Time sucker

This whole internet thing is just a big black hole for all my free time. I woke up at 1pm (don't worry, I got to bed at 10am - I didn't get to sleep 12+ hours!) just to be able to do work. But all I have managed in those two hours is checking facebook, the New York Times, my email repeatedly, and getting a recipe that I will try for dinner.

Living in Twilight

I feel like that's how I've been for the last week or so. It's been a crazy few weeks. In no particular order, I finished up on my medicine rotation, cried for the first time in internship, has my first weekend off in forever, and managed to squeeze in two (albeit unsuccessful) dates. Sometimes, when I spend a lot of time at the hospital and the rest of my time in my tiny studio apartment by myself, I feel very holed off from the rest of the world. Albeit, I do read the New York Times online more often than once a day, but I feel like my whole world is this parallel universe to what the rest of the world is living. Sometimes I even find myself using language that implies as much - calling non-hospital life the "real world," as though my hospital life is not part of any world most people know.

I guess that this is all a part of residency, this feeling of isolation and feeling like you're fighting a current of trying to get as much learning in as possible without sacrificing your personal sanity. The first few months actually went by smoothly - I was adjusting, I was getting praise and constructive criticism, and felt as though I was really going somewhere. Now, in my fifth month, I feel like I'm stalling. I'm haunted by the feelings of inadequacy that every intern encounters (Am I good enough? What do my attendings and senior residents really think about me? Will I ever be good enough? How will I manage as a real doctor?), feelings like my real life is being neglected (Will I ever find a good base of friends here in the south bay? Will I ever find a steady date? Will I ever get to my crafting/gardening/reading project?), and feeling purely exhausted and drained.

I hope that this post isn't coming off as depressing, but just more serious than most. I'm not depressed at all - actually, I delivered my first baby in two months last night and it felt great. I just feel that this is a time of reflection for me, as I am almost halfway through my intern year. Also, I can't wait for my first vacation (just bought my plane ticket yesterday!) and the ability to sleep in for more than one day in a row and the freedom to take a few calm, deep breaths.

The inspiration for the title is the song currently playing on my computer, Living in Twilight by The Weepies.

MIA

I have been held hostage by something called "ward medicine" for the last few weeks. That has left me with very little time to sleep, eat, do work, and otherwise have a normal life. I am perpetually sleepy, perpetually grumpy, perpetually tired, and perpetually feeling behind. Hence, I haven't been updating. I haven't even been cooking (gasp!). I did manage to throw together Ma Po tofu (silky tofu with ground turkey) the other day in 10 minutes - but was too tired to take pictures. I will give the recipe one day, as it's a great one and really easy and quick to make.

5 more days to go, then back to a more "normal" schedule of 6am-6pm with overnight call 1-2 times a week. Yeah, normal. It's amazing what intern year does to your perception of things.

Polypharmacy

I have a patient who is under the age of 40 and is on 16 medicines. Yes, 16. And some she takes more than once a day. Who really can keep track of 16 medicines? Of course, the reason why she takes so many medicines was completely preventable if she took the 2 or 3 she had to take years ago. And, of course, she doesn't take all of her medicines, which brings her under my care.

There has to be a better way of doing things.

Ergh

This week has not been a fun week at all. And to top it all off, I'm sitting in my apartment, about to throw my Palm (not my hand, my PDA) against the wall. It just pooped out the other day, and I turned it back on and lo and behold - all was lost. Now, I can't even sync it to my computer to restore everything. It's driving my positively insane. Now I want to open my palm (now my real palm, not the PDA) and hit smash the Palm (PDA, not hand) against the wall.

What did you say?

Isn't there a saying that "A watched syringe won't melt"? Because that's what I'm doing - watching a frozen med syringe defrost in front of my eyes before I can give it to the patient. This is what I trained 4 years for, right?

All in a night's work

Last night had to be the most challenging for me since the beginning of this wonderful journey otherwise known as intern year. All in one night, I...

... sat by a patient's bedside for nearly an hour as I drained nearly 4 liters of fluid out of his belly. In that time, I got used to his smell (he was homeless and probably hadn't seen a shower in a good amount of time), and got to know his story (a Vietnam veteran who has been homeless for almost 30 years).

