Thursday, July 29, 2010
Today was the first day in a while when I haven't been at work during a weekday.  I took the opportunity get some long-procrastinated tasks done:  take my car to a tire shop to get a slow leak fixed, and get my NC drivers license.  I've been meaning to get the license for a while, but after reading the DMV website, I realized that I was missing some of the 1400 documents I needed.  So I called home, and had my sister bring my social security card and a copy of the insurance policy down.  So today I gathered all necessary stuff up (my license, passport, social security card, proof of address, proof of insurance, etc, etc etc) and rolled on down to the DMV. 

I start pulling out all my stuff, and the lady comments on how prepared I am!  Yes, I think.  That's what 20 years of education gets me... the ability to be prepared to get a drivers license.  So I pull everything out, and much to our chagrin, we realize that the insurance form I brought was NOT the one with my name on it.  Crap.  So the lady tells me I can go get it after I take the test, no worries.  Phew.

I went and did the little vision test, registered to vote, took the written test, passed (phew), and went back to pay.  At that point I realized you needed cash or check to pay.  Crap.  I didn't have either.  So I decided to run home, get my check book and the insurance form.  So home I go, jiggety jig. 

Crazy driver #1: When I'm waiting to turn left into my apartment complex. the car in front of me decided not to wait for the arrow to turn green, and he turns while it's still red.  Not only does he do that, but he turns onto the WRONG side of the median, successfully driving directly into traffic, that incidentally just got a green life.  Dumb.

Moving on, I get home, grad my check book, and start looking for the RIGHT insurance form.  I looked through all my files, on my desk, in my desk, and couldn't find it.  I started looking through the trash trying to find it.  Finally, I gave up.  I went back to my car to head BACK to the DMV, and checked my purse one last time to make sure it wasn't there.  Much to my disappointment, the form I needed was on the back of the one I'd shown her.  Whoops. 

So I headed back to the DMV with my insurance paper and check book in tow. 

Crazy driver #2:  I was waiting to turn left into the DMV, and there was someone turning left out of it.  They turned, but didn't find it necessary to make it to the other side of the median, and started driving the WRONG way down a 4 lane highway.  What is wrong with people today?!?!  He made a hasty u-turn to avoid becoming road-squish, and went the other direction. 

So, I checked back in, waiting again for my number to be called, went back to the desk, handed her the insurance info, and got out my checkbook to pay.  "Is that an out of state bank?"  the lady asked.  Yes.  Yes it is.  Well, they don't take out of state checks.  WTF??  I wanted to ask what it mattered, since all the money IN the account came from her tax dollars... but I didn't.  Instead, I went BACK to my car, got in, and drove to the nearest ATM.  Which happened to be across a number of busy intersections that were packed and took forever to get through.  Then I got to an ATM and waited behind a lady who may have never seen one before... she didn't quite know how to work the thing.  17 minutes later, I headed back towards the DMV, cash in tow.

Crazy drivers #3-10.:   Maybe my LEAST favorite thing in the world of driving is when people with a green turning arrow keep going through the arrow when it turns yellow, and red, just because the people ahead of them got to go and they were in line.  Then, the people who get the green light have to wait for the illegally red-arrow running people move.  When the light turns yellow, you have to stop.  Even if you don't want to.  Sorry.

So, anyway, I went BACK to the DMV for the third time, paid with cash, had my picture taken, and successfully got my NC drivers license. 

Moral of the story:  If the NCDMV spent as much time making sure drivers knew what yellow and red lights and medians meant as they did making sure my bank account is from NC, there would be less accidents. 

Drive safely,
Wednesday, July 28, 2010
First off, what do you think of the new design?!  It's totally different that the last one... and my first real redo since settling on a design months back.  I wanted something a little fresher, springier.  Any suggestions for improvement?  I'm sure it will get tweaked a bit in the next few days...

