Finally Got My Call Schedule

Yes, I just got the schedule today, Saturday, and the rotation starts on Tuesday. What? That's not normal?

Fortunately, it's not such a bad call schedule. I'm on call the first time Wednesday, July 2, so if you're having a stroke and you come see me, please ask me to call my upper-level resident STAT. After that, I get the long weekend off (WOO!), and I have one Sunday and one Saturday call in the month, with the rest of the weekends off. All in all, 6 calls for July, which is better than the q4 I was anticipating.

My friends and I have been sending each other emails about what we're up to now. Most everyone else has already started their various rotations. One is in a clinic where an attending told him to "just do the usual for the patients, you know, write your assessment, write the prescriptions, here's my sticker". He's in his first week of real doctoring. Another is in a cardiac care unit, where he has already learned how to deny morphine to the "chest pain" patient who has ruled out for MI (and had other signs they were seeking). Still another is doing a medicine rotation and had to call a code on a patient the other night when they were pulseless and apneic (the patient, not the intern). A life was saved, so that the patient might go back to taking cocaine (which likely caused the MI in the first place).

In other words, they're out there in the big world of American medicine. Take pity on your young-looking doctors these next few months. If they're nervous, tell them to relax. If you're the patient, and you're nervous, remember that these fresh interns are heavily observed (usually) by the more-experienced.

And if you see a very small intern on a neurology service, and she says "Hi, I'm TS, your medical student, I mean your doctor", well, you still might want to be a little nervous. Because I hate neuro.

Disorienting Orientation

Is it just me, or is the word "orientation" completely abused nowadays? It seems like it should be applied to a process which helps you know where you are, keeps you from getting lost, puts your head back on your shoulders and find your way around. Right?

The problem is this: has anyone EVER been actually oriented during a session called "orientation"?

Yesterday, I went to the program's session, where we received a very thick binder full of papers. During the course of the morning, various people filed in and added even MORE papers, including some we'd already been emailed (and so, of course, your OCD-highness here had already printed them out). Statements in the binder conflicted with the verbal statements of the program directors on very important subjects, like parking, so much time was lost in working out the nitty gritty details of parking at multiple different clinical sites (how much does it cost per day? per month? will I be reimbursed? how far will I have to walk to the site?--etc.)

Today's was far worse. We arrived at the Very Large Hospital and eventually found the conference room (helpfully titled "6B-183", but located on the 6C wing), only to find that none of the people orienting us were present (and I was 10 minutes late, due to an alarm clock malfunction and lack of parking spots). We spent awhile filling out paperwork, then were led to a 3 hour computer orientation on the very-complicated EMR system. (On the way to the computer lab, our leader, who WORKS IN THIS HOSPITAL, got lost. And when she asked for directions, two different employees had no idea what she was asking about. This does not bode well for me--I have zero sense of direction indoors). The computer session was awful. The woman leading it had a mild speech impediment, yet spoke rapidly. I would look at my screen for 5 seconds, look up, and she'd be on a whole new window, but I'd have no idea what she'd clicked to get there. About an hour and a half in, I gave up and surfed the Web (conveniently NOT restricted on that computer) until it was over.

Lunch was yet another boxed sandwich meal. I don't mind them, but honestly, why would you put tuna and chicken salad sandwiches on a catering menu? You know those sandwiches were delivered up to an hour or so before we got to eat them, and who knows how hot the delivery driver's car was (it was in the 90's here today). I ate warm chicken salad until I couldn't stand it (it also had pineapples or somesuch in it--yech), and then survived on potato chips and a granola bar until dinner. Nothing like a little warm mayonnaise to breed a little staph food poisoning.

After lunch, the real crap started. The lady led four of us to Human Resources to get our badges. We signed in and proceeded to wait. Eventually, the rest of the group came into HR, but we original four were still waiting. Now there were 15 or so of our group, plus other new residents who were there before us, all crammed into a tiny waiting room with about 6 chairs. They started calling us out one at a time. I went, and found that one woman, by herself, had to verify ID, fill out the form, take my fingerprints (twice), take my picture, upload the picture, copy my documents, and lead me to the exit. It took her about 10 minutes to complete my paperwork (and she wasn't lollygagging, either). I then had to go to another office where they actually printed my badge; the whole thing took me an hour, and I was the first done. They scheduled our group to finish this in 2 hours.

After waiting for another hour, our lady came in with some forms to sign and get notarized, and then we waited some more. I tried to go get my parking decal, but the office closed at 3:30 (we went at 3:39). Eventually, our last (and reasonably important) lecture started late and ran long (naturally), and I spent what was probably the most important time of the day trying not to fall asleep or let my stomach growl too loud.

