i wish i was a writer who sees what's yet unseen

So when the only elective I could register for was another two weeks of radiology, I decided that I didn't have any more excuses, so I'm going to try and do NaNo. Ten essays, 5,000 words apiece, 30 days - piece of cake, right? I am going to try and write more than the average word count I'd need in these first two weeks, because the end of November will be interviews and Thanksgiving and less free time, probably, even though I'll technically be taking two weeks of vacation.

So, there's a new widget on my sidebar so you can see how I'm going, word-count-wise, and I'll try and post here with updates - public failure to finish might help motivate me. I decided to post my notes, thus far - my scribbled thoughts may not make much sense, but I have a few ideas for topics, at least. Anything not on the list that you'd like to see me write about?


- primary care and how it will save the world. (ha. not really.) Radiologist wanted ENT to look at his infected ear, woman d/c from hospital not on warfarin --> in ED two months later c PE. People need to expect more from their doctors. The trap of the specialist perspective. Common sense.

- On bodies, body modesty, viewing people (self included) as bodies, too, not just brains. Looking at their insides, "eww, gross." Body "modesty" as contributing factor to sedentary lifestyle, obesity.

- palliative care, pain control, end-of-life. the guy I'll never forget from research experience. why doctors hate it and why I don't, really. how is this influenced by my own life experiences (or lack thereof). grief. psychiatrist who couldn't treat grieving pt.

- obstetrics in the inner city. frustration, difficulties, "i just keep getting pregnant and i don't know why." troubles with contraception: "i don't want anything up there." delaying own child-bearing.

- how medicine changed me, how I thought it might and how it did. Decisiveness, callousness, comfort level with people not my own.

- how people view their doctors. trust. responsibility. "are you in high school?" how doctors don't have the doctor-patient relationship any more. "who thinks their doctor is above average?" fraternity of mutual silence, united front. self-policing. double standards: our own drug use, etc, vs our patients' drug use.

- why abortion, what people do and don't get about abortion, looking at it from the inside vs looking at it from the outside. S. L. MSFC. Bunker mentality.

- difficult patients. what makes a patient difficult. M. J. why difficult patients get better and worse care.

- pediatrics vs adult medicine: EMLA, murals, art therapy, etc. why do we care for children differently? their fault vs someone else's. pressure (self-imposed) to get it right; disability matters less to us at fifty than at five. integrating consideration for life and life factors into care: teachers, unlimited visiting hours, mental health care.

- CPR, resuscitation, "saving lives," what actually saves lives and what medicine looks like on TV. how TV medicine shapes patients' expectations. how it shapes doctors' expectations.

title from "Wish (Komm Zu Mir)" by Franka Potente, from the movie "Run Lola Run." My favorite techno-German song. Mostly because I don't know any others, but if you've got some to share, I'd be interested for sure. I'm still trying to figure out what the song was that played on German MTV incessantly in 2004, with the video of creepy monster-kids' birthday party - one of those artistic endeavors that was just so bizarre you had to love it.

that time of year when we push ourselves ahead

*deep breath*

So, it's been, um, a while since I was here. Things that happened/were accomplished since July:
- I've applied for residencies (in family medicine, of course) and scheduled my interviews. So that feels good. I'm really looking forward to the interview thing, actually, even though it's going to be tiring and all that, but I'm excited to meet the people I'll be working with for the next 3-4 years, whomever they are. (For the record, in case anyone is interested, I applied to UH here in Cleveland; Montefiore, Beth Israel and Columbia in NYC' Tufts, Boston Univ Medical Center and Lawrence in the greater Boston area; Brown in Rhode Island; and Middlesex and UCONN in Connecticut.)
- Did rotations in emergency medicine and geriatrics, did my acting internship in pediatrics, and am now chilling in musculoskeletal radiology. And kind of scrambling to figure out what rotation I'm doing for the next two weeks, but that's another story.
- Took Step 2 CS! Our clinical skills exam, part of our licensing boards, is a big pain in the butt (expensive, offered in only 5 cities, long and tiring) but I took it in Houston on Monday and now I am done with standardized testing! Until Step 3 in, like, a year or two, but whatever.
- Attended some lovely weddings of family (my cousin Lisa) and friends (my childhood friend Christine). Discovered that yes, it is possible to drive to Connecticut and back to Ohio for a weekend. Thanked God and good fortune that I have a life partner willing to actually do all that driving, so all I had to do was sit and knit and be conversational and not get a DVT.
- I've also been knitting a ton, although, as Ben is quick to point out, I haven't actually finished a project since, like, May or something. However, I believe firmly in the utility of parallel knitting projects and many of them are nearing completion, so stay tuned. I've been working on:

