B Projects

On vacation this week. Thus, I have a lot of time to pursue my side projects. Perhaps too much time. The one depicted above literally occurred to me in a dream (it is also not real, for the record). Mostly, I've been spending my days waking up when I feel like, reading about Steve Jobs (visionary crybaby), and watchin' teh Netflix.

Oh, and I drew that picture of a dream I had and put it up on the internet. That too.


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Christmas!

Happy Christmas Everyone!

I've always felt sorry for December 26th - December 30th. Because let's face it, after this, the year is pretty much over. How can you hold a candle to this? No getting around it, Christmas is awesome.


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Milestones

Took a big test today. A test about pediatrics. It seemed appropriate to finish off such a test before I actually finished the rotation.

On these sorts of tests, they like to ask questions about developmental milestones. Babies have relatively predictable progression through their development of fine and gross motor skills, language development, and social development. The thing is, I don't lose milestones. I have become an unstoppable emmer-effer of block stacking.

I bet I could get at least 10.


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Next Steps

This is my last week in Pediatrics. Colon. Beginning Parenthesis.

I had a generally good experience. I think, in practice, a lot of my cohorts had a good experience with this third 'big three' (Medicine, Surgery, Pediatrics) rotation. By virtue of having done the other two, and having 4 months of experience under one's belt, I think we all tended to fail less often. Good for us.

Plus, babies is cute.

Next, I'm headed off to Ob/Gyn - so I am practicing my diction to avoid any confusion. Med-i-cal student. Not 'Midwife Student'. Or 'Janitor'. I hear the hours are going to suck. I have good feelings about January being a month where all the babies are born from 9-5 though. It could happen...


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Tempus Fugit

Medicine. Surgery. Pediatrics.

It is exactly six months ago that I took Step One, and started this whole... thing. You've got to be careful not to spook yourself by looking at the big picture too often. As a rule, I find it's better to just keep marching, putting one foot in front of the other and getting up to fight a new fight every day. But I've come a damn long way in six months. Good for me. Good for all of us.

I really have learned a ton about doctoring, which I assume will come in handy when I work as a doctor. I'm certainly not there yet, but I'm a whole lot less lost lately than when I started out. I've managed to break myself of raising my hand to ask permission to use the bathroom, for example.

Anyway, as we come up on Winter Break, I think it's valuable to take a moment and reflect on how far we've come. Or at least, reflect on the fact that, "We don't have to go through that emmer-effer again."


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Rout

I'm a Wisconsinite. I like the Packers. It makes me happy when they win. They won today.

And yet, while I am happy, there's also a sense of ennui. Had I been a Raiders fan, I might have turned off the TV in disgust. And certainly I wasn't going to stop watching the Packers win, but it seemed appropriate to start doing other things during. So it became more of a background game. With side bets. For example, will they more than triple the spread?


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New!!!

More dispatches from the grocery store, unfortunately. I guess pediatrics is giving me too much time to live freely on the outside. Anyways...

My roommates tend to flock toward bizarre, novel delivery options in food. For example, they wouldn't buy a Little Debbie cupcake, but some 'new and improved' ice cream cupcake that you store at room temperature and is exactly the same would be snapped up immediately from the end of the isle. 'Pancake in a Pouch', 'Maple Syrup Flavored Go-Gurt', 'Soda in a Ham' - all would be sought-after items.


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Jagged Little Marketing

OTC medicine advertising is dumb. I recently had occasion to purchase a bottle of Tylenol. All I want is some acetaminophen, allocated into proper doses, and covered with a little bit of coating so that it doesn't get murdered by my digestive system before some of it can be absorbed. Between brand names and generics, the grocery store literally had about 20 riffs on this simple theme. Every single superficial change you can make to this drug has been done, and then put in brightly colored letters on the box.

