confession

Ok, I totally fucked up Josh's beef stew recipe from the other day. I'm sorry, Megan! Somehow, I burned it so badly that when I heated it up for lunch the other day in the ob-gyn office, the chief resident walked in and immediately asked, "Is there a fire??!" So yeah... that got trashed. Next time, smaller batch, more frequent stirring.

BUT I did manage successfully the paprika chicken from this recipe, which turned out just delicious! Caloric intake is probably disastrous, but right now, after working long hours on gyn-onc, I really don't care. Besides, I can always work out "tomorrow" :-P

a punch in the face

... sometimes is just what you think someone deserves.

What can I say? I can't be sweet 24-7.

Happy Pumpkin!

I'm probably not going to dress up for Halloween, unless it involves some hairbrained scheme to allow me to wear the new dress I just bought. But actually, I don't feel like freezing or being a pretty pretty princess this weekend, so I guess I'll just console myself with my happy-as-hell pumpkin that I carved the other day with Lydia. I mean, seriously, look at this guy! It makes me smile every time I pull my car up to my door :-)

If you've got a creative costume idea to bring me out of my nay-to-Halloween stupor, please let me know. I already loaned out my genius idea of the year to the brother of a friend. Oh, he BETTER do it...

article from Tim

Tim posted this article on his Gchat, and I really liked how it started and progressed, but was not such a big fan of how it ends.

* spoiler warning *

The author gave a great discussion - with some truly convincing examples - of the idea of competing selves and how it influences our actions without contradicting an idea of "self." He then goes on to discuss paternalistic libertarianism and how it utilizes this notion of "good self" versus "bad selves." At this point, I had a vision of where the article was going to lead, and it had to do with caveats. And indeed, the author's next paragraph starts out with "It’s more controversial, of course, when someone else does the binding. " Sweetness, I thought! He's going to talk about the potential problems of paternalistic libertarianism.

Only... NOT. Read the article, and I think you'll understand what I'm talking about.

I mean, seriously? "We benefit, intellectually and personally, from the interplay between different selves, from the balance between long-term contemplation and short-term impulse." does not cut it. It's not news. It gives no guidance for policy. It's crap.

Is it not obvious that the main danger of paternalistic libertarianism is that it could be wrong about what is best for ourselves? As a pro-choice advocate, I immediately thought of the mandatory consent laws and 24 hour waiting periods that stand in the way of young women getting legitimate abortions. Those are paternalistic measures too, but I'm hard-pressed to see how they encourage our "best" selves. Moreover, while some people who push for these types of measures are just assholes, the majority of them truly believe they are doing good.

The question, then, comes down to who should make the laws in a paternalistic libertarian society or how. This is where the idea of a republic of selves within ourselves mirrors itself in the political process of America itself, and convolutes the metaphor too. After all, we can all believe that there are good and bad versions of ourselves, but in the make-up of American society, which of us are good and which of us are bad? And if we're the neurons making up the moral and intellectual network of America, who, then, is the total self??

I know I know I know

mixed feelings :-/

Josh's beef stew recipe

It looks delicious, and if I can get a hold of a bottle of wine tomorrow, I'm definitely making it! Thanks for passing it along, Megan!

Here is my recipe. It makes a lot of stew (about 8 large bowls).

Ingredients:

• 2.5 Lbs. Cubed Beef (I usually use Chuck); larger chunks are better than smaller
• 1 Bottles (750 mL) Red Wine (cheap wine is best for cooking!); an extra bottle is a good idea so you can add extra wine instead of water (and have something to drink with your stew, if you're not a teetotaller)
• 2 Small Onions (or 1 really big onion)
• 1 Package (2 Lbs.) of Carrots
• 3 Lbs. Russet Potatoes (about 7 Potatoes)
• 1 Package Frozen Peas
• Vegetable Oil
• 3 Bay Leaves
• Thyme
• Flour
• Salt
• Fresh Ground Black Pepper
• Water

Recipe:

1. Brown the Beef

In a plastic bag, combine flour, salt, pepper, and beef. Shake and work the beef until all chunks are thinly coated in flour. In a large stew pot (or in a frying pan), heat vegetable oil on medium-high. Once hot, brown the flour-coated meat on each side. You do not need to cook the beef through, just brown the outside. You may need to brown the beef in multiple batches, depending on how much meat you have and the size of the pot. Once all the beef is brown, set it aside.

