Spring!

January and February, as they always do, had me in a funk this year. The only good thing about it was the snow, and even that wasn't all happy, because once I had the taste of a real, honest-to-goodness snow day (last one ever, I'm sure!), I just became more and more bitter at ever having to go to work at all, snow or not. Give me an inch, I'll demand a mile, and all that.

March, on the other hand, has been a whirlwind of work. I'm working very long and very hard hours this month, including a 20-day-in-a-row stretch, the only "days off" being two, one at the end of each of the last two weeks, because I was post-call. And "day off" is a misnomer, because while it counts toward compliance with the 80-hour work week, no one could honestly call it a full day off because it only lasts 20 hours, and I have to catch up on sleep since the night before, while on call, I got anywhere from 0-60 minutes of sleep, total. So, 20 days in a row, with 20 hours off on day 6 and 14. Today, however, was day 16, so the end is in sight!

And what an end it's going to be. After this crazy stretch, I get one. entire. week. off! To do nothing with! And hopefully the weather will warm up again.

Even though my day-to-day life sucks right now -- I come home, eat either on the couch or out somewhere, watch TV, and fall asleep on the couch until Eric drags me to bed -- my work life isn't that bad, despite the grueling hours. I'm getting to be a better surgeon, and my C-section time is decreasing, while my skills with a scalpel and needle are getting to be pretty impressive. It's been [relatively] quiet on Labor and Delivery this week, so I'm getting to do some reading at work. And I've had some good vaginal deliveries, including a patient who took my picture -- holding the new baby -- after I delivered her.

Still, I can't help but wish I had the time to sit at home all day and cook, start my seedlings, and read magazines. It's probably time to start playing the lottery.

But in other good news, we bought plane tickets to Brussels! We'll be in Europe at the end of May, and I'm quite excited.

Less depressing stuff

Last week we had a patient who came into the ER with chest pain. 33 years old, otherwise previously healthy, though with a significant family history of cardiac disease. Chest pain, and in the ER, he went into V-fib, and was shocked back. It doesn't happen all that often, but what made it even more exciting was that because he had no other comorbidities, he was a candidate for our hypothermia protocol. I had never heard of it before, but lo and behold, a day after we dropped his body temperature to 33 degrees Celsius, I saw this article on CNN.com: Cooling is catching on for cardiac arrest patients. (No, I do not generally get my medical news from CNN; however, I was post-call and just doing some fluff reading on the Internet.)

Our patient did great! He was cooled for 24 hours, then rewarmed slowly. He slowly came to and did well neurologically, and we transferred him from the ICU out to a regular floor bed later that day. The other night I was walking through the floor units and saw him -- sitting in a chair outside his room reading a book. Totally normal. He's definitely shaken by what happened -- imagine waking up in a hospital having no idea why you were there, and being told that not only did you die for a minute, but that your body was then frozen (OK, not really frozen Austin Powers style, but you know...) and rewarmed. Crazy! He'll do fine physically, but I hope he follows through with his emotional/psychological counselling, because boy, will he need it. In any case, I thought you'd enjoy a slightly more happy story from the ICU.

And here's a Can You Believe It story: I have an 87-year-old woman who is on a ventilator because she developed respiratory distress the other night. She's a sick woman, and when it came time to think about intubating her, we needed consent from someone, and since she was unable to give consent due to her respiratory distress, we called her son, who consented over the phone, saying she would want to be intubated. So she was intubated. The next morning, another son contacted us and said he was her healthcare power of attorney and she did NOT want to be intubated. Uh oh! The first son, when approached with that information, maintained that there was a newer document in which HE was named power of attorney, and she DID want to be intubated. And when we told him to go home and get the papers, he came back and said he couldn't find them. Hmmmm. And of course, it turns out the two brothers don't talk to each other. So we scheduled a family meeting and waited. And in the meantime, one of the nurses found out the scoop: The first brother, the one who initially consented to the intubation, is apparently $1.5 MILLION in the hole from gambling debts. And he continues to gamble. He has multiple sclerosis and lives with his mother, and he uses her social security money to continue to gamble! So of COURSE he wants to keep her alive and on the ventilator -- he wants her money! Juicy, juicy.

In the end, papers were found at the lawyer's office, in which the patient had checked off that she did want to be resuscitated and did want to be intubated, so we will continue to treat her. But I can't look at the son the same way anymore. The gall!

And finally, I walked home today via the Italian Market and stopped to pick up a couple lemons and some bread. Dinner plans tonight are for chicken scallopini and bruschetta (home grown tomatoes ripened yesterday!). Sarcone's was sold out as usual (they sell out first thing every morning!), so I walked down to Talluto's, where I've also gotten bread before, about 10 minutes before they closed. Alas, the bread bin was empty, but the woman behind the counter said there was some at the register. I peered into the large brown bag full of rolls and as I asked for a couple short rolls, the woman shoved the whole paper bag into a plastic grocery bag and pushed it toward me. "Oh," I said, a little confused. "How much for the whole bag?" "Have a good day," she replied. And when I looked even more confused, she explained, "We don't sell day-old bread so we won't sell them tomorrow, so you can have them." Wow! What luck! Yay for the Italian Market.

Oh, hello

It's hard to pick back up when you haven't blogged in so long. I want to do a huge recap and tell all the crazy stories from the last two months -- TWO MONTHS! -- but that would be a novel in itself. And I have very little free time these days. So maybe it's better to just start back as though I never left. Even though that would be weird, too. So here are a few references to some of the things I would tell you about if I had all the time in the world, and maybe someday I'll come back and tell you about them for real.