Guess what? "Extra strength" just means you take one capsule instead of two. "New formula" means that they added some orange food coloring to your NyQuil. "Dual action" doesn't mean anything outside the 'Not-Quite-Perfect' Glock Outlet Store.

So anyway, I went with the one that has two colors. Why would I pick plain white? If it works, it's probably good enough to paint with food coloring.


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Jumping the Shark

I remember the old times, when you jumped in the car, went places, and afterward were rewarded for your compliance. It was a simpler time, when life was more about he acquisition and deployment of stickers.

I really don't get it anymore. I mean, these kids have the internet, and yet they still seem to be pretty dead-set on a sticker-based reward system. It can't just be the brightly colored image - I mean, those are everywhere. My YouTube has 1080p. I don't know what that means precisely, but the image is damn good. So I'm left to conclude that the appeal of stickers must be in the overall stickiness - which is possible, as this is one of the prominent textures in pediatrics.

Anyway, as in all childrens' doctors' offices, we have rubbermaid baskets of stickers to choose from. In the processes of 'helping a child pick a sticker' (which is a mixture of building rapport and policing the process to make sure the kid doesn't just take 30) you often get asked certain questions, usually of the form, "Who's this?" I still know some of the characters - an Elmo is still an Elmo. But I'm pretty sure we have some unsanctioned stickers with nameless characters meant to look like they're from a Disney film that the child hasn't seen yet. I'm pretty sure that's what this guy was, but then again, I do watch way less Cartoon Network than I used to...


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Once More Unto the Breach

I was a diligent studier during my outpatient month; I've got my pediatrics questions from the UWorld squared away. High averages on those puppies, by the way. Very demoralizing. Anyway, if you know to give vitamin A for rubella, there's two free ones for you right there. Congratulations.

But now I'm going to have to start waking up again. Inpatient starts at 6am in some undisclosed location. These next few weeks are going to get rather dark - hopefully I'll manage to see some sunlight out a window or something.


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Thankful for Bickering

...Because political cartoons are black and white, that's why!

My apartment is politically savvy. That is to say, we enjoy sitting around, watching a DVR'd debate, screaming things at each other. The back and forth usually lasts about 30 seconds before the "baby killers" and "fascists" come out, at which point we calmly begin listening to the candidates again.

This year, however, has brought us like 2 debates a week. I think they have another 45 scheduled in December (including a Boxing Day Blowout of 5 consecutive debates, and Newt Gingrich doing 3 additional consecutive "Lincoln-Douglass Style" debates with people that don't know they're debating him yet). It's a lot. And the positions really don't change too much - so at this point, we're pretty much just doing dress rehearsals for Rick Perry to remember his entire name and which state he was governor of.

Ugh. Bring it home. I'm thankful for free speech, I guess?


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5 Minute Drill

In my apartment, 'occupy' jokes have become the 'yo mama' of the past week and a half or so. This exact moment is the apex, where they are 1) plentiful, 2) relevant, and 3) the concept hasn't yet been driven into the ground. Anyway, I sat down for 5 minutes and the above is what I came up with. Given another hour, I could have probably pounded out 50 more without a problem. It's an easy format to use. You just need a thing that is more or less compared to some other thing. Comedy gold.

For example, for my impending 26th birthday, I'm getting myself health insurance. It's the gift a 26 year old gives himself because he has to. In any case, the lady who does that sort of thing evidently does not work Fridays. 20% of the weekdays are 90% of the vacation days taken. #occupylazyinsuranceladysoffice

Eh. Nevermind. It's not funny anymore.


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Careful Scheduling

Since July, I have not had more than two consecutive days off. In fact, two day stretches of days off have been somewhat rare, statistically, though there have been more lately.

I have now worked my schedule to allow the following:
-3 day weekend
-1 day on
-1 day off
-1 day on
-5 day weekend

Whooooo!

That is all.