2. Saute the Onions

Coarsely chop the onions. In the stew pot, head some vegetable oil over medium-high heat. Once hot, add the chopped onions and saute until soft and slightly brown.

3. Start Simmerin'

Once the onions are ready, add the beef back into the pot. Pour in a bottle of wine, and add 4 cups of water. Add bay leaves, salt, pepper, and thyme to the pot. Cover the pot and bring it up to a simmer, then cook for about 70 minutes.

4. Add the Carrots

Peel and chop the carrots (Big chunks! This is a stew for MEN, not little babies). Add them to the pot, cover, and return to a simmer. Let cook for about 20 minutes.

5. Add the Taters

Peel and dice the potatoes. Make sure to set them in water as they are diced so they do not turn brown. Again, big chunks are best! Add the potatoes to the pot, cover, and let it cook for 70 minutes. You may want to add a little more water (or wine, if you have another bottle); you want the top layer of chunks to be just above water level.

6. Add the Peas

Add the frozen peas into the pot. Return to a simmer and let it cook for about 5 minutes. Season to taste with additional thyme, salt, pepper, or anything else you want to put in there.

7. Keep Cookin' (if necessary)

The stew is ready at this point, but if it's still soupy you want to cook it uncovered for up to another hour in order to boil off some water; your goal is a stew which is very thick!

8. Resist Temptation

Smell your stew. Mmm . . . delicious. NOW DON'T EAT IT. This stew will taste much better in a day or two. Put it in the fridge and let it "stew" for a while. It can also be frozen and stored for quite a while.

9. Enjoy!

If you made it right, this will be a stew you can eat with a fork. I recommend a nice loaf of bread to mop up the sauce, and I'm told a nice bottle of red table wine (perhaps the one you didn't finish off while cooking) goes very nicely with it.

Things to Do

(inspired by Lisa)

make a good pot roast • create my own “When Harry Met Sally” story • work abroad for a good cause • draw a thoughtful comic • create a reproductive health presentation that is relevant to medical students • blow bubbles by the river walk • grow a vegetable garden • finish a commentary • make a paper crane in less than 30 seconds • slide down a snow-covered hill • yell on the top of a mountain • roast marshmallows on the beach • dance around a bonfire • get at least one person out of homelessness • hold my own private shadow puppet show • look less stupid dancing • plant flowers and keep them alive • safe, controlled explosions • cartwheel in public • learn Spanish and French • get a dog • get a bike and use it • more traveling with friends • learn at least one song on guitar • call Lisa more • be car emergencies competent • get away with crazy eye makeup or lipstick • be able to recommend restaurants to others • recognize 3 constellations not counting the Big Dipper • identify poison ivy with confidence • save a life • make that tousled knot with my hair • be punk for a day • match make a good friend successfully • space out on a roof • visit a Eurotrash club and live it • paint my own walls • feel comfortable crying in front of someone • make postcards • invent a strap to keep my shoes from falling off • solve a Rubix cube • plan my own wedding • paint something I would be proud to hang on my walls • write poetry again • stumble around in a strange new town giddy and happy at 3 am in the morning • sail for a week • learn to surf • introduce a friend to the pleasure of fresh crabs • show at least one person the meaning of joy • come up with a hilarious Halloween costume • improve medical education • get a killer LBD • bury myself in sand • make a necklace for someone special • visit my grandparents as an MD • collect old family photos • read up on Chinese history • know what syllable should be in my child’s name, per family traditions • make dumplings for New Years • be less scared of caves • visit a Scottish castle and play a modern day Jane Austen heroine for a day • learn to whistle • host a huge-ass water balloon fight for adults • find vitamin gummies for adults • perfect my signature dish • find my signature scent • be better at picking out favorites in general or else come to a philosophy that solidly refutes their value • chase a storm • eat ice cream by candlelight during a power outage • spend a week hiking and writing in the mountains • drive a fast car fast and not die • own a custom made outfit • watch the rain eating mac n cheese with my dog • make Chinese desserts • break into dance while at work and not get in trouble for it • make a dirty joke on the sly that no one else gets but I crack up internally with • play Jessie’s watermelon game • hang glide • grow my hair long • learn to French braid • catch fireflies again • feel lucky every single day because I should

so not suave

My attending today asked me what I learned today, and like a retard, I replied, "Um, I learned what a hernia repair looks like." Technically correct, but still the wrong answer. Ugh, I hate getting flustered and just blurting shit out. But really, what was I supposed to say? "Well sir, I really didn't learn anything new today yet - that's why you should let me go home and study/look up answers to questions I had today"?? That would've gotten ugly fast.