So onto the diet.  No, I'm not really remaking my diet.  But I was thinking today about how I should start paying attention now to what I am eating throughout the day, so that in three weeks when I'm laid up after my surgery, I won't gain like a billion pounds and become a lazy blob who will break my nice clean bikes.  Clearly that is an exaggeration.  But when I had this ankle whacked on years back, I had a hard time not eating crap.  When I can't do stuff, I get grumpy, and when I'm grumpy I eat.  You can see the road that would go down...   Anywho, I started to thinking about trying to eat more veggies than ice cream and more fruit than cookies.  So for dinner, I made a lovely salad to eat with my leftover Thai food from mango sticky rice night.  I do realize there are many croutons, and they don't count as health food... but they were getting stale so I had to use them.  Anyway, we've got arugula, tomatos, red onion, carrots, a bit of feta, and some greek dressing.  It was delish. 

And then I had some ice cream. But not too much. I love ice cream.

I've also been thinking of ways to keep in shape with one leg.  I did the same thing back in January when I hurt the ankle to begin with, and really it was an unsuccessful effort.  I jumped on one foot... did some situps... tried to ride a bike with one leg (that's a fail... they should invent one you can power with your knee...)  So I am thinking there will be lots of upper body working, and swimming a LOT when I am allowed.  In my mind, I should be allowed to swim right away.  I am the reason they invented gortex cast padding.  But they tell me it was for 8 years olds who broke their arms and can't keep it dry in the bathtub.  Bummer.

Anyway, let me know what you think of the new look!

Tuesday, July 27, 2010
You all know the story of the boy who cried wolf...  In case you live under a rock, or in another country where this story isn't a childhood staple, I'll give you a brief recap. 

Boy sits on a hill, bored, watching his sheep. 
Boy decides to spice up his day and cries, "WOOOOOLF!!!"  People come running.
Boy says, "Heeeeeyyyyyyyy.... wanna hang out?"  People give him dumbfounded look, and walk away.
Boy continues to sit on hill, bored, again.  It's the equivalent of day 6 of an 11 year old's summer vacation.
Boy decides to try again to have a little hill party, and cries, "WOOOOOOOOLF WOLF WOLF WOLF!"
People come running again.  Boy says, "Well, hey, now that you're here, wanna hang out?"
People give boy angry perturbed dumbfounded look, and walk away.  And stop inviting is parents to parties.
Boy sits on hill some more, and gets a little MORE bored.  He contemplates calling for "friends" again.
Boy notices moving object in a distance.  He realizes it's a WOLF!!!!
People look up hill, laugh, and go back to playing cards. 
Boy gets eaten.

So, maybe the ending wasn't just like that, but it's close enough. 

Ok, so now you ALL know the story.  Moral of the story:  Don't cry wolf if there really isn't one, because people won't pay attention when you're about to get eaten.  So, how does this relate to medicine, you may ask?  And how does it relate to the ED?  Well, I'll tell you.

There's not a lot of continuity of care in the ED.  That's kinda by design.  But there are some patients who are seen quite frequently, and some of them are what I would call the boy on the hill.  They come in with the same complaint multiple times, and each time the workup reveals nothing, they get sent home, and shockingly, don't spontaneously combust.  Then a week later, they return with the same complaint, the workup is negative, and they get sent home again, and shockingly don't spontaneously combust.  And they come back again, and again.  Why?  I'm sure it varies.  Drug seeking, secondary gain, real symptoms, who knows.  But they keep coming.  And in reality, people stop taking them seriously.  They still get the workup, because there's always the chance that they WILL spontaneously combust (or get eaten by the wolf), but they lose credibility.  We wait for the wolf to come, even thought it probably never will.

