Out and About

Life is changing again, and I am trying to keep up.

September was full of shifts crammed together, a week of interviews, and getting to spend one whole weekend with my husband.

October brought on oral boards, a visit to AG and my hometown, and the never-ending upper respiratory infection.

November meant AG returning home after five months of training, a Thanksgiving with his family, and a house hunt.

We are relocating in May to a much warmer location! We have been trying to work towards making it a smooth transition. I have found a job and signed a contract, we found a house and are closing on it next month, and we crammed in several visits with friends at the beginning of the month.

I just receieved word this week that I passed my oral boards, so no upcoming tests looming over my head!

Now if we can just catch up with all of the holiday shopping.

More Testing

Last weekend, I flew to Chicago to take my oral boards. To be board-certified in Emergency Medicine, one must first pass a written exam (woohoo!) and then the oral boards. Oral boards are scheduled twice a year, and there is a lottery system to determine whether or not you get the Spring or Fall test date. Luckily, I drew October, since there was that whole wedding business going on in April.

If you ask me, the concept seems kind of outdated. The oral boards take place in a hotel by the airport, and several floors are rented out. Over a four-hour block, applicants are shuffled around from room to room, and given test cases. Basically, you go into a hotel room and sit down at a card table with a plastic divider set up between you and the examiner. They give you a sheet of paper with a few lines on it, and some vital signs. From there, you have to ask 50 bazillion questions to scratch out a review of systems and physical exam, and respond to the answers given by the examiner. It's like a painful GI-distressing version of "20 Questions" in formal business attire. You are also given x-rays, EKGs and lab results to review on the spot. Each case lasts about 15 minutes and there are a few multi-patient cases that last 30 minutes.

The whole situation is just awkward, from having to wear a suit, to being in hotel rooms, to trying to picture a patient that is not in front of you and respond to them. I feel that it is outdated, as a lot of residency programs (mine included) have Simulation labs, where residents are tested with interactive mannequins that you can do procedures on and respond live to your interventions. I am just not exactly sure what the oral boards are testing. My knowledge base was already tested with the written exam. They can't really test my bedside manner or procedural skills by a on-the-spot dialogue in a hotel room. It seems like they should just get rid of the oral boards or modernize them with Sim testing if they really want to ensure that candidates have been trained equally by their residency programs.

That being said, I do think that the Board does go through a lot of effort to make sure that everyone is fairly tested, from their bizarre scoring system, and all of the examiners were very courteous and professional. All of my patients lived, and I think that I passed, although now I have to wait for three months to get the official results. Even more revealing is that once I am board-certified, I will have to take the written test every 10 years, but never the oral boards again, so I don't really see the point in the whole thing.

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The nice thing about the weekend, is that I did get to see some of my buddies from residency. We went out to dinner together after the test, and then took the train downtown to a piano bar called "Howl at the Moon". It was a fun place, and there were a lot of people there who had just run the Chicago Marathon, and still had energy enough to dance away the night.

Here, for your viewing enjoyment, is a new bride dancing to "All My Exes Live in Texas"... the groom was off drinking in the corner.

9

It is hard to believe that it has been nine years since September 11, 2001. While I personally didn't lose any friends or family members that day, I still remember that awful feeling of seeing the Pentagon burning, planes crashing into the World Trade Center towers, and people evacuating across the Brooklyn Bridge on foot.

A lot has changed in my life in the past nine years. At the time, I was working as an EMT in Arizona and had come into work early that morning as a favor to a co-worker on the previous shift. It was still dark outside, and everyone else in the ambulance station was still sleeping. It was almost 6 am, and I had just finished watching a movie on TV and switched over to the news to see all the madness and confusion. Gradually, my partner and other co-workers came in for our shift. The entire day was spent glued to the television when we weren't out running calls.

What started out as an ordinary day turned into a defining moment for so many people. It is unfortunate that this year so much media coverage was drawn by a hatemonger not deserving of attention. I hope that friends and family members of both those who gave their lives and those who were victims by chance have found some healing. Hopefully, in years to come, September 11 will be less about uniting against Muslims, and more about uniting as a country.