Tomorrow, I have stuff in the morning, then a break of several hours, then more stuff from 3:30 pm on. Our schedule says "dinner" (another box, from the looks of it), with no end time given, so for all I know I'll be in the Very Large Hospital all night. I'll have to try to go get my PPD read, since the occupational health people aren't going to take my word for it that it's flat without erythema. One of my classmates said "Well you know, MD, you need that LVN to read that PPD." (My med school's clinic just let us call in with the results if it was negative, hence the confusion).

At this point, I have one ID badge (out of 3 I need), 0 passwords/logins (out of 3 I need), 0 pagers (out of 1 needed--I'm not in a hurry for this) and I have not seen my call schedule for July because apparently the neuro department is known for not getting it done until 2-3 days before the month starts.

So now I've finished my little temper tantrum, and I've finished compulsively typing in the entire year's lecture schedule into Outlook, so I think it's time for bed. I'm still reading The Devil in the White City, which is really interesting and more than a little creepy. Nighty night from a tired, cranky TS.

Shrink Rap Grand Rounds

I think everyone should go to Shrink Rap and read their amazing Grand Rounds right now. Or at least, go over there and look at their awesome rendition of the new iPhone 3G. They even put my icon on there!

My Grand Rounds post is here.

The image above is from the Apple website and is their property.

Windows Vista Sucks

I have gotten that error message "Windows Explorer is not responding" twice today, which necessitates either restarting Windows Explorer or just turning off and turning on the computer. Also, I have plugged in a printer so I could print orientation materials. At first, it worked very well. Later, I tried to print a Word document, and it wouldn't print. The little print icon told me that it was printing, but it wasn't. I tried to cancel the document and resend it--nothing. Eventually, I turned off the computer, and turned it back on, and the document printed twice (great).

I just tried to print another document for tomorrow--nothing. Then, when I tried to close the document folder it was located in--"Windows Explorer is not responding."

GOOD GRIEF! I'm not playing large PC games, I'm not listening to music, I'm not doing ANYTHING but surfing the web on Firefox and trying to print a friggin' Word document! That's it! What the hell is wrong with the computer and/or this OS? This is a BRAND NEW LAPTOP. IT SHOULD NOT BE RUNNING WORSE THAN THE 4-YEAR-OLD LAPTOP IT REPLACED.

I miss XP.

Dilettante

From Merriam Webster:
"Main Entry: dil·et·tante
Pronunciation: \ˈdi-lə-ˌtänt, -ˌtant; ˌdi-lə-ˈ\
Function: noun

1 : an admirer or lover of the arts
2 : a person having a superficial interest in an art or a branch of knowledge : dabbler"

And that second definition fits me like a glove. In my personal life, I have many hobbies and/or things I like to do, but I am a jack-of-all-trades and am truly a master of none. I got to thinking about this the other day and I made a list of all my various hobbies/interests. I was astonished at how long it was.

• Singing: I haven't had any instruction in singing since I started college and quit going to church. Looking back, choir was the only part of church that I truly enjoyed all the time. Now, my only singing is in the car or while playing Rock Band. I'd love to take voice lessons and maybe find a choral group to join, because I miss singing with a passion.
• Playing trumpet: I haven't played my trumpet since second year of med school. At this point, I couldn't join a group, it's been so long since I played. Sad.
• Playing Rock Band (drums and vocals): I do love me some Rock Band. Unfortunately, I don't play often enough to actually be any good at the drums, despite my occasional daydreams of becoming a drum goddess and touring with Metallica.
• Dancing: I took ballet, tap, and jazz lessons for most of my childhood (nine years, in fact). I had to quit when I started band, because of time and money constraints. I miss it. I've picked up a little salsa here and there, but it's a rather useless skill if I'm out dancing with my hubby, because he doesn't really know how. (Well, he can do the merengue, if he counts...) I don't really know how to teach him, and whenever we dance I end up leading (and counting for him). I'd really like to take salsa or ballroom lessons with him, or even take tap lessons again. Now, though, I have my own time and money constraints.
• Working out: I was working out like a fiend toward the end of fourth year, and lost 10 lbs, which made me extremely happy. Even better, I found myself able to jog a bit on the treadmill WITHOUT a heartrate of 200+, blue lips, or painful gasping breaths. My total cholesterol was down in the 170's last time I checked it. I was seeing results. And then I graduated, and had to turn in my student ID that got me in the gym. Now, I'm debating whether to pay for a membership for a gym near the hospital (cheaper), or a gym near my house (more expensive), and so for the past month my butt has grown roots into the couch. I've kept the 10 lbs off for now by mowing the yard and Krav, but I'm deathly afraid it's going to come back.
• Krav Maga: I had started taking Krav lessons with my husband after I came back from China. It's a form of martial arts started by the Israelis. I'm not great at it, but I'm a rank n00b. However, it costs $90/month and we get too busy to go NOW. I'm cancelling my membership after June, because there's no way I'm going to be LESS busy while taking q4 call and working ("no more than") 80 hours per week.
• Biking: My husband and I just bought nice road/hybrid bicycles. I'd love to be a good rider, and I also like to use it to make small grocery runs when I don't want to take the car. Now if I could just find the time to ride, and if only it weren't 100 degrees & 90% humidity outside...
  