- a shawl of my own design (ran out of (discontinued) yarn on the edging, need to devote some time to emailing Ravelers to see if they'll part with a skein)
- a scarf for my mom's birthday (in May) that I, um, still haven't finished. (There's beading. It's driving me crazy. It will be done by the time I go home in November.)
- a Pi shawl that may or may not be wedding material (halfway through the edging, it started to get not-fun; I'll be picking it up again soon when I'm ready for more finicky knitting)
- a pair of socks that exist solely for portable knitting, which I started during the AAFP conference in August. They'll get finished while I'm interviewing.
- the Luna Moth shawl (ran out of yarn doing the bind-off. This was even more annoying as I purchased three skeins of this yarn, but could not find the third skein anywhere in the house. Since it's only $2.99 a skein, KnitPicks got an emergency order from me.)
- another shawl (noticing a trend?) that may be a gift so I'm not going to say more about it. But I got a lot done while I flew to Houston and back earlier this week, with connections both ways.

However, as it gets colder (and these projects get finished), I think I'm going to transitioning to winter knitting. I appreciate a lapful of wool in November in a way that's just not possible in August. I have yarn and patterns for the Urban Aran, cardigan version (Cascade Ecological Wool in beige) and the Sayuri sweater (Rowan RYC Soft Lux in amethyst or green - I lost it a little when I found it for $1.99/skein, so I bought two sweaters' worth. This is how that excessive stash thing starts, isn't it?), so those will probably be my next projects.

In other news, I'm thinking very seriously about doing NaNoWriMo. (Since their site has been very slow, the short version: November, National Novel Writing Month, write 50,000 words in 30 days. Go.) Except I think I'm going to skip the "novel" business and just try to write 50,000 words of more-or-less non-fictional essays. I've had a few medically-related essays percolating for a while, and this might be a good way to actually get them down on paper. And interview season might be just the right time to reflect on the practice of medicine. And writing ten 5,000 word essays seems a lot more possible at this point than 50,000 words of plot. So we'll see.

Tangentially, I'm loving Genius, iTunes' version of Pandora: you pick a song, and it builds a playlist from your library based on that song. I've been actually listening to music again, and enjoying a lot of the stuff I'd forgotten I had. (If I end up doing the NaNoWriMo thing, I have a feeling it will come in handy.)


title from "The End of Summer" by Dar Williams. Because it's snowing here today.

drive-by posting

Hi! I know, it's been forever. And I'm not even really here (because how do I get caught up on two months?!) except for how I didn't want July to go by (like June almost did) without posting so... hi! How's it going? Here's what's been occupying me lately:

Things that Are Awesome:
- Manhattan. Seriously. I had my doubts about living in NYC but I had a great month when I was there at a fantastic hospital that is basically exactly what I want out of a residency, and I'm getting pretty excited about this next-stage-of-our-careers business.
- The beach. Specifically the beach in Westerly, RI, where Ben and I passed a lovely week with my family and Anna earlier this month. Speaking of...
- Family and friends. A lot of this online silence has been because I've been visiting and hanging out with all the people I love in person, which has been delightful.
- Weddings, other people's. Specified as such because of how you just get to buy presents and show up looking pretty and eat cake and enjoy how much they're enjoying their day. And also because of how we've been to a few lovely ones recently. Planning ours is lots of fun, too, but... see below.
- Being done with Step 2. I think this is self-explanatory.
- Knitting!
- (and, similarly) Reading! (I have actual books to talk about soon!)

Things that Are Hilarious:
- How the Cleveland Clinic starches the scrubs. I always forget this, and then I pull on a weirdly-crisp set of scrubs, and I think about how much better my real clothes would look if someone else tended to them.
- That was actually it, really. Starch! On what are essentially pajamas! I don't even know how (or to be perfectly honest, why) to starch real clothes!
- (The back half of season 3 of Entourage was pretty fantastically hilarious, though, now that I think about it. Highly recommended.)

Things that Will Never Be Done, OMG (even though they totally will be, of course):
- Ordering wedding invitations. Seriously, people: April 25th, 2009. Come hang out. It'll be fun. (I have to think about cardstock weights and ink colors for this?)
- Importing my CV into ERAS* one line at a time. Bah.
- Laundry. Bah again.
- Getting my car to e-check. Mostly because it is so low on my internal list of priorities, I keep forgetting it's, you know, something I have to do.
- Wading through my back-logged email.

Things I'm Looking Forward to:
- AAFP** conference: on Wednesday! (If anyone knows of some crazy-cool hotspots in Kansas City, let me know.) (I'm serious.)
- International Blog Against Racism Week: I talked about this briefly last year, but this is a really interesting (and, for me, a knock-me-out-of-my-comfort-zone) event, and I'll probably be linking around to different posts that I find intriguing. If I manage to blog more regularly.
- Emergency med rotation: So this technically started today, but I enjoyed it a lot and I'm looking forward to the rest of this month. (Which you should all remind me about when I'm cranky from having my circadian rhythms completely disrupted.)
- Being done with ERAS: which is a long way off (see above) but I've got my eyes on the prize, people. Or something.