I had one of those today.  He was a 26 year old guy who had been seen in multiple hospitals multiple times for abdominal pain.  In fact he was seen YESTERDAY in the gastroenterology clinic, and they wrote a nice note about the visit.  It said he'd been seen many places many times, had had multiple x-rays, CT scans, scopes, and blood tests all of which revealed nothing.  He'd been given pain meds on many occasions, and was once caught in the ED trading pills with another patient.  Today he left AMA (against medical advice) from the ED after a minimal workup again revealed no problems.  We did it.  We checked him out.  And it again was negative.  Maybe he went home and spontaneously combusted, I don't know. 

All I know is I hope the kid never gets appendicitis. 

The moral of the story:  Don't cry wolf unless there really is one... or something bigger, like a charging moose, out of control Hummer, or a falling star.


PS.  I'm in the process of reformating this bad boy, and plan on adding a "fun fact of the day" section.  Be excited.
Monday, July 26, 2010
Have you ever eaten something and thought you maybe just stumbled into heaven?  If not, you should try Mango Sticky Rice, and then get back to me.  I know you'll know the feeling.  Mango Sticky Rice is a Thai dessert made with rice,  mango, and sticky...  I think the sticky is made with what would be the equivalent of sweetened condensed coconut milk.  It's sweet, and sticky, and a little salty, and pure heaven.  Somehow, they take normal white rice, and turn it into this little patty of goodness.  Then they cover that with MORE stickyness, and then mango.  Good mango.  I don't know where they get good mango in North Carolina, but they do.  Sigh. 

And, in an effort to keep up with the medical theme of this blog, here is a fun fact of the day...

Coconut milk (the kind straight from a coconut, not the sweetened condensed sticky kind) is isotonic (google it) and makes a wonderfully fantastic rehydration solution because of it's combination of electrulytes that mimic the body's.  Translation:  I think that means I'm supposed to eat mango sticky rice at the end of races... probably every time after I exercise.  Medicine rocks.

Do you think I should post a fun fact every day?  I have lots....
Sunday, July 25, 2010
This weekend, my sister came to visit!  We have been trying to figure out how my ED schedule and her work schedule would fit so she could come visit me, and spend a little time in the rehab unit with the speech and language pathologists (because that's what she's studying).  So she and a friend drove down on Thursday night!  And my Thursday night, I mean half Thursday, half Friday morning... She rolled into town sometime after 4am (I was asleep... didn't notice).  Apparently the trip was extended because her  1996 Camry... formerly my Camry, my brothers Camry, and my dad's Camry, was turning over 300,000 miles on the way down, and it needed a proper celebration! 

This car is no stranger to celebrations... when Sarah and I drove around the country in 2006, the Camry turned over 250,000 miles in the middle of the desert in California, and we too had a proper celebration.  Here's the video...

Caitlin (my sister) and her friend Steph took it a step further with cupcakes, car window paint, and candles, which the car blew out itself with a little AC.... look for it on a Toyota commercial soon.  So, all of the stops and driving slowly so they didn't miss the change extended their trip, but they managed to make it here alive.

Friday, Caitlin spent a little time with the SLPs while I was in lecture.  Then we made guacamole for lunch and had Cookout milk shakes (a must for everyone's first trip to Winston...).  I worked Friday night and Caitlin and Steph did something that involved getting very very lost...

Yesterday, we went to Boone for some shopping and hiking!  It was hot, but not too bad...  We got some ice cream and I picked up a couple new Pyrex measuring cups... I dropped one a few weeks ago and needed to replace it.  Then we headed home and went swimming until the pool closed... the water was like bathwater it's been so hot out.  Not as refreshing as it could be, but it was still fun!

Today, we made french toast for breakfast before they left! It was delish. We covered it with berries, real maple syrup (complements of my grandparents in Michigan!) and this sweet cream cheese stuff Caitlin and Steph made (using my new hand mixer!).

Caitlin (left), and Steph (right) with breakfast... mmmmmm!

Note the journey mug from Tom the Australian and the little syrup pitched from Caitlin from Malawi!