• My graduation speech was awesome, thank you very much. I got the DVD in the mail last week, but haven't watched it yet.
• The two weeks between graduation and the wedding were crazy. Crazy fun, but still crazy.
• The wedding was amazing. I love looking at our pictures. I need to share the Flickr link with everyone.
• The honeymoon was amazing. We need to write it all down before we forget all about it.
• Moving to Philadelphia was not much fun. We were tired -- no, exhausted -- and packed everything up in 36 hours. Then drove 12 hours to Pennsylvania. The moving truck got damaged mysteriously, and of course, we had declined the damage insurance. We just got the estimate this week. It's bad, but we were imagining numbers in the 4 or 5 figures, so it's really not that bad at all, by comparison. I drove through the night, slept at various roadside stops, arrived at my mother-in-law's house at something like 6:30 in the morning, and slept for two hours before we had to wake up to go to our mortgage closing. We pushed through it, said hi to our new house, and went back to Downingtown to sleep all afternoon. We saw Up that evening, and I cried and cried and cried. There were a surprising number of touching moments, and I was just so emotionally drained that the tears kept flowing. "This is what residency will feel like," I thought.
• And now I'm a doctor! My white coat is ridiculously too big and I haven't had a chance to get it tailored. I took care of a former Eagle for a week, and I told him he needed to finish college. I've felt maybe 3 cervices, and have had no idea how dilated any of them were. I'm an expert in hypertension and diabetes -- which will be useful in OB/Gyn, no doubt -- but I know even less OB/Gyn than I did as a med student, because I'm spending my first two months on medicine/ICU. I've had three overnight calls so far, and a "good night" consists of an hour of uninterrupted sleep. I have not had to do CPR on a real person yet, and I have not delivered any babies. I haven't cried at work once (there was one almost time), and I haven't come home and cried since the first week. I've had two golden weekends (this is #2) and no black weekends, and I've come very close three separate times this week to discharging all of my patients, which would mean I wouldn't have to come in the next day. Each time, though, the patients foil me at the last minute. Oh well.
• Our house is 85% set up, which means it's very functional. It's not completely put together, though. We have lots of little projects, and some big projects. In some ways, we have less space than we did in Louisville, and in some ways, we have more. The net effect is that we will still need to get rid of some stuff, so that's happening slowly.

And I think that's it for the updates. If, next week, I all of a sudden tell you a good medical story (I know you like them, after all, and I've got some good ones!), I'll consider it fair, since I've now updated you, and you know I'm an intern in Philadelphia, and no longer a med student in Louisville.

Oh, hello.

You probably thought I had forgotten about you, right? Of course I didn't. Things have just been really... busy. And un-busy.

I spent 4 weeks in NJ, and it was devoted almost 100% to looking for a house in Philadelphia. Of course, looking for a house consists of a few days of looking at a ton of houses (we saw 15+ each day!), and then tons of inactive time looking around the internet at MLS listings, Craigslist listings, and learning about the finances associated with buying a house.

I got really bored and unhappy and mopey on the inactive days. Eric commented that I'm really bad at being unemployed, and it's true.

I've been back in Louisville for two weeks, and the boredom is over. It's been non-stop action for the last 10 days. First there was Senior Week -- a trip along the Bourbon Trail, a trip to a winery, Senior Skits, a Bats game, a class cookout, Doctors Ball (aka Med School Prom), our awards banquet, and finally, graduation itself. As class president, I gave a speech -- in front of probably close to 2,000 people! -- and it went really well.

So I'm a doctor now! Yay! Finally! So far, it doesn't feel any different, other than using it in arguments with my mom: "I KNOW about the potential dangers of lead paint; I'm a doctor!" Haha.

This week has been split between wedding stuff and house stuff. On the house front, we had inspection on Monday, and submitted our request for repairs/price adjustment today. Let's hope the seller does everything we've asked; some of them are non-negotiable on our part, which means we'll walk away if they aren't done. That would suck, since we're moving in less than 3 weeks and need a place to live.

Lots of people have complained that we haven't posted any pictures of the house, but I'm a little bit wary of doing that too soon. I was definitely nervous doing so before the inspection; even now, I'd rather wait until we know the seller has agreed to our terms. And even after that, there's still the final approval of the mortgage to wait for (a friend of ours had problems with that, through no fault of her own; we've been following the saga via her Facebook feed). So you'll get pictures when I know for sure we can call the house ours :)

On the wedding front, I've been buying lots and lots of things, making final calculations to see if our money is going to cover everything we need it to (it's going to be close, but we'll make it!), organizing all the wedding crap we've accumulated as nicely as possible in the office, and cleaning the rest of the apartment. A good pre-wedding workout is to move 10 boxes of wine from your car to your building lobby, then from the lobby down the hall to the elevator, then from the elevator to your apartment at the end of the hall, and then from the door to the office. Repeat with 10 cases of beer, and again with 20 bottles of bar mixers, as well as all the other wedding stuff you've brought home. I'll get toned triceps by the end of the week, no problem!

I may not post again for a while, but at least this time I'm giving you warning.

-Dr. HWong14

Gardens

Every spring for the last four years, I've planted an herb garden inside the apartment. The first year, I was really ambitious and had two large window boxes, but through trial and error and figuring out which herbs I liked to use, I decreased to one window box plus some larger pots. Last year, I had a major planting project, setting out to grow 100 3" pots of Kentucky Colonel mint, for wedding favors. I don't think I ever documented the end of that project, but at its peak I had about 20 individual plants rooted, but then things quickly took a turn for the worse when I had to do my away rotation in Philly last August. Needless to say, our wedding guests are not receiving mint plants.

My must-grows are basil, flat-leaf parsley, and cilantro. I've also grown oregano, thyme, and chives, but the first year I tried it, I didn't thin the seedlings enough, so they never really flourished (I didn't really believe in thinning before that, but now I see the benefit). Mint does not grow well from seed, so I buy it already started -- and actually, the mother KY Col. plant I bought last spring has survived the winter and is sprouting like crazy again. Same with rosemary -- buy it started, and as long as you keep it watered through the dry, hot (indoors) winter, it will survive. Unfortunately, I was traveling so much this December for interviews that mine died. I love to have rosemary for my Thanksgiving turkey, though, so I'll likely buy another small potted one this spring.

Cilantro is a funny plant because it grows really quickly, then quickly goes to seed (the seeds are coriander) and dies. You can harvest the coriander, of course, but what I really want is the cilantro, so if you want a continuous supply, you have to continuously re-plant it, probably every month or so. It definitely takes constant attention.

But basil and flat-leaf parsley are great, grow wonderfully, and pretty much survive as long as you keep it watered. They add such a wonderful fresh taste to all of your dishes, and that's why I love to grow them.

A few weeks ago, I was itching to start my seeds -- I use peat pellets then transfer the seedlings to pots or window boxes -- and then I came to a realization.