Here's to hoping tomorrow goes better.

*slamming head into wall*

and on a lighter note...

Things that made me crack up laughing this week (and therefore look like an idiot to passersby):

1. Dr. Lue: "Median.... median what? What happened to this slide? Oh, ok, median thrgh."
Mind you, this is a lecture on pubic hair. The median thrgh! The pirate's favorite leg part!

2. Text from Phil: "Why'd you send me that? I'm sitting right here in the corner!! FOR SHAME LULU!!! For shame."
Phil responding indignantly to me replying to his "Let me know when we get started" text at 4 pm, when he had in fact sent it in reference to conference at 8 am. So you were the asshole whose phone went off :-)

3. Adam: "Yea, I'll do a panniculectomy on you.... but I'll take that fat and put it on your back! Watch out, he's got Cushings!!"
Fat feet, Adam, fat feet. Seconds later, he reneges on his unwarranted aggression and wonders why it isn't a medically indicated procedure covered by insurance.

Currently listening to: "Sexy Boy" by Air

Air - Sexy Boy
Uploaded by musiclover4

sometimes, you have to be pleased with small accomplishments

(image courtesy of xkcd.com)

I spent the day today in gyn-onc clinic, feeling, for the most part, useless and in the way. As a medical student, there is so much we don't know or don't have the power to decide. We go in, we barely have time to say hi and get the chief complaint before the resident barges into the room (in the interest of time, of course). If we're aggressive, we can snatch in a few questions or an abbreviated exam before it's on to the next anxious patient. Wowee!!

It was sheer luck, then, that I had one patient today with whom I was able to spend a fair amount of time. The residents had actually presented her at Tumor Board this morning as an example of a non-compliant patient who was now experiencing a recurrence of her cancer, and the topic of discussion had been how to best treat a patient who is now at high risk for complications given her need for repeat radiation therapy (not to mention what would happen if she again didn't finish her treatment). This was the dreaded impression I had when I went in.

I don't think anyone would have fallen in love with her at first glance - the neurofibromatosis nodules were scattered unpleasantly over her face, she was poorly dressed, and her initial manner was aloof. But after just a few minutes of talking to her, it was clear that underneath the tough facade was a scared woman who was acutely aware that the doctors here thought her an ignorant psycho who didn't give a damn about her body. Her discomfort was warranted. Both the oncologist and the radiologist who came in to speak to her were stern, and the radiologist's explanation of the risks of additional radiation was shrouded nonsense. When she started to tear, he had only the grace to look uneasy.

Perhaps it is the case that all people, when faced with enough tragedy, become jaded. Moreover, I can understand their frustration - it isn't easy pouring your heart into somebody, and it is a rejection when they refuse to meet you halfway. So this post is less about the shortcomings of physicians than the obligations of medical students. Put simply, we are the naive, the ones who are meeting the patients with fresh eyes, the ones who have not yet been shat upon. As such, it is our responsibility to compensate for the distance of our superiors, to provide kindness even if it is, ultimately, unwarranted.

I only had to stay in the room a few extra minutes to explain to her the risks of her needed radiation therapy, and why it was so important - difficult as it is for her to drive 100 miles to our clinic - to keep all our appointments. It felt good to be able to explain why surgery wasn't an option for her, and it felt good to be the person who made sure she got to talk to social work and came up with a feasible plan for receiving her radiation. I may be useless 99.9999% of the time, but it's that little 0.0001% that makes you want to stay in medicine.

Today's episode also brings up an important topic in cancer care, which is its huge regional bias. Everyone serious about oncology trains at a major city, where the research is good and patients are abundant. But statistically speaking, most cancer patients live outside the borders of these major cities, in the rural and suburban areas where preventative programs are scarce and support networks are stretched. I spent a good amount of time talking to my colleague about this access barrier this afternoon, but neither of us can think of a good solution.