So, that's ... wow, about all I've done for the last two months. I've been so computer-shy recently that not only have I not been blogging, I haven't been reading at all. So... how've you been?

* ... Electronic Residency Application System? Too lazy to look it up, but you get the gist.
**American Academy of Family Physicians (i.e. my future tribe) (!)

Edited to add: I can't believe it's been 19 days since I've listened to music on this computer! That's... really sad.

to break the still of day

Just popping in here to say that I'm loving family medicine. The patients come into the hospital, they get more or less fixed up, and then the same person follows up with them after their inpatient stay. And, you know, addresses the issues that landed them in the hospital in the first place. Love it. (Additionally, we're only calling consults when we have an actual question for the consultant. My consultant calls are going like this: "We've got a patient who's still having blood in his urine 4 days after his traumatic Foley placement and we've worked him up, done these labs, gotten this imaging and we're thinking it's 60/40 for Diagnosis A vs Diagnosis B but we'd like your input and additionally some recommendations on the current best treatment modalities for either diagnosis" vs "This patient has diabetes and we need endocrine on board. Just because." Incredible.)

I really don't have much else to say, and I'm off to bed in about 5 minutes, but just - *happy sigh* When do I get to go do this full-time for real again?

Also, totally stolen from Ben: go check out Pandora - it's this fantastically fun music streaming site where you enter in one or two of your favorite artists and it builds you a radio station. I've already found 3 new artists whose stuff I love.

title from "Of Angels and Angles," The Decemberists.

none of us forget about who we are

But, um, sometimes we forget to blog about it. I do apologize for all the radio silence around here lately - my only real excuse is that I've gotten back into writing fiction lately, and I've been trying to do that when I sit down to write. Nothing really ready for public consumption yet, but I've got about eight thousand words on a story that might have a viable plot if I can bring the fortitude to actually write it. (I'm trying to ignore the fact that it's going to require that I invent a religion from the ground up. There's already poems and folk songs involved, and I think it's just going to get worse.)

If you've been Ravelry-stalking me, you may see that I've uploaded some pictures of finished objects over there. I'm going to wait to post about them, though, in order to do an update sort of entry. (And it'll also give me some ready-made content while I try and remember to post regularly.) But here are some teaser pictures, from the Tuscany shawl and from the kitchen rug:


I've got two laceweight shawls on the needles, one of sort-of my own design that I'm very pleased with and another that I may end up frogging. The pattern isn't really speaking to me, and it's becoming a chore to knit it, which is, you know, not the point. I also started Eunny Jang's Endpaper Mitts, which are fun but may also get frogged and re-knit (I've only done most of one so far, but I learned a few lessons about colorwork in the process, which was most of my motivation for knitting them). I think it's interesting that I've reached the point in my knitting career where I can quite comfortably contemplate just ripping something out and starting over if it's not working out well. Gone are the days where every stitch was precious to me, and I think that's a good thing.

Non-knitting life stuff has also been proceeding in my blogging absence. I really liked my family med clerkship (surprise fun procedure I enjoyed? Botox, of all things. And I&Ding abscesses, but I knew that already) and I held on to the family-med love during my med-peds elective, so I think the winner is going to be family med in the end. I've set up two away electives in NYC (Beth-Israel in June and Columbia in November) so I'll be checking out some programs relatively soon. And applying not long after that, which is something I'm trying not to dwell on. I still need to work out where I'm staying in June, but I imagine Craigslist will come through when it gets a little closer.

I'm currently doing perioperative medicine at the Clinic, which lives up to its reputation of legendary organization. I'm already thinking about doing another core or elective over there. So I'll be hanging out in the ORs on the other side of the drape for the next little while, trying not to freeze to death. I have never missed being wrapped in non-breathable plastic-coated paper so much as I have today.

title from "La Familia" by Mirah; link goes to a remix that differs subtly but unfortunately from the copy I have sitting on my hard drive.

Anybody wanna join Pownce (messaging/social media/file-sharing network, now out of beta so you don't need an invite) and I can post these there? I'm theraveledskein over there, too - friend me and I can cross-post a copy of the next title-song for your listening enjoyment.

old men with broken teeth stranded without love

(Odds are Dylan wasn't intending to describe the patient population that comprises the vascular surgery service at the VA, but he did a pretty good job of it nonetheless.)