I'm driving to New Jersey in two weeks, to spend the month of April on the east coast. It's difficult to bring all those seedlings with me (I did it last year with the mint, and it was a huge pain), and they'll definitely die if I leave them here. Then, while I'll be back home for the month of May, we go on our honeymoon in early June, and then pack up the apartment to move to Philadelphia in mid-June.

So for the entire spring growing season, things are going to be very much in transition, which means it's a smarter idea if I just don't bother with planting this year. That makes me sad.

But the good thing about growing indoors is that you can pretty much start seeds at any time of the year, so there's always a chance that I can start those little seeds in mid-June, after we move.

And if we end up with a place with one of the top things on our "Nice to Have" list -- a deck or patio -- then I can transfer my pots outdoors and probably even give composting a try. Plus, if I had a little more room outdoors, I could do potted vegetables, like tomatoes and peppers. I have to admit, that deck is really high up on my "Nice to Have" list and the only reason it's not a "Must Have" is because I have to be realistic. Let the house hunting begin!

A day late, no dollars short

I got my first choice, Pennsylvania Hospital!

It was really exciting to open the envelope and see those two words. I looked twice, gave a muted shriek, showed it to Eric, and gave him a big hug. Then I may have shrieked again, this time a little louder :)

Today has been a whirlwind of house shopping on Craigslist (Do we have a loan or broker yet? No...) and getting wedding crap done. After collecting and tasting samples from four -- count 'em! FOUR! -- bakeries this afternoon, we've made our final choice. And all evening, we've been going through music playlists from our DJ, various places on the web, and our iTuneses to pick wedding music. Whew! All while massively hungover, I must add, because the celebrating yesterday was hardcore.

Unfortunately, Eric leaves in the morning, and then I'm left to the neverending task of trying to straighten up this apartment, finish the invitations, and get a tiny bit of work done before the tiny bit of motivation I have left disappears in the next week. Because I only have ONE WEEK of school left! Smart me, I took the month of April off, which is among the best decisions I've ever made.

Yay!

Roses and pot pie

Check out what I scored at Kroger on Monday:

Valentine's Day leftovers for 75% off! First I saw the "Valentine's Day"-specific rose bouquets, and was going to buy 3 roses with some filler for $3.25 (originally $12.99), but then I saw, over by the regular flower display area, that ALL the roses were 75% off, so I got these beautiful terracotta-colored ones for $3.75 for a DOZEN, no filler (originally $14.99). Sweet!

They were kind of cruddy looking, but that's where working at a florist in college comes in handy. With some love, some lukewarm water, sharp scissors, and some floralife, they perked up immediately, and bloomed beautifully. The fact that they were already "past their prime" when I brought them home was OK, because they're all maximally open right now, and I'm leaving tomorrow morning for a long weekend, so I was able to enjoy them to their fullest potential.

And then, check out what I made on my (unexpected) day off yesterday:

Chicken pot pie, inspired by this Real Simple recipe:


The only thing that could have made it better (other than a little more salt; I didn't season it enough) would have been a cute casserole dish like the one in the magazine. I need more pretty baking dishes. NEED. On Sunday when I was cleaning out the refrigerator, I salvaged some almost-bad chicken breasts by poaching them in water, then stuck the cooked chicken back in the fridge (I intended to cook this recipe on Monday after I got the pie crusts, but things got put off...). I wasn't able to salvage the already-bad chicken thighs, so those got tossed. I hate wasting money like that.

Here are some action shots for you:
First step: Sauteeing the mirepoix (the celery was my addition, since I had some; but why would you write a recipe with just onions and carrots and not make it the full mirepoix?).


Last step: Eating! It's a store-bought frozen pie crust (the package came with two and I used them both) and I also added frozen peas, as per the recipe. We discussed pot pie today at work and decided potatoes would also be good in it (although I hardly ever buy white potatoes any more; what do you think of sweet potatoes in a pot pie?). If you added bell peppers you'd have a mirepoix AND a trinity!

As I was cooking it, I realized I was making a "lite" version of a regular white sauce, and I was annoyed I hadn't read the instructions a little more closely before starting to figure out what their method was. No butter?! Give me a break. I have to admit, though, that the pot pie was very good, aside from my too-little-salt error, and WAS very rich-tasting. And then I looked back at the recipe and saw the butter omission was on purpose. They meant for it to be a "lite" pot pie. Oh well. At least now I know that I know the method of making a pot pie sauce the right way -- BUTTER and flour, then some wine and stock and milk :)

Now I have a confession: A mere 24 hours later, that entire 9x13 pan of chicken pot pie is gone. I had it for lunch yesterday immediately after it was cooked, as a snack a little while later because it smelled so good and I'm a pig, for dinner last night while watching Lost (OMG, what happened to Aaron?!?), for lunch today, AND for dinner tonight. If I weren't leaving for 5 days tomorrow morning I might have let it last longer, but really, it was THAT GOOD and I didn't at all mind eating it so many meals in a row. I already said I was a pig, so we're covered there.

And with that, I'm off to Snowmass, for one final year of skiing -- I mean, learning how to be a better student leader. My goal: black diamonds without shaking in my boots! And since I'm a lazy fourth-year medical student with growing senioritis, I hope I DO get snowed in on Tuesday morning and have to stay an extra day... or two!

Snow Days

OK, so I was wrong and the weather people were right. We got about three inches Monday night, and another 3+ (I didn't really measure it) last night.

I've never seen snow like this in Louisville:



(It's kind of hard to see, but the falling stuff is real snowflakes, not rain. Video taken from my bedroom window.)

So I was going to drive to work today (when it's this yucky out, I deserve to drive and not walk), but this is what my car looked like, and I couldn't get into it:
The handle is completely frozen shut. I managed to chip the ice off of the lock itself, but I couldn't open the door to save my life. So I walked. I still have to go back out there and try to clean the car off this afternoon. Snow days were so much more fun when I was a kid.

Oh and guess what else was wrong about my last post: I wasn't an amazing medical student who went into the hospital to care for her patient on her day off yesterday. I slept in, and it was as divine as I thought it would be. I felt a little bit guilty upon waking, though, so I had my friend David look up the pathology results for me, and guess what -- they STILL weren't back! Guilt gone. They ended up coming back yesterday afternoon, but that would have been after I would have left, anyway, so no harm done. So I saw him this morning and it turns out that the guy does have cancer (not surprising), and it's probably not good, but he still needs a PET scan to look for mets, which will tell us how bad it is.

