was demented, because there are a few rare things that can cause reversible dementia and the surgeons sure as hell weren't going to look for them.

After my glorious weeks as part of the general surgical team, I headed off to my surgical elective, anesthesiology. Good god, what a shitty speciality. All fiddly deadly drugs and monitoring. The gas passers live a life, as the saying goes, of endless boredom punctuated by bits of sheer terror. As students, we were paired up with an anesthesia resident (no interns; anesthesia residents generally do a medical internship) with an attending overseeing. One attending in particular, the Chief of Anesthesia, enjoyed the reputation of being a remarkable jerk and was, for some inexplicable reason, heavily into professional wrestling. As students, we had to call the surgical patients we were to anesthetize the next day, the evening before, and go through all the questions they'd already been asked by the residents. The same EXACT questions. Which I thought was beyond bogus, especially, as we all know, I really don't like talking on the phone, especially cold calling strangers for no reason but to bother them on the night before their surgeries.

So I made it a rule not to call them.

Which, as luck would have it, came back to bite me in the ass the last day of the rotation, the biter being the dreaded professional-wrestling-besotted jerk attending. He asked me something that I would have known, had I called the patient (nothing vital to their care, don't worry, just something beside the issue). I said that I didn't know. He asked "Why not", bushy eyebrows descended to an alarming level. I said, "Because I didn't call." Seeming to swell to the size of a large grizzly bear, he thundered, "Why the hell not?" "Because I'm worthless and weak," I said matter-of-factly, looking him in the eye. I was exhausted and, I suspect, not averse to goading him into killing me and relieving me of my misery.

And then he laughed. And laughed and laughed and left for his standing date to watch Portland Wrestling. And he passed me with an acceptable grade.

Always tell the truth, dearest darlings, no matter what. You're likely to be caught in a lie at some point, and who knows, you might provide comic relief to someone. Plus, the truth is always simpler. Like surgery.

So that's how things ended with Diana and surgery, except I still get to wield the scalpel and suture from time to time in the office, with small things. And I still feel a bit whistful as I don the sterile gloves and ask my nurse to pass me the #11 blade.

But I make it a point to always say "please" and "thank you", just so no one thinks I'm a jerk.

What I've Learned On My Summer Vacation

2008-08-07T09:16:00.008-04:00

I really don't know what I was thinking.

See, a few months ago, when there were still the remnants of all that winter snow in the mall parking lot, the kids were in raptures over one of those crappy little 'fairs' that were set up by the chain toy store. You know the sort: a small Ferris wheel, some sort of half-assed mini roller coaster, probably a tilt-a-whirl, a few win-a-.99-cent-prize by spending $5 and seeing if you can toss a ring around a bottle and some cotton candy and popcorn concessions.

Their pleas of "pleasepleaseplease" were answered with a 1-2 punch of "No!" and "We'll see about going to the big State Fair in the summer."

A trip to the fair in summer, being months away and warm and bright, seemed like just the ticket. Visions of tents pitched on the grass, breezes amidst the trees, parades of well-groomed cows and the like, accompanied by all sorts of fair food. What's not to like? Sort of a grown-up version of our small county fair that we went to a few years ago.

Oh, Stupid-o mio.

Concrete. Miles and miles of concrete overlayed with a cacophony of screaming. Unbelievably overpriced, with tens of thousands (hundreds of thousands?) of people scuffing along in the opposite direction of where ever it was we were trying to get to.

And to top it all off, I inflicted the whole thing on poor pal, Teri, who I've not seen in 2 years. "We're going to the fair! We'll be near you! Do you want to meet up with us and do the fair? We can get to spend some time together while the kids enjoy themselves."

Alas for her and her girls, meet us they did. The cranky, over-heated family who didn't bring enough cash for both riding and eating, or really even just riding. (Who the hell doesn't take credit cards these days, I ask you? That's not just unamerican, it's anti-commercial. Don't they watch TV? Life stops for those who taketh not the bits of plastic.) After a few hours of dragging around, we called it a day and packed it in, leaving poor Teri a little cotton candy colored puddle in front of the cursed Ferris wheel. (We'd gone back on purpose, right before leaving, so Colin could ride it, as promised, but he decided that he'd really rather not ride it after all and just.wanted.to.go.home.) As a topper, Sara succumbed about 1/10th of the way back to the car (conservatively a generous 1/2 mile (1 km) away, swimming like salmon up a stream of lemmings) and so Charles and I lugged her back, between us, Colin dragging behind.

Had we only stopped and indulged the lil' darlings all those months ago with the crappy parking lot fairlet, we'd have saved us all a bunch of woe, not to mention a chunk of change. Live and learn, cupcakes. Live and learn. Trade not the small pain of today for the large woe of tomorrow.

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A couple of weeks ago, though, I got to meet another of us, Teresa, out from Seattle to visit the relatives. We met up at the very large farmer's market around the Madison capital square and I got to sit and laugh with Teresa and her sister and daughter while her brother-in-law entertained her niece and nephew. It was, as it invariably is, an all-out gab fest as two people who've never met in person and yet know scads about each other's lives finally get to sit down and sip coffee and nibble baked goods. It's never long enough, is it? And what is Teresa like? Just like she looks: You have to hug her as soon as you see her. She absolutely sparkles. It should come as no surprise to know she teaches kindergarten. I don't know if only lovely people teach kindergarten or if teaching kindergarten makes people lovely. (I strongly suspect the former. 5-year-olds are sweet but I think were it me in a classroom of them I'd be heavily medicated or lobotomized and Teresa is neither.) I forgot my camera but she brought hers and posted one of us if you care to scoot over and wave "Hi" to her.
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And while we're on the topic of catching up over the past few weeks, what happened to The Pool? Well, it was replaced with a more modest and demure inflatable one that was used with reckless abandon by kids and dog, alike. When it was about to qualify for protected status under the umbrella of the endangered species act as a habitat for several newly emerging life forms, I emptied it, scrubbed it out and left it to desiccate a bit in the sun before filling it anew. Then one of those freak violent summer storms blew up out of nowhere. It ended up down at the bottom of the pasture impaled on something large and sharp, leaving it with a ragged rent in the side, rendering it no longer either "inflatable" or a "pool". Luckily, the pools are still on sale at an even more reduced price. I did toy with putting 5-6 of them in the cart. I think I will live to rue the day that I did not. I was wondering why Jocelyn was disparaging inflat-a-pools in her comment. Now I know.

I'm just a-learning lessons left and right, aren't I?

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Speaking of learning, I did finally take that agricultural medicine test last week. Not that anyone was really wondering, but take it I did. It was well and truly taken. Now I just need to wait for the results and then figure what the hell I'm going to do with all that newly gotten knowledge about tractor safety and the lot. Assuming I pass, of course. If not, then I guess I'll not need to decide. Win-win.

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Interlude:

Here's the two fawns who seem to be growing and learning without their mum. They keep eyeing my vegetable garden but have decided that the tomatoes that have taken over most of the space aren't what they'd really rather eat. Aren't they pretty? I tried to post a larger, cropped picture but flickr wouldn't have any of it for some reason. Trust me. They're adorable and still have their spots.

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Firmly entrenched in the heading of "When Will I Ever Learn" is finding that I have somehow agreed to serve my Network and can be found on the roster of the Physician Practice Committee. Gads. For almost 8 years I had successfully avoided such things but found myself thinking, "Hmm. This could be interesting and a way to make some positive changes in the good ol' firm. And breakfast will be served."

All this must have taken place right before lunch when my defenses and blood sugar were at a double ebb for I found myself responding that I'd be delighted to take a seat at that table. I now find that I've somehow become one of 2 physician leaders of the Patient Access sub-committee of the original committee. That's 2 committees. What were they thinking? What was I thinking? I'm the one who sits in the back and nods in agreement from time to time while eyeing the danishes and wondering if I can somehow snag another one while looking like I'm just stretching, sort of a variation on that old first-date-in-the-movie-theater move where his yawn ends with an arm around your shoulders. Now I'm to be at the head of the table at the horrible hour of 7 am, expected to contribute many things of worth AND I've not heard a word about food at these sub-committee meetings. I fear a large tumor has taken over the logic and reasoning bits of my frontal lobe. Here's hoping it rapidly eats away the rest of my higher functions and personality so I won't suffer too long. As an added bonus, we're to round up several other physicians to serve along with us. Ever try lining up docs to do such things? Forget herding cats. It's like herding birds. Birds who never return your calls. Can't say I blame them.

