This is Why I'm Hot

Yesterday I overheard some of my office staff stating the following two reasons for why I'm considered cool:

1) I'm in a band

and

2) I'm married to a doctor

Finally, I'm getting the street cred I deserve.

What Does an Intern Do?

New doctors in the first year of their residency training are referred to as 'interns' and much of modern academic medicine is built on their backs.

Certainly, internship has a steep learning curve. It is the moment of transition from 'medical student' to 'doctor' and many, many competencies must be mastered.

It is a privilege to have access to all this learning, and the cost of that privilege is scutwork.

Scutwork (also known as 'scut'): Monotonous work or menial tasks that--while not pleasant or fulfilling--have to be done, usually as part of a large complex job or project, often by an underling.

Scut is, by definition, neither direct patient care nor clinically-relevant learning. Unfortunately, all residents (all doctors, for that matter) must manage some degree of scut, but--at least in academic settings--a large portion falls on the intern.

My daily scut work looks about like this:
-enter nursing/medication/diet/imaging/PT/etc orders on the computer
-talk to the ward social worker (now called a "patient resource manager") to make sure that patients' insurance companies will pay for their necessary care
-call Radiology to make sure that all the imaging studies I've ordered will actually be performed
-call the clinical laboratory to find out why missing blood test results aren't back
-make 1289746166739509 follow-up appointments for the patients who are soon-to-be discharged
-write 23891612876498793877466 prescriptions, because every patient goes home on a full pharmacy's worth of medications
-type discharge instructions for the patients who are leaving the hospital
-call Radiology again to inquire why the studies they said would would get done haven't been done yet
-answering plenty of pages from the nursing staff
-change wound dressing, stick fingers in surgically-created orfices, put tubes into various bodily openings

Nonetheless, there are still upsides of being an intern:
1. Painful though it may be, you are still a doctor. You wouldn't have gotten this far if that wasn't important to you.
2. Sometimes (rarely, since you don't know anything) you can actually help people.
3. In one year, you won't be the intern anymore, and you will have an intern of your own to carry out all the necessary but painful tasks of the modern medical center.

The End of The Tell

For folks who may not know, I play bass in a local rock band called The Tell. Tomorrow night is our last show because our lead singer/primary songwriter is moving to Atlanta to go to grad school. I'm pretty bummed about the end of The Tell because, although we are actually quite good, I feel like there was so much more potential then we ever came close to reaching. The band is full of talent and good natured folks, but everyone's "real" lives kept getting in the way. We had planned to record an album of new material at some point during Summer 2009, but getting everyone together for practice or songwriting was always difficult because people just had too much to do, so it just kept getting pushed off until it never happened. Real jobs, bar exams, weddings, new babies, and distance all conspired to make the band meander rather than excel.

Maybe that's what happens with most bands. Maybe there is some broad takeaway about modern society and reaching for too much, but I can't quite put my finger on it. All I know is that finding a very talented group of musicians that are also friends and truly enjoys playing music together is a very rare commodity. And it will be missed.

New York Magazine

New York Magazine recently ran a very interesting article on the current trend toward viewing children as 'projects to be perfected.' As my cohort hurtles toward helicopter parenthood, I found Jennifer Senior's critique to be especially apropos.

An excerpt:

"Before urbanization, children were viewed as economic assets to their parents. If you had a farm, they toiled alongside you to maintain its upkeep; if you had a family business, the kids helped mind the store. But all of this dramatically changed with the moral and technological revolutions of modernity.

As we gained in prosperity, childhood came increasingly to be viewed as a protected, privileged time, and once college degrees became essential to getting ahead, children became not only a great expense but subjects to be sculpted, stimulated, instructed, groomed.

The Princeton sociologist Viviana Zelizer describes this transformation of a child’s value in five ruthless words: 'Economically worthless but emotionally priceless.' Kids, in short, went from being our staffs to being our bosses."

Read the rest here.

When I Heard the Learn'd Astonomer

When I heard the learn'd astronomer;
When the proofs, the figures, were ranged in columns before me;
When I was shown the charts and the diagrams, to add, divide, and
measure them;
When I, sitting, heard the astronomer, where he lectured with much
applause in the lecture-room,
How soon, unaccountable, I became tired and sick;
Till rising and gliding out, I wander'd off by myself,
In the mystical moist night-air, and from time to time,
Look'd up in perfect silence at the stars.

-Walt Whitman

My Castle!

A man is the king of his castle. That much is undisputed. But how can a man truly feel like a king when he is relegated to cleansing himself each day with a shower head installed at a height between his belly button and sternum? He cannot!

Pictured: A shower head for peasants

A "master" bathroom deserves a masterful shower head, so I quested over to the local home improvement store and slew a mighty shower head with a mere card sized bit of plastic and brought its carcass home for mounting. BEHOLD WHAT MY TERRIBLE WRATH HAS WROUGHT!