Hard Times

Me: "So, the chart says that you cut yourself yesterday?"

Pt: "Yeah."

Me: "Why did you do that? Were you trying to hurt yourself?"

Pt: "Yeah. I thought that if I cut my hand deep enough, you could amputate it, and then I could get disability."

Me: "Do you work now?"

Pt: "No, I'm on disability."

Me: "So the idea was to get more disability?"

Pt: "Yeah."

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No, the hand didn't need to be amputated, it was actually a very minor laceration. I guess the economy is hitting everyone pretty hard right now, even disabled schizophrenics. And for the record, I don't think that you get bonus diability money for further injuries, so don't try that one at home.

Restrepo

The other weekend, AG and I went to see the movie "Restrepo". I actually hadn't heard anything about this movie, and apparently it is only playing in certain theaters. AG had heard from one of his instructors that it was playing in Tucson, so we were able to catch it up there.

"Restrepo" is actually a documentary that follows an individual platoon during most of their 2008 deployment in Afghanistan. It was filmed by embedded photojournalists from National Geographic and won an award at this year's Sundance Film Festival.

I was particularly interested to see the film as the platoon was in the Korengal Valley in the Kunar province, which borders Pakistan. AG spent the second half of his deployment in that province, and so I was curious to see what it looked like. Apparently, we abandoned operations in the Korengal Valley this past April. For me, it was interesting to see the things that we had talked about. During the first part of his deployment, he was at a small outpost and talked about establishing perimeters and building walls from HESCO's (large containers filled with dirt).

Most of the soldiers in the platoon were very young, and I guess that from dealing with a large military population at work, I have become somewhat desensitized to this. What did surprise me though, was seeing how much responsibility was put on this individual platoon. Most of the direct supervision appeared to be coming from one sole captain, although I think a lieutenant colonel did make an appearance at one of the meetings with village elders.

I didn't really get a pro- or anti-war feeling from the movie. A good bit of it features one-on-one clips with individual soldiers, and clearly several of them are dealing with PTSD and are yet unable to process their experience. I wouldn't say that the film is very graphic, although when one of the platoon's members is killed, it does show the varying coping mechanisms of the soldiers, ranging from rage to complete shutdown. I think that whether you are for or against our current involvement and Afghanistan, this documentary gives the viewer a good idea of just what today's individual soldier might experience during deployment.

The Distance to Here

Well, so much for regular updates. Life has been a little complex lately. AG (Army Guy) and I have been married just short of four months now. We had about a month together after the wedding, but the last three months we have been apart. I suppose that it is not the most conventional arrangement, but we are making it work.


Basically, AG is at a point in his military career where he had to attend a six-month long officer course. AG was able to transfer out of the infantry and into an intelligence position upon redeploying from Afghanistan. We had talked about it a lot, and with his unit already slated to go back to Afghanistan in April, it just seemed like too much. The plan is for him to transition to his new base after completing the career course. I was still under contract with my EM group when he started the course. It also didn't make sense for me to apply for a state license and a position for six months or less, so I have just stayed on with my group.


Unlike his time at remote bases in Afghanistan, we have been able to communicate regularly by email, daily phone calls, and Skype. We made a road trip of driving him out West, and set him up with enough linens, kitchen supplies, and clothing to live comfortably with. My group at the hospital has been really supportive, and I have been working a compressed schedule. I still do full-time hours, but squeeze a month's worth of shifts into a 2.5-3 week period to accommodate me visiting AG for a week at a time, once a month. I won't say that it isn't tiring. I have been trying to revamp my exercise habits, but most of the time, I am just too tired after work. It has also been an expensive arrangement, between paying for rent and utilities in two locations, and monthly flights. In the end though, we have both decided that it is worth the expense to keep our marriage strong.


Currently, I am out visiting. I have been trying to be productive: doing job searches, applying for a medical license in a new state, but to be honest-- there's also been a lot of daytime TV watching and lounging around. Things were hectic for a bit when we were thinking he was going to start at the new base in January, but now it looks like nothing will happen until next spring.


