Doctor, I'm Having Mid-Cycle Pains.....

So I'm about half-way through my first Emergency Dept month as an ER intern. And it's been painful at times.

But overall, surprisingly not bad. Whereas the first week I was seeing about 6 pts a shift and feeling pretty overwhelmed during it, staying 2-3 hrs past to finish typing notes; now, I am seeing 7-8 pts/shift and, in accordance with ED policy, finishing each note before physically discharging the pt from the dept. Probably the only pts whose charts I sit on are admissions....and for those I usually have the clerks come and find me to have me put down timestamps and diagnoses so they can release the chart.

There were 2 shifts so far where I had 3-5 fairly sick & complicated pts each time who ended getting admitted. Those were sort of bad. The hardest pts are the ones who are old, have multiple medical problems, come in with multiple complaints and you're standing in the room with the nurses looking at you waiting for orders while you're trying to listen, jot history notes, and think about all the things that could be stealthily and steadily killing this person right before your eyes.

I mean, jeez, the pimping during board rounds is anxiety-provoking enough. I have now realized that the practice of emergency medicine means going to work knowing that you could save someone's life or kill someone based on how well you know your stuff. And I'm just an intern. At times it feels like everyone else knows more than I do. Of course, everyone has thoughts of insecurity like that. But the scary thing is that I'm almost convinced that most of my class DOES know more than I do. Maybe even some of the med students. Christ.

Anyways, as mentioned, this is the first of many months of training - 36 to be exact. Three years sounds like a lot, but actually it's not. I have just over 1000 days to learn everything I can about emergency medicine under the supervision of more senior physicians. Yikes.

Beaten to the Punch: Lesley Ann Machado

Has anyone seen the latest Rosetta Stone commercials running on TV? I know it's a great system and people in the military get free access to it, but every time this commercial comes on, I usually stop what I'm doing and watch & listen intently. Why you ask? Because someone in wardrobe worked very very hard to get my attention; the least I can do is admire their talent:

http://www.youtube.com/watch?v=k2Vx9Tz6AA0


Up until today, I thought I was alone. Looks like I arrived late to the party.....again.

Army Fat Smoker Testing

The APFT (army physical fitness test) is coming up. From what I understand, in the past, officers (particularly non-combat) who were not meeting minimum PT standards were reprimanded, but not really punished. I am willing to bet medical officers were a respectable percentage of those numbers. Cuz we don't take shit from no one and we roll like that....

Lately, though, Big Army has been cracking down on us fatties in the officers' corps. Apparently, those who do not pass the PT test may flunk out of residency and be immediately deployable as a general medical officer. Suck.

So I am putting my floor to good use, practicing the front leaning rest position and beating my face, as they love to say. Max pushups in 2 mins, max situps in 2 mins, 2 mile run. Where are my gym shoes....

Through rose-colored glasses?

There are certain things that trigger memories of childhood for everyone. Sights, smells, songs, foods, textures....

When something triggers an old memory for me, it always seems like I am viewing the memory through a sepia-toned filter. Everything seems warm, a little yellowed with age, and static....frozen in time just the way I remember it, never changing.

Being away from home means being away from Chicago. Plainly put, my heart feels beaten and ripped sometimes because I miss it so much. I think I haven't really settled into Tacoma and the Northwest yet because I am having such a hard time letting go of the Midwest.

But you know what they say: laughter is the best medicine. As a physician, I can attest to that fact. What better way to kill 2 with 1 than this?

http://www.youtube.com/watch?v=VNPp6x7j9I8

http://www.youtube.com/watch?v=4MxPoxxt7n0

I think John Hughes and I would have been great friends. RIP, John.


An entry dedicated to Chicago, the Midwest, and everything I like about it (and the few things I don't) is on my to-do list. But like a PERSONAL STATEMENT (also in the works), it is not something easily tackled. But it's on there.