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And while we're on the subject, is there anyone else who would be horrified to find that the gown you were handed by the nurse for your daughter to change into at her kindergarten check-up/meet-her-new-doctor-now-that-your-insurance-has-changed appointment had 8 McDonald's characters spread across the front in various medical garb, all grinning horrifically?

I felt like putting posters of "Supersize Me" up all over the exam room. Good grief.

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So, that's my hiatus in brief. Well, not really brief, actually.

I'll leave you (and you, Teresa as I promised you one, and you, Jocelyn, as you appreciate the inappropriate conversationalist that is the manic gardener, and you, Teri, as you are a true friend as you're still speaking to me despite the horror that was the state fair) with the following of my lovely tree lily. It topped out at over 6 ft (2 m) high and smelled of sweet, sweet summer. Don't look too closely as each cup was full of gorged and stupefied earwigs. The good with the bad, as is life.

Hope the rest of you are well and you avoid state fairs and committee meetings.

(Oh, and if you happen to not look where you are vigorously weeding along your raised garden bed, and put your hand --gloved, thank god, but inadequately so-- in a hornet's nest, this will lead to a most painful stinging, causing a stream of fuckingshitfuckingshitsonofabitchFUC!KING!SHIT! to issue from your mouth as a reflex, and your small children will learn how to correctly pronounce, enunciate and vocally inflect those most taboo of words. They'll be the pride of the school playground in a few weeks.)

Haikus For My Own Private Waterloo

2008-07-22T19:48:00.002-04:00

I suck as a mom,
not for the obvious, but
for the stupid stuff.

I make them eat their
vegetables and drink their milk
And do their homework.

Their wails make me smile
as I set the course; mixing
Athens with Sparta.

But then I get a plan.
Something to make them smile,
Glad I am their mom.

Good in it's way, but
then I get cocky and make
promises. I'm doomed.

Like just this Sunday:
"Hey, Colin, let's have your friend
to play in the pool!"

What pool? Well you ask.
Really more a plan as it's
still stuck in its box.

See, after years of
inflatable pools that
die and go to ground,

this year we made a
change and got a Slip 'n Slide
for their summer fun.

But it was no pool.
Nope. It was a little fun,
but it was no pool.

So, "Fuck it," I said.
Life's too short to not have a
pool in your backyard.

The problem is it
kills the grass as it sits there,
for more than a week.

But, wait! We've a slab
of vacant concrete poured by
the prior owners.

It's flat! It's grass-free!
It's level (I think it is).
The place for a pool.

Off we go, to Toys
R Us, Where pools are on sale!
(Who needs measurements!?!)

So, after breakfast,
and laundry. And dinner prep.
And my exercise,

I head out to the
Midwest backyard, where its now
90* in the shade.

Colin's friend arrives
with flip-flops, swimsuit and towel,
ready for a dip.

Alas, the pool is
still theoretical and
laughing at me.

See, it's a full yard
(a meter) too big for the
handy cement pad.

The pad, I might add,
is only mostly level,
for all it's grass free.

Two options there are:
Charles says let it go and get
another, smaller pool.

Me? I say let's do
the more miserable way
and build up the slope.

Thar's rock a-plenty
in the fire pit. I can
build a pool rampart.

Yeah. Good plan, that. Hot
and humid. The sweat burns with
the dirt in my eyes.

I forgot the bush
I had to transplant so the
pool wouldn't crush it.

(Colin and his friend
went down to the basement and
played video games.)

Charles, always wise,
remained exiled on Elba;
he had to study.

Hours later, I
Once again filled the bastard
and prayed for success.

Let's define 'success',
shall we? It holds some water
and is sort of round.

Maybe it is less
than half its expected depth
and shaped like a "D"

And there's a sort of
waterfall at one place as
one side collapses.

On a side note, I
noted a water beetle
made the pool its home.

This was only a half
hour from starting to fill the
cursed fucking pool.

(How a water bug
got in that fast? I'm flummoxed.
Call her 'Harriet'.)

So, there we are kids.
I tried, I really did, but
I suck as a mom.

Tomorrow, you can
splash in your puddle and make
friends with Harriet.

Maybe now you'll find that
the poor Slip 'n Slide is not
such a wretched deal.

-------------
The following day,
my own private Waterloo
sinks to sad, new depths.

Hell with it. I'll clean
it and donate it to some
poor sap at Goodwill.

The rock, of course, will
all have to be schlepped back to
the fire pit site.

The transplanted bush?
There it stays. I'll plant a spare
in its former spot.
------------

I want it noted that
I was just transiently
thwarted in my quest.

The next day I found
Another pool, smaller, less
tricky to put up.

Napoleon has
nothing on me for stubborn
personality.

*34 degrees C for the civilized world.

Anyone want a minimally used pool with filter-pump (complete with O rings lubricated) and ladder assembled? You need a 13 foot (4+ meter) scrupulously level spot of yard or you will rue the day and regret the loss of your sanity. Actually, I've been using the ladder in my multi-month window-washing quest, so at least the ladder has been pressed into honest service.

Call of the Sirens (Part VII)

2008-07-14T20:31:00.001-04:00

And so, we come back to our continuing saga of a goof attempting to become a physician. We've seen her go through the first two years of unrelenting butt work and are now in the spring of her discontented third year, having finished everything but pediatrics, something she already knew she didn't want anything to do with.

Which, of course, led her to just relax and have some fun and be told she should really go into pediatrics by lots of misguided people. But nonono. She knew better, she did. She could never see the tinytiny eardrums of those tinytiny infants, brought in by their terrified parents worried that they had ear infections. She also knew that she just couldn't take a life of constantly reassuring those worriedworried parents. But most of all, she knew if she went into peds, she'd have ended up in prison for having messily and publicly murdered the first person she came across to abuse a child. Either that or she'd have offed herself after the first time she made a mistake that endangered a child.

No. Peds it was not to be, fun as it was. She did learn how to give a good shot, though. How vaccinations would happen in the out patient clinic was someone would have a small child who needed several vaccines and the call would go out to all available nurses, nurse practitioners and me, the lone med stud. As soon as we had enough bodies, each armed with a syringe, we'd sidle on up to the tot, peacefully resting in the arms of a trusted adult. We'd each grab a limb, syringe firmly grasped in the other hand and, on the count of three, we would simultaneously stab the little angel, instantaneously transforming them into a howling, sobbing devil, complete with bright red complexion, banshee howls and visage of doom and destruction.

They said this was apparently less traumatic than giving each shot separately. Maybe they were right. I think there were studies quoted. There are always studies quoted in medical education. There seemed to be about the same amount of screaming this way as there was when my own two got their shots, one at a time, and there wasn't all the distressing repeat performance for the subsequent injections that happened with giving them in series.

The other thing I remember was that lunch and a show was provided each noon. Lunch was usually some sort of sandwich assortment and the show was usually something along the lines of "Pediatric Eczema and You" or "Meningococcemia: Know it. Fear it." Good times. The peds residents and attendings were also a happy, cheerful bunch, almost to a person.

I'm sure they were all heavily drugged or lobotomized. Perhaps both.

So that's that for the third year of med school. The rotation that was by far the most fun was the one I'd known from the start that I had no desire to pursue. I'm sure there's some sort of life lesson in that but I'm damned if I'm going to learn from it.

Now, the fourth year of med school is sort of like the third, but the rotations are usually smaller bites and you have to decide what the hell you want to go off and be an indentured servant for at the end of the year. You get to take ENT ("otorhinolaryngology" for those who crave big, multi-sylabic words) and learn to use the head mirror (that mirror thingy that olde-tyme docs wore strapped to their foreheads), which is actually really hard to use. At least it was for me. There's this trick to peering through the hole in the middle while focusing the light from the lamp across the room that reflects off the mirror and into the patient's throat, all while using an angled mirror (like the dentist uses) to see around the bend in the throat to examine the vocal chords, while NOT making the patient vomit all over you by inadvertantly bumping the back of their throat with the mirror. Of course, now-a-days, you'd just use a head lamp to see, or, even better, a fiberoptic laryngoscope, so you could actually see 'round the bend of the throat and not make everything thing up. ("Oh, yeah! I see it! That bitty nodule on the miniscule vocal chord. Really. I see it. Promise.")