This time around, I am taking my job search a lot more seriously. My current job I pretty much just walked into, but this time there are recruiters and job postings to try and decipher. It is also more serious as we are looking at spending the next 15 years or so in this next location, so I need to find a job that's a good match. I think that we both have a lot of exciting changes to look forward to, but it does kind of seem like we are currently in limbo.

Yellow

I looked at the nurse's notes, and there it was:

Chief Complaint: "My skin is all yellow."

I sighed, and pulled back the curtain. 2 am isn't exactly when my peak diagnostic skills are kicking in. To be honest, I think I almost dropped my clipboard when I first saw her. Icteric eyes blinked back at me. There in the stretcher was probably the most jaundiced woman I have ever seen. She was fluorescent yellow, including her scalp.

As we chatted about her medical complaint and history, it was clear that there wasn't going to be a happy outcome- progressive jaundice, abdominal pain, unintentional weight loss. This was all adding up to cancer.

The patient related that she had been seen initially in an urgent care and what started with x-rays led to a referral for a CT scan as an outpatient. She had no private physician-- "I'm healthy." She said that she was told that she had a hiatal hernia and was put on an antacid, but it wasn't helping. In fact, she thought the medicine was making her more yellow and now was giving her itchy skin, so she quit taking it.

I asked her if she had the report, and she handed it over. Sure enough, in tiny print, it mentioned a hiatal hernia. However, just below that, there were several more lines about the existence of multiple masses in the liver, abdomen, pelvis, and spine. I asked her if she was told about the tumors, and she said no, but an appointment had been set up with a local specialist at the end of the month.

I reviewed our labs with her and told her that it didn't look good. I called the hospitalist for admission and ordered a contrast study. I went back to the patient and told her we needed more images to define the tumors better, but it looked like she had widespread cancer and that it was likely too advanced to be treated. I'm not sure where her cancer originated from, but at this point, she will probably just be put on palliative care, or referred to home hospice.

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The way that the woman presented herself from the beginning was kind of bizarre. I feel certain that she must have been told about the tumors, and she had a copy of the report in her hand. I think that she was just in denial, and hoping that her symptoms could be blamed on anything else. She did thank me for letting her know what was going on, I just think that the diagnosis was probably too much for her to process the first time she heard it.

Voodoo Child

Nobody died during my last shift. Normally, I would say that deaths in the ED (at least mine) are a fairly infrequent occurrence. However, for a couple of weeks, I was pronouncing someone every shift, sometimes two a shift. In my defense, all but one of them were dead on arrival, so it really had nothing to do with me, but it still got around to where some of the techs were calling me Doctor Death.

Most deaths at home involve calling patient's primary physician to sign the death certificate, but trauma-related or unexpected deaths get passed on to the medical examiner. During my last conversation with the ME, he asked if maybe there was someone sticking pins in me because it had only been just over 12 hours from the last time that I had spoken to him.

I blame it on summer. When you live somewhere where winter can last for seven months, people are eager to get out on their boats and motorcycles in good weather. Trauma cases seem to peak, not to mention heat-related deaths from elderly people living in hot, older homes with no air-conditioning. Hopefully, July and August settle down some.

Um, Not Dead

Sorry, things have gotten pretty stagnant around here. I am now a married lady, and there's been a lot going on. I haven't entirely forgotten about blogging, it just kind of got shoved on a the back burner. I have been thinking more about what to do with this blog--whether to start a new one, and whether or not I want to re-evaluate making this more accessible to friends/family.

Thanks to my few loyal readers for your concern, and for not giving up on me entirely.

Looking Up

Currently, I am feeling rather content with myself.

• Downstairs, there are BBQ ribs slowly cooking and tenderizing in the crockpot, releasing a wonderfully spicy smell.

• My legs and butt are giving off small, painful protestations about how they have spent the last two days at the gym every time I sit down or climb stairs.

• AG has been home for almost two weeks now, and it is starting to feel more like our life rather than my life.

• A white envelope arrived in the mail two days ago, and... I PASSED MY BOARD EXAM!