So, I'm back! Surgery clerkship is over and done with, and I have been a Very Bad Blogger for the duration of it, but frankly, there's enough whining on the internet, and I didn't have anything really positive to say. In summary, now I know how to: do a guillotine amputation, dress a lot of really nasty wounds, distinguish a mono- from bi- from tri-phasic arterial Doppler signal, recognize gangrene at twenty paces and keep my head down while angry people in nicotine withdrawal shout and cuss a lot. Valuable lessons indeed.

General surgery was far, far better, but still not what I want to do with the rest of my life (seriously, if I ever see another *^#%# hernia repair it will be too soon), and I'm happy to leave the OR behind for now. I'll have at least two months of gen surg during residency, but we'll cross that bridge when we come to it.

Speaking of residency, a decision has been made! I'm (99.9% sure that I will be) applying for family medicine residencies, and I am going to be spending June and November in Manhattan, checking out Beth Israel and Columbia-Presbyterian, respectively. The away electives are still pending some paperwork, but I think family med is going to be my eventual destination. As such, I am completely delighted to be on my family med clerkship, which has been really fascinating so far.

I start my outpatient clinic next week, and so this week I've been working downtown at Care Alliance, a clinic for the underserved. I don't know the exact specifics regarding who qualifies for care, but a number of the patients are homeless and most are uninsured. It's been a pleasure to be back in a primary care setting, and I've been really enjoying working with this population. I understand how chasing an obscure diagnosis can be really intellectually exciting, and there's the thrill of stabilizing and managing the acutely ill patient, but... seriously? A free bottle of hydrochlorothiazide (a super-cheap diuretic, used to treat high blood pressure and heart failure) can make an incredible difference in somebody's life, and hopefully prevent that somebody from landing in the ED retaining 40 kilos of water and unable to breathe.

So I'm still getting excited about preventative medicine, which bodes well for the whole family med thing. I'm going back to Care Alliance tomorrow, but today my big adventure was tagging along with one of the staff at 2100 Lakeside, a men's shelter downtown. The day included: a discussion with Cleveland PD regarding this hostage situation, a board meeting for another shelter in town, an hour-long intake interview with a new client, and a tour of five of the area's homeless shelters. It was a pretty busy six hours. (Generally, on this day of the rotation, us medical students shadow a nurse who drives a van around town providing mobile medical care for the homeless, but she was off today, so I saw the more administrative side of things, which was probably more of a unique opportunity.)

All and all, it's been a great week, with more professionally interesting and satisfying patient encounters than I had over all five weeks of surgery, so... three cheers for primary care! I've also had the opportunity to get my life back in order, and have gone to the gym, done some knitting, started a non-medically-oriented book, and even cooked dinner a couple times. And blogged! Which will hopefully be a more frequent occurrence from here on out.

title from "Shelter from the Storm," Bob Dylan

I want to wreck my stockings in some juke box dive

(Or, you know, be able to stay awake past 10 pm. That would be fun, too.)

There's something about cold rainy days that make me want to cook comfort food and listen to Joni Mitchell albums. Luckily, the weather is completely awful here (just cold enough that it's not quite snowing, but not really raining either) and I got out just after 5 today, so.... there's cornbread and muffins in the oven, and chili simmering on the stove. (If you're reading this and haven't had dinner yet, feel free to stop by around 8:30.) I really do enjoy this first part of winter, when snuggling up with a sweater and tea is not yet necessary to maintain my circulation and so it's just cozily comfortable.

Internal medicine has been tremendously fun, if time-consuming (see above re: my usual bedtime these days) and I'll be sorry to leave it behind and switch to surgery next week. I haven't quite figured out how to blog about my patients without violating HIPAA about six million ways, but I haven't had any crazy cases yet, so it really hasn't been an issue. I did hear today that we have the city's first influenza case in house now - 'tis the season.

I actually got some knitting accomplished over Thanksgiving - the shrug is finished (Karen, remind me to return your needles - thanks!) and I've finished 5 of the 7 repeats of Ben's scarf, so we're making progress. Photos pending.

I hope everyone had a lovely Thanksgiving!

I will not be afraid of women

(Dar Williams may be the most quotable songwriter on the planet.)

I am post-call and have not yet browsed all of this - or even most of it - but check out this collection of thoughts and opinions: "Feminism is not your expectation." Thought-provoking and interesting.

Because I love academics being totally geeky and calling it work: No, I'm not telling you what it's about.

It's hailing here. Profusely. How likely is it, do you think, that tomorrow's admissions are all elderly ladies who slipped and fell and have been hanging out in the ED all night? I hope not very likely. We'll see, I guess. (Also, I've apparently forgotten how to compose the future past tense. Did I completely mess that up back there? And is that even what it's called? Sarah, help me out.)

That's really it, I think. New yarn was recently purchased in a fit of optimism, fueled by the realization that, Oh, crap, it's not that far till Christmas. I really haven't done anything interesting lately, except work through the weekend and think about metabolic acidosis and morbid obesity.

How are you?