His lung cancer is almost 100% due to smoking, based on the kind of cancer it is and his smoking history -- 90 pack-years. Yikes! (A pack-year is the equivalent of smoking 1 pack per day for 1 year. So this guy could have smoked 1 pack/day for 90 years, but he's only 74, or 2 packs/day for 45 years, or 3 packs/day for 30 years, etc. In other words, he's a heavy, heavy smoker.)

So don't smoke, kids. Seriously. He's a really nice man, and his 5-year survival prognosis, depending on what this PET scan shows, is 1-30%. There is a 70-99% chance he will be dead within 5 years. That's really sad. Did I mention how nice he is? I don't like days like this.

To end on a slightly less depressing note, here are some snow day pictures from my commute.

In between the two rounds of snow, we had ice. The trees can't handle it, and all over the city, they're falling over and taking out power lines. I still have my power, thank goodness.


I like the icicles hanging off of the traffic light pole. I was walking in the middle of the street because the sidewalks weren't cleared and there were hardly any cars. Look at all those big, fat snowflakes that are falling!


I like how frozen trees look.


I can't remember what this tree used to look like, that is, whether it's a weeping willow normally or not. I love the look of weeping willows, so it's too bad I can't ever have one; it's bad feng shui.

And since that's another depressing thought, here's what Eric just bought me for my birthday:

source

With liners, so they can be used in the rain or snow. Versatility AND purpleness! (And no more walking to work in the snow/rain in my Danskos.)

Snow night?

It's supposed to snow tonight. Anywhere from 1-6", I've heard. I'll believe it when I see it.

Tomorrow is supposed to be my day off from work (1 day off each week, averaged over 4 weeks, remember?). I would LOVE LOVE LOVE to be able to sleep in, just this once. I mean, I normally don't work very long days this month -- if my team isn't on call, I'm usually in around 7, and out by 2 or so (today it was 1), and I'm not working very strenuously while I'm there. Actually, I take that back; we THINK a lot on medicine, as opposed to surgery, where we are doing things a lot. I prefer doing, which is why I chose Ob/Gyn, but both are tiring in long doses. Anyway, like I was saying, I don't work very long or very hard, but I still have to wake up early, and that's the part I don't like. So a morning off tomorrow would be divine. Small problem: my one and only patient is a 74-year-old guy who has a big thing in his lung. The top differential is tuberculosis vs. malignancy. Unfortunately, we've ruled out tuberculosis. They took a biopsy of the mass on Friday, and the pathology was supposed to be back today, but it wasn't. It will be back tomorrow. I've been taking care of this guy for almost a whole week now, and when I say I've been taking care of him, I mean it; I'm being a true acting intern for this case. He is my patient, really and truly. So I really want to be there tomorrow morning to find out the biopsy results and tell him and his family. I think they'll appreciate that it's coming from me. And that means no sleeping in. ARGH. On the bright side, I guess I'm really dedicated to my profession...?

I took part in a brain wave study this afternoon, for a professor in the Birth Defects department for a study about the origins of dyslexia. They took an EEG of me while I read different words, some jumbled and some not. I got $10, but the real reason I did the study is because they're going to give me a copy of my EEG. My very own! Yes, I'm a dork.

Happy Chinese New Year! Here's my ox-related story for the day: During one part of the EEG study, I was supposed to push a button if the word I saw was an animal. So, don't push the button if the screen says, "ftea," don't push the button if the screen says, "couch," do push the button if the screen says, "cats". What did I push the button for? "Beef." Yikes. I hope they don't ding me for that one, but believe me, I'm totally ready to defend it!

Stuck at Midway

So here I am, stuck at Midway with an estimated departure time of 5:45 pm, instead of 4:05 pm. But guess what -- I couldn't be happier! You see, I've spent the last couple of weeks dreading the interview I have tomorrow, for a variety of reasons, but unable to cancel it in good conscience. Yesterday, I was really about to cancel it, but I was worried about coming off as rude on the interview trail (the program coordinators talk to each other on a listserv!). On top of dreading the interview itself, it was going to be kind of a pain getting to the airport today, and getting to the pre-interview dinner tonight on time, so it was going to be an all-around annoying experience.

But when I woke up this morning and turned on my trusty Headline News, they warned me that flights in the mid-Atlantic region would probably be delayed today, so I was sort of expecting this. My flight out of Louisville was delayed about 30 minutes, also, which was good because it allowed me to leave the hospital once I was actually done for the day, and not have to cut out early, and it allowed me to grab something for lunch -- key! I napped the entire flight to Chicago, so now I'm refreshed and not cranky -- also key!

Now, I'm not getting to Philly until 9 pm, which is when the interview dinner will be ending, so I can get to my friend Marjorie's apartment without worrying about a time crunch and trying to still make it to the dinner. Sweet! I still have to interview tomorrow, but I'm not feeling so mentally exhausted and filled with dread about it.

Thursday I'm doing a second-look visit at my top choice program (no, I'm not going to tell you which one it is), and Friday is my last -- LAST!!!! -- interview. Even though I'm completely tired of interviewing, I don't mind the one on Friday, because it's at a really good program that I had given up on after not hearing from them all season. But over winter break, they emailed me and offered me a spot for Friday, and I took it. I must have been on some waiting list and a spot opened up.

So my interview season is almost over, and next comes a few weeks of anxiety before Match Day. But before that happens, it's time for My Traveling and Residency Interviewing Tips, which I have developed as I have become an expert traveler over the last 3 months.