You'd also do a week or two in ophthalmology (the eyeball guys), and get really skeezed out by all things horrible and eyebally. (The worst? The enucleation surgeries where they removed the whole damned eye for some sort of hellacious tumor or other. Heart rending and really gross. Yeah team.) Why the hell anyone would want to go into that was beyond me, but they did. It was a highly sought after residency. Blech. Two of my friends went into it. I'd always thought them sane, but I had to reconsider after that.

There was a week spent in the auditorium doing Law And Medicine, which scared the shit out of us. "YOU WILL BE SUED." "IT WILL BE HORRIBLE." "YOU WILL WANT TO KILL YOURSELF." "THIS IS NORMAL." "YOU WILL THEN TURN TO COPIOUS DRINK AND/OR DRUGS." "THIS WILL RESULT IN THE LOSS OF YOUR PRACTICE AND YOUR LICENCE AND YOUR FEW SHARDS OF SELF RESPECT." "HERE ARE SOME MORE CAUTIONARY TALES OF REAL PHYSICIANS, EACH ONCE A WONDERFUL, PROMISING PROFESSIONAL, NOW TO BE FOUND UNDER THE BURNSIDE BRIDGE WITH THE DISBARRED LAWYERS AND OTHER BUMS." Gah. "But don't let that bother you."

There were several electives, like dermatology (oozy and dull and all the rashes looked like all the other rashes) and ICU (terrifying but cool); and you also had to take neurology (oh, good GOD the damned neurologists and their 5+ hour attending rounds with nary a chair in sight; oh, how we all hated neurology with all their fiddly tests that never worked like the books said and their confounding and complicated tracts and cross-tracts. Like learning the wiring of an enormous 1910 house.)

And then, there was surgery. And the sirens called. Oh, yes they did.

But I am tired and there are children to be put to bed. So I will leave you here with images of eyeballs and rashes and a line of drooling, incontinent patients (and students) with horrible neurological diseases in your heads.

Because I'm not a pediatrician and, therefore, not nice like that.

20

2008-07-09T18:02:00.000-04:00

20 years ago found the above starry-eyed, broke kids standing up in front of their nearest and dearest, dressed in meringue and tails, promising to care for, love and provide really good beer to for the rest of their lives. As neither of them could think of anything they'd rather not do more than stand up in front of a couple hundred people and be the center of attention, the whole damned ceremony, from bridesmaids slow-stepping down the aisle to Pachelbel's Canon in D, (I'd always loved the music and this was at least a year before I'd heard ANYONE else use it in their ceremony.) to the last of the bride's train disappearing out the door at the end, took 5 minutes. 10 minutes tops. For real.

They then went off with those nearest and dearest and ate cake (which they did not smear on each other and the white-white dress and rented tails) and cold cuts (poor, we were) and drank good beer and cheap champagne.

All while making their very best friends dress in the height of wedding fashion of the late '80s: the tea length, off-the-shoulder dusty rose dress and the morning coat, with cravat. Amazingly, some of those friends still speak to us, although not the majority. If anyone wishes to step forward and identify themselves in the pictures, feel free, otherwise, I'll preserve anonymity. (Hi, Stacy!)

There was no dancing (including no Chicken Dance), as Charles detested dancing, and the music was initially classical music, followed by a compilation of U2 at the end, on the cassette player of their boom box. (With some of their wedding loot, they bought the first CD player of their lives and a TV. Marvelous Charles was already starting down that long, slippery slope of home electronics obsession.)

And everyone had their picture taken. A lot.

After that, the two kids, high on champagne, cake and love, went home to stop shaking, open the pile of loot in their skuzzy med school apartment and grin, falling into exhausted sleep. The friends all went to the campus grounds of the happy couple's alma mater, and celebrated more. (The ceremony had been held in the campus chapel and the reception in the law school library.) The friends all got very happy on the leftover champagne and food and some bushes were fertilized with minimally digested cold cuts. We have pictures of that, too, but are holding them in reserve for either a slow blogging day or the reciept of the appropriate blackmail funds.

The next day, the young pair left for a lovely week in Canada (Victoria and Vancouver), where it was very cold and rainy and they bought thick sweaters and their first few CDs for the CD player.

And how'd that all work out?

Swimmingly, thank you. Every morning, Marvelous Charles makes me a latte and asks me how I slept. If he gets up at night (because the dog, she has neeeeeeds, she does), he always shuts the door so the light and noise don't keep me awake. He tells me I'm pretty when I look disgusting. He brings me tea when I'm sick.

In short, much better than that other Charles and Diana. Besides, my Charles is way cuter.

So, happy anniversary to the disgustingly happy couple who still holds hands in public, just to annoy everyone else. We may be revolting, but at least we're revolting together.

Feel free to throw rock-filled rice balls now.

Second Childhood

2008-07-02T08:42:00.005-04:00

It came as something of a surprise last night when I found myself, after work, stopping at the local Shopko and, after a serpeginous route that took me past the sunscreen, bug repellent and little girls' sundresses (sale! $3.99 a piece--to replace the ones that have shrunk in the wash to Hollywood starlet length) standing in front of the baseball mitts, my real reason for stopping.

Me. Baseball mitts. Me. The one who spent her school years dreading the hours spent in PE, where balls were frequently thrown. Balls combined with poor hand-eye coordination, thick glasses and jeering classmates rarely lead to happy, smiling outcomes, except in trite family-oriented movies. Rest assured, there were no game winning saves in my PE history, only years of scheming how to have the fewest times at-bat or at-serve or at-pummelling as possible:

For softball, you make sure you are last in line to bat and, as able, discretely trade places with the athletic kids in line behind you who want to move up in line. It goes without saying that you go waaaaaaaaaay out in left field when it's time to switch sides.
For volleyball, you place yourself at the front of the net in the spot you rotate to AFTER you serve (I think it's front left).
For basketball, you pass the ball as soon as you touch it and never make eye contact with the person with the ball, so they don't throw it at you.
For dodge ball (the worst!), you get yourself hit as soon as possible, sometimes even faking it so you can go to the sidelines and, again, swap places with those who want to get back in, making sure you basically stay toward the middle-end (but not conspicuously at the very end) of the line.

I actually liked soccer, but we rarely played it. This was the '70s, people. Soccer (OK, yes. 'Football' for the civilized world.) was not played by middle-class, red-blooded American children.

So, back to standing in the middle of the baseball mitt aisle. I then proceeded to spend 20 minutes trying on all the sizes and models, finally deciding on that particular glove, above, being suspiciously examined by Mad-Kitty.

My very own first baseball mitt, at the age of 42. After I got home, we all went outside and played catch, liberally covered in bug spray, until Sara got unbearably cranky and Charles got tired. After years of trying unsuccessfully to ignite a passion for soccer in the small ones, we find that baseball seems to be our family's game. It goes without saying that I now love playing it.

Go figure. I still can't throw to save my life and I am at a 2nd grade level when it comes to catching and batting, but I'm having fun! with a ball! and coordinating the hands and eyes!

Never too late to indulge yourself or continue your childhood. I will draw the line at dodge ball, though. Some scars run too deep.

In Which She Inflicts Vacation Photos On All Of You

2008-06-25T08:20:00.004-04:00

So I'm back, sort of. Back in the sense that the bags are unpacked and put away, the wash is done, the house is in its usual state of disarray and the kitty has forgiven us for abandoning her. Actually, she seemed fine with the whole thing and looked rather horrified when we walked in the door all loud and stinky. She wore that look of "Oh. God. I thought you were coming back tomorrow. I thought I had another day to finish that season of My Name Is Earl."

All told, we had 4 days in lovely Door County (that pointy bit of land at the NE end of Wisconsin that sticks in such a fragile way between Green Bay and Lake Michigan) and did little but eat, nap, hang out with each other and go fishin'. (Caught nothin' but a very small bullhead that looked really pissed off, but after all was said and done, was left with a belly full of worm and tales to tell of his abduction to the drowning atmosphere above the lake and the monsters that live there. I'm sure he'll get lots of use of that tale down at the fish pub where they'll buy him pints and await the tale of how he single-fin-edly beat up the 4 enormous aliens and then escaped back to the deeps with their sweet, wriggling food. Good for him.)