... had the same patient nearly give me a heart attack when he starts getting all seriously sick on me. Seriously. And this happened in my 27th hour on call. Yeah, 27th hour. Yeah, like I'm thinking properly at that point.

... seen and smelled the worst smell ever and something that no one should ever smell, or, worse, smell like. I guess that's one of the things that can happen to you when you're 400+ pounds.

... realize that a Spanish-speaking patient doesn't not understand me - rather she just refused to answer any question directly. Me: "Do you have pain?" Her, about a minute later, "Oh, I think I have pain on my hand, and phlegm in my throat. Can the phlegm cause a heart attack?" Not kidding you.

So yeah, not a pleasant night. Now, I'm awake and I don't know if it's better to just stay awake or to actually go to bed. And what day of the week is it? It's a question I ask almost all my patients (you'd be amazed at how many get it wrong), yet sometimes I have to reconsider and think to myself. Yeah, it's a Saturday, a "leisurely" day for most of the population - unfortunately a population to which I do not belong.

Ending the suffering

I don't know whether it's me or the patients suffering more (yeah, yeah, I know the patients are suffering more, but let me whine). I just want to sleep, but I have to keep on truckin'. Let's just say that I'm hating internship at this moment in time. Check on me in a few hours.

And now this...

I was talking to a friend the other day about the state of politics in this country nowadays. Of course, my knowledge is limited and a lot of what I say may be nothing at all. However, I'll tell it to you anyways.

I told her that I think politics has always been divisive, with Democrats on one side and Republicans on the other. Politicians have never really gotten along well if they're on opposite sides of the aisle, and sometimes don't get along well even if they are on the same side of the aisle. However, what I think has changed in recent years is that it's no longer the politicians who are divisive, but cities, neighborhoods, and even homes. My friend is voting for Obama but her husband is voting for McCain and she realizes that this is sometimes a point of contention in their house, as it is in many thousands of others across the nation. I don't know if the divisiveness will end with the election, instead, I think that it will just continue to grow until something changes. One side will always be unhappy and the other side will always gloat in their victory, at least until the newly-elected president makes a mistake, which is bound to happen.

This all came to me when I was reading this article, which was just so profoundly disturbing. They're calling Senator Obama personal names and insults, as though they were bullies on the playground pushing the new kid in school around. Worse yet, they're throwing thinly veiled threats at Obama. I give the McCain campaign credit for trying to subdue their crowds, but I can see how it's hard given the crowd mentality that can build up to seem like a witch hunt at times. It's just so unbelievable to me that the attacks on both sides are getting personal. Maybe McCain is to blame a little because he is running negative attack ads (though so is Obama), but I don't think the blame can be placed squarely on either of the campaigns. I don't think the blame can be placed on anyone, except maybe the obvious.

A nonsensical policy

When did family planning become a bad word? When I was little, we used to drive past this building with the words, "Planned Parenthood" on it. I didn't know what it was nor did I know the controversy surrounding such clinics. However, the words struck me. "How great is that? People can plan on when they want to become parents!" This was when I was in elementary school. Now that I am older, I still think the same. How great is is that people can control their own reproductive choices?

This post is about family planning. I had a friend call me the other day and we discussed family planning. She is pro-life, I think, and asked me, somewhat rhetorically, "Why wouldn't any pro-lifer support family planning?" She went on to argue (and I'm paraphrasing here) that anyone who is pro-life should be for any prevention in unwanted pregnancies, including comprehensive sex education and teaching and enabling people to use birth control. So, this in light of a recent op-ed in the New York Times highlighting President Bush's "pro-life" choice to cut off birth control funding to many international organizations, got me raging. Seriously, doesn't he get it? Not giving people condoms doesn't stop them from having sex. Giving them condoms simply gives them a way to protect themself from infection and unwanted pregnancy when they do have sex. I mean, if the President decided not to fund any programs that provided sex education or birth control in the United States, people would be outraged - wait, he already did and people are outraged. I guess we can give President Bush brownie points for being consistent.

Meanwhile, a "young woman lies in a hut, bleeding to death or swollen by infection, as untrained midwives offer her water or herbs. Her husband and children wait anxiously outside the hut, their faces frozen and perspiring as her groans weaken." [Quoted from Kristof, "Can This Be Pro-Life?"]

One of those days

It's just one of those days where I want to curl up into a ball and hide in a corner of the hospital - after I throw my pager into a brick wall. 