Don't get me wrong, there are still plenty of things to worry about... the wedding planning I have been dodging lately, oral board exams now that the written component is finished, and a project that I can only refer to as: The 3rd Bedroom, and all of its messiness. But for now, I am enjoying the moment.

2009 Reading List

Currently I am recovering from a string of overnight shifts. Here are my reads from this past year. Since graduating, I have tried to not be a complete recluse by joining a book club. It has been good in that a lot of the books I probably would have never come across otherwise. As far as discussion goes, we are really more of a wine and dessert club, with often hardly a mention of the month's read.

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Walking Across Egypt - Clyde Edgerton. A funny, quick read-- kind of like reading several episodes of Golden Girls.

Twilight - Stephanie Meyer. This was a gift from someone, and I was curious about what all the fuss was about. It seemed like there wasn't near enough action in the book to warrant it's length.

Empire Falls - Richard Russo. This was a book club pick. About life in a small town, where nothing seems to ever happen, and everyone is stuck and unhappy with their positions in life until there's a dramatic turn at the end.

The Proper Care and Feeding of Marriage - Dr. Laura Schlessinger. This was a homework assignment for AG and I by our chaplain (I have yet to meet the guy). There were a lot of duh! forehead-slapping statements in it, like how one should treat their spouse nicely if they want niceness in return.

All the King's Men - Robert Penn Warren. Would have been better had the politician been shot much earlier in the book. Apparently, this was made into a movie, which I probably should have just watched as it wouldn't have wasted as much time.

A Tree Grows in Brooklyn - Betty Smith. Somehow I avoided reading this in high school. I liked it, as its protagonist is a scrappy girl and her struggle to educate herself and rise above her surroundings.

Hornet Flight - Ken Follet. WWII thriller, a nice, quick and entertaining read.

Dead Heat - Dick Francis. I had never heard of this author before. My future father-in-law lent me this book, and I really enjoyed it. It's about a chef who keeps having accidents until he figures out that someone is out to get him, and becomes a bumbling detective in the process.

Scarpetta - Patricia Cornwell. It had been a while since I had read a Kay Scarpetta thriller, and I think that this one may be my last. Cornwell seems to be capitalizing on America's current obsession with Little People. It was so bad, I donated it to the hospital library in St. Lucia.

The Last Juror - John Grisham. Read this one on a plane. It was entertaining, and more about Southern living than legal sleights of hand.

One More Day - Mitch Albom. Very quick read about an alcoholic and his regrets for not appreciating his mother.

The Proper Care and Feeding of Husbands - Dr. Laura Schlessinger. Another homework assignment. I thought the first one was misogynistic (if that's possible from a female author) until I read this one!

Crime and Punishment - Fyodor Dostoevsky. I was warned that this one would be a difficult read, but I didn't think it was too bad. A disillusioned student murders out of theory and then drives himself mad dwelling on it.

Peace Like a River - Leif Enger. I think that this book was probably the best discovery I had from book club this year. The characters are very likable, and the story is about miracles happening as a result of faith to keep a family from falling apart.

The other benefit from joining a book club has been rediscovering the value of the public library system. My local library is in a historic building from when this crippled town was populated by millionaires. It has marble staircases, a domed ceiling, and lion statues guarding the front door. It is much more accessible than libraries were when I was younger. One can reserve and renew books online. Checkouts are for four weeks, rather than just two. The library is also linked to three other ones in the area, and they don't even mind which branch the books are returned to, regardless of where they came from. In times when people are looking for cheap entertainment, I would suggest the public library system, as you can also check out popular dvds and workout videos with equipment!

Past reading lists: 2008, 2007, 2006, 2005

2009 In Review

I borrowed these questions from another blogger. Several of my answers are kind of redundant, but if you've been reading lately, it has just been that kind of year.

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1. What did you do in 2009 that you’d never done before?


I sold my house, and took my Emergency Medicine boards.


2. Did you keep your new year’s resolutions, and will you make more for next year?


It doesn’t look like I made any last year, but this year I am going to shoot for being fitter, smarter, stronger, and a better cook.


3. Did anyone close to you give birth?


I can think of 5 friends with new babies this year.