They had to go home after a nap, and I spent the rest of the days catching up with a friend and cleaning my apartment.  A nice weekend off before working the next two in a row.  I'm sure that will come with more stories to share...

Until then,
There is an eerie feeling in the room before you receive a patient who is in cardiac arrest.  Sometimes, you don't know it's going to happen, and there's no time to prepare, no time for the eerie feeling.  But sometimes, especially in the Emergency Department, you get that call from EMS, the "CPR in progress" call, and you know it's coming. 

Everyone switches gears from normal ED business to preparing for this patient to arrive.  Jobs are assigned, gowns and masks and gloves are put on.  Someone prepares to manage the airway, someone get ready to put in lines, someone manages drugs, a couple people get in line to do chest compressions.  Every detail is planned and assigned so that as soon as the person hits the door, everything gets done.

And then, you wait.  Silently.  Everyone knows what's coming.  Well, you know a person is coming in dead.  Our job is to try to bring them back to life.  Maybe that's what everyone is thinking about while they stand there silently.  Maybe they are thinking about their job, working through each step in their head so they don't miss anything.  Maybe they are thinking about the person who is coming in, a 55 year old dad who had a heart attack, or a 33 year old mom with cancer, or a 95 year old great great grandfather.  Maybe they are thinking about the family they will have to talk to after it's over.  But everyone is thinking about something.  And the room is in asystole.  Still.  Silent.  Pulseless. 

And then the patient arrives, CPR in progress.  You move them from one gurney to another.  Someone takes over chest compressions, someone puts the pads on, someone starts more IV's, someone puts in a central line, someone takes over the airway.  The room comes to life in an effort to do the same to the patient.  And you either succeed, or give up.  At some point, you have to stop.  You have to decide that there's no hope.  You watch them go into asystole, flat line.  You call time of death.  You tell their family their loved one is dead.

Last night, it was an 11 year old boy.  How he died doesn't so much matter.  He went through the same process.  We did CPR.  We pumped on his chest, pushed drugs, intubated him.  At some point we had to give up.  We called time of death.  We told his family.  And then we went back to the rest of the patients. 

But you don't forget, the silence in the room before you get what you know is coming, or the stillness after it's over.  You don't forget the asystole.
Wednesday, July 21, 2010
I love gear.  Hiking gear, running gear, cycling gear, kitchen "gear".  I love it all.  Now, this isn't to say that I go around buying every cool thing I see, but when I do find something I think will be useful, I do a LOT of shopping around, and usually am willing to spend a little more for a quality product with a good track record that I think will take the abuse I dish out.  Now I've already talked about my bikes, so they don't need further mention... well they do, but they will get it later, when I can take proper pictures... maybe even of me riding them!

There are a few things I've gotten in the recent past that I'll throw up here to give you an idea of what it would look like if I melted in the woods, and only my stuff was left behind.

When I was in Michigan a few weeks ago on vacation, Betsy, her mom, and I took a trip to Cabela's.  I love Cabela's.  I love to go to the bargain cave and see what I can find super-cheap.  On this particular day, I happened to stumble across a plum Columbia soft shell for a mere $40, down from $150.  Good deal, eh?  But that's not what I'm writing about here.  I also finally broke down and bought a new CamelBak/day pack.  I've had the same small day pack for a LONG time.  It's been all over the world, served me well, and has lived a good life.  But some of the zippers are busted, the corners are worn out, and it's just time to retire the thing.  I wanted to replace it with a hydration pack (because I almost exclusively use it to hike), that has enough space that I can take everything I'd need for a full day hike, but can tighten up and not have extra flop if I'm just out for a few hours or not taking lots of stuff. I'd been putting off buying one because I hadn't found a model and color that I loved, and if I'm going to spend the money, I need to love it.  But on this trip to Cabela's I found "the one".  It's the CamelBak MULE, with a 100oz reservoir and multiple pockets, it's perfect.  AND, it's bright yellow.  Very much my style :)  It's not been broken in yet, but the day will come soon. 