• Crochet: I learned how to do this when I was eight and bored at daycare. I can still make the occasional baby blanket (oh geez, I have several to make!), but it hurts my wrist unless I wear a brace. This is one skill I am actually pretty good at, without any further instruction needed.
• Painting: This is not something I am good at, but I decided I wanted to paint some "wall art" for our new house. It's... interesting. I'm sure someone will make a comment about their three-year-old's fingerpainting when they view it. However, I've barely done one, and I have several to go.
• Making jewelry: Something I randomly picked up third year for no apparent reason. And really haven't done since.
• Gardening: I haven't planted anything new at our house, because the front was already landscaped and everything else was sod. However, I plan to have an herb and vegetable garden in the future. If my thumb isn't so black anymore, that is.
• Cooking: When I want to cook, have time to cook, and have bought the ingredients, I'm not a bad cook. I make a mean lasagna, for example. I'm always buying new spices or ingredients to try out, that then languish in my pantry. We eat out a lot. But just when I think "I'm not so bad a cook", I read TBTAM, and her recipes make me cringe with fear, because they are so complicated. I want to be able to throw together a lovely, tasty meal in 10 minutes using only what I have on hand, no more than 5 ingredients, and have it be low-fat, low-cal, and amazing. Oh, and I want the dishes to do themselves. Is that too much to ask?
• Reading: Another skill I don't need more practice at. I am an extremely fast reader, probably a) genetically and b) because I read all the time. My med school colleagues (at least those in my half of the alphabet) used to get really hacked at me because I'd finish exams so fast. I didn't usually tell them I'd gone through it twice before I left. I finished Genghis Khan and am now reading The Devil in the White City, as well as having read (entirely) several new blogs.
• Blogging: Heh. I want to be a super-blogger, one with thousands of readers. But when I read the super-blogs, I get really discouraged. I don't write often enough (or well enough, let's be honest) to be one of the big boys. I'm not sure how so many busy physicians and residents find the time to write so much, but I'm just not that good. I'm happy that I've kept writing here, because I've saved memories in these pages for myself. I also love writing (I was once told I was good at that, too--you'd never think it to read the drivel I post here). I may just have to become a super-blog-reader, and leave it at that.

So why am I worried about this now? I'm trying to figure out why I'm spread in so many different directions, and what I can do about it. I think I just want to do too much stuff. I feel the rush of getting ready to start residency (oops, orientation starts tomorrow), and feel like I have to do everything NOW. Of course, that usually ends with me on my bum on the couch reading medblogs, which is marginally better than curled up in a closet in fetal position sucking my thumb. I also feel intense pressure to be a whole person, a good person, outside of medicine. Medicine is my calling, and I'm passionate about it, but I don't want to be that person all the time. It's only part of who I am, and I'm a little ashamed that the rest of me is so splintered and unfocused. I'd like to be really good at something other than medicine. I'm not sure which of my little hobbies (if any) will provide what I need, so I guess I'm afraid to commit fully to any of them.

I use the "I have no time" excuse a lot, especially when I'm working hard. Well, guess what? I'm NEVER going to be totally "unbusy", now that this month is gone. And look what I did with a month off--not a damn thing. It's time to buckle down and pick something to do and spend some time doing it, even if it's only a little bit. Money is going to be less of an issue now that we're going to be a two-income household, so long as I don't go totally nuts (or make my new hobby shopping--I do too much of that as it is).

But what'll I do? I'm not sure yet which of my little hobbies is worth my precious time outside of the hospital on a q4 call month. I guess we'll find out soon enough.

EP Has Done It Again

Today's Empowered Patient on CNN.com has really "chapped my hide" (as an old salsa commercial used to say). Today, she has gone for the vaccines. She even titles the article with a question: "Should I Vaccinate My Baby?" LIKE IT'S REALLY AN OPTION!

Ahem. Must... not... throttle... aweraerfd... must try to write rationally...