4. Did anyone close to you die?


Nope.


5. What countries did you visit?


St. Lucia and Canada


6. What would you like to have in 2010 that you lacked in 2009?


My soon-to-be husband around on a daily basis!


7. What dates from 2009 will remain etched upon your memory, and why?


End of residency- June 30, 2009.


8. What was your biggest achievement of the year?


Graduating and starting my first full-time EM job.


9. What was your biggest failure?


Hmm, judging from the tightness of these jeans, I would have to say not keeping up with my running/exercise.


10. Did you suffer illness or injury?


I broke my toe, although I think it was technically just before New Year’s Day, and currently I am on day 13 of this stupid cold.


11. What was the best thing you bought?


My new car (it has heated seats!), although my iPhone runs a very close second.


12. Whose behavior merited celebration?


Hmm… I would have to say AG’s. He’s been sleeping on a cot and getting shot at on a daily basis, and somehow remains positive.


13. Whose behavior made you appalled and depressed?


There have been several patients that come to mind… although Octomom is definitely up there, too.


14. Where did most of your money go?


Paying off realtor/mortgage balance, starting on my student loans, wedding deposits.


15. What did you get really, really, really excited about?


AG coming home for “Mid-leave” break in October.


16. What song will always remind you of 2009?


“Use Somebody” by Kings of Leon because they won’t quit playing it already!


17. Compared to this time last year, are you:


a) happier or sadder? I think I am happier than I was last December, as by this time, AG had just left. Overall, it’s definitely been a bummer compared to 2008.
b) thinner or fatter? Fatter.
c) richer or poorer? Richer, in terms of less total debt.


18. What do you wish you’d done more of?


Working out, spending time with friends.


19. What do you wish you’d done less of?


Sitting around, watching TV, complaining.


20. How did you spend Christmas?


Christmas Eve and Christmas Day were spent at work. I celebrated Christmas with my family back in Arizona earlier in December.


21. Did you fall in love in 2009?


Nope. I was already in love, although 2009 has definitely reassured me of the strength of our relationship, and that I have a great future to look forward to.


22. What was your favorite TV program?


I think the best new show that I started watching is "Castle", although I continue to hang onto Gray’s in spite of its silliness.


23. Do you hate anyone now that you didn’t hate this time last year?


I don’t think that I have the energy to hate anyone, although I do have a new batch of frequent flyers at work that exasperate me.


24. What was the best book you read?


Currently reading “Peace Like a River” by Leif Enger and am loving it.


25. What was your greatest musical discovery?


Can’t think of any new artists that I really like… maybe this means I’m getting old?


26. What did you want and get?


AG kept safe and sound.


27. What did you want and not get?


AG home for Christmas.


28. What was your favorite film of this year?


Missed a lot of movies that I would have liked to have seen, but I think “X-Men:Wolverine” and “Julie & Julia” were two of the best that I can recall.


29. What did you do on your birthday, and how old were you?


I turned 31 this year, and I think I went out for dinner and drinks with friends, although I can’t remember exactly.


30. What’s the one thing that made your year immeasurably more satisfying?


2009 has probably been one of my least favorites… it sounds bad, but I’m going to say the knowledge that 2010 will be better.


31. How would you describe your personal fashion concept in 2009?


Ponytail and scrubs, alternating with jeans and t-shirts.


32. What kept you sane?


My friends and family are really supportive.


33. Which celebrity/public figure did you fancy the most?


President Obama. You can say what you want about the guy, but at least he is making congress work.


34. What political issue stirred you the most?


Healthcare.


35. Who did you miss?


AG


36. Who was the best new person you met?


I would have to say one of my co-workers is really supportive and helpful.


37. Tell us a valuable life lesson you learned in 2009.


Um, real estate is not a safe investment.


38. Quote a song lyric that sums up your year.

I feel it’s gonna rain like this for days
So let it rain down and wash everything away
I hope that tomorrow the sun will shine
With every tomorrow comes another life
I feel it’s gonna rain for days and days, I feel it’s gonna rain.

--Creed “Rain”