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Outgunned

My roommates and I have been playing MW3. I am good at a lot of things, but the new generation of video game playing kids has completely eclipsed my abilities in the first person shooter genre. Back in my day, we had auto-aim, and we just used one stick to control James Bond as he ran around environments with big polygons. But now, these kids find you on line and quick-scope headshots on your head. Or something.

They're quite good at playing the game.

So anyway, I play the multiplayer because it's there, and I like to unlock things and get better at things that I'm not good at. But there is a steep learning curve here. I feel like Jonah Hill...

See also: Vet & Noob


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Incremental Improvements

I am not what you would call 'good' at art. But I try, because it's fun to do. Furthermore, I don't see it as an entirely useless skill. Sometimes, for example, I would like to be able to draw a thing in which a thing goes behind another thing without the whole thing getting all befuddled and criss-crossy. That's the goal, anyway.

At some point, it must have been cool to say that oneself is terrible at drawing. I suspect this happens at about the same time that we all start saying that we are horrible procrastinators. Get some original weaknesses people. Just once, I'd like to hear someone say that they are terrible at hygiene and that their biggest weakness is heroin.

And then I would get farther away from that person.

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Professional Appearance

A lot of pediatricians don't wear the white coat. As someone who once threw up into the pocket of a pediatric dentist's white coat, I can see why. Other reasons include the fact that white coats ostensibly frighten children - I imagine because of bad experiences with barbers and butchers.

I miss the pockets, but I appreciate the sentiment. You just have to be careful not to go too far the wrong way.


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Closing

All done with surgery!

This is based on a true story. 'Based on' meaning that one time I was in a room with two other people, and I was thinking to myself some alternate lyrics for 'Closing Time'.

What ever happened to Semisonic, anyway? Whenever I think of these one hit wonder bands, I think of how funny it would be to act as though you expected to have your love for some obscure, defeated band be reciprocated by this new acquaintence. "Man, I'm so excited for the big Blind Melon concert that's coming up. Aren't they great? You wanna come with me? Big T-shirt swap at my place later, you should come!"


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Marketing

One of my 'toward the end' patients on surgery required, among other things, a colectomy. Generally, when you're doing surgery that involves cutting the bowel, you want to do a 'bowel prep' to maintain asepsis to the extent possible.

In other words, to keep shit from getting everywhere.

There are a few products that will do this, with fun names like GoLytely. A gentler option, apparently, is 64 oz of Gatorade with Miralax dissolved into it. We had cause to wonder if the Gatorade people knew about that, and if so did they have initial branding disscussions in which they had to choose their marketing path. I.e.:

"Gentlemen, we can market this product one of two ways:"

A) Gatorade is a tasty sport beverage.

B) Gatorade is a conveyance of dissolved nonabsorbable osmolytes that will purge your bowels and scourge your mucosa of any solid remnant.

It must have been a tough choice - I bet the hospital can charge like $20 per bottle...


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Jealousy

Four days left on surgery. Home stretch.

I like when I can help with things. That is, I like to be assigned useful tasks I'm good at. For example:

1) Page me when the patient goes to the OR - Good task, can do, serves a purpose.
2) Hold this retractor with your left hand - Another good task.
3) Write a note that we can't use and no one will read - Not such a fun activity.

Useful busy work is okay, un-useful busy work annoys me. Recently though, one of my main jobs (retracting) has been outsourced to this bizarre piece of equipment that looks like a spider (retractor). I guess it's actually called an 'Omni-tract'. My list of useful, doable jobs is being encroached upon! The worst part of this is that I am then left with no task to do, so I steal some other piece of equipments job - such as holding the suction hose closed (thereby stealing some clamp's job... it's a vicious cycle).

I'd like to wipe that pretty extender off the omni-tract's smug lode bar, if you catch my meaning.


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Two Rules

I've lost about 5 pounds on surgery.

I'm not the only one with the weight change. I can think of at least a few others who have gone up or down a few pounds since this thing began 7 weeks ago. They're asking us for feedback; I want my time to feed back.