Okay, so here's what I think of her article: it sucks. It teeters on the edge of inflammatory journalism to bring bad information to worried parents. AND, she never actually answers the question she poses in the title.

As always, we start off with a story. The worried parent who wants to change up the vaccine schedule for her kiddoes, even though her first child received them all on time and was fine. Did you read that right? Yes, her first child was fine, and didn't die of measles and wasn't crippled by polio. Yet, she decided she wanted to change it up for kids #2 and #3.

Then, a quote from the enemy: the doctor. He says he'll work with a parent to change up a vaccine schedule, even if he disagrees. He then says "I share with them what I know, but ultimately, it's the parent's decision." In other words, he shares the science of vaccines with them, and they still choose to go against. Sadly, this is not the point Ms. Cohen is trying to make.

Then, she lists five changes that some pediatricians and families might be making (right now!) to the vaccine schedule. She even specifically says she is not going to address the pros and cons to each approach, or touch the autism/vaccine debate. In other words, this is what people are doing, but we have no idea why.

#1. "Delaying the first hepatitis B shot". Since the first Hep B is given prior to discharge from the hospital, some doctors find this ludicrous, as babies aren't having unprotected sex or injecting drugs, so they'll delay this shot till the baby is two months old. Since, according to the CDC vaccine schedule, the child is supposed to receive the second Hep B at 2 months, I'm not sure when they'll then receive dose 2.

Also, kids who are household contacts of people infected with Hep B are also at risk. Just because mom didn't have it doesn't mean someone else couldn't. I'm really not opposed to Hep B at birth.

#2. "Not doing some shots at all". Since some diseases aren't as scary as others, some parents opt out of certain shots. The parent interviewed in the article opted out of the rotavirus vaccine and the chicken pox vaccine. Now, I've heard the argument for skipping the chicken pox vaccine before--"well, I had it, and I was fine." True. I had chicken pox at 3 years old and I did fine. However, there are currently several problems with this scheme. First, it's harder to find kids who have the chicken pox in order to get your kid exposed to get it. Therefore, your kid is going to be older when they get it, and the older you are the sicker you get with Varicella. Second, Varicella is a required vaccine for school now, so if your kid didn't get this shot you're going to have to go through the vaccine exemption form.

As far as rotavirus goes, it's a brand new vaccine and a lot of kids end up missing it anyway (at least in the clinic I was in), because it has to be given at 2, 4, and 6 months. There is no catch-up for that vaccine, so if you miss it, it's done. In the United States, infectious diarrhea is not a leading cause of infant mortality, so I guess this one is really up to you.

#3. "Checking for 'titers' before giving booster shots". First off, I like how 'titers' gets quotation marks. It's like they're not even real! Sorry. So now she suggests that you can get titers drawn before booster shots to see if the booster is necessary. She does at least have the decency to add that this procedure will not be covered by the majority of insurance, so if you want this you'll pay out of pocket (depending on how many titers you want, this might be over $100 or so--I couldn't find an accurate price online.) I don't think there's anything wrong with this approach, so long as you use it appropriately. Just remember, though, for those parents whose main objection to vaccines is the number of pokes for your kid: it's a lot easier to give a tiny little shot than it is to draw blood from a baby. I'm just sayin'.

#4. "Spreading the vaccines out over a longer period of time". Here's where it gets funny again. She provides a link to the Sears Schedule, "an alternative vaccine schedule developed by pediatrician Dr. Robert Sears. Sears' patients bring their babies in for shots seven times between the ages of 2 to 9 months, never receiving more than two shots at each visit." Unfortunately, if you click on her link, it takes you to an ad on Sears' website for his book on vaccines. If you want all his magic information on what's really in your vaccines, and how to spread them out, you have to buy his book (it's only $11.19, come on!). I've looked up on Pubmed "Sears vaccine schedule" and the answer was "No items found." Nor does Robert Sears appear to be a published author on PubMed. Neither Cohen nor Sears gives a really convincing argument for stretching the vaccines out like this, although I'm sure Sears' business manager likes getting kids in 7 times instead of just 3, as they can bill for each visit (at least as a nurse visit). Note that if your kid is on most Medicaid plans, this will not work, as you get visits at 2, 4, and 6 months or when the child is sick. That's it.

#5. "Splitting up combined shots". I reread this section several times and I cannot find any reason behind why you would want to do this. Sears' website states that some of the combo vaccines have a less favorable ingredient profile, but to find out why you'll have to buy his book. (one more bitch about Sears' website: below this is a link to "Find a vaccine-friendly doctor near you." Um, I'm sorry, isn't every doctor who gives vaccines "vaccine-friendly"? Oh, I'm sorry, you must have meant "vaccine-suspicious" doctor, like you.)