It's good to be King.

A glorious brushed metal shower head with selectable output speeds and, most importantly, an upper vestige level with my own royal head now hangs proudly in the master bath. No more shall I stoop like the serfs gathering their miserable harvests. Instead I shower while standing straight, as I am due by my divine right. One must only look upon this shower head to know that, in addition to my mastery of my castle, I am truly a just and beneficent ruler. My fair Queen is so lithe and dainty that the great heights of the upper shower head escape her grasp. Knowing this, I selected a shower head that will allow for a selection of water flow from both a Kingly height, and a lower level perfect for my Queen, thus preserving peace and tranquility in all the realm.

White Coat Pockets

As an intern, you must travel light but be prepared for anything.

Thus, our white coat pockets are jam-packed with all kinds of essentials.

Here is what I found when I unpacked the 3 pockets of my white coat:

-Resident Survival Guide
-Maxwell's Pocket Medicine
-'Important Numbers' memo book
-Alcohol swabs
-Scissors
-Blood draw tourniquet
-Silk tape
-Prescription pad
-Stethoscope
-Vasoactive drugs reference card
-Diabetes management reference card
-Laminated Duke phone directory card
-Size small gloves (1 pair)
-Patient list
-Note paper with random patient info
-ID Card
-3 paper clips
-2 pens
-1 highlighter
-Penlight
-4x4 gauze pads
-2x4 gauze pads
-Sweet note Matt wrote for me
-Bandaids
-Post-It notes
-Dunkin' Donuts sugar packet
-One dime

Shelter

I've been taking a lot of shelter lately in 1) my long white coat and 2) the fact that I can now call myself "Dr. JLlo".

You see, as the intern, you spend much of your time managing patients on 'the floor' who are either waiting for their operation or recovering post-op....and these patients have a lot of questions.

Fortunately, as a new doctor, I know a lot of stuff.

Unfortunately, most of the things I know are either irrelevant (all the enzymes involved in glycolysis), really irrelevant (how much detergent is left in our jug of Tide at home), or crazy (the entire dialogue of the 2000 Hollywood 'mega hit' Love & Basketball).

Thus, it is hard when patients and families look to me and want (need) answers that I don't have. My policy is to only say what I know and otherwise, defer defer defer. I spend a lot of time explaining the hierarchy of a teaching hospital, and how, as an intern, I have the least amount of experience and the least decision-making clout.

It is easier to say, "That decision is best left to Dr. So-and-so (the boss) because he has much more experience" than to say, "I have no idea." Really, though, these explanations go hand-in-hand.

I worry that patients will give up on me because I often can't answer their questions, but I'm realizing that they don't.... A lot of this has to do with the two things I mentioned at the beginning: the letters M.D. after my name and the white coat I wear. These are powerful symbols that earn new doctors trust and credibility in the eyes of our patients. They make up for our lack of practical knowledge. In these early weeks of my residency training, I feel lucky to have them -- and I hope to become continually more deserving of the authority they give me.

Dogs are Delightful

Since we moved to our new house, Mitchell has been spending a lot of time snacking on our walks.


Now, Mitchell has always enjoyed grazing. Like, he eats so much grass that I used to worry (does he need more fiber? Is he constipated? Is it because he has colon cancer? Is he going to die tomorrow?). But, after 1.5 years, he's still here (maybe it's a really slow growing tumor?), and I've come to terms with his grass eating... Not to say that it isn't embarrassing when a rabbit hops directly in front of him, and instead of trying to chase it--or even noticing--he just gulps another bite of someone's lawn.

Anyway, I figured his walk-snacking--during which he burrows his nose right into the dirt--was just an attempt to get down to the lowest, juiciest blades of grass. Now, this guy will eat coffee grounds directly from the trash can, so why I thought he was being picky about getting the best grass shoots is beyond me...

Then, one day, Matt comes in from walking Mitchell. "How was your walk?" I ask.

"Good, but Mitchell was really slow because he was eating all those grasshoppers."

"What?"

"Yeah, that's what he's been snacking on -- grasshoppers. Our dog eats bugs."

Matt doesn't know this, but I hate grasshoppers. They are so smug, just staring at you with those bulging bug eyes, hopping just out of reach when you try to catch them. Regular bugs are bad enough, but smug bugs are just unbearable.

Therefore, I was actually a little bit proud that our dog was single-handedly perpetrating a grasshopper massacre. And I couldn't wait to see him crunch down on one of those suckers for myself.

I spent the next days carefully watching every time Mitchell appeared to eat anything on our walks. Grass, discarded chicken bones (don't worry -- I pried those out of his mouth), some scraps of paper, a pebble...but I didn't see any grasshoppers. I figured they must be really small and stay really low down in the grass...