Feedback? Feed back!

I think it might actually be pretty sensitive. Rather than solicit everyone's subjective and inane interpretation of whether they have been overworked or given adequate time for activities of daily living outside work - I think they should just have a 'weigh-in, weigh-out'. The data is there.

In any case, I have definitely learned to eat when I can, because sometimes you are stuck in surgery (or worse perisurgery) through two consecutive meals. But what can you do except grin and bear it? Right of passage, and all that jazz? Sometimes, you scramble home with a bag of McDonald's that you eat as fast as you can so you can get to bed and be back to work in seven hours. It happens, and all you can really do is count the days down until you get to eat like normal people again.


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Crossover

This is the beginning of a little project I'm dabbling with. It's a fake, fake children's book titled ABCs of Bovie. Fake (1) because it would make a horrible idea for a real children's book - kids don't need to be exposed to electrosurgery until they're at least 8. Fake (2) because it's not really a book; it's a powerpoint presentation I'm whipping up to satisfy the humanities requirement for my surgery rotation and get out of doing some H&Ps.

Really though, the bovie is arguably the most ubiquitous surgical instrument. I'm not sure I've done a surgical procedure (some fistulagrams notwithstanding) where the bovie did not get significant playing time. It's not a classic like the scalpel, or as awesome as the argon laser, but it's a damn fine cutting tool all the same.

I expect the book to follow on the heels of my previous bestsellers in surgical/childrens literature: A Beginner's Guide to Tying Tiny Knots, The Grumpy Attending and the Lost 'Long Richardson' Retractor, and Your Stepmommy's New Face.


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Zeus and/or Jupiter

I think the best tool is the bovie.

For those not in the know, a bovie is an electrosurgical device that uses step-up voltage and alternating current to create a stream of electricity that heats tissue at the point of the instrument to 750 degrees F. Hot enough to stop bleeding, cut through skin, and create a smokey plume for the JMS to corral with the suction.

It's pretty neat, and ubiquitous. I think for how much it gets used, there should be more said about the bovie. Popular media is letting us down! The age of the scalpel is over, long live the bovie!


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Latinized

I found out the other day that I had been spelling 'flatus' wrong. I don't want to go into it, but I thought it had the old fashioned double 'u', as in Equus. It doesn't.

Luckily, since my notes are not binding, not legal, and not read, it is not such a big deal.

Effing Latin.


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Wierd Fact

I figure I know about 10,000 human beings.

Not that I necessarily know them all well. I just think I have met about 10,000 people and been around them long enough to make some quick judgements. I have met, out of the 10,000 I know, the most terrifying human being on the planet. Granted, other people also have a 'most terrifying', and I expect there will have to be some kind of double-elimination runoff system to truly decide the contest. But I am confident that I found the guy, the Most Terrifying Human Being on the Planet.

And he is a surgeon.

A lot of surgeons are nice, caring people who will gladly take a moment to teach you something when they discover a gap in your knowledge. The majority are like this, in fact. But the field also breeds a type of person who has so thoroughly refined their own expertise as to alienate themselves completely from the relative incompetence of all other human beings.

Then they get mean.

I suppose the other part of this equation is that an OR is a special situation, in which there is not always time for pleasantries and manners. But I like to think that I would not be the kind of person who had to yell at someone for not having a tool. Especially not if 99 times out of 100, they can turn around and slap it into my hand within 2 seconds.

I wish I had someone like that. That would be handy. Hasta la vista, pockets.


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COPD

Staff asked me the other day if I could imagine what it would be like to be a pair of sick lungs. Not to have a pair of sick lungs, mind you, but to BE a pair. I can imagine that. Represented above is my best attempt at recreating the image that popped into my head.

Actually, this sort of thing happens to me a lot. Do you ever get that feeling where you're trying to suppress a laugh about something stupid, which just makes it funnier? I find the best bet is to let it out and fake a cough or two, personally.


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