As a token of how much the Windy City means to me, I even watched The Lake House. And.....hey, it wasn't that bad. Right?

Wow, this relationship might be a touch unhealthy.

*Addendum: I googled "rose-colored glass" and the first hit after the dictionary was for a play called "Rose Colored Glass" set in 1938 Chicago. Coincidence? I think NOT! Actually, it probably was coincidence.

Survivorman

The second month of my intern year is ending. Anesthesia has been educational, but sometimes frustrating. One day, while waiting for my microwave soup, I flipped through The New Yorker and this poem caught my eye (mostly because I am a fan of the TV show by the same name):



"Survivorman"



Here's a fact: some people want to live more

Than others do. Some can withstand any horror



While others will easily surrender

To thirst, hunger, and extremes of weather.



In Utah, one man carried another

Man on his back like a conjoined brother



And crossed twenty-five miles of desert

To safety. Can you imagine the hurt?



Do you think you could be that good and strong?

Yes, yes you think; but you're probably wrong.



-Sherman Alexie



I think people who have never been truly physically tested, like myself, think that they're hard or very capable of handling physical adversity. For myself, my default frame of mind is "I can do that." But like the line says, I'm probably wrong.

Westward Ho!

I have come west to seek my fortune!

Much has happened in the past couple months. In fact, it has been a whirlwind (at times, literally) of activity that started with my 2 week Phoenix rotation with Hoy, ended here in Tacoma, and stopped off in Italy, Kirksville, and California along the way. I have so many pictures I ran out of room on my computer and had to buy a hard drive! 


***published incomplete after the fact 17 Feb 13***

Down to the Wire

I'm back from Arizona, which was at once thoroughly relaxing, maddeningly busy, and (almost) completely unproductive of Italy trip progress. No, I shouldn't say that. I sent CouchSurfing requests to close to 10 people all over Italy; I highlighted a bunch of Lonely Planet; spent many hours narrowing down dSLR choices, only to decide on taking the parents' super point-and-shoot; spent some more hours ordering a buncha crap online, including Kifaru pockets. Now that they're on, I think it'll work, but it looks....not great. Whatever.

In the remaining 3 days, I have to buy a Eurail pass for city-city travel, lay out all my stuff for real and test-pack, get a AAA international driver permit, book hostels for all remaining cities as most CS requests have fallen thru from non-replies or people unable to host. 

***published incomplete after the fact 17 Feb 13***

Dislikes & a Long Unanswered Question

Two of my least favorite things in the world, experienced in the space of 5 mins:

1) Big ass truck in the lot with a park job that looks like the driver was using the Force.....badly. Don't people have a basic perception of what's going on around them....full employee parking lot, mid-morning, I am taking up 2 spaces....

2) Walking directly behind 2 women exiting the parking garage. Not more than 3 ft. I am not tiptoeing. I left the ninja suit at home. There is clearly a person behind them about to follow them through a door. Lady pushes the door, walks through, lets it fly shut in my face.

I understand that the world is not black and white. Things used to be blacker and whiter. I'm talking medieval times-used-to-be. In today's world, double standards abound and nothing less can be expected these days just because our world is changing and progressing, at least more than it was in 1300 AD. I guess what I'm saying is that people make an observation: "chivalry is dead." I don't believe chivalry is dead. I think I have chivalrous traits. I always check behind me as I go through doors. I will pull chairs out at the table for a lady or an elder. I never hesitate to give up a seat for someone who may feel more relief from sitting than myself. You know, as I come up with examples, I'm realizing that what I'm referring to as "chivalry" is actually just shades of good manners, respect, and compassion. I think in the bygone days of harder living, positions in society were much more rigidly defined and hence, a code of behavior was necessary. Our 1st world Western society is what I call "softer": less definition to who's who and what's what, there are general feelings of people can be what they want to be, and tolerance for differences are improving.