My first interview was October 16, which was very early in the interview season, at a small community program in NJ. I have to give this disclaimer about my interviews: I had very little trustable guidance about programs in the mid-Atlantic region, simply because my advisors don't know those programs as well. And I wasn't sure what I was looking for in a program or what my plans for my future Ob/Gyn career might be (fellowship or not, academia or not). So I identified my geographical region of interest, and applied to every. single. program. in that area, for a total of 31. I was really convinced I wasn't going to get any interviews at good programs, so I scheduled all the interviews I was offered at these tiny community programs as early as possible. So starting October 16, I went on one interview a week for 6 weeks straight. In week 3, I interviewed two days in a row. And every single one of those interviews required a plane trip east. After a week off for Thanksgiving, I interviewed three days straight on Dec. 5, 6, and 7, had another on Dec. 13, and had my most recent three on Dec. 17, 18, and 19, for a total of 16 interviews. Whew! (In case you're wondering, I got 12 other interview offers and either declined them right away or canceled them later on, was rejected by 2 programs, and never heard from one random, weird program.) So here is the routine I developed:

Figure out how to pack everything in carry-ons only. First of all, if you're just flying into and out of town for an interview, you don't want to run the risk of your suit possibly getting lost. Second of all, have you seen the new checked baggage fees on non-Southwest flights?? So I bought a really nice carry-on sized rolling suitcase with a suiter compartment (we needed one anyway; our old luggage was falling apart), and I bought a really nice new suit (I needed one anyway), and started a little collection of travel-sized toiletries. I will say that it's key that I use Bare Minerals makeup, because if I had to pack liquid foundation, the whole process would have been a disaster -- I fill my one quart-sized zip-top bag to the very breaking point! Find non-liquid versions of other essential toiletries, too, like makeup remover wipes instead of a bottle of makeup remover. Need travel sizes of high-end styling products? Check your local salon or Sally's Beauty Supply, or if you're really really lucky and know someone with a cosmetology license (like I do), tag along when they go to a licensed-people-only salon supply store. If you need to, get a small empty container and fill it up from your full-sized product container. If you happen to use products from The Body Shop, go into your nearest store, act like you've never tried the product you love before, and ask for a sample to take home -- they'll gladly give you one.

Wear shoes that are easy to remove while traveling -- it really slows things down if you have to tie shoelaces at the security line. I wore a pair of ballet flats usually, and they were dressy enough to wear to dressy-casual pre-interview dinners.

Are you an overpacker like I am? Quit that bad habit right now. Bring shoes that are multi-functional and lightweight, like flats. I wore my ballet flats (did I mention they're purple?) and packed my interview heels, and that was it, for the most part. Sometimes, like today, I wore my Danskos, because they're better for yucky weather. Decide what you're going to wear ahead of time, and pack only that. There will be no unexpected clothing needs on an interview trip, I promise. All you need is something dressy casual to wear to the pre-interview dinner, which can be what you wear to travel, your interview suit, and possibly a third outfit to wear on the plane ride home. Extra underwear and pantyhose, though, are always a good idea and they don't take up much room, so definitely pack extra. To pack shoes in a way that doesn't involve plastic bags (it works, but for some reason I don't like it as much), put each one in a shower cap to cover the dirty soles, and then you can put them anywhere in your suitcase. I actually swiped a bunch of bouffant hair caps from the OR instead, but same difference.

If you're still an overpacker like I am, make your second carry-on bag one that does double duty as your interview bag. I bought a huge laptop/work bag at Target to stuff the rest of my crap in and stash under the seat in front of me, and then bring it along to the interview to complete my put-together business person look (anyone who knows me knows I am not that person at all!).

Bring a snack and a water bottle. Forget overpriced airport water bottles -- bring along an empty bottle (you'll have to take it out of your bag to go through security) and fill it up at the airport water fountain. I've drank Louisville, Chicago, Philadelphia, and Baltimore airport water and I'm still alive, so I'm sure you'll be fine, too. Snacks like Clif or Luna bars are there if you need them, and can be a lifesaver.

Pack a breakfast. Instant oatmeal in a zip-top bag works really well. Most interviews feed you breakfast, but it might not be right away, and it might not be what you like to eat, so it's better to show up with some food in your stomach. But no matter where you're staying the night before, you'll be able to find some hot water and a spoon and a receptacle of some sort to make instant oatmeal in. Likewise, packing a couple teabags along can work really well in your favor.

If you're traveling on Southwest, check in 24 hours ahead of your flight to get a good boarding number. When you get to the airport, make sure you have nothing in your pockets -- at the very least, take all that loose change out of your pants pocket and shove it in your jacket pocket before you put your jacket on the security belt -- and have your boarding pass and ID ready. Check to see if your airport has instated the different speed lines at security. At the Louisville airport, there is an "expert traveler" lane, a "casual traveler" lane, and a "family and liquids" lane. The casual traveler line is always really long, and there is never ANYONE in the expert traveler line, even though they go to the same place! So I use the expert traveler line, get right to the front, and because after 2 interview trips I WAS an expert traveler, I can speed right through security. Keep your bag of liquids easily accessible and be ready to take your laptop out of your bag. Work quickly but efficiently and leave those clueless people in the dust!

My No. 1 recommendation is to bring a pillow with you. I have a comfy pillow I made a while ago as a throw pillow that is the perfect size for traveling. The scheduling parameters I had to work under to schedule my interviews and not miss too much school required me to travel on post-call days very often. So I'd go to work on day 1, stay the night on call and get very little sleep, get out of work post-call sometime in the morning of day 2, go home and get 30 minutes to 2 hours of sleep, grab my suitcase, and go to the airport, get to the destination city and have to go to a pre-interview dinner, and then do the actual interview on day 3, fly back home and go back to work on day 4. It was a very exhausting process, so being able to sleep on the plane both ways was a lifesaver. With a comfy pillow, an airplane blanket, and a large pashmina that doubles as a scarf and blanket, you can sleep in total comfort on a plane, I promise. It probably helps that I'm only 5'1" and can scrunch very comfortably into very small spaces, but still, you can do it, too. And if you're lucky and the flight isn't very full, you might end up in a row all to yourself, in which case you can lift up all the armrests, put on an eye mask, and lie down for glorious, wonderful sleep. I sometimes get weird looks when traveling with the pillow, and one time a guy in my row asked me to explain myself, but I don't care that I'm a 27-year-old woman carrying around a pretty striped pillow like an 8-year-old -- I sleep in comfort on planes, so there!

Keep your suitcase 90% packed at all times. In between trips, I would hang my suit up, take out my toothbrush, hairbrush, and makeup bag, and leave everything else in the suitcase. I washed my shirts and undergarments as needed, but made sure to have extras that I left in the suitcase at all times. That way when it was time for the next trip a week later, I simply threw my daily necessities and suit back into the suitcase and left. No wondering if I had packed toothpaste or deodorant or underwear -- the travel versions of everything stayed in their zip-top bag, and there were always extra clean undergarments pre-packed.

