I haven't posted in a while

And the end of the year is approaching, which means I'll probably take a trip through my really really old posts.

You might, too.

Pretty much. 

Shelf exam over

Guilt free TNG

Watched delightfully by D

As he drinks green tea

Finally got to use it

D makes fried chicken, a photo essay.

 Trying to use as little words as possible.

Smoke from the burning

Only a couple of possible outcomes

When every shift ends, you think to yourself - Did I actually do something? Most of the time, the answer is... 'sorta'. I sorta helped. Of course the attendings did something, residents a bit less, but them too, so maybe it's not a discontinuity when you get to the med student - Maybe I did something too.

But this always happens. When you do a thorough H&P, plucking every flower from the crannied wall, a few things can happen

1. Grunt - Patient grunts, you get along with your day and start thinking about the A&P. 
2. "Ok thank you" - Get along with your day, start thinking about the A&P. 
3. "Thanks doc" - Sometimes I let this slide, especially if it's a combative patient refusing blood draws; I may need to come back later with the nurse and throw down the short coat hammer.* But sometimes I correct them.

"Not a doctor, not yet." Some of them then say "ok." Others say "Oh.. nurse, then?" Haha. A few (and just a few) tell me "You're a doctor to me.."

Always important to end correctly and on a high note. 

Finally I recently had a patient with increased white count and vague abdominal pain (per nurse). When I went to go assess him, he didn't want to talk about his abdominal pain (non existent). The first thing he says is "My uterus is giving out."

In the back of the ER, were beds are 1ft from each other, about a dozen patients chuckled. I mostly held it in and looked to see if he had an adam's apple. He did. 

*In possibly the longest aside ever, on my last day of Transplant, there was a patient who didn't have morning labs. The assumption? Patient is leaving. A shitty way to draw conclusions but it happens. 

When I got around to his floor, he was still there. He had refused morning labs. And noon labs. I talked to him. He wanted two pillows and a blanket. I got him two pillows and a blanket (and is it just me or does everyone look at me funny when I ask where the linen cart is?). I made him compare his hand with mine (he was jaundiced like a diseased frog), asked him whether he thought that was off. "It's off." So can we get some blood to find out why? "Ok let's do it." Told the nurse to page the incoming student if there were more problems. Boom. Ending Transplant like a bawss. 

How to have a successful call

A guide for MSs.

I just finished a month of MICU (awesome) and 2 weeks of Transplant. Here's what I got. Night call is a terrible, terrible beast to be conquered but it's possible - dare I say.. easy? Follow these steps (in no particular order).

1. Workstation - Regardless of which hospital you're at, you better have a place where you can access all the records and labs for every patient you are monitoring, with a phone nearby. This sounds stupid but when I was on Transplant at SLEH/TCH, I didn't have TCH access to certain areas (nor EPIC access) mostly because I didn't have the time to sit through a 6 hour training for something I already knew how to use. So I had to bounce around a lot, let my upper levels log in. BT-MICU was simpler.

Primary recommendation - Find a computer, claim it (easily done if you clutter the workstation with your own crap) and hack away. Don't let anyone near it 'til the morn.


2. Food - gfy, I'm not a fatty, this is important. Bring food from home. Is it just me or did the interns stay much less than MSs when they were on night call? MS on night call means - still have to show up that morning (~6am) and leave the next day with the intern (~10am). Holla, 29 hours. How much food did you bring? Probably ate it all by lunch time, huh? I've done that. Best to just bring in a bag of stuff, like you just came from Kroger and it's your stash for the week.

Primary recommendation - Say... 5 sandwiches, 4-5 yogurt cups, 5 granola bars, possibly some powdered gatorade and whatever else you need (see #3) per 24 hours.
Secondary recommendation - Blow your life savings at McDonalds and pine afterwards at your grossly inflated food expenditures.

3. Coffee - Doesn't work on some people, doesn't work on me. However, with the abundance of free coffee and espresso and cappucchino at TCH, I became a junkie. I was lucky that they had the french vanilla creamer almost everywhere, but just in case they didn't (SLEH does not, just regular creamer*), I had a ziploc back full of my french vanilla elixir to make my coffee palatable.**

Primary recommendation - Just hit it repeatedly. It's not going to work after 2-3 days of abuse anyway and it has other effects, which brings me to..