A few days ago, I popped into Dicks Sporting Goods to see if they happened to have a chain to replace the one that I... damaged, doing work on my bike last week.  They didn't... sad.  But I did manage to stumble over to the shoe wall.  I've had my current running shoes since about December which is FAR longer than I normally keep a pair.  Usually, they stay around about 4 months before I wear them out and start to get blisters and sore feet.  But the pair I have right now I got right before I hurt my ankle in January, so they didn't see a whole lot of use through the spring, and have taken until now to show their age.  Now they are starting to squeak (a sure sign that SOMETHING is wrong structurally), and my feet don't feel so great after a run.  So I decided to pick up a new pair while I was out.  This usually involves me trying on about 14 pairs of shoes in many brands, and then picking one of about two styles I always go back to.  I've been a dedicated Asics shoe wearer for years, with occasional traitor-ship to Nike and Mizuno.  I'm currently running in the Nike Equalon, but have found that the forefoot stretched a bit (not necessarily a bad thing), and became too wide for my narrow foot (a bad thing).  I've usually run in either the Asics Kayano or the 2130 (or equivalent model).  I used to love the Nimbus, but Asics bulked up there shoes a bit and they just weren't as streamline as I liked.  So, I went to the requisite trying-on of lots of shoes, and narrowed it down to (shockingly!)  two pairs of Brooks shoes, the Glycerin 8, and the Ravenna.  The Ravenna was lighter and more streamline, with a relatively simple design and not too much fluff.  The Glycerin has a bit more "technical cushion" as I like to call it, or something fancy the company claims to work well.  I am always wary of "technical cushion" and try to find reasons to not buy it if I can.  I ran around the store with one of each on each foot, switched feet, put on both pairs, did it all again, and finally decided to go with the Glycerin.  They just seemed to fit my foot better.  We'll see if they hold up well over the long run or not, but I'm optimistic.  I've also decided to put them in the closet and not bring them out until AFTER my ankle surgery when I am allowed to run again.  New shoes always motivate me, and I have a feeling I might need a bit of motivation when the time comes.   

Bruce and I were at Dicks Sporting Goods in Atlanta, STILL looking for a chain for my bike (no dice), and encountered some very appealing clearance racks.  What's a person to do?  Well, buy a bright orange hoodie, of course.  Let me tell you the reasons I love this hoodie...  1)  It was like 67% off.  2) It's bright orange (refer to two paragraphs ago re: my love of color).  3)  It's under armour, generally good quality, although usually overpriced.  4)  It's a full zip without elastic at the bottom.   Hard to find.  5)  It's this cool stretchy smooth material stuff on the outside with fleece on the inside.  It's my fav.  I have lots like it.  But none in orange.  Problem solved.

I couldn't find a good picture of it, so I just took one in the mirror.  Quality photography, I know. 

What is your favorite piece of gear?  Something you just love, or can't live without, spent lots of time saving for, or are saving for right now!

Tomorrow is my first shift in the ED.... be prepared for stories galore. 


Tuesday, July 20, 2010
Alternatively titled, "8 Hour Test Meets 5 Hour Drive Meets 3am Meets Sale At Dicks Sporting Goods."