She concludes the article with "another consideration: what's best for your child." Now, she tells the story of Hannah Poling, the child whose autism was found to have been exacerbated by her childhood vaccines by the "vaccine court." Here's a review article in NEJM, but watch out--the author holds the patent on Rotateq, the rotavirus vaccine. Apparently, Hannah Poling had a rare mitochrondrial disorder and had been susceptible to infection prior to receiving the shots.

By throwing in this anecdote, and then getting a pediatrics professor to endorse recommending a change in vaccine schedule for any family history of autistic spectrum disorders, now Cohen has added credence to this faulty theory. Of course, if Poling received those five shots at 19 months old, she was way behind the schedule anyway (why?) and probably shouldn't have received at least a few of the shots she was given--she was too old. (Not that I think that's what caused her problem, but still--something else was not right here).

So, there we have it. The Empowered Patient strikes again, telling nervous parents that doctors don't know what we're doing, that it's a fight between us for your health (and now your child's health), and that making unproven changes in the vaccine schedule are fine. Good job! So when the next round of children goes unvaccinated, and gets measles or polio, or has necrotic varicella, I think we should send them to Ms. Cohen's house--she clearly knows more than we doctors do, anyway.

*** I will go on the record here to say that I'm not at all concerned about vaccines and autism. I've seen the data, over and over again. It's not the vaccine MMR itself, OR the thimerosal (which has been removed*). That said, I know perfectly intelligent people who have become parents and start worrying about this. Of course they do, it's their kid! I'm not making light of people who worry about this. I think vaccines are great, but I do have concerns about how many we give at a time. However, without seeing any evidence that it's causing health problems, that's all they are--my concerns. Of course, if you'll pay me $11 for a book, perhaps I'll write a book of junk science, too, and then we'll both be happy.***

*I meant that the thimerosal has been removed from MMR (in 2001). It's true that 2 influenza vaccines contain measurable (though small) amounts, 1 contains trace, and 1 DTaP vaccine contains trace (<1 microgram per dose. There are 2 flu shots without thimerosal: FluZone and Flumist [nasal]). If you are still concerned about thimerosal, here's one study to check out: JAMA 2003 Oct 1;290(13):1763-6, which showed no difference between children who got thimerosal-containing versus thimerosal-free vaccines (in terms of ASD), AND failed to show a dose-response relationship between thimerosal and ASD. That said, I'm not opposed to removing it from vaccines, so long as you can find a suitable means of keeping the vaccine bacteria-free for injection. Thanks to Sweet Mama for the correction.

Fun With HIPAA

In my extensive perusing of medical blogs recently, I came across an article at The Happy Hospitalist which asked whether HIPAA applied to the deceased. This comes in the wake of health information we've received via the media about Tim Russert. It's not surprising that in the comments section, no one knew the answer to this question. In every HIPAA training session I've attended thus far, we're basically given a brochure, told to take the test, and told the page number at the back where the answers may be found. In one HIPAA session I took as an undergrad (to work as a medic on campus), we were shown a video about "Protected Health Information" but not really expected to listen, as "it's really boring." Great. In the wake of all this HIPAA misinformation, even amongst health professionals, I decided to *try* to read through the actual rules and come up with some answers.

First, I'd like to clarify that it is "HIPAA", which stands for Health Information Portability and Accountability Act. It is NOT spelled "HIPPA", which I see all the time and makes my inner spelling bee demon ANGRY.

1) Does HIPAA apply to the dead? There are layers here (it's like an onion): First, if you are getting this info because it might apply to your own healthcare, then you can get it, as HIPAA allows release of information for treatment, "even the treatment of another individual." Second, if you are the legal executor of the estate of the deceased, then you can have access to information. Third, hospitals may release records to medical examiners or funeral directors as needed.

This was very important when I worked in the ME's office, because usually what happened at the hospital before death was vitally important (ha) to the autopsy results. If the patient grabbed their chest and said "OW" before passing out, and an EEG lead showed ST elevation MI, then V fib and asystole, then when the body goes to autopsy and even a small coronary plaque is found (but minus large ischemic tissue because it was too sudden), tada, "Hypertensive Atherosclerotic Coronary Artery Disease" is your answer.

The next part of this is that autopsy results are a matter of public record. Many public medical examiners' offices websites have a formal process for request of public records. (Note that you have to know a good bit about the decedent in question; you can't just write in and say "send me reports".

2) Can I have access to my own health care information? YES. I see this all the time. Patients ask for a copy of their health care records (maybe a copy of a radiology report, or a lab value) and are told "we can't do that, it's a HIPAA violation." That's crap. Fine, make them sign the waiver, cover your bottom, but it's their information, not yours (be you the hospital or clinic, doctor or nurse).