4. Self-fucking-care - Does this mean daily exercise? No, although that's ideal (and possible). After about 16 hours of being awake, I'm not necessarily slower, but clumsier and start taking shortcuts.. Once after leaving the OR at 11 I flung my arm like a rabid orangutan into the wall panel door switch/plate and a small screw on the plate took a clean chunk right out of my index finger. I should have moonwalked back into the OR main desk and slapped on some tegaderm for some overkill wound protection but I ended up coddling and nursing it instead and wondering when the granulation tissue would appear.

Primary recommendation - Bandaids, listerine (because although you may end up looking like warpig after a while, at least have that minty cool breath), ibuprofen
Secondary recommendation - Not being a dumbass.

5. Clothing - This could fall under self-fucking-care, but it deserves its own category. My body is used to dropping the temp at night. Hell, I still sleep with covers on, in the middle of Houston. Bring extra clothing. This does not mean your whitecoat. Bring a real coat. This was a long time ago, but on OB L&D nights, after the first night, I came with a jacket, sweater, scrub top, tshirt and definitely had all 4 on at one point. Feels good, man. On MICU night call, because I have Alzheimer's and forgot to bring extra clothing, I was hitting up all the blankets I could find. Thankfully MICU has its own linen cart to pilfer from. Figure something out. Jeans under scrubs (seen it / done it). Hoodie like Eminem, all the time, even when seeing patients (seen it).

Primary recommendation - Extra clothes
Secondary recommendation - Linen cart. Find it, use it.

6. Rest - Good thing we just covered warmth and food and self-care so you're not bleeding because if you've taken care of everything, you'll feel tired. Find 10 minutes to wig out, and wig out. That's all. Just do it. Don't make it excessive or anything. On MICU, I used to set a timer for 15 minutes, put my head down and once the timer was up, go around and see all the patients and make light conversation with them*** if they were awake. This is also where #1 is important, for if you've claimed a good spot, you can wig out there. I do not recommend finding a bed, you will be in it for hours.

Primary recommendation - Take some time off. Very few ways around this.

*Regular, unflavoured half and half? What kind of plebian horseshit is that?
**And by coffee I mean, cream and sugar, with a little bit of coffee to taste.
***Hospital TV is atrocious.

Trip - 12 - Hotel in Jaipur

I much preferred the Janakpuri Hilton. Here are some pics. 

I'm just going to ignore the fact that I haven't posted in > 1 mo.

Every night...

Trip - 11 - Jaipur clothing

Just a picture:

Ninja edit: They pretty much made whatever you wanted. A ton of white people were at this particular location for some reason, trying to hammer out simple English for the locals to understand. 

Trip - 10 - Pizza Hut

I'm not the only one to get homesick. Shit-fits were had, and it was either Pizza Hut or KFC (I think).

There were unusual masala flavors. No anchovies, though. Also, they were playing club music? 50-Cent and the like. Dance music. What is this, Pearl Bar?

Can't do without.

I got homesick a lot. Can't do without this memento from home. Every trip I go to starts with me landing at the airport and thinking - fuck this, let's go back. Regardless of whether its Yosemite, Vancouver, NYC, Singapore, New Delhi, Costa Rica. 

I'm not an Apple fanboy but I've had that iPod for years and it works awesomely. Battery life is down to about 8 hours but I hear replacement batteries are on the order of  $15. 

Trip - 9 - Open Market

This : http://en.wikipedia.org/wiki/Chandni_Chowk

Part of the problem.

The current screen shot is last night. 

4h 33m over 21 nights. Are you kidding me. 

No wonder I doze off for about 20m around 4-5pm. 

...

I bought a bunch of bowl noodles from Costco. I should have read the damn label.

Beef tallow? Who still uses this stuff? From Wikipedia - "Tallow is used in animal feed, to make soap, for cooking, and as a bird food." Bird food.

So I bartered 2 off for a Lean Cuisine.

Didn't fill me up.

Finally started using some raw ingredients

I will call it - shrimp breakfast tacos. No egg added though.

Trip - 8 - More Taj Mahal

One of the flanking side buildings. That's how bad my knowledge of the Taj Mahal is - "flanking side building"

Looking upwards at the Taj Mahal

Someone was right about people trying to steal the gems in the wall. 

Not too much to comment on here. 

Pretty much.

I'm going to be jacking a lot of her pictures.*

Also:

I'll be posting some of my artwork sometime too. I got this program for the iPad to draw on. Disclaimer: I am not an artist.

Edit: I just wiki-ed tumblr for the first time ever and perused through the site. Now I'm considering a move to tumblr. No worries.