So, yesterday I took Step 2: Clinical Skills.  This is an 8 hour test where we see 12 standardized patients, do a history and physical, and then write a note and come up with a plan.  Each patient takes 25 minutes, and we get a dinner and snack break.  There are only FIVE testing centers in the country (yes, EVERY medical student in this country, or others who want to come work as doctors in the US, have to take the test at one of those 5 centers).  So I got stuck with the afternoon session, which started at 3.  After the test (which was not hard, just long and exhausting), I had to drive from Atlanta to NC because I had an appointment this morning at 8:30 with my orthopedic surgeon.  So, a little after 10 last night, I hopped in my car and drove the 5 hours home.  Luckily, Sarah and I had prepared me well, with a cooler, two bottles of water, two starbucks drinks, twizzlers, pretzel M&Ms, a loaf of bread, cheese, meat, fruit, napkins, and a garbage bag.  We're good at this road trip thing.  So the trip home was uneventful, but I was very tired.  I wore a dress for the car, and threw on my new under armor sweatshirt for the drive so I could crank the air up without freezing.  When I got home this morning at 3 (which, you should note, would make it TUESDAY morning...), I took off the dress and sweatshirt and threw them in a pile before putting on PJs and hopping in bed.  This morning, I decided that was about as close to WADT as I'm going to get today, so here's the picture!  Glamorous, isn't it?

On the bright side, I had another great weekend in Atlanta.  Highlights include pizza with Bruce at Everybody's, watching Sarah dodge raquetballs while trying to take pictures of Bruce and I playing, watching Dual Survivor, seeing Sarah's coupon clipping in action, and learning that I should never seek work as a blind, one-handed sanwich maker. 

On the not so bright side, at my doctor's appointment this morning we decided to go ahead and do surgery on the ankle to see what is still causing me pain and swelling and ideally fix it!  It's scheduled for August 18th, and should be pretty easy as long as there are no surprises!  You may remember the original post about this injury from back in the winter.  Note: being a patient still sucks!  But I'd like to have this all fixed up without running into interview season.  I'm hoping.

Until next time,
Sunday, July 18, 2010
I haven't posted anything about medicine in a long time.  I know that's what this blog was originally supposed to be about, but on the rehab unit there was not a whole lot of crazy stuff happening to talk about.  And I start in the emergency department on Monday, so for the next month there will be LOTS to talk about.  I figure I can have at least one more "non doctor" post. 

So I have two bikes, one I talked about Wednesday, and the other I will talk about today.  I've always been afraid to do anything about the simplest maintenance by myself, because I don't want to break anything I can't afford to replace!  I haven't done more than change a tube and break pads on my trek.  But I decided that my Redline needed some maintenance, and I would tackle it myself.  The parts are a bit cheaper to replace and I've gotta start somewhere, right?

I got a new set of wheels for my cyclocross bike, the Neuvation M28X Aeros, because I bent my front wheel backing over it with my car (not recommended).  So I wanted to put the new wheels on, which meant taking the cassette off my old rear wheel.  And I figured while I was doing that, I should replace the chain because putting an old rusty dirty chain on new wheels and a clean cassette just sounded like a bad idea.  I also decided I would finally put my new pedals on.  And the whole bike needed a good cleaning.  So, I went to a local bike shop and picked up a few tools and parts I would need.

Chain whip
Cassette lock-ring tool
8-sp 3/32 chain
Crescent wrench
Set of allen wrenches
Shimano SPD pedals
Chain tool
White Lithium grease
Chain lube
Simply green cleaner

I had a lot of this already, but needed to get the tools and a new chain.  Then I set to work.

I got my bike down and set it on my patio table upside down and popped the wheels off.  Then I used the chain tool to take off the old chain so there wasn't anything in my way while cleaning it.  Then I used some warm water with Simply Green to clean off all the dirt and grime that's collected over many trips through mud. 

After the frame was clean, I went to work cleaning the old wheels and tires, and switching the tires and tubes from the old wheels to new.  About this time, I moved from outside to inside because it got too dark to see anything.

I started to work on getting the cassette off, and realized I didn't have a wrench.  So I headed to Lowes to get a crescent wrench.  I picked one up, then headed to Starbucks to get some iced coffee because it was already 8:30 and I could tell my night was NOT close to over.  When I was at Starbucks, I realized that I'd left my phone at Lowes (a sign that the coffee really was necessary), so I went back to get it, and finally made it home with my wrench and my coffee.