Until this morning...

...when got a good look in a sparse patch of grass and realized that what he is actually eating is bunny turds. Like, literally, the poop left by the neighborhood rabbits as they frolic around.

Delightful.

If Urology Doesn't Work Out

I'm sure I can get a job at the New York Times as a copy editor, because I know I could do better than this drivel opening an ostensible science article:

It’s hard to imagine a more fundamental and ubiquitous aspect of life on the Earth than gravity, from the moment you first took a step and fell on your diapered bottom to the slow terminal sagging of flesh and dreams.

Gag. I may not be an astrophysicist, but I'm pretty sure that gravity does not affect dreams.

Here is the article, if you dare.

FIGS

Remember my feelings about the mulberries? Well, I have really mixed feelings about these guys...




...that's right. We have figs.

Two huge trees of them.

All I'm saying is, in about 3 weeks, you best leave your car windows rolled up and your front doors locked, because otherwise you're going to find a big box of figs waiting for you when you return. And if you get something in the mail from me, open it right away...leave it out, and it might start to smell.

Financial Lifestyle

Becoming a doctor is a long road fraught with delayed gratification. Like, I'm 25 and just now finally starting my first real job...although working 80 hrs/week for a salary that equates to $11/hr doesn't sound that good. And I won't be an attending physician until I'm 31 (i.e. better wait awhile before signing on the dotted line for that Lexus).

Nonetheless, going from -$50k annually in tuition to +$45k-ish in salary (no big secret here -- resident salaries are set by the Federal Government and more-or-less uniform nationwide) is a big swing and I've been thinking a lot about how I'm going to spend all those Benjamins.

And don't get me started on all they ways I've been mentally spending my future earnings when I'm an attending.... The AAMC quotes average Urolgist earnings to be in the ballpark of $325-425k, which will buy Barbie a lot of pink Corvettes. (Or pay off all of my student loans, which are themselves in the 6-figures.)

So, the point of this post is, I've had money on the brain lately...but, as I go from negative-earner to positive-earner to someday primary-breadwinner, I look forward to continuing to spend smart.

I want to continue to live a 'financial lifestyle' that I can be proud of.

Financial Lifestyle? By that, I don't mean a budget exactly, but rather a balance between luxury and austerity that seems reasonable.

We believe in budgeting, money planning, and living slightly below one's means, but, beyond even that, we believe in buying things that aren't RIDICULOUS.

What is ridiculous? Well, to my mind, it's things like this:


This Waterford crystal retails for, I kid you not, $79.50 per glass. I could have as much money as Bill Gates and not justify that expenditure. Wine glasses chip in the sink, people rap forks against them to make toasts, sometimes guests accidentally-on-purpose take them home after parties... All I'm saying is, if I owned this crystal, when I entertained, I'd be wearing a velvet glove on one hand and holding a whip in the other, just to keep people in line (trust me, that's not a party any sane person wants to attend).

What I'm saying is, no matter how much money we have (or don't have) someday, I want to spend in a way that feels justifiable.

Today

Today:

This morning my car wouldn't start,*
Matt drove me to Duke like a dart,
He went to Autozone twice
To get parts that suffice
Our day was terrible.


*made all the more miserable by the fact that it was 5:25am and I was trying to get to the hospital before the night guy left at 0600

Entryway Styling

Spent some time recently making our entryway look it's best (okay, it's really just the far-left 1/3 of our living room where the front door opens...but doesn't "entryway" sound a lot fancier?).

What do you think?

What does a lawyer (like me) do?

As a commercial litigator and business attorney most of my job involves taking situations that would otherwise be completely FUBAR and mitigating the damage to make whatever has gone wrong a bit more manageable.

I also specialize in personal injuries as a result of tank accidents

I spend a significant part of my day, like most Americans, in front of a computer. The internet has revolutionized legal research to such an extent that most law offices have either phased out their physical library or are in the process of doing so. I'd like to imagine that this has actually reduced the costs of hiring an attorney because they can access the required information so much quicker (using less billiable hours), but I'm not sure clients would always agree when they see the bill.

Despite the cost, I still think lawyers provide valuable services for their clients. The law is really complicated, and protecting or vindicating your rights is long hard work that most folks have neither the time nor the inclination to perform. So they hire a lawyer to take care of the hard stuff for them. Otherwise, we'd have lots of folks just resorting to "self-help" to recover from those who have wronged them.

This is "self-help" according to law school. Seriously.

Cute!

Look what came in the mail for me today!

I used to think that those women (okay, and gay men) who had like 2374129809887645 pillows on their beds/chairs/sofas were *crazy* ... but now I'm becoming one of them. What can I say? Pillows are a room's accessories...and if there's one thing I feel good about, it's accessories!