Bring your box of thank you cards along with you, and a book of stamps, and you can write your thank you notes after each interview while sitting in the airport. Believe me, once you're home, you won't have any desire to write them, so just get it done in the airport.

Make sure you sign up for all the frequent traveler accounts for all the companies you do business with! Booking so many flights with Southwest for interviews earned me a free roundtrip flight, which we're using for our honeymoon in June. I signed up to be eligible for quick service at the car rental companies I used repeatedly, so I could go straight to the front of the line. This applies to non-travel as well, but make sure you're using a credit card with a rewards program of some sort. Points, cash back, or miles, it's your choice, but make sure you're getting something back in return for all the credit card usage you're giving them!

And, as always, shop around. The residency program may give you a list of local hotels that offer "discount" rates for their applicants, but the discounts probably aren't that great and there's no real reason you have to stay where they suggest. Check Sidestep.com and don't be afraid to Priceline something else. For things like car rentals, check to see if you qualify for any group discounts based on memberships you already have. For instance, if you're a member of AMA or AMSA, they offer discounts when booking with certain car companies.

So those are my recommendations for being a pseudo-business traveler without the expense account of a real business traveler. And after 13 weeks of nearly constant travel, I finally understand why business travelers hate traveling. I never used to get it -- I loved flying, loved the excitement of traveling because it meant I was going somewhere fun, and the minor hassles happened so infrequently that they were truly minor hassles. But now? Now I know. So after this Saturday, when I fly from Philadelphia back to Louisville, I will not be flying anywhere for quite some time. Thank goodness. But in case you need to, I hope my travel tips have helped. I still have 45 minutes before my plane takes off -- this is the longest layover I've had all year, but like I said, I'm kind of enjoying it!

After these last two interviews, I'll share a little more about the programs I interviewed at and what I might be thinking as I get ready to submit my rank list. It's definitely exciting times!

Lessons from "ER"

I watched an episode of ER the other day that featured a storyline in which a physician trying to take care of a child flashes back to the time when she misjudged her own son's medical status, declaring him less sick than he was, and he died.

It's not an uncommon lesson within the medical field; it's one of the reasons physicians are not supposed to treat their own family members. It's too easy to forget objectivity when it comes to the people you know so well, which means you could overlook something you shouldn't -- and wouldn't, if you were at work.

So when Moxie, started having really goopy discharge from her left eye a few days ago, then started keeping that eye half-shut a lot of the time, I was initially worried, then evaluated it a little closer and decided she probably just had conjunctivitis. No big deal, most likely a virus, and it should pass in a couple days.

At least, that's what it would be if she were a human.

She's a cat.

Maybe cats are different?

Since I'm going away for another round of interviews this weekend, I got a little more worried, and thought about that ER episode. Do I really know what she has? Is it really OK?

I guess, to be honest, I have a pretty good idea, but I'm not 100% sure.

And I would hate to come home Sunday night to find a dead cat. I mean, that's totally a worst-case scenario, but that's a scenario I don't want to face, so I guess I should take the cat to the vet.

She's overdue for her shots this year, which means the vet will probably give them to her.

And if she's going to get shots, then it would be the responsible thing to let her brother get his shots, too. After all, they're going east for the holidays and might hang out with some of their feline and canine cousins at various relatives' houses. Better safe than sorry.

The vet put fluorescein in her eyes and didn't see any corneal abrasions or ulcers. "Duh," I thought. She just has a viral conjunctivitis. Still, fluoroscein in a cat is kind of cool -- until she rubs up against you and get it all over your sleeve.

In the end, the vet diagnosed her with a viral conjunctivitis and gave me some neomycin/polymyxin drops to put in her eyes for the next 5 days. The thing is, I'm going to be gone for the next 4 days. And I know she doesn't truly need the drops -- just like in humans (but we commonly give them out in humans, too). But now I'm torn between being a cold-hearted clinician and a guilty pet parent. I was a little happier to learn the differential diagnosis included herpes, because I would definitely hate for her to have herpes conjunctivitis and not know it because she couldn't tell me she was in pain.

So $174 later, both cats have shots, Moxie is given the diagnosis I thought she would be given, has unnecessary eye drops that I still feel compelled to administer but can't because I'll be gone, and my fleece is stained fluorescent yellow.

Worth it, right? No dead cat when I come home Sunday, right?

This behavior of mine is going to stop before I become a mother, right?

Right? Because I don't want to be responsible for any ruptured appendices on my watch.

Great buys

I discovered this week that my local Target now sells wine! In addition to the usual suspects of things I can get at the grocery store, they have (of course), a Target-branded version of boxed wine. Of course, boxed wine has a ... certain reputation, but I've also been hearing over the last couple years that there are some really good boxed wines out there on the market. The advantages are that they stay fresher longer, you can dispense single servings without worrying about the whole bottle going bad, and you save on packaging.

source

So my choices in "wine cubes," as Target calls them, were a 1.5L box of 2007 Vintner's Red Blend or White Blend, or a 3L box of pinot grigio or shiraz/cabernet sauvignon blend. Seeing as how it is just me by myself drinking this stuff, I went for the smaller box, red blend, for a whopping $12. To be honest, I didn't have high hopes, but this stuff is good! Now I can have a glass of wine on any night I feel like it, either to wind down after work, or with dinner (when I actually cook), and I have 4 weeks to drink the whole box. That's much less pressure than finishing a traditional bottle by yourself before it goes bad! I may not exercise ever and eat complete crap at the hospital all the time, but I'm happy that now I can have my one glass of red wine a night working for me :)

If you're waiting for an actual review of the wine itself, sorry. I don't have a handle on that vocabulary. But I can tell you that the wine is good, pairing well with both tuna noodle casserole and filet mignon, and going down just fine on its own while straigtening up the bedroom. Don't worry -- I do have enough of a palate to figure out when I don't like wine, and this is definitely one that I like and will buy again. And now you should, too!