I went to work taking the cassette off and put it in a dilute solution of degreaser to work on loosening all the grime.  While that was brewing, I started taking off the pedals.  Note:  It's helpful to look at the new part you are putting in before you try taking the old one off, so you know how the mechanics of the part work.  I did not do this.  Pedals are threaded oddly because of the rotation of the cranks.  So the right pedal is a right hand thread (normal), but the left is opposite.  I knew this, and in theory would have had no problems if I was using a wrench to take the pedals off.  But I was using an allen wrench instead (which goes in the back of the pedal instead of around the front.  And I spend more time than I will admit here cranking the wrong direction trying to take the pedals off.  At some point, I looked at the new pedals, realized my mistake, and went to work undoing my serious over-tightening of the old pedals.  Eventually they came out, and I was about to put the new ones on when I found out I needed some grease for the threads.  Who knew.  By this point it was after midnight, so I decided to put the hunt for grease off until the morning, and went back to the cassette. 

I took the cassette out of the degreaser and scrubbed it with a toothbrush (it will never see the inside of my mouth again), until all the grime was cleaned off.  Some of the teeth are looking a little worn, so a new cassette is in the future.  But for now, I cleaned it off, and put it on the new wheel.  Then I popped the wheels on, and it started looking like a bike again!

The chain was the next mission.  I took out a pin, put the chain on, and then popped the pin back in.  I cranked the pedals a few times, and noticed it was skipping a bit.  Turns out the link was stiff... So I googled "stiff chain link"  and got all sorts of helpful hints on how to fix the link, all of which failed.  I thought I'd just start all over, and took the pin back out, except I went too far and took it the WHOLE way out instead of just enough to separate the links.  Now I can't get the pin back in... I think that chain is a lost cause.  I'm going to buy a new one today, and put it on when I get home from Atlanta.  Whoops.  At least that was the only casualty of my self-repairing.  Here are some pictures of the process...

Here's the set up, before the process was well underway.

Old, gross, rusty chain.

Old wheels.

New wheels.  Sooo shiny.

Frame: before cleaning.

Frame: after cleaning.

Indoor setup.

Cleaning the cassette.

Pedals:  New and old.  Yes, this is a bad "photograph"  But the glare just proves they are shiny.

Wyatt reading the directions and trying to tell me I was turning the pedals the wrong way.  Shoulda listened.

All in all, I'd say this was a fairly successful adventure.  I learned a lot about my bike, got some confidence in not ruining anything, and started collecting tools for future repairs.  I also added a few more things to the list of repairs I want to continue to make:

New cassette (the old one will go on my old rear tire for a trainer-only tire)
New crank (I've crashed on the old one a couple times and it's seen better days)
New brake pads (riding on a bend wheel for a while created a very odd wear pattern)
New water bottle cages (yellow: to match the bar tape so looks more like an accent color)

I think that will do it for now... this might become a bit of an obsession... 

Until next time,
The bike doctor (in training...)
Wednesday, July 14, 2010
One of my favorite nights of the week is Wednesday.  On Wednesdays (well most... when it's not raining, snowing, too cold, or winter when the sun sets too soon), my friend Chris and I head over to Clemmons Bike Shop for their weekly group ride.  It's really the only night that I get out and ride with a bunch of people, which is always fun to do (and a nice change of pace!).  We ride a 6 mile loop, and usually do 4 laps at a casual pace (average about 18 mph), and then people take off on the last lap and get a good sprint in.  There is a pretty broad range of skill, but for the most part everyone sticks together through those first four laps.  Tonight, I'd say we had about 25-30 people out. 

After the ride, Chris and I started the tradition of going to Chipotle for burritos, which might be the greatest tradition ever.  I love Chipotle.  I pretty much get the same thing EVERY time:  a chicken fajita burrito bowl with grilled veggies, black beans, mild salsa, corn salsa, a touch of sour cream, cheese, and lettuce.  And I almost always get Coke Zero "on tap" because it's WAY better from a fountain than a bottle... and I'm thirsty. 