3) If my husband is in the hospital, can they notify me? YES. I pulled this straight from the HIPAA FAQ page. They do add the caveat that if the patient is awake and can consent, or at least not object, the hospital can do this. In other words, try to tell the patient this is what you're doing, which is basically like asking them politely anyway (or should be). They then clearly state that if the patient cannot consent, the "covered entity" (health care provider) can still notify family or close friends of their "location, general condition, or death." In other words, if you call the hospital, identify yourself as family and ask where is my loved one? and how are they?, the hospital is not being truthful if they say "we can't tell you, it's a HIPAA violation." (They may have other reasons for not telling you; they might like to see ID first, to make sure you're not a reporter or someone else who doesn't need to know).

4) Can I pick up my husband's prescriptions at the pharmacy? Yes.

5) Can I see my kid's medical records? So long as your parental rights haven't been terminated, you didn't sign an agreement with the doctor to allow the records to remain confidential, or it was a situation where the kid didn't need permission to consent (like for birth control or STD testing), then yes, you may see your child's medical records. If it was an emergency, and the child received treatment before you got there, you may see the records unless the hospital/doctor decides there's a reason you shouldn't (like, the kid has a strange set of fractures with a bad story to go with it).

6) What are the consequences of violating HIPAA? In civil court, you may be fined $100 per incidence, or in criminal court, up to $50,000 and up to a year in jail, depending on how you violated it (ie, failure to provide privacy notice versus deliberately leaking public health information to the press). This, friends, is why everyone misinterprets HIPAA and why everyone is so afraid of this law. This is why you will sign a release form to receive a copy of your own medical records, or why some doctors won't fax records for fear of a HIPAA violation (by the way, that's a load of crap.)

More can be found here: HIPAA Frequent Questions.

So what does this mean about Tim Russert? I think there are several issues at play here.

First, his autopsy records are a matter of public record, and therefore available to the media.

Second, for his physician to be talking publicly about his treatment of Mr. Russert, I'd assume that family had to have given permission for him to do so. If they hadn't given him permission, and he went on Larry King, he could be prosecuted under the HIPAA laws and/or sued in civil court. His physician can reveal all the information he wants to the ME, or to the family representative, but Larry King doesn't count.

And there you have it. Funny how a law that was intended to make health information "portable" has instead hampered my own ability to see my records or my doctors to talk to each other, but I guess that's politics for you.

Blog Work

I've been reading a ton of medical blogs lately. It's one way of getting me ready for what's coming to me in 14 days (or 13 days, 5 hours, and 50 minutes, according to my handy counter on Facebook). I've added some blogs to the drop-down menu on the right, in addition to changing my template. I may keep it, I may not--who knows? Does anyone have an opinion as to whether the drop down menu is better, or should I just list out all my blogs down the page? These are tough questions here, people!

I have to reboot my computer now, which is why I only made a few small changes to the olde blog here. It seems that "Windows Explorer is not responding" and quit doing so at 7:50 PM (that's the time still showing on the laptop as of now--it's now after midnight). Fortunately, Firefox kept working, so I was able to indulge in medical blogs all night (tasty), but I couldn't maneuver between windows. This is a brand-new laptop, good brand, purchased towards the end of May, and already I think I've crashed Windows Vista 3 times. I'm averaging around 1 crash per week. I don't do anything very exciting--mostly play around on Firefox, use Outlook, or play Spider Solitaire. I'm not sure why this is just too much to handle for this new super-duper fancy OS. I've never really considered going Mac because they're just so friggin' expensive, not to mention I'm used to Windows, but with all the changes they put into Vista to make it look more like OS X I'm not as familiar with it as I was, and with all these crashes god forbid I try to do something important on this computer! (Otherwise, it's a lovely computer, very shiny; I just wish it had come with XP). GRRRR!

While I'm soliciting advice here, does anyone use a particular feed reader to read blogs? I've never used one before, because I always just click the links from my bookmarks or from my own blog. However, I think that if I contain them within a reader, it will make catching up easier from the hospital. I've put stuff into Google Reader, but is this a good one? Any tips for using it?

I really will try to post more. I realize I'm not a prolific blogger (just wordy when I do write), and I probably won't become one, but surely I can do better than this. At least until July 1, when all bets are off. GAH, I just got that cold feeling in my guts and my heart rate just accelerated like 40 bpm JUST THINKING ABOUT IT! It's a good thing I haven't had a real medical rotation since my AI in January on pedi, and I haven't done neuro since the January before that one, so I'll be just super prepared. It'll be great!