We also taught Colin and Sara how to play Monopoly and how he who 1) buys up all the railroads and utilities and 2) doesn't get bored and quit after the first couple of hours tends to win. It's good to pass on such knowledge from one's own childhood to one's offspring.

We did, indeed, go to a fish boil and ladled butter on fish, potatoes and onions. We ate many cherry-inspired products, like pie. And wine. And brought back lots of pancake and scone mixes. And jam and syrup and dried cherries. And wine. I also let Sara learn to take pictures with my camera, and so for the first time in 20 years,I have vacation photos with me in them because someone else was snapping the scenes as well.

And so we all had a short, lovely, restful time, except for poor Molly-dog, who just thought the whole thing was wrong and WHAT the hell were we doing in this little house that smelled funny and had red tartan carpet in the kitchen and hall and WHAT would the kitty do with no one to chase her and give her a good butt licking. She clearly felt that it was all so wrong and couldn't understand why we didn't take her hint of staring hard at the car whenever we passed it, and just get in and go back home where we belonged.

It's always good to mess with your dog.

And so we've been and gone and returned and had our vacation.

The second half of the ag-med conference was as good as the first. I can now talk of ROPS and help you figure out what sort of respirator you need if you are cleaning out a silo, working in a CAFO or spraying your fields. I can also be found hollering from inside my car when driving past the fields and barns in my locale, "Hey! You! What the hell are you doing driving that tricycle tractor with the front end loaded!" and "Hey! You! I see you plowing that field in your cabless tractor without adequate hearing protection, sun screen, wide brimmed hat, respirator mask or ROPS!" In short, I've become even more of an embarrassment to polite society.

Now I must get the contents of the 2" (5cm) syllabus and good-sized textbook into my squash, so I can pass the damn test and make my employer proud to have spent all that money (actually, in the scheme of things, it wasn't that much money as such things go) for me to have done this, which means that I'll still be blogging sporadically for weeks to come. That study time has to come from somewhere.

Charles is winding up his days as principal at his soon-to-be-old district. He drove to work today in the SUV to load up almost all his office-ly possessions and move them to the new digs. He starts next Tuesday, which means we have only one more day of driving in to work together. The end of an era.

And, so, I'll leave you with this year's before and after shots of the front flower beds. You'll notice that the 3 low-lying juniper bushes at the front of the bed have gone the way of Wanda and Muriel, last year's alien-abducted cinquefoil and have been replaced by about 20 pretty-pretty flowering lovelies. (Well, they will be flowering when it's their time to do so.) You'll also notice that I need to get busy and divide all the pretties that have cancer-like grown and taken over the garden, transforming it into something that looks like the Amazon jungle.

Gone Fishin'

2008-06-12T21:52:00.002-04:00

Bags packed?

Check.

Paper towels and plastic bags and fishing gear and more paper towels?

Check.

Molly's food, bowls, bed?

Check.

10 lbs of kitty food left out and all the toilet lids up (because she just won't drink out of anything else and getting everyone to remember to shut the lids in this household so isn't going to happen)?

Checkity, check, check.

Windows shut so we only come back to a wet basement and not a wet 2nd floor, what with all the damn storms stacked one on top of the other from Kansas on, all pointed straight at us for the next few days?

Oh, yeah, baby! Check!

Crackers, coffee, granola bars, other junk?

Are you kidding me? Of course check. That was the first thing I packed.

DVDs for the kids in the car (clearly I was born a generation too late, having to look out the window and play the 'alphabet game' with license plates and signs) and Harry Potter V on CD for Charles and I?

Check.

Destination directions and phone number of the lovely lady renting us a place on the lake in Door County?

Check-a-roo.

See y'all in a bit. Off to spend some time with just us. Then off to the second part of that agriculture in medicine conference.

Camera?

Check.

Kiss, kiss. It's been 7 years since we've done a vacation with just us. I'd say that's long over due. Over and out.

Check.

Bleak, Living Hell

2008-06-06T09:09:00.003-04:00

There's this wan, peacefulness I've seen in the faces of grandly multiparous women. You know the ones--those with more than 5 kids. They seem serene in the face of all sorts of chaos and I'm fairly sure I know why.

They've had enough of their souls removed, a piece at a time from that horror of horrors: the school concert. In particular the Grade School Concert. At least in the secondary years, the 'music' is at least somewhat recognizable and, if you are lucky, there's a tune you know and can therefore count down the stanzas until it's done. Unless it's been butchered by scatting and whatnot by some demonic jazz stylist, and then you'd best just resign yourself to your misery.

I've heard there are some districts, pushed to the brink by budget crunches, that are forced to cut music in the schools. "Hah!" I scoff. It's not that the parents are not willing to pay the taxes, it's that they've wised up and realized that if they vote down referendum after referendum on school funding that they'll NEVER HAVE TO GO TO ANOTHER SCHOOL CONCERT AGAIN. These are fine, intelligent, free-thinking people.

"It's not that bad," you who have yet to experience the horror say. I, too, remember performing in these concerts and looking forward to the singing of "Feelin' Groovy" and "Rainy Days and Mondays", complete with hand gestures and careful swaying in time while standing on the bleachers on the stage, or the playing of "The Theme From M*A*S*H", if you were of an orchestral bent. (This was particularly subliminal as the lyrics, as most of us know, go "Suicide is painless, it brings on many changes, and I can take or leave it as I please." I wonder if the actual suicide rate did bump over the following days among those exposed to such sawed out works. Someone commission a study.)

So as I sat, with Sara at my side (the kindergartners only have to do the winter concert), in the 100+ degree F (38+ degree C) fetid, rancid gymnasium, hunched among the sweaty family members of the rest of the student body (some who spent the entire time in a slack-jawed stupor, others, like the pair behind me, desperately trying to hang on to their shards of reality by dissecting the private lives of various and sundry of their village acquaintances throughout the whole thing in normal speaking voices), I realized that I felt progressively lighter and lighter--the result of bits of my soul being torn away, piece by piece. The largest bite, sadly, was when Colin's grade performed a piece called, I kid you not, "Galactic Swamp Dance" entirely on flutophone (a cheap, plastic recorder sounding rather like a kazoo, but more nasal and grating, if possible). Painful does not begin to cover it. Nails on a blackboard could take a lesson. We had descended to the depths of hell: hot, smelly, humid, hopeless, helpless, interminable. At this point, trapped as Sara and I were, in the middle of the bleachers, having gotten there too late to score one of the folding metal chairs or at least a bottom seat on the bleachers, by the doors and the fire alarm pull, I abandoned myself to my fate and sunk into a funk. "Oh, woe is me" droned on the interminable chorus of one song. Oh, woe, indeed. Trapped like rats.

But then! Lo! Sara pulled free, and summoning her strength (and perhaps with the help of a guardian angel or 4) uttered the words of my salvation, "Mommy! I HAVE to go to the bathroom N.O.W." A small shaft of light pierced my psyche and somewhere the trace of a breeze stirred. The lackluster clapping of my fellow suffers gave me hope and a shifting of time and space indicated a slight path down from the bleachers.

I grabbed Sara's hand and took the shining way, jostling those still trapped in their misery and garnering many baleful and downright angry looks. "Sorry, coming through. She needs the bathroom." While envious, none dared to bar our escape. No one wants to mess with a child in need of the toilet.

And so, we spent the last sets of the most recent Concert from Hell seeking out and then dawdling in one of the grade school bathrooms. And then we caught the Grand Finale, standing just outside one of the gym doorways, where all the little darlin's come in and do the splashy finish-y song, some incomprehensible number called "Save the Earth", complete with cheerleaders (Yes. Really.) and hand gestures and cartwheels.

Actually, just before breaking into this cacophony, some poor kid spewed his gastric contents all over the gym floor, next to the piano, causing an interminable delay as the janitor was frantically sought via loud speaker and faculty runners. He appeared with mop and rolling pail and attended to the sick. Sadly, the rest of the audience was too far gone to break free and flee, and just continued sitting there while this took place, waiting as cows for the slaughter.