*: I kept the watermark!

K, done.

Man, this book is a beast.

If you'll remember one of my earlier posts - I was supposed to finish one book a month. Well this one was so long I had delegated it to finishing it over two months. Nah. 10 days in to April, and might I add reading furiously over this last weekend, it's done. 

I recommend it although I am heavily biased, even within the medical community, towards oncology. I was lightly displeased at the lack of mention of gliomas. Although traditional visceral cancer has just recently seen targeted therapies, it's not so with neuro-oncology. 

Also, over 1000 pages* and no mention of p53!? 

I had mentioned that I'd get some sort of reading device. I joke that I need my laptop to keep me from playing games on the computer and that I need this device to keep me from watching Star Trek on my laptop, but it's partially true. Speaking of watching stuff / wasting my time, that new series Camelot on Showtime isn't half bad. I'm also intrigued at Gigolos. Haha.

Initially I decided to give Honeycomb a chance and got the wifi version of the Xoom. The screen was nice and multitasking far better developed than the iOS systems but the interface was choppy. I'm a big fan / user of Google's services but I'm not sure what possesses Motorola (or Google for that matter) to come out with a tablet operating system largely inferior to something that came out a year ago - the original iPad. 

Google books is limited and locked from loading your own ePub or PDF files. Flash support exists, but flash kills the device's battery life and brought the webpage of the New Yorker to a crawl. 

Fuck that.

I returned it a few days later and for the same price, got me a 32GB iPad 2. Yes the camera is inferior, but I've taken one picture total, just to see what it was like. Also, incredible battery life. In fact, when I just finished the aforementioned book 10 minutes ago, I was at 8%, having last charged it to 80% Friday afternoon. 

Read that last line again. By comparison, I've had to charge my iPhone >2x a day on average to keep it al

What of the overall goal? Can I focus more? Read better? Probably. We'll see. 

Next up:

I'll let you know how that goes. 

*: iPad pages

Rediscovering some old stuff

Time to update my wakeup cd. I'm starting to think I may need to update my alarm clock too. 

Some preliminary data

I started biking to school. I'm thinking I might keep this up.

The numbers include stopping at crosswalks and locking up my stuff. 20mph!

Taj Mahal

Yep, I was there.

Leading up to it. Lots of people come and try to sell you little trinkets at prices which I thought were totally reasonable. They probably mark it up at least 100-200%. At least. What, a snowglobe for $3? Probably cost 0.45c to make. Come on!*

Lines outside the entrance, separated M/F. It's sort of dirty outside, but well maintained inside. 

Glory shot. Extremely crowded. I singlehandedly negotiated a guide for 50 rupees. He wasn't a very good guide. I did learn the minarets are slightly angled outward in case of an earthquake, so they don't break the primary structure.

*: In Job's voice.

Resolutions

I stuck to my 2010 resolutions - start cooking, exercise more, learn to invest*
Here's one for 2011 - relearn to read. The goal was one book a month with magazine articles and the like intercalated between.

So I found a subscription to Rolling Stone for $4 a year and ordered three years' worth.

I also bookmarked a few sites to visit. A recent favorite is theweek.com. The problem is - reddit. And facebook. And music.**

My solution to all that is to get a tablet - single purpose (mostly) and won't distract me as much. I could discipline myself more, but it's time for a new toy anyway. The xoom-wifi is coming out on the 27th. Current plan - play with the xoom at Costco some, then get the tablet if I like it. Else, iPad 2. I will have a tablet by the end of this month, come hell or high water.***

In any case, I finished up -

January - Casino Royale
February - nothing
March - Finished up Fahrenheit 451 (again), working on Emperor of All Maladies... to make up for the deficit, and then will finish up Our Inner Ape
April - The Immortal Life of Henrietta Lacks? Something else? Suggestions?

Looking forward to getting a tablet.

Finally, I only have 2 resolutions so far (haven't mentioned the other one). I need one or two more.

*: Tacked on late.
**: Will talk about my autism/asperger's at some point.
***: Sigh.

Trip - 6 - Finishing up

I just got back from Costa Rica. Those pictures will follow at some point. 

There were lots of monkeys in Fatehpur Sikri. They don't give a damn about people around, unlike the ones I recently saw in Costa Rica, who were terrified. I made a face at one, he made one back. 

You can see the Taj Mahal from Fatehpur Sikri off in the distance. 

Close up and enhance!

Taj Mahal shots next.