Telemedicine, which is getting some publicity in areas such as Emergency Medicine, has limite utility in oncology because, as my attending pointed out, you can't telemedicine PET scans, chemotherapy, and other tools that don't exist in the target area. Satellite clinics, another option, faces the difficulty of staying financially afloat in areas where patients are scarce, yet still take up a lot of healthcare dollars for their expensive and lengthy treatments and tests. So far, I know of no satellite oncology centers that can serve the indigent. Another solution, which has been used with some success in mammography, is to create mobile clinics that can travel to the patients themselves. Of course, they would have nowhere the resources that an academic center has, but it is feasible that they could at least provide chemotherapy and radiation treatments, as well as physician consultation. Personally, I like this solution although I don't know of any place that does it - most likely due to cost, as is everything in medicine. Finally, you could improve the transportation system itself, but I think this would have to be done by the federal government and the DOT because the grassroots transportation aid programs that exist can serve only a few areas. But better than none - my patient is going to try to find a driver from the Georgia Cancer Society.

I'll sum up this post with a quote from Anne McCaffrey, an American science fiction writer, which I think is wise and a good motto to go by: "Make no judgments where you have no compassion."

Two from the Wainwrights

One I think I posted before on another blog, but it deserves an encore. Love both their voices. I apologize that the Martha Wainwright one is set to Grey's Anatomy, but it's a good song.

Rufus Wainwright - Going To A Town
Uploaded by misslupin

Candle Making and Flowers

There are two kinds of productive in the med student's life: one that gets you the stellar grade, and the other that keeps you sane. I had plans for both today, but so far, I've been focusing on the latter, and I don't regret it one bit :-)

This is a pic of the candles I remelted and recycled today - I'm really excited to use them again. These two are my FAVORITE scents for candles, and it was SUCH a waste for them to just sit there in scraps. Thank you Internet and Lydia for showing me how. Now on to brownies!!

adult wisdom

(I know I haven't been updating this as often as I said I would. I've been busy and lazy - my apologies!)

Had dinner with my roommate tonight, and we had a good conversation about relationships, the differences between them in China versus the US, and the similarities too. He's a good guy. Anyway, at one point during our dinner, he said something that I think is true and not very often said, which is: Love is not just the willingness to make promises to someone, but also the determination to follow through on them.

It reminds me a bit of the Gavin McGraw song: "What good is a life/ with no one to share/ the light of the moon/ the honor of a swear?"

happiness can be so easily attained

sometimes :-)

It's so nice to see people you hadn't seen for a while!

Me Time!

It's nice to be home again with the family, even if our time together is less than coherent. I especially like spending time with my little sister because it reminds me of what it's like to be young, hopeful, and uncertain. I know the last characteristic is a funny thing to be thankful for, but I've always considered unwavering confidence a bane of adulthood. We haven't learned all there is to learn! Even if our uncertainty causes us to make mistakes, it's also what keeps us dynamic and - this I believe too - decent. We'll see if I still think this in 20 years when I have kids of my own ;-)

My week on postpartum hasn't been that bad, although I did feel somewhat under-utilized. Talking to other people, though, I guess my experience was not as inferior as I had imagined it to be. I got to deliver a placenta (and it was my own fault that I wasn't there to deliver the baby as well), some nice residents taught me how to tie a two-handed surgical knot, one even let me do a sub-Q stitch on a C-section patient, and I've met some really great patients. There is much to be thankful for, and I just have to remind myself of that during moments of stress. Also, I'm considering working abroad with a nonprofit for a while once I finish residency, but more on that later.

That's a photo of my sister, by the way. I think she's the greatest :-)

things I learned about myself from emode

What can I say? I'm a total insomniac. I can't say I agree with all of it, but anyways:

#1: My perfect movie boyfriend is Mr. Darcy - score!
#2: I'm definitely left brained. I agree with that.
#3: I have commitment issues? I do???
#4: I would like Chicago. Perhaps, perhaps!

hmm....

i figured out...

... what's been causing my jaw aches and headaches, and I'm not happy with my discovery.


"When the chambers are empty, when the only sound you hear is dust, thoughts begin to bleed. There are lots of other ways to lose people, and none of them can be put on a milk carton."