But finally, it was over and Sara and I (Where the hell was Charles? Why at school registration. So he said. I'm not entirely sure, though, as he is widely known to have an extra helping of brains and more than his fair share of dislike of such things.) struggled through the halls, with the rest of the lemming parents, in search of our young, who had been kept hostage-like from us. (The only announcement at the start of all this was that we WERE to REMAIN seated until ALL the children were done performing. NO ONE would be allowed to collect their children before the concert was over. Sneaky bastards.)

It wasn't quite as bad as this, but close. At least last night's concert had a program that could be followed, so you could count down the years until your sentence was served.

And so, here I sit, several ounces lighter, thanks to the soul-ectomy, plotting ways to organize my fellow parents into a "We'll pass any tax that'll fund schools as long as music remains firmly separated from us." Sort of like church and state. Complete separation or else no tax dollars.

I see why people home school. It's starting to sound worth it.

In Which She Reports In And Goes Overboard With The Links

2008-05-28T21:28:00.001-04:00

For most of us medico types, there is a love-hate relationship with zee conference. On the one butt cheek, there is the familiarity of sitting and have someone drone on and on about some esoteric disease topic. It's how we were raised, so to speak. Sort of like returning to the womb.

But on the other butt cheek, after the first several hours or after the first day if it is a very good conference, you realize why you were so very eager to get away from learning by lecture and so gleefully dived into trial by fire.

So, it was with a combination of up front eagerness and yet lurking tedium that I hopped in the car early Wednesday morning and headed south to the First Annual Agricultural Occupational Health Training Conference.

It's always good to go with a buddy to sit in the back with, eat meals with and make snide remarks to. I was fortunate to have at my side, C, one of the two nurse practitioners in the occupational med clinic that I am to lead at some point in the hopefully far-distant future. In addition to being a fun person to hang with (and a damn good practitioner), C had lived in Springfield, IL, where the conference was held and theoretically could co-pilot me through the roads with the help of the set of Internet directions, which feel that having the correct information 95% of the time will get you an "A".

We respectfully disagree and point out that substituting a "left" for a "right" will, in fact, lead one way the hell off in the wrong direction and get one rather hopelessly lost.

But, we made it, thanks to leaving extra-early, along with the other 30-40 of us, to the small building that is the administrative offices and classroom space of the School of Nursing for Southern Illinois University. As an added bonus, they served lunch before hand! As a special added bonus, the lunch was not only edible but really quite good, with brownies (very small but tasty) at the end. Charles and I often shake our heads over the difference between the fare of the education conference and the medical conference. I definitely chose the right field.

I settled in for the duration of the afternoon, prepared to enjoy the first 15 minutes of the novelty of sitting and having someone blither at me rather than being the one to blither for a change. And, damn, if the whole afternoon had me with my attention riveted to the speakers. I mean, really, hardly a daydream of wandering the shops or taking a nap. Unheard of. I mean honest-to-God, chin in hand, elbow on the table, eyes blinking less than usual, attention riveted on the speaker for the whole 2 +1/2 days. And the stuff I learned: The various risks of old vs new tractors (here's a hint--a covered cab WITH a roll-bar is a handy thing if you are fool enough to operate such a machine. Also--mowing the ditch with your beast of a tractor? Bad idea. They tend to roll over when used at a 45 degree angle (duh) and the odds of surviving a tractor rolling over on you? 25%. And your health benefits as a farmer? Oh, let's all laugh at your $10,000 deductible unless you're lucky enough to have a spouse with an outside job with insurance. ) And silos? "Silo" is the Russian word for "Certain Death Should You Venture Inside What With The Silo Gas And The Sucking Down Into The Grain Where Death Awaits You In Less Than 2 Minutes Plus Your Rotting Buried Corpse Won't Make The Grain More Nutritious For The Cattle And Will Be A Burden On Your Family So Don't Be A Stupid Git And Stay The Hell Out Of The Damn Thing". We won't mention the multiple deaths as a result in unsafe exposure to the manure pits under the CAFOs (Confined Animal Feeding Operations) where the hydrogen sulfide gas waits for you to succumb in 4 (yes 4) seconds and then pick off your buddies as they try one by one to rescue you. Bad that. No matter how you feel about such factory farming practices, I think we can all agree that it's best that the humans don't die, yes?

Oh, and the amputations and mutilations! 3 solid hours on this topic the second day, spanning lunch, with picture after picture, enlarged on the projection screen, of the most horrendous injuries and what to do. Oh, and the auger accidents. Seemed that 2 out of every 3 horrific injuries was due to the various damn augers catching a piece of clothing and pulling the human into the enormous machine. The lucky only lost body parts (which are sometimes re-attached, if not too mangled and are able to be retrieved and brought in with the rest of their owners within 4-6 hours). My favorite was the guy who lost 1/2 his hand (the distal 1/2 with all the fingers) that they fashioned a working limb with his two 2nd toes as transplanted digits that worked as a sort of a pincers so he could grip a bit with them.

I've the pictures in the syllabus. I've all the pictures in the syllabus. You know, just in case I need help with dieting some day.

And the Anabaptists? (The religious groups including the Amish, the Mennonites and the Brethren) Seems that while they don't have the tractor and auger injuries (as they don't have tractors and mechanized augers), they've got plenty of problems, what with being kicked and trammeled by the livestock they use in place of the wicked machinery, and, yes, the damn silos, and their natural distrust of modern anything. So that's what's up with the Anabaptists. Nice folk but leery.

And then! After the first 1/2 day, (which started out with us all going around the room and introducing ourselves, the horror!) we then all re-convened at a rather good bed-and-breakfast for no-bed-and-dinner and cocktails and appetizers and conversation and damn if we didn't come together and become friendly and start to chat together as acquaintances and not just isolated, anonymous strangers at a conference. C and I fell in with a nurse from Missouri and a Veterinarian from Illinois and ended up having dinner and walking around the town the next night together as well as walking the mile to the conference together the next morning, all gabbing like old friends.

They even had us all sign the official First Poster of the Red Barn AND had us all assemble for a group photo. As C said, "I think they'll be having us back for a 10 year reunion." It felt like that.

And it was good.

And it was so very interesting.

And we get to go to Part 2 in a few weeks.

And we can't bloody wait.

And why can't all the conferences be like this?

Sabatical

2008-05-20T19:59:00.002-04:00

I know, I know. I suck as a blogger. I've been AWOL from visitin' and commentin' and all that. The digging and planting and weeding is nearly done. Well, sort of. Over half done. For now.

But! I'm off again for more conferencing and learning bold new things. Things like the human hazards of pesticides and herbicides and what to do if a farm worker inadvertently spreads some on a sandwich. And farm animal-to-human illness. And special farming community issues like what's up with Anabaptists. (I had to google 'Anabaptists'. Didn't know there were special farming issues with them. Still don't. Guess that's why I'm going to the conference.) And it's to be in glamorous downtown Springfield, IL!

A step up from Lisle, IL, I'm sure.

So, anyway, I'll be back around as soon as I can, probably this weekend, and I'll read every single word that you've all written, and leave finger-up-my-nose comments; but for now, I'm off for 2 nights and 3 days of fun and farm frivolity that is the agricultural medical conference!

Come on, admit it: You do wish you were me.

Can't Talk, Digging

2008-05-16T21:23:00.003-04:00

Sometime during the past several days of aerobic gardening, something decided to siphon some of my blood, leaving a large, red, itchy welt right over my external jugular.

I sincerely hope he has a large case of indigestion.

Damn.

Doin's

2008-05-06T20:34:00.000-04:00

There's this back bathroom in our clinic, away down the end of the long physical therapy/chiropractor hall and around the corner past the tiny excuse of a break room. The advantage of that back bathroom is two-fold: First, it's away from a passing hallway, being at the bendy-end of the passageway, next to the emergency exit door (to be kept locked at all times on pain of hairy-eyeball of our practice director). It's a good place to go for some 'private time' with one's bowels, should the office coffee be a bit too much. It's also something of a game of Russian roulette with the toilet seat, as there's someone in the clinic who likes to anoint it and not dry it off. If you've a brain in your head, you check the seat every time before you place your cheeks upon it. If you've left your brain elsewhere as you nipped down the hall for a quick deposit, then approximately once a month you find your buttocks all wet and saddened as you've once again fallen prey to the scourge of toilet seats. (Fool me once, shame on you; fool me 43,892 times and counting, shame on me.) Actually, I don't think it's urine, I think it's water. God knows why someone would repetitively cover the seat with water and not wipe it off. I know who I suspect but it's not something you can just go up to someone about (especially this Someone) and demand that if they're going to wash the seat that they have the common decency to dry the damned thing off afterward (and while we're on it, why the hell are you washing the toilet seat?????).