Tonight I strayed from my usual, though, and got tacos with chicken, salsa, cheese, and lettuce.  They were super-delish, and hit the spot after a 30 mile ride. 

I'd also like to take this opportunity to introduce you to something very important in my life... my bike.  Well, one of my bikes.  I love them both, and will introduce you to the other soon. But tonight will be dedicated to my 2009 Trek Madone 5.2 WSD.  Non-stock on the bike as you see it here are a Clemmons bike shop seat bag that I use when I train and take off to race, Look Keo Classic pedals, a Gettysburg bike shop water bottle I picked up on a ride through the national park with my friend Dan (we had to go get a tube inflated...), a Blackburn bike computer with cadence, a couple carbon water bottle cages, and some blue handle bar tape that replaced the stock white when it became not so white. 

I bought this bike the fall after my first road racing season with the Wake Forest University Cycling Team, after working very hard for a summer and making more money than I'd anticipated.  I rode a used Trek 1500 for about a year and a half first, and it was a very good bike but didn't fit me perfectly (it was a touch small).  I would DEFINITELY recommend buying a used bike to make sure you like the sport before dropping some money on a new one.   Anyway, this bike has been one of my babies (the other are my cat Wyatt, and my Redline cyclocross bike), and I love it.  It's been dragged all over creation (and allll over the state of NC), climbed many a big hills, and even made a short appearance in Virginia during the middle of a poorly planned century ride.  I plan to keep it around a LONG time, and hope it gets some use during the spring racing season.  I missed the whole season this spring with an ankle injury, but plan on making a comeback!  

Look in the near future for a description of my Redline.. it's not photogenic enough right now because it's been well used on some dirty trails, and also needs to feature it's new wheels!

Until next time,

PS.  I MUST note that while spell checking this entry, the computer tried to correct the spelling of the word "Clemmons", and the first option of corrected spelling/right word was "chortle".  Aside from that being COMPLETELY not correct, I absolutely love the word chortle, and thought I would share.  I may have even chortled out loud. 

Tuesday, July 13, 2010
Let's start with WADT for the week.  This, sadly, may be the last WADT for a long time.  My next rotation is in the emergency department, where we wear scrubs.  Although if I don't work on a particular Tuesday, I'll probably wear a dress then.  After that, I'm doing a rotation in orthopedics, and on Tuesdays in the OR, I will be wearing scrubs, and not a dress.  Sad, I know.  But anyway, today I wore a dress that I got last year about this time for my brother's wedding rehearsal dinner!  I had no one to take a picture of me, so when I got home from the gym tonight I put it back on the hanger and took a picture.  Not great, but the best I could manage today! 

So, onto the pedicure paradox. 

I'm not what you would call a girly girl.  The fact that I wear a dress every Tuesday (and even days in between!) is probably a total shock to my mother.  I haven't had so many dresses in my closet since I was 5 and owned every color Lands End made of their white and color striped dress with a little pocket.  My hair is usually up in a pony tail, on weekends I wear sweat pants a lot, and whoever I marry better like seeing me in running clothes because I wear them a lot.  So, knowing me as you now all do very well, I will tell you about pedicures.

A couple friends and I started getting pedicures last fall at the end of each rotation.  It's a great way to relax and spruce up for the next rotation.  The first time we went, it was early fall and we all wanted something fresh and springy.  We all asked for designs, and this is what we got.  First of all, my toenail is huge... it's the one in the upper left corner.  We like to call it a blank canvas on which you could paint a mural or write the Hippocratic oath.  This picture was posted on facebook and there were a couple comments that were particularly descriptive.  "Kari's toe is like a really big awesome party with a chocolate fountain!", and "It looks like Chinese new year.  On a toe".  Since the initial pedicure, I'd say we've had four or five, and without fail I've had the most outlandish, awesome design painted on my toe.