 

The other side

Warning to those who may be "shy" - the following post contains references to male and female body parts.  Gasp!

So, I have been doing internal medicine for the last 6 weeks or so - it's an ob/gyn's way of getting primary care training and being able to manage things such as hypertension, pneumonias, and diabetes.  I actually really like the program that I am at because it does offer this training as I think being a primary care physician is integral to the way that I want to practice in the future.  However, there have been a few times when I wished that I was delivering babies again - and this is mostly when I have to do a male-specific exam or manage a male-specific problem.  For instance, I did my second prostate exam - ever - the other day.  Yeah, how did I manage to get through medical schol without being required to do more of these?  Maybe I was just in the right place at the right time, meaning not in the vicinity of any person in need of a prostate exam.  Granted, it's not that bad, and admittedly, easier than a pelvic exam - but still unpleasant nonetheless (and yes, I will acknowledge that it was definitely less pleasant for the poor soul who needed it).

Reflecting on my service, I have had 4 men with urinary tract infections (UTIs).  I do get a lot of experience managing UTIs, but in men, it's a somewhat different ballgame.  So, I find myself trying to figure out how to ask about their prostate.  And I find myself asking patients about "penile trauma" and then patiently wait for the awkward answer. 

That's not to say I am not getting a lot out of this rotation.  I set a goal for myself to learn more about antibiotic use and that definitely is coming to fruition (out of 4 admissions last night, all 4 were on antibiotics).  And I am definitely getting the hang of managing high blood pressure, diabetes, pneumonias, etc. 

In short, I miss delivering babies.  I miss not having to worry about my patients and their hallucinations (such as the one I had last night).  I miss the generally healthy ob/gyn population.  I miss doing more than mountains of paperwork and orders for my patients.  Ah, only a few more weeks, then I'm back to the OR. 

Candidates on the issues

I just stumbled upon this handy dandy "candidates by the issue" voter's guide on the New York Times web site.  It's short, sweet, and to the point.  Discovered just in time for the debate! 

Yum!

Today's cold weather and my wet bike ride inspired me to make something that was homemade and warm, so I made a soup that my mom used to make when I was a kid. I think she made it whenever she had random stuff on hand, because all it really needs is a good broth and pasta. Yes, you heard me, this soup uses pasta. No, it's not Asian and no, it's not Italian. I have no idea what it is - it's just soup that's yummy.

A warning that it's not as easy or quick as my usual meals. And it's definitely not vegetarian friendly, as it requires three different meats (all pork).

The broth can be modified and used for any kind of soup you desire. You can also add a few stalks of celery in there (I just didn't have any).

So, here I present you:

Pasta and meat soup
Feeds: 5-6
Active prep time: minutes at before simmering the broth and 15 minutes at meal time

Ingredients:

• (3 lbs) chicken or pork bones. My mom swears that pork bones make the broth "smell funny" but I don't buy it. I use either, whichever one looks better at the grocery store.
  
• (3-4) large carrots, cut into inch segments.
  
• (1) large onion, cut in quarters, but not completely. In other words, cut the onion like you're going to cut it into quarters, but don't cut it all the way through. That way, when the onion cooks, it doesn't fall apart and is easy to take out in one big scoop. I used red because it's what I had on hand, but you can use yellow.
  
• (1) tray pork trotter. I don't know how much is in a tray, perhaps a pound and a half? And you may ask, "What is pork trotter?" Well, it's a euphemism for pork feet. Yeah, pork feet. It's something that is uniquely Vietnamese, in the way it's prepared here, I think.
  
• (1 lb) lean ground pork, sauteed with 4 cloves garlic until cooked.
  
• (2 lbs) chives, chopped into 2 inch segments.
  
• (5) green onions, chopped.
  
• (1 bunch) cilantro, chopped.
• (1) jalapeno, sliced.
  
  
  
• (1 lb) pasta, cooked. My favorite pasta to use in this is generic macaroni, but all I had on hand was rotini.
• (1 tbsp) sugar.
  
• Salt to taste.
• Freshly ground pepper to taste.
  

To make broth:

1. Boil 4 quarts water.
   
2. Add pork or chicken bones, bring to gentle boil, gently. The rougher the boil, the murkier the broth turns.
   
3. Add carrots and onion.
4. Simmer covered as long as you can stand. I like to it to boil for at least 4 hours, for the most flavor.
   