Just to go back, what did I mean by double standards? One single example is with women and the issue of chivalry. (Some) women complain about today's man lacking chivalrous characteristics: the boyfriend who doesn't think to offer a hand when stepping around a puddle, the husband who seats himself at a restaurant while his wife sheds her own coat and pulls out her chair. At the same time, women demand to be treated as equals (and which they absolutely should because they....we are all just humans) and sometimes these two standards collide. I'm not trying to make a blanket statement; it's just one example, and probably a unique issue to this time in history which has seen so many women stepping of household-only roles and into the workplace-at-large. So.....I guess we'll see.

A second less serious example is something I've always been curious about, but have never brought it up face-to-face with women: the toilet seat. Here are the facts: the toilet is an appliance for men and women to use. Women need to have the seat down to use it always. Men need to have it down sometimes. Yet women insist that men should put the seat down after they use it. Are there any men out there insisting that women return the favor and put the seat UP after they are done? I think not. If a man uses the toilet to urinate and sees that the seat is down, he lifts it, goes, washes, leaves. Let's say a woman uses it next to urinate and sees that the seat is up. She lowers it, goes, washes, leaves. Each human has done the same amount of work to complete the task. Difficult? No.

Of course, there are men out there who don't lift the seat. And there are the guys who don't lift, don't aim, splatter all over the seat, and leave. Bad apples do exist, what can I say. And they do exist in both barrels, ladies. Not in the form of women peeing on toilet seats though. Dammit, I hate how you have to explain every little thing on the internet because it's so easy to misinterpret cold, inflectionless text.

But seriously now: why do women expect men to raise a lowered seat, then lower it again while women are only expected to lower a seat then walk off? I mean it's a small thing and I'm not about to write my senator about it, but it begs the question: what is chivalry? what is equality? Good manners, conscientiousness?

The bigger picture of the post has to do with cultural norms and how they differ from people to people. Happily, if you travel to new lands and are a mostly well-adjusted, open-minded, non/minimally judgemental person, you ought to have no problems getting along. Every now and then, though, you learn about the way things are done in that new place which rubs you the wrong way. I guess that's part of the adventure. Makes me sort of nervous about my upcoming trip, though.

Eurotrip Pt. 2

Digression off the bat: A trauma patient came into the ER today and my ears perked up when I heard it was a motorcyclist who had fallen at low speed. Not too impressive, but what was unusual was the fact that he was 84 years old! Luckily, it was at parking lot speed and he was pretty much with it, answering questions and such. Then I found out he was actually on a bicycle not a motorbike, and I stormed out of the room.

So my Eurotrip planning continues. I think I'm going to try to pursue this couchsurfing thing for the entire 3 week length. The only hitch is that most people who are on this site say they can host for a max of days or so; some of them stipulate wknds only, etc. I suppose those cities I want to stay in for >3 days, I could always hostel it.

Trip Spotlight: Cinque Terre

Cinque Terre (Five Villages/Lands) is a coastal network of 5 villages in the Liguria region of Italy. Running along the Mediterranean Sea, there is a hiking trail that connects all 5 of the villages. And I mean they are literally on the sea...almost in it, in fact. Every one of them looks like it's hanging off the rocks or precariously terraced into the side of the cliffs. Think Hopi Indian adobe villages + Summer X Games. Or something like that.

According to my handy dandy travel guide (Lonely Planet: Italy), the hike from 1st thru 5th should take about 6 hrs if done non-stop. I'm planning on taking a day or two...maybe more? How often do you get to see this?

So I will hike, I will hydrate with tasty regional wine in my Camelbak, and I will maintain a constant level of suspicious alertness for pickpockets, of which I hope there will be few on the trail.

I am finding there are a few basic things which are different in Europe I hadn't really thought of much. Converters for electrical devices. Iffy tap water still in many of these developed countries. Different protocols for bathrooms. Buy a prepaid cell phone vs. bring my GSM Treo? I guess the overseas destinations I've visited have been underdeveloped to the point where I didn't bring things to plug in or they're countries where I stayed with family members.