- Anne Mathewson

"Save Yourself"

Yeah, Sense Field is way old and only had this one hit song, but I like it.

Interesting Excerpts from the 2nd Presidential Debate

I prefer to read transcripts of debates - it prevents me from having a merely visceral reaction to the candidates, and more importantly, it gives my now sluggish mind time to identify the merits and demerits of each candidates' ideas. I'm pretty much set on voting Obama, but I'll try to be nonpartisan in my critiques and accolades. So, without further ado, here are some quotes I found noteworthy from the 2nd Presidential debate.

source: Transcript from CNN

QUESTION: With the economy on the downturn and retired and older citizens and workers losing their incomes, what's the fastest, most positive solution to bail these people out of the economic ruin?
McCain: "Now, I have a plan to fix this problem and it has got to do with energy independence. We've got to stop sending $700 billion a year to countries that don't want us very -- like us very much."
**First off, McCain's plan for energy independence is certainly not the fastest solution to the economic depression. But I won't take off too many points for that one, because Obama's solution was also a long-term one, and it's unfair to ask for quick speedy solution to such a complicated situation. But McCain's 2nd line really caught my eye. Of course, what he meant was the money we spend on purchasing oil from Middle Eastern nations. But couldn't that statement apply just as well to US involvement in Iraq, which costs us hundreds of millions of dollars every single day, and with minimal tangible benefit to the average American? If McCain really doesn't believe in investing money in hostile nations, then why is he still pushing for indefinite US intervention in Iraq?**

QUESTION: Well, Senators, through this economic crisis, most of the people that I know have had a difficult time. And through this bailout package, I was wondering what it is that's going to actually help those people out.
McCain: "...One of the real catalysts, really the match that lit this fire was Fannie Mae and Freddie Mac. I'll bet you, you may never even have heard of them before this crisis. But you know, they're the ones that, with the encouragement of Sen. Obama and his cronies and his friends in Washington, that went out and made all these risky loans, gave them to people that could never afford to pay back."
**I can't believe McCain used the words cronies, and accused Obama himself of playing some pivotal role in the decisions of financial institutions. Not to mention his own recently exposed history of having his "cronies" profitting from Fannie Mae and Freddie Mac.**
Obama: "...let me tell you what's in the rescue package for you. Right now, the credit markets are frozen up and what that means, as a practical matter, is that small businesses and some large businesses just can't get loans."
**At the risk of sounding already biased, I'm glad the Obama's opening statements showed that he understood why the hell the government was bailing out us in the first place. As McCain himself admitted, economics is NOT his own strong point.**

QUESTION: "Are you saying to Mr. Clark (ph) and to the other members of the American television audience that the American economy is going to get much worse before it gets better and they ought to be prepared for that?"
Obama: "No, I am confident about the American economy."
**Personally, I think this was a mistake that could come back to bite him later. It very likely is going to get worse before it gets better, and Obama should have just said that.**
McCain: " I think it depends on what we do"
**Again, a more realistic response. I respect that. As McCain said this, Obama was probably kicking himself for pandering to naive optimists."
QUESTION: How can we trust either of you with our money when both parties got -- got us into this global economic crisis?
Obama: "...I think it's important just to remember a little bit of history. When George Bush came into office, we had surpluses. And now we have half-a-trillion-dollar deficit annually. And so while it's true that nobody's completely innocent here, we have had over the last eight years the biggest increases in deficit spending and national debt in our history. And Sen. McCain voted for four out of five of those George Bush budgets."
**Again, just like McCain's "maverick" line, this one is getting old for me from Obama. Yes, we know you think Bush sucks, and you want people to see that you're from the other party and you want change. But I think a more effective tactic would be to just point out McCain's voting record - which does approximate Bush's. After all, Bush is old news, and you two are both campaigning with a motto of change.**
McCain: "Do you know that Sen. Obama has voted for -- is proposing $860 billion of new spending now? New spending. Do you know that he voted for every increase in spending that I saw come across the floor of the United States Senate while we were working to eliminate these pork barrel earmarks?"
**McCain's answer, on the other hand, misses the point. The question does not imply that we should not spend - what matters is where we put our money. And though McCain goes on to claim that he's cut down on spending, he mentions no specific legislation and neglects to mention that he's approved spending Iraq that would overshadow that chump change by billions.**