Yes, I Said That

The other night, I wanted to make my husband laugh, so I decided I would tell him a funny story.

"Honey," I said, "I have a confession to make."

"Oh? What's that?"

"Well, you know who Warren Buffett is, right? CEO of Berkshire Hathaway, one of the richest men in the country?"

"Uh, yeah?"

"Well, I have to confess that for a very long time, until very recently, I didn't know that he and Jimmy Buffett were two different people. I thought they were the same person."

**speechless hubby bursts into laughter**

"Yeah, I couldn't figure out why that stupid song would have gotten him to be the second richest man in America. I hate that freaking song, but everyone in college loved it."

**he's still laughing**

"Sadly, it was only very recently, like within the past few months, that I read a US News article on Berkshire Hathaway that I realized my mistake. I guess I'd just heard 'Buffett' and never really looked farther than that."

At this point, my easily amused husband is nearly crying with laughter as I sung snatches of "Margaritaville" to him. He has since relayed this story to many of his friends.

Well, apparently Warren Buffett heard about this.

Yesterday in the mail, I received an envelope (addressed to me) that said "Exclusive financial advice from Mr. Warren Buffett." The return address was from a local furniture store. Inside was a card, advising me that "Warren Buffett, CEO, Berkshire Hathaway" says "There's never been a better time to buy furniture" (I found a copy online--look, there's even a video message). In tiny print, it reveals that BH is the parent company of this furniture chain (they're not even near us, I'm not sure why they sent us a flyer). On the back, there's a "$100 dividend check" (good for purchases of $499 or more in tiny print), and a registration form to win "one 'B' share of Berkshire Hathaway stock valued at over $4000".

So apparently, the "Oracle of Omaha" has spoken directly to me. He said I need to go buy furniture I don't need with "no down payment and no finance charges til 2010" and if I provide him with my name and email address, I might just win 1 share of his stock. In other words, he's going to remain the second richest man in America so long as people take his advice and go buy furniture (in a time of rising gas and food prices).

I guess I should apologize. I didn't mean it, Mr. B! I would never hold you responsible for that stupid song! It was all a misunderstanding! There's no need to insult my intelligence with a really bad furniture offer! I promise, I'm smarter than that now! Or at least, until I go to my friend's wedding tonight, where I might just be "wasting away again in Margaritaville." Woo!

Reading

Since I have nothing medical to blog about for the next three weeks, until they unleash me upon an unsuspecting neurology service, I'll blog about what I've been doing recently, and that is reading.

It's such a simple thing, reading, yet it was so hard for me to do until I went to China. Ever since I learned how to read, I've always had my nose in a book. I used to read through dinner, in the car, while everyone else watched TV, in the bathroom or even in the shower (this amazes my husband). In fact, I used to get in trouble for reading so much when I'd visit my dad's house as a kid. "Put your book down and come join the family" was a refrain I heard often. At my mom's house, the punishment that worked the best (until I had a car) was to ground me from reading (unless it was for school, of course).

Sometimes, I'd have two or three books going at a time--one for school, maybe, and one I'd read before, and sometimes a third. I used to get in trouble with Mom because I'd leave them lying face down, bending the spines. I still do that, but I own the books, so it's not such a big deal. I read all through high school and through college. I laughed at a professor who told me I'd eventually get too busy to read. To me, reading was like breathing. I read extremely fast (as does my mother and hers), so I often reread books that I've enjoyed and gain new insight into them every time(as opposed to my father, who reads extremely slow, but retains everything perfectly, so he only reads a book once, ever).

Then, I hit medical school. And I'm not sure when the reading stopped. There were 1,000 page syllabi (per class) to read, as well as textbooks and reviews and such, and frankly, my brain was tired. Then, on the wards, I'd be so busy and exhausted and full of what was going on with my patients and studying for the shelf that I was all used up. For a long time, I didn't even want to watch movies--I didn't have the ability to concentrate on two hours' worth of material. Television shows became the limit of my concentration--one hour max. (This change also coincided with moving to an apartment that offered free cable, which didn't help.)