Anyway, it's a small price to pay for privacy.

But the second reason to use the far-back bathroom is that a few times a year, there's a show. The bathroom abuts the outside wall of the clinic and about every 3 months during the non-frozen season, these tinytiny ants use the bathroom as their landfill.

It's fascinating.

I was thrilled to find that his week marked their spring return. Usually, their public works are partially hidden by the wastepaper basket in the corner, but this time it's been moved to the space between the sink and the toilet, so you can sit and watch the tinytiny ants tote them barges and lift them bales. Today, they were expelling grains of dirt, each the size of 1/2 their heads (the ants, themselves are about 2 mm long) and and! trying to get these two round white things (?? small donut sprinkles?? Who would eat a donut while using the crapper??) twice the size of their heads out of the bathroom and through the tinytiny crack between the vinyl baseboard and the floor and, presumably to their kitchen so they could dine upon them for dinner (it was past breakfast and lunch). 2-3 ants at a time would try over and over to get the sprinkle-balls through the crack, only to get stymied at the end and have the sprinkle balls shoot out of their grasp and pop back into the bathroom, flying about an inch (a whopping 25mm, such a vast ant-distance, just think) each time.

I have no idea what happened in the end, whether they finally found a wide enough crack or if 1 of the 3 workers said, "Fuck the rest of them, we've been doing all the work and we deserve a little tiny-sprinkle snack right here. Bob, Tina, grab a sprinkle and dig in." In any case, by the end of this afternoon, the ants and the tiny, white sprinkles were no where to be seen. Just small piles of tinytiny dirt grains at each break in the baseboard vinyl.

For some reason, they made me think of the manufacturing plant some of us went out to visit last week. 'Twere clean and well run as a factory goes but I was struck by the mind rotting tedium and the workers who didn't seem to mind their minds being rotted by the tedium. The plant pays well for standing and running a machine 8-12 hours a shift, 5-7 days a week (overtime pays well and most work at least 6 days a week). It was loud in many areas (ear plugs required), so no chatting possible. Many of the machines were fed every 10 minutes to every hour or so, and the rest of the time was spent staring and standing, perhaps tending another machine in the interim. The worst of the jobs (as seemed to me) were the 2 women chasing each other in a 6' (2m) circle as they moved small pieces of metal from station to station, washing and oiling and assembling the small parts for tractors and other heavy machines. Loud, dull, smelling of oil and metal. The lives of the ants seemed more full of interest. And these factory jobs, being both well paying and not requiring an education past high school, are in this town highly sought after and diminishing in number. I don't know what's worse: Having one of these jobs or wanting to have one of these jobs and losing it.

I am so lucky to love what I do and to find it endlessly fascinating.

Anyway, sadly, someone (the cleaning service?) will eventually notice Bob, Tina, Lou and the rest of the ant crew and spray neurotoxins and clean away the tiny grains of debris and all will be back to dull toileting, but until then, I'm only using that loo, wet butt be damned. There's worse jobs than being an ant.

Call of the Sirens (Part VI)

2008-04-30T20:11:00.000-04:00

When last we left things, our heroine was poised to leap into her 3 month internal medicine rotation, in the dead of winter, having just come from the soul-leeching misery of ob/gyn. Her defenses, while never robust, were at an all-time low. As you all know, she did, indeed, end up bubbling in "Internal Medicine" on her computer Scan-tron sheet when it came to ranking residency programs and so it can be reasonably anticipated that this will be one excruciatingly long post, even for the wordy one. If you've anything better to do, feel free to use the down arrow to the right. She'll never know and you'll free up at least 30 minutes of your life that you'll otherwise never get back again.

(Oh, and if curious, here's a view of OHSU today. The skybridge to the right of center connects part of University Hospital to the blue Veteran's Hospital.)

----------
So, internal medicine it was to be. I don't think my stomach stopped churning the whole of the three months. The first half was spent, again, over at the University Hospital, this time on the cardiology service, which meant that we not only did regular general medical admissions, but also covered the Cardiac Care Unit and had double attending rounds.

Let's take a minute and discuss 'rounds'. Rounds are to medicine as dough is to bakers. There are endless varieties of rounds, some of which are truly endless. You start your day, if an underling, doing pre-rounds, usually about 6-7 am (5-6 am if on a surgical service). That's where you fly around to all the patients on your inpatient service and make sure they're all alive and nothing horrible, like a cardiac arrest or a transfer to the Intensive Care Unit happened over night, if you were not on call (and therefore theoretically left the hospital for a few hours to sleep and perhaps see something of a loved one or two). If you were on call, presumably you'd know all this and therefore would pre-round on those patients who were unstable or newly admitted over night to make sure they'd live a few hours more.

Then you'd go off to Morning Report. Here, one of the medical teams, usually the team that was going on call that day, would present a case that would then be discussed in depth, dissected, critiqued, and any blame assigned. Stressful, in a word. The presenting intern/resident/student was to be an expert on the patient and the condition being presented. All medical house staff, including the chief residents, and students assigned to the medical services were expected to be there, and it was usually attended by several of the attending physicians, including the Chief of Medicine. Many, many white coats packed into a small room.

After Morning Report, came work rounds, where you stomped around the wards and did the actual work for an hour or two. Work such as examining your patients, garnering lab and radiology reports, calling in consultants, writing chart notes, speaking to families, doing procedures, dictating admission, procedure or discharge notes, etc. New admissions from the night before, if transferred to your service because they were recently discharged by your service and re-admitted with a similar problem, like congestive heart failure exacerbation ('bounce backs'), were re-evaluated by the receiving team, patients discharged (hopefully to remain out of the hospital for the magic 2 weeks, so they were no longer under the 'bounce back umbrella'), and new admissions that came in during the morning to the day admission team were worked up. All this in just a couple of hours.

Later in the morning, or sometimes in the afternoon, were Attending Rounds. Each medical service (usually consisting of 1 resident, 2 interns and 2 students) had an attending physician, who was ultimately responsible for all the patients on the teaching service. During attending rounds, each patient was discussed and the plans were laid. All new patients were presented in depth, usually by the med student or the intern assigned to the case, and lots of pimping was done. Pimping is the time-honored tradition in which a senior medico asks questions designed to teach, instruct or downright humiliate the junior medicos, usually done in a group for maximum degradation. ("So! Dr Piffle! Give me the 5 mechanisms by which serum calcium may be elevated in multiple myeloma." "Ummmmm...Errrrrrrrrr...") Attending rounds were often done at the bedside and were particularly painful after the 24th hour of sleeplessness. (That's what you're seeing on a medical TV show when the whole damn team troops to the patient's bedside and one junior team member starts talking about the poor sick soul in front of them: "Mrs Muskox is a 67 year-old woman with a history of ovarian cancer who presented to the ER last night with a 6 week history of heavy vaginal bleeding and shortness of breath.") Often they go on for a couple of hours, minimum, except neurology attending rounds which usually went for 4-5 hours or surgical attending rounds, which were often less than 5 minutes, if they took place at all. If your feet are lucky, the attending is happy to conduct most of the rounds in the team office, in chairs. If not, you will rue wearing anything but the cushiest of shoes, and even they will be of little comfort after the second hour.