QUESTION: "As president, what sacrifices -- sacrifices will you ask every American to make to help restore the American dream and to get out of the economic morass that we're now in?"
Obama: "I believe in the need for increased oil production. We're going to have to explore new ways to get more oil, and that includes offshore drilling. It includes telling the oil companies, that currently have 68 million acres that they're not using, that either you use them or you lose them."
**WHAT??! Did Sarah Palin just gain possession of Barack Obama's lips?? How can he say that, and then just a few questions later, say, "So what that means is that we can't simply drill our way out of the problem."??**

QUESTION: [paraphrase] What is your plan for fixing Social Security?
McCain: "Social Security is not that tough. We know what the problems are, my friends, and we know what the fixes are. We've got to sit down together across the table. It's been done before. I saw it done with our -- our wonderful Ronald Reagan."
**Oh really? It's not that tough, we just gotta talk about it? We haven't done that already? And Ronald Reagan is the solution to all our problems? Oh boy. We're in trouble.**

QUESTION: "Do you believe health care should be treated as a commodity?"
**Both politicians gave stereotypical fluffy and dodgy responses to this question, which I thought was a very important one, from a philosophical and policy standpoint. That was unfortunate. However, McCain did say offer this gem of wisdom about the health insurance policies of most Americans: "All of those people will be covered except for those who have these gold-plated Cadillac kinds of policies. You know, like hair transplants, I might need one of those myself." Is he really not aware that the health insurance coverage gaps people are complaining about aren't the hair transplant types? Or that even rudimentary health services can come out to astronomical sums not covered by many insurance companies?**

QUESTION: "Should the United States respect Pakistani sovereignty and not pursue al Qaeda terrorists who maintain bases there, or should we ignore their borders and pursue our enemies like we did in Cambodia during the Vietnam War?"
Obama: "What I've said is we're going to encourage democracy in Pakistan, expand our nonmilitary aid to Pakistan so that they have more of a stake in working with us, but insisting that they go after these militants. And if we have Osama bin Laden in our sights and the Pakistani government is unable or unwilling to take them out, then I think that we have to act and we will take them out. We will kill bin Laden; we will crush Al Qaeda."
McCain: "You know, my hero is a guy named Teddy Roosevelt. Teddy Roosevelt used to say walk softly -- talk softly, but carry a big stick. Sen. Obama likes to talk loudly. In fact, he said he wants to announce that he's going to attack Pakistan. Remarkable... By working and coordinating our efforts together, not threatening to attack [Pakistan], but working with them, and where necessary use force, but talk softly, but carry a big stick."
** First off, McCain totally and deliberately misinterpreted what Obama said. Second, what the hell exactly is carrying a big stick if not using military force to enforce your will?**

QUESTION: "If, despite your best diplomatic efforts, Iran attacks Israel, would you be willing to commit U.S. troops in support and defense of Israel? Or would you wait on approval from the U.N. Security Council?"
McCain: "I want to make sure that we put enough pressure on the Iranians by joining with our allies, imposing significant, tough sanctions to modify their behavior. I think, joining with our allies and friends in a league of democracies, that we can effectively abridge their behavior, and hopefully they would abandon this quest that they are on for nuclear weapons."
Obama: "I believe that we should have direct talks -- not just with our friends, but also with our enemies... When we take that approach, whether it's in North Korea or in Iran, then we have a better chance at better outcomes. When President Bush decided we're not going to talk to Iran, we're not going to talk to North Korea, you know what happened? Iran went from zero centrifuges to develop nuclear weapons to 4,000. North Korea quadrupled its nuclear capability. We've got to try to have talks, understanding that we're not taking military options off the table."
**I never did understand why McCain considers it such a bad thing that Obama wants to talk to hostile leaders without preconditions. We don't have the upper hand here, and everyone except conservative Americans seem to realize that. We don't have the right to be making demands of hostile nations, and as Obama points out, the outcomes have not been good when we've tried that. The "league of democracies" that McCain talks about is impotent and irrelevant to religious fundamentalists, and I certainly can't imagine why it'd compel them to abandon their quest for power.**

For a funnier and possibly more insightful commentary on this debate, I refer you to this facebook post by an acquintance of mine.