5. An hour before you're going to eat, put in pork trotters and bring to gentle boil, then simmer and cover.
6. Season with salt to taste and sugar.
   

To assemble:

1. Pasta goes in the bottom of the bowl.
   
2. Add a little bit of chives, little bit of onion, little bit of cilantro and a little bit of ground pork.
   
3. Grab one piece pork trotter and soup bone (if you're into that kind of thing - some people aren't).
   
   
4. Scoop soup over whole thing, top with squeeze of lemon and dash of freshly ground pepper.
   

A picture of most of the ingredients. Yes, I cooked this all for one person - me.

Afternoon snack

My afternoon snack today blended the good (green apples) with the bad and the smelly (shrimp paste). For those unfamiliar with shrimp paste, it's basically shrimp and salt. And then ground up into a paste. Yeah, probably doesn't sound very good and to a lot of people, tastes even worse. However, to someone who loves anything salty and doesn't mind smelly things (durian, anyone?), shrimp paste is great stuff. It's not used in many recipes and it's a wonder I even keep it in my fridge. The one good thing that it's always good for is as a dipping sauce, albeit sparingly, for green mangos or green apples. The tartness of the fruit goes well with the saltiness of the shrimp paste.

Please be forewarned that shrimp paste is very salty. Seriously, it should have a haz-mat symbol on it. The physician in me tells me that I should warn people with high blood pressure to stay away from this (and all other salty things!). Also, if you can't stand smelly things (and you know who you are), don't even try this. If you have normal blood pressure and don't mind smelly things, eat away.

The shrimp paste from my fridge:

Rain, rain, go away

Today, I decided to explore a little of the south bay and go biking on the Los Gatos Creek Trail. It was supposed to be a great trail and a great day and a great ride. However, things just weren't going my way and my day ended up looking like this:


All gone down the drain.


First, my front wheel was slightly flat. However, I was still determined to go. Yeah, I'm crazy.

Second, my pants leg got stuck in my bike and promptly tore a hole in my pants. I'm not so sad about the pants, just sad about it happening. It literally happened one minute after hopping onto my bike.

Third, it started raining. Now, this wouldn't be so bad if it was simply sprinkling. I can handle that. But then, it started to get real bad and I wasn't even able to see. My clothes got soaking wet, but only on one side (the rain came in sideways, thanks to the wind). If you look closely, you can see my right pants leg all tied up to keep it get from getting caught into my gears!

This part of the trail was swollen over on the way back. It was hard to tell how deep it was and I didn't dare go until some other bikers went through before me. It was about 5 inches deep. Fun stuff.

On the way back, I saw this woman gearing up, getting on the trail, and then her little dog on a leash!

And, after all this, I am still smiling. Look closely and you can see all the raindrops on my face.

Needless to say, I didn't go the whole way of the trail. I didn't even go halfway. Biking while soaking wet with a semi-flat tire is no fun at all. So, I decided to try this falafel place that is always so busy on the corner of Stevens Creek and 880. There were about 20 people in line, but well worth the wait. Falafel sandwich was crunchy, great tahini. However, the hot sauce was all in a dollop on top - totally unsatisfying (I'm really into making sure ingredients and sauces are spread evenly). The banana shakes are also good, but not great. I feel like there's something in them that makes it taste like fake sugar (maybe it is fake sugar?). However, I'd still go again, the falafel was pretty damn good. Next time, I'm trying their "meatball in wheat" - sounds delicious, eh?

Healthcare reform

The New England Journal of Medicine, for which I have a lot of respect after seeing how it works (I spent a month at their offices in medical school - one of the best months of medical school, ever), just published two "articles" written by Senator Obama and Senator McCain on how healthcare reform will look like under their administrations.  It's interesting to see the perspective in both.  For those of you interested in healthcare, as everyone should be, it's a good read. 

I will save my opinions for another day.  And, I can't seem to focus enough right now to really read the articles in-depth to be able to converse intelligently about them - just thought that I'd put the articles out there. 

Yum!

08.10.01 003-2, originally uploaded by yenniet.

My afternoon snack as of late. Easy, quicky, and satisfying.

(Ingredients: vine-ripened tomato with a dash of salt, low-fat sharp cheddar cheese)