The other great buy I had recently was at Ann Taylor last week. I went in looking for pants and came out with some of the best deals of my life. First was a beautiful purple silk blouse, originally $59, marked down to $29.99. Perfect for my interview suit! Next was a black wool sheath dress, originally $158. It had gone down the clearance line, first priced at $69.99, then $39.99, then $29.99, and finally, put on "Final Sale" at $19.88. A great work dress for less than $20! And it has pockets! I wore it to clinic yesterday and it was amazing.

And finally, the piece de resistance, one of the Ann Taylor Celebrations dresses, Flora, a cute strapless, taffeta, tea-length, bridesmaid dress in "espresso," originally $198, marked down to $39.44 and now to $19.88. Are you freaking kidding me?! The only problem: It's one size too big for me. I bought it anyway. For that price, I can either pay to have it altered or sell it on eBay. If I get $40 for it, it's a great business venture. Or if I can find anyone one size larger than me, they're going to be getting an awesome Christmas present.

source

The best, best, best part? I had a coupon for 30% off everything. And at the register, I consented to switching my Ann Taylor store credit card to a different version to get an additional 15% off. So the two dresses, originally $158 and $198, were each $12.74. Unbelievable. (And the silk blouse came down to just under $20.) I am an awesome shopper!

A deal that good may have even succeeded in quenching my shopping thirst for a while -- I'll enjoy sitting on my laurels for a while. Although I never did find any pants I like. Anyone have any ideas for a nice pair of tweed pants?

Commuting Fail

see more pwn and owned pictures


I submitted this, and it got on the main page! Go me!

I took it in Nottingham, Pa., on the way to Downingtown from Maryland. After passing the Herr's Factory and the giant Wawa, I was supposed to get on Route 1 north from Route 272. I missed the exit, though, and pulled into this park and ride lot to turn around. And right there in front of me was this ridiculous sign. And I happened to have my camera with me. The end, by Holly.

Nothing makes me boiling mad like pregnancy termination

and the threat of removing a woman's right to access it.

Project Runway is over (Congrats, Leanne, although I think I would have picked Korto), the Phillies are beating the Dodgers 5-0 and the game went to commercial, and I flipped to the debate.

Just in time to hear John McCain say he believes abortion rights should be left to the states.

I firmly, strongly, adamantly, 100% DISAGREE.

Terminating a pregnancy is a decision between a woman and her physician, and no one else. States' rights are fine for some things, like how you're going to handle road repairs, but this is a fundamental right to privacy and a situation in which we need a country of United states, not of 50 states with 50 different opinions. Or, god forbid, 50 South Dakotas. A politician cannot tell me what my opinions about a treatment are and force me to repeat lies to patients.

Barack Obama has sidestepped the question somewhat, but I can't blame him.

It's 10 pm and I need to go sleep, because I wake up at 6 am for my first interview! And I am completely ready to answer any and all questions about my stance on pregnancy termination with regards to my future career as an obstetrician/gynecologist.

By the way, in case you're wondering, there is no medical procedure called a "partial-birth abortion."

OHMYGOD, I can't listen to this debate any more. I'm about to scream.

Ben Folds

Last night we went to see Ben Folds with the Louisville Orchestra. It was a really cool show. The orchestra started out with 5 pieces in the first half, and they were all fairly friendly to an audience that bought tickets to see Ben Folds and not the orchestra. Tchaikovsky, Aaron Copland, a medley of Star Trek themes. But that didn't stop the high schoolers sitting next to us from talking and being generally obnoxious during the whole thing. Look at your programs, people; that's what they're there for. If you don't want to sit through the first half, go out to the lobby and wait.

Geez, I feel like an old geezer. But seriously, I was about to slap them.

Then Ben Folds came out, and he was really good, as was expected. At first, his piano wasn't miked enough, so he blended with the orchestra too much, but after the first song, that was resolved. He played lots of favorites, and one song from his new album. With an entire orchestra to accompany him, I hoped he would play "Steven's Last Night in Town," and he did. Since it's my favorite song, I hoped he would play "One Down," and he did -- all by himself, with no orchestral accompaniment. It was better that way. I totally love that song.

(By the way, I just Googled "one down three point six" and the first hit was Transmogrification. Small world!)

The low part of the concert was "The Ascent of Stan," for which the orchestra was dragging a bit.

The low part for me was when he performed "Gracie," the first line of which goes, "You can't fool me, I saw you when you came out." He had told us about watching his twins be born, and used the phrase "saw them come out" a couple times while talking, and I guess the third time, in the actual lyrics, was too much for me. Remember that very, very sad thing I mentioned before, that I hadn't had any time to process?

Well, my subconscious sent it flying up into my consciousness, and I processed it right there in Whitney Hall, while Ben Folds sang "Gracie." And I mean tears were running down my face uncontrollably. That's how emotionally exhausted I am from this month.

The very, very sad thing involves a baby dying last week. I don't think I want to tell the whole story any more, so please forgive me. Let's just say that in obstetrics, there are a few different types of "fetal demise," but I think I've concluded that for obstetricians, there are only two types: expected/unsurprising, and unexpected/surprising.

This one was out-of-left-field unexpected and very, very surprising and upsetting. Not least of all for the mother, of course, but also for the rest of the team. I barely met the mother, she wasn't my patient, but there I was, crying uncontrollably at a Ben Folds concert last night for a baby whose father didn't get to watch it come out.

Two weeks down, two weeks to go.

Pine Mountain, revisited

Remember when I did this?

Well, now the NY Times has done it, too.

(OK, he hiked and I drove. But still -- driving alone up there is JUST as scary as hiking, I promise!)

(And, sniff, I kind of miss Whitesburg now. Until I think of that Super 8 I lived in for a month. No "stately Salyer House Bed and Breakfast" for me, unfortunately.)

Labor and Delivery

I'm at the end of my second week of four of these overnight shifts. It's 5:00 in the morning, and I don't get to go home for another 3 hours. I've seen a lot of things, some very happy, some very, very sad, and a lot in between. I wanted to write about the very, very sad things, but my brain doesn't function properly anymore -- that's due to the whole overnight thing. It's easier to be sad for 5 minutes, process it as quickly as I can, and move on to the next thing. Frankly, I just don't have the energy to spend any more brain power on it, and that in itself does make me sad. Maybe once it's all said and done, I can find the energy to process it correctly and come up with emotions that will allow me to tell you about it.