3rd year can really suck the life out of you....

I had a girly moment today and splurged on some earrings and a necklace at Target. (I was partially inspired by Alyson and her impeccable fashion taste.) As I was checking out, however, the cashier innocently asked me where I was wearing the earrings out to. That's when I realized that I can't even imagine the next time I'd have an opportunity to wear such cute jewelry out. I don't go "out" anymore. All I do is sleep, go to clinic/wards, scarf down some lunch, occasionally grab a workout at the gym, and then back to bed again. The few hours I get off once a week, I usually spend running errands. My most consistent extracurricular activity at this point is updating this blog and reading Wired magazine on the john. As someone else once said, "I think I'm getting more boring."

The only thing setting me apart from those happy automaton people I used to find creepy is the fact that I'm uspet about this. But come March? April? Maybe I'll become one of them too! It's a frightening thought....

I've decided I need to take a vacation, or at least, plan one. I'd love to go abroad. There are also some people I'd really like to visit before 3rd year is out, and some weddings I'd love to be able to go to! But for now, I'm taking suggestions on places to vacation, preferably for around or under $1000 (that's for going abroad, mind you, not Las Vegas). Travel buddies, too, are always welcome :-)

I know this is mean, but OMG, it's hilarious

Poor Palin, why did she let McCain convince her to run for a job for which she has zero qualifications?

"Things unspoken break us if we choose"

The quote is from Sufjan Stevens, the video of Dar Williams.

a few notes on office politics

It's no surprise that patient care suffers when there is drama in the hospital workplace, but it's distressing how common that drama is. A few suggestions for improving the often petty environment of the medical hierarchy:

#1: Divide and Conquer.
One of the most annoying aspects of working on L&D is that no one is assigned a particular patient, and as a result, everyone competes for the "interesting" patients, leaving the mundane (and thus the most commonly encountered) patients out in the cold. Triage the patients as they come in, and assign work/patients by rank. The medical students can do the triage and other scutwork, interns can take the more simple cases, and senior residents should work or supervise more complicated cases. This schematic requires strict dedication to rule #2:

#2: Maintain upward mobility.
I once read this piece of advice in a magazine for getting your dream job: "Don't become too good at the small things." Same thing goes for medicine. You can't keep people at the same level of intellectual challenge, no matter how competent that might make them. After all, older doctors must retire, and younger doctors must replace them. I firmly believe that part of the reason that senior residents get so greedy with patients that ought to go to junior residents is because they don't have anything better to move on to themselves. Yes, I know not everyone can be Chair of Medicine, but it's medicine! There is always something to be done! Get more people into administration, encourage them to do research, force them to do didactics... really, there is no limit to the tasks you can push your doctors to do. It increases productivity, expands the scope of your program, and most of all, decreases dissatisfaction in the workplace!

#3: Education should be a priority.
No joke, my resident's main piece of "teaching" to me my first day was, "Antepartum means before birth, and postpartum means after." Um, I already knew that, I took Latin in high school. Even though I've been only through 3 rotations to far, it's quite obvious that some residents are good teachers and some are utter crap, and the sad thing is, it only takes doing a few, non-intensive things to be a good teacher. First, allow your med student to take the history on the patient and - this is the part many residents leave out - offer their opinion on the diagnosis. Make them argue for their choice, and if they don't have good reasoning, make them do a homework assignment on the differential. (I know, I'll regret this once I'm on surgery and internal and zero time for anything). Second, just take the 30 seconds to ask, "Do you understand what I'm doing and why?" Or, "What do you know about [insert diagnosis]?" We're med students, we forget a lot over a course of a summer. Third, if you have time, make it a priority to teach at least one clinical pearl a day. All this literally takes mere minutes, and will save you time in the long run as your student becomes more competent and thus doesn't have to badger you for info every other minute. Genius? Or just common sense?

That's it for now. I know I haven't been doing posts every other day like I said I would, but honestly, time has just been flying, and I'm not even keeping track of the days. I'm on call tomorrow from 7 am - 7 am, and this is nerdy, but I'm excited. I'm really enjoying ob-gyn, despite my complaints about the office politics. Could ob-gyn be the field for me??