My aunt sent me three books to read in China. I packed them, unsure if I was wasting the room in my backpack. After all, surely I'd be too busy to read much. I mostly did Sudoku on the flight over, and it was at some point later that I picked up the first book. I proceeded to read all three of my books, one of A's books, three of B's books, one of C's books (on the flight home; she didn't want to have to pack it) and a book I bought at the Bookworm in Beijing. It was like rediscovering breathing, I felt so refreshed. Since I came home, I've been off, and I've made several trips to Half Price Books. My shelves are stacked with new books that I've been cramming down, bingeing on the new reading material. I'll list off a bit of what I've been reading lately (during and since the trip):

• Suite Francoise by Irene Nemirovsky (lovely reading about WWII in occupied France)
• The Glass Castle by Jeannette Walls (memoir about a very dysfunctional family)
• The Memory Keeper's Daughter by Kim Edwards (girl with Down's is taken away, mother is told she's dead)
• The Time Traveler's Wife by Audrey Niffenberger (a new favorite, this book is amazing)
• Remember Me? by Sophie Kinsella (beach fluff but fun)
• The World According to Garp by John Irving (very odd, and book really has no theme or message)
• Salt: A World History by Mark Kurlansky (a little dry, but interesting nonetheless)
• Spook: Science Tackles the Afterlife by Mary Roach (not as good as Stiff, but still fun)
• Coyote Blue by Christopher Moore (read in China, was fascinated by Moore's work)
• Fluke, or I Know Why the Winged Whale Sings by Christopher Moore
• Lamb: The Gospel According to Biff, Christ's Childhood Pal by Christopher Moore (well-written and not as blasphemous as it sounds)
• You Suck: A Love Story by Christopher Moore (vampire love story)
• Prairie Gothic: The Story of a West Texas Family by John R. Erickson (interesting West Texas history; I've been looking into genealogy lately so this was fun)
• Goodbye to a River by John Graves (quoted often by Erickson so I had to read it)
• The Liars' Club: A Memoir by Mary Karr (found in Texana section at HPB, also a memoir of a very dysfunctional family)

China books:

• Iron and Silk by Mark Salzman (read prior to trip)
• The Rape of Nanking by Iris Chang (read prior to trip, heart-breaking history)
• Red China Blues: My Long March From Mao to Now by Jan Wong (fascinating)
• Tiananmen Diary: 13 Days in June by Harrison E. Salisbury (great account of Tiananmen student protests in 1989, compare to Red China Blues account)
• Falling Leaves: The True Story of an Unwanted Chinese Daughter by Adeline Yen Mah (very sad memoir)
• Genghis Khan and the Making of the Modern World by Jack Weatherford (currently reading, just started; written by researcher who helped translate the long-lost writings of the Mongols)

I have quite a few more books to try to get through before my break is over. And hang curtains. And hem curtains prior to hanging. And paint wall art for dining room and guest bath. And write more China stories before I forget. And try to organize office a little more. And talk to county extension master gardeners about our oak trees being planted too close together. And... We'll see how much I actually accomplish in between riding my new bike, reading all my new books, and catching up on medical blogs (I just started reading The Blog that Ate Manhattan, and it makes me so hungry!). But, because I like reading and procrastinating more than doing chores...

Anyone read any other good books lately?

Introducing Doctor TS

We graduated this past weekend. I walked across the stage, picked up my diploma, received my hood, and took the Hippocratic Oath. For the rest of the day, anytime someone said "Dr. TS", I giggled. It doesn't feel real, despite working for the past four years to get here (and in reality, the past 10 or so, because I've been planning this for a long time). My mom was laughing at all of us with our "shit-eating grins" (her words); we were just walking around calling each other "Doctor" after the ceremony was over.

I felt pretty good all weekend, but today I got my PGY-1 schedule and I will be starting on neurology. We all know how I feel about neuro, so add my fear of being the intern in charge + fear of being the intern on neuro = rather scared TS. I do hope that I can learn to enjoy neuro more--I think part of the reason I don't like it is the way our school went about it. But who knows? I'm going into psychiatry, not neurology, and while I hope to learn what I need to get by in the overlapped area, I'll never be a neurologist. That job is my friend newly-Dr. B's job, who is now moving to the East Coast. At least some of my other newly Dr. buddies will be staying here, at least for their intern year, before moving far away. It's bittersweet at this point--I'm so proud of my friends, but sad that they're leaving. And sad I only get 2 weeks off, so I can't possibly visit everyone. Oh well.

Thank you for the comments on the post about not being a nurse. It really isn't that big a deal, but for some reason it gets to me. If the roles were reversed, and I'd just finished four brutal years of nursing school, I'd be offended if someone called me "Doctor". Or maybe not, who knows?

Just so it will be in writing somewhere, it took a village to get me through medical school. Or at least a very loving husband. He has put up with me when I was cranky, brought me food when I was exhausted, and snuggled with me even when I was post-call scuzzy. The rest of my family has also been very supportive through all this. Also, I have great friends, both in and out of medicine. Of course, entering residency won't be very relaxing, either, so I will continue to rely heavily upon them, but at least I can take a minute to thank them all for helping me get this far. To all y'all, you know who you are; thank you, and I love you.