My day starts at 5:30 pm and ends at 8 am, and that leaves me just enough time in between to sleep like a rock for just long enough to function for the next 5:30p-8a shift.

Every night I eat breakfast/dinner somewhere between 9-11pm, and it's usually a cheeseburger and fries. Or a turkey cheeseburger and fries. There are no vegetables at the late-night grill other than the lettuce and tomato that goes on my burger. Fries don't count. I'm craving broccoli hardcore. Sometime in the middle of the night, I inevitably eat a snack, like chips -- tonight it was an oreo-and-vanilla frozen yogurt blendy dessert thing, which was delicious. Most mornings, I run back down to the early-morning grill and get breakfast -- bacon, egg, and cheese sandwich. Yesterday I caved and got a Krispy Kreme donut IN ADDITION TO the sandwich. I ate all my groceries at home last week, and didn't go grocery shopping last weekend, and I'm paying for it this week, for sure. There's no way my wedding dress is going to fit when it arrives in 8-10 weeks. Oh well.

I'm so behind in everything involving the rest of my life, it isn't even funny. In residency, I'll do this for 8 weeks in a row. Can it really be too late for my backup plan of a career in public health? Or my backup backup plan of becoming a florist? If only I didn't have $300,000 of student loans to pay back.

Speaking of loans, I found out there's a Residency and Relocation loan I can apply for -- up to $15,000 to be used toward the cost of applying to, interviewing for, and relocating for my residency. I think I'm going to need it -- as of today I've gotten 12 (12!) interview invitations (of 31 applications), and almost none of them can be scheduled back to back. So that means I'm booking plane tickets back east once a week for most of October, November, and December, at a cost of at least $200 a trip. Yikes! Plus hotels, rental cars, you name it. It was exciting at first, but now it's just stressful. And I found out that one of the biggest lenders for these relocation loans is going to quit lending in a couple weeks, due to the credit crisis. Two weeks ago, I blew off the credit crisis as being serious for the country and for other people, but not for me in particular, since I have no assets whatsoever. Today, I see how it is going to affect me. Blah. So I guess I'd better sign up for an additional $15K of debt while I still can. The "perk" is that since I'm going to be a doctor, I can get special doctor rates for things like this relocation loan, and for mortgages. A better perk would be if I could crawl into bed at a normal time and sleep for a normal number of hours. Why do I have to like Ob/Gyn so much? I could be a dermatologist. Or an ophthomologist. Or an anesthesiologist. Except rashes give me the heebie-jeebies, I think eyeballs are the most disgusting part of the human body, and the thought of having to suction phlegm out of someone's throat makes me gag. So vaginas and a horrible lifestyle it is. Sigh.

So far, I've accepted all the interview invitations that have been extended to me, even though most of them are for smaller programs, because I feel like I need to. I may not hear from the bigger programs, so I need to take what I can get. I still want to interview at as many places as possible, because I still don't believe my chances can be very good (mostly, that's just me being cautious. But it's possible!). But the scheduling is starting to get to me. A lot of places interview on the same days, so I'm having trouble fitting them all in. Plus, I have to take time off from school to interview, and officially, there is a limit to how many days I'm allowed to be gone. So if one school in Pennsylvania interviews on a Wednesday, and another interviews on that Friday, my grades can't afford for me to take Tuesday (to get there the night before) - Friday off, but my wallet can't afford for me to fly out Tuesday night, fly back Wednesday night, and fly out again Thursay night to interview Friday. What to do?

I don't know what the answer is. All I know is, it's the weekend, and I'm going to sleep as much as possible, which may not be much, because:

Did I mention that Eric's here? And that we're going to see Ben Folds this weekend? And having our tasting with the caterer? And going to a wine tasting with some friends?

It's going to be glorious. Sleep be damned.

Where did my week go?

Being on a night schedule is craziness. I get home in the morning between 8 and 9, take a few minutes to eat some breakfast and watch something quick from the DVR, then go to sleep. I wake up around 4 or 4:30, take a shower, eat another quick snack, and head to work, which starts at 5:30 pm. Work ends between 8 and 8:30 the next morning, and it starts all over again.

The good news is that this week I pretty much completely converted to a night schedule. Wednesday night actually felt like a day shift, I was so awake.

I've done some cool stuff on L&D: Checked a few cervixes (but I need to check way way more), learned some ultrasounding, diagnosed a miscarriage (sad), put in an IUPC and fetal scalp probe, and some other cool stuff. My role isn't really 100% conducive to getting deliveries, but my goal is to get a few during this 4-week rotation.

Problem: I have literally done NOTHING else this week. I guess the weekend is for food shopping and cleaning the apartment.

This is totally Intro to Residency 101, and it's a tough transition.

Tammy can't die yet!

Massive car trouble over the weekend and the last couple of weeks.
I think I might be jinxed.

It's almost close enough to the point where you wonder whether you should get a new car or sink a little (or a lot) more into this car to make it last longer.

Not that I can afford a new car -- not even a new used car.

And, a/c or no a/c when I get back to Louisville, bike to work or not once I'm there, the bottom line is: I need a car to get back to Louisville. In 5 days.

Let's see what the mechanic says tomorrow.



more animals

It still kills me that I just gave Tammy a new convertible top last year. She can't die yet!

...hypodermics on the shore, China's under martial law...

I was all set to have a picnic lunch on the beach today, a nice compromise to the whole hurricane's-a-comin' and no-lifeguard situation.

Then I got a phone call from a certain fiance of mine who works at a newspaper, alerting me to the fact that a syringe had been found on our very own beach.

Dammit.

Off I went anyway with my leftover Wawa turkey hoagie and a can of Coke, watching where my flip-flops landed, but I didn't see anything other than a couple of dolphins playing out past the swells (I love seeing dolphins!). After about 5 minutes, a beach patrol car came up and the guy apologetically told me the beach was closed due to medical waste washing up 10 blocks north.

Of course, then I went 10 blocks north to see if I could see anything, but there was nothing going on, other than a reporter from the local NBC affiliate doing his thing.

As of about an hour or so ago, the beaches are back open, but I've had my sun for the day.

If you haven't heard about the string of medical-waste-on-the-Jersey-shore incidents over the past week, you can catch up here:
Brigantine beaches reopen
Press of Atlantic City search "medical waste"