I have my rough itinerary planned out now:

4/14-5/7
--------------------------
Rome - 5 days
Naples - 2 days
Sicily - 3 days
Florence/Pisa - 3 days
Bologna - 2 days
Venice - 2 days
Cinque Terre - 2 days
???- 3 days
---------------------------
22 days total

Of course, the best laid plans of mice and men often go awry and so on and so forth. The name of the game with this trip is going to be improvisation and spontaneity, something I know I have just a little trouble with.

Long Way Round, Down, and UP!!

I finally bit the bullet and bought Long Way Round.....and Long Way Down......and Faster. Motorcycle madness!

What a fantastic show. For those unfamiliar, Ewan McGregor and his best friend and fellow actor, Charley Boorman (2nd from left) decided to take a motorcycle trip together.....around the world. Both gearheads, they thought the ultimate way to test their riding skills, meet locals at ground level, and develop their wits would be to head east from London until they came back to where they started.

Their travels took them through over a dozen countries and more than 20,000 miles. 4 months. 2 producers and 2 cameramen, one on another bike and the remaining 3 in 2 support cars. But the only time the cars and Ewan/Charley met up were at border crossings or emergencies. For all practical purposes, they were on their own.

How radical is that? Travelling to new places is amazing, but the thought of a journey always causes feelings of tingliness....

They do daily video diaries while on the road, which makes for great TV cause it really captures the difficulties, excitement, and danger of the road. Maybe I'll try something like that on my trip....though I'm no professional actor so, remember, low expectations people.

On another note, I've ordered the side pockets which will expand my pack's volume...hopefully they will be here by the end of March. Glad that's done; I tend to spend a disproportionately large amout of time looking at and researching gear. All good cause it better be good kit and not shit. But it's sometimes excessive....

Ewan and Charley's mounts? A pair of BMW R1200GS with some serious goodies. Meanwhile, my Black Beauty sits frozen in the garage....

This day was pretty cold too. Ankle socks and gym shoes not recommended.

Eurotrip, Pt. 1

After much thought and hand-wringing, I've decided to spend my vacation in Europe - Italy to be exact.

Long story short - I had a long list of things I wanted to do and places I wanted to go. But nothing really popped out at me. Some places were too expensive, too domestic, or just didn't seem like it would be fun for the solo traveler. But after thinking about it (and spending hours on the Intarweb), I settled on:

-a moderately long time frame: 3 weeks
-living the austere lifestyle: will carry one backpack with a total volume of ~50 L depending on how many pods I attach (separate kit review coming up)
-european destination but concentrating on one country and really trying to experience depth; the final 2 were Spain vs. Italy, with the latter winning out
-the concept of "couchsurfing" rather than hostelling, because it truly lets you interact with the locals....and it's cheap!

That was my framework - the rest would be details to be filled in later. So then, first step? Transpo, my man. My research had led me to several sources for flights. These included the usual suspects: Orbitz, Travelocity, Hotwire, Sidestep. Studentuniverse is also a good site; they advertise special fares available only to students/faculty and actually go to some length to verify you have a legit .edu address. I didn't happen upon any incredible deals when I bought my tix...in fact, rechecked Sidestep just now and I see my itinerary available on Delta for ~$100 less than I paid on Iberia. *sigh*

So. I'd chosen a destination and committed to it by purchasing airfare. With a timeframe set, tasks to do started faling into place. Next up, I'll talk a bit about the nitty-gritty planning that is ahead of me. Countdown: 6 wks, 1 day.

Until next time...




Addendum: In my research I came across a myriad of sites dedicated to international travel, backpacking tips, forums for youths and the youthful at heart, gear reviews, networking sites....the list goes on. These have provided good info so far, as well as introduced me to the world of couchsurfing!

couchsurfing dot com
nomadbackpackers dot com
raileurope dot com