If you had time and there were no really-really sick people to attend to, you'd get to go to Noon Conference, with your actual non-cookie lunch, where someone would stand up (and not eat their own lunch) and yammer on for an hour about the renal tubular acidoses (Yes, I chose to talk for an hour on that very subject, once. Never again.) or the various treatments for esophageal varices or what-have-you. Usually, you'd sit there blissfully slack-jawed and zone out, letting the knowin' wash over and beyond you. If Noon Conference were presented by an attending known for pimping, you'd sometimes opt for plan B, which was to grab some lunch in the cafeteria and keep on working, because who the hell needs the stress of being pimped while eating? Often, however, if your team was on call, you'd have no choice but plan C, which was plan B without the lunch, unless you still had your cookie in your pocket, and then you hoped that you were eating your cookie lunch and not your cookie dinner, because breakfast was a long way in the uncertain future and the cafeteria closed by 7 pm. If you weren't on call, you'd go home sometime in the evening, prep for the next day by reading from your 20 lb (10 kg) tome of internal medicine, doing your many-page write-up, and memorizing every last thing you could for the next day's presentation during attending rounds in the vain attempt to look less shtoopid.

Typically, there were 4 medicine teams and so call rotated every 4th night, so in a typical 4 day rotation, you'd be in the hospital 60 hours out of every 84. Generally, as a student you'd get 3 days off a month and as an intern or resident, it'd be 1-2 days off a month. If your team were on call, then you didn't leave the hospital until the next evening, about 36 hours after entering the hospital. Depending on the dress policy of the hospital you were working in, at some point you'd change into scrubs, the better to slop around and be slopped on, and give yourself over to 'the zen of call', trying to just flow with it. Usually this would be short lived as you started to fold under an avalanche of admissions. It wasn't so bad as a student, as you'd usually concentrate on just one or two patients and tag along with the rest for the ride. As you didn't know as much as as, well, anyone else, including the housekeepers and the guy who filled the vending machines, you had to do a lot of looking things up in textbooks and journals (this was just before the internet was coming into use).

It is at this point that we must point out that our heroine was a less-than-impressive medical student. Filled to the brim with compassion and an interest in the subject of sick folk, she was a mousy, timid, oh-so-unimpressive lump of a thing. Presenting a case left me wanting a toilet in which to empty my gastric and colonic contents. As a result, one of the cardiology attendings I was under at the University Hospital (admittedly rather a jerk) told me at the end of his stint with me that I'd never make a good physician and I should just cut my losses and quit med school. I was mortified and crushed. And then I was pissed. What an asshole. To this day, seeing the combination of a man with slicked-back hair wearing a cashmere turtleneck with a camel hair blazer is enough to make me want to run over and hurl both insults and eggs at him.

And so ended that month and a half at The U, and it was time to change venues to the Veteran's Hospital, across the way. At that point the building was all shiny clean and new, having opened only a year or so prior. It was still a vast government bureaucracy, though, with everything done in triplicate and 4 patients per room. The nurses ruled the roost and if a task was not something specifically in their job description, the request was met with an icy stare and maybe a smirk. But! It was filled with the most spectacular patients ever. There were a few ancient WWI vets, all in their 90s. Many, many WWII and Korean War (oops, make that Korean Conflict as we apparently don't consider that a war) vets with a mind boggling array of illnesses, most having at least 5-6 severe problems all together, like coronary disease with emphysema and kidney failure, a history of cancer(s) (usually lung, colon, and/or prostate) with a frosting of pneumonia or endocarditis or decompensated cirrhosis of the liver or all of the above. The youngish (this was almost 20 years ago, remember) Vietnam vets were mostly tragic, though, as they often were AIDS patients in the early years of the disease and there wasn't much we could do for them but treat the opportunistic infections and try to stave off the inevitable. Many of them were very angry, bitter men; a combination of ill usage from the war and the disease. All but the Vietnam vets were more than willing to let a 10-thumbed med student do any procedure on them or to spend 4 hours taking a detailed history and physical. "You need to do a 5 vessel cardiac bypass on someone and want to do it on me? Sure, kiddo. You just go ahead. Like my tattoos?" Again, there's a reason they are known as the Greatest Generation.

Given all this, most med students acknowledged that the internal medicine rotation was the worst, the hardest, the most soul-destroying part of the clinical years and I'd agree. The VA was the worst of it as there was little in the way of ancillary services, most everyone was cranky, the patients were very complicated and the stress and hours were brutal. Even the coffee in the cafeteria was truly undrinkable, even post-call. The worst of the attendings was at the VA, Dr M, who was notorious for handing out poor grades and dreadful evaluations to even the best students. He would require these 20 page write-ups on each patient a med student evaluated and didn't allow you even a 3x5 card from which to present the patient. As an unbaked student, memorizing all the details of a complex vet with 20 medications, 20 prior surgeries, 20 abnormal labs and 20 items on his allergy list, not to mention the complex discussion Dr M expected at the end of the case was a nearly impossible task. Frequently smiling and seemingly pleasant on the exterior, he was Pure Evil in a chocolate brown corduroy jacket and a mustache. I remember a toupee but I may have embellished. Fortunately, I was not assigned to his service, which means Somebody wanted me to actually become an internist. Had I been under him, I'd almost certainly have quit.

Actually, I almost did quit one bleak January morning. Tears streaming down my face, I sat on the edge of the bed and told Charles that instead of walking down to the VA, I was walking over to the registrar's office as soon as it opened and withdraw. Marvelous Charles somehow managed to get me to try one more day and it wasn't as bad (probably because I stopped caring whether I did well or poorly) and then it wasn't that bad and then it was even a bit good.

So, Dr M wasn't my VA attending but Dr McD, the then Chief of (the Whole Damn) Medicine (Department) was. He was, as I recall, the President-elect of the American College of Physicians (a Really Big Deal) and one of the best teachers I've had the honor of learning from. He absolutely adored teaching and internal medicine and was incredibly patient and empathetic to the insecure. I still had the shakes, sweats and stammers when faced with a presentation or a good pimping, but he was able to guide me through it all and in the end told me that I had what it took and gave me a very good grade and recommendation. I could have named all my future progeny "Walter" in his honor.

I can honestly say that, while he wasn't the only reason I became an internist, he was the reason I held it as a shining thing to be. Years later, at the banquet at the end of my internal medicine residency, I was awarded Resident of the Year and Dr McD was in attendance. I got to gush out a mushy "Thank You" to him in front of many and tell him that he was the most instrumental out of all my scads and scads of phenomenal mentors. He blushed and I felt just plain good. Sometimes life does work out as you'd like and you do get the chance to really thank someone who meant the world to you. If you are presented with such an opportunity, seize it and make a sloppy fool of yourself and them. You'll not be sorry.

I ended the rotation still enrolled and accruing Big Debt, but with confidence that Internal Medicine was my calling and even considering doing my residency at OHSU.

Newsy

2008-04-24T19:36:00.004-04:00

After 4 years of living in this house, I've finally learned how to get the upper windows to swing over so I can clean them. With this knowledge, I then spent 30 minutes cleaning one window. I'm guessing 4 years between window cleanings is probably too long. Actually, it was probably longer than that as the previous owners were house cleaners on the same level as I am, so make that 8 years.

So, to celebrate, I've decided to admire the lone clean window and, as an added bonus to seeing how nice and, well, transparent it is, I've decided that to reallyreally get the full shiny effect, I should not clean it's brethren until after tomorrow morning, when the morning sun has really shone upon the glass.

So, that's one down, 19 to go, meaning another 9+1/2 hours, give or take.

So nice to have settled that.

It's finally spring, here and all the green things are green and all the bulb things are blooming and all the other things are doing what ever else they do.

And for final proof of spring, yesterday, I saw the year's first patient presenting for 'removal of retained tick parts'. Her husband had only been successful with decapitating the embedded tick in her shoulder and his attempts at blunt dissection with bathroom implements did not have the outcome they hoped for. But she's better and I got to excise and suture, so win-win, yes?

Of course that was preceded by the tick that dropped of my mother-in-law while she was reading on Tuesday and followed the tick I found under the computer desk yesterday. For an encore, I encountered one in my hair, getting ready to mine for red gold this afternoon, so I'm feeling a bit less sanguine, but I'll still take the spring.

It's been such a long damn winter this year. Record snowfalls and all that, and while I firmly avow that colds, flu and gastroenteridities are all caused by various viruses, I can't help but notice that Sara's missed more days the past few months of school than she's attended and yesterday was the first time in 2 weeks that I've been what I consider well. Not symptom free, but not ill, if you get my meaning.

So I feel a little symbolic (and actual) house cleaning is in order.

I also got those scary morning glories planted out by the front porch. Hopefully, they will scramble up and drape themselves picturesquely over the railing. Realistically, they will scamper up and strangle the lilies, monarda and butterfly bush and I won't be able to stop it as I'll be prostrate inside on a couch in the air conditioning wilted from the heat and humidity come July. Actually, I'm fine with summer, I'm just bone lazy, but it makes a better tale to say that I'm swooning like an Edith Wharton character.

What else, what else?

Oh! We should now take time to pat Marvelous Charles vigorously on the back. He's gone and landed himself a position as Superintendent of Schools. "Schools" as there are, indeed, two schools in the district, but we are very excited. It's tiny (the whole district has fewer students than his current school) and they have no textbooks. Well, that's not precisely true. Apparently they do have a social studies book written in the early '90s, and lord knows the world hasn't changed in the last 15 years. So we'll be adding Friday night sports events come the fall and he'll attend all sorts of school board meetings and have new tales to tell. That'll be the end of riding to and from work together, but it really is time for him to do this. It's also about 15 minutes closer than his current district and in the more stable state of Wisconsin.

He's also taking his comprehensive exams for his doctoral program tomorrow, so that's one more hurdle he'll have jumped. He's got, we think, 3 more classes to take and then he launches into all the ballyhoo surrounding the proposing, writing and defending of The Dissertation and so, with luck and a few bribes, he should be a newly minted 'doctah' in 2 years, give or take. Then we can mess with callers who ring asking for 'Dr Piffle'.

So, if you happen to have time on your hands Friday between the hours of 8:15 am and, say, 5:00 pm CDT, and you feel like sending a good thought his way as he hunkers in the basement of some cement walled ed. building on the U of W Madison campus, feel free to send them his way.

Me? I'll be taking the day cleaning another window, musing on the nature of spring and wondering if there's a service you can call to come and vacuum your property to remove all those blood-sucking parasites that make living in the country not quite so nice as it would otherwise be.

Haikus For Sneaky Girls

2008-04-13T13:51:00.003-04:00

Sara's sick again.
Again; third time in a month,
nineteenth time this year.

(OK, maybe I
exaggerate. A bit. Just
seems like forever.)

And while we hate it
that she feels so bad: achy,
snotty, sniffly, wan.

It's the fevers high
That suck our souls dry, and leave
us ashen with dread.

See, the thing our kids
do well; really, really well
is run HIGH fevers.

105 is par
for their little viral course;
eggs fry on their brains.

Colin set the way
of violently refusing
all good medicine.

He'd vomit as soon
as any flavor or form
of med reached his mouth.

Luckily, by five,
he learned to swallow his pills
and it's been fine since.

Sara can't bear to
be less of a stress to us,
so she vomits, too.

We threaten, cajole
and yell, but still the fevers
rise and terrify.

But this time, it was
different, she took it well
and smiled all the time.

"Finally!", we cried
She realizes that it
makes her feel better.

Ah, what saps we are.
For in the bathroom trash are
all her fever pills.

They don't work so well
if they're not in her system.
Sneakiness and lies.

Tough to punish her,
Flushed and ill, sobbing still, she's
sad at being caught.

But still, it must be
done. No more Samurai Jack
or Open Season.

And, Hey! What's this? A
find! While cleaning out cupboards,
something for next time!!

There is another route,
you see. I found Tylenol
suppositories!

Don't mess with Dr Mom.

High Rent

2008-04-06T15:11:00.001-04:00

'High rent', as Jocelyn called my gardening efforts in the last post, but worth it, I've decided.

These are the grow lights a couple of days ago, 5 days after I stuck the little seeds in the little peat patties and placed them under the magically radiating light sources. (See, I can't be trusted to remember to schlep the little growing things out to the deck in the morning for their dose of light, and back into the house away from the nightly frosts. I also can't be trusted to keep them adequately watered. Plant infanticide is my invariable path: They either wither in the heat and drought or become little plantcicles. So very disappointing, and I'm tired of the guilt.)

As you can see, the morning glory are the first out of the gate. Shall I repeat that they are 5 days past planting?

Here they are 2 days later, yesterday, only 7 days in the peat. Note it's not just the morning glories that are a couple of inches high.

Is anyone else a little scared? No? Just me?

A good friend of mine had a nightmare that morning glories were growing through her bedroom window and strangling her in her sleep.

I think she has a valid basis for this nightmare. And yet, here I am, not only choosing to plant them in our front garden, where they may happily twine up the front porch railing but have easy access to the bedroom windows of our children.

Fortunately, hundreds of Colin's little soldiers are scattered all over the house, keeping guard. You can see the sentries on the pass-through from the kitchen to the dining room (plant nursery, as the number of times I can be bothered to have us eat in the dining room can be numbered on the fingers of a partially amputated hand).

See them?

Better? There are many dozen camouflaged in the dining room carpet, bayonets at the ready for bare feet and malcontent plants.

I feel better.

Plus, I won't need to keep nagging him to pick up his damn soldiers, already, at least until next fall's frost.

Spring Cleaning

2008-03-29T22:55:00.004-04:00

Enough.

Enough of the endless winter ennui.

Enough of feeling sorry for myself for the lack of spring. And the persistance of grime. And mouse turds.

Enough.

Enough of yet another week lost in work and illness. (Yes. The ninth bout of crud for this season. Not approaching that horrible season of '01, where I succumbed to 14 separate bouts of crud between November and June--the first year of same-day-caring and therefore abbreviated, no less, so stop whining.)

Enough.

So, I arose with some semblance of energy and a bee in my butt. Well, a bee after a morning loafing with the small ones on the sofas, eating breakfast and doing nothing of value beyond the eating and getting breakfast for various and sundry beings. And that after sleeping in to the slothful hour of 7:04 AM CDT. ("Boy, mom sure sleeps late on weekends, doesn't she, Dad? Yes, son, she sure does, but some people like to sleep in a bit on the weekends.")

Enough.

Well, enough after lunch and a rest. And the getting of lunch for the various and sundry. And the starting of seeds in small pots of peat under newly purchased grow lights. $100 spent to save $40 in new plants. If they live. But if one is going to claim to be a gardener, at some point one really does need to commit to growing more than sunflowers from seed. (And let's face it, the sunflowers have had less than a 50% success rate. More like 5%. Sunflowers. The things that grow where birds poop them.)

Enough. 1:30 pm and out you go. To the garage where you need to expell the garage floor of winter gravel and sand and dust on the floor of cement. And mouse doodies. Let's not forget the pounds of mouse doodies. Apparently the few field mice that did manage to get into the garage this winter found it to be the land of milk and honey and bags of garbage of partially eaten foodstuffs. And it was good. And cathartic. And they did eat much of it. And now, that they are no more with us (may their little beady-eyed souls rest in peace in the great garbage-filled garage in the sky), it is time to rid the garage of their evidence, the small black ovals blanketing the garage. (Let's try not to remember the symptoms of Hantavirus, shall we? Or the Hantavirus deaths.)

A full hour spent sweeping the detritus of the winter from the garage. And now to the garden. The first day of gardening. The first day of cleaning out two of the three parts of the front flower beds, each finally with noses of the bulbs of daffodils and tulips and the first flowers of the bravest of crocuses up, finally exposed to the sun, previously hidden by the rotting, frozen plant matter of last fall's fallen, now removed. New. Green. Forgotten. Remembered.

Oh, but wait.

I forgot the visitor.

Standing 100 meters (100 yards for those of us who still cling to the outmoded) from where I paced, sweeping, was the large, antler-free quadroped, gleaning the freshly plowed cornfield across the road and looking like chiseled Adonis. Molly-dog and I surreptitiously watched him from across the road for 10 minutes as he studiously ignored us, looking buff but aware of our admiration. And then the spell was broken.

Charles, sleepy from his afternoon nap (naps are important if you start your day at 5 am on the weekend for no better reason than habit), stepped out to investigate the dual sighting of a llama in the cornfield across the road.

("Dad! Dad! Wake up! There's a LLAMA across the road! Really! You've got to come and see!)

We decide that our children may not be as countrified as we thought, if they can't tell the difference between a llama and a deer at a distance of 100 m. (The 'llama' having bounded away in a distinctly un-llama-like fashion, flashing his white tale.)

Or maybe it's not that they aren't yet countrified, but it's in their genes to see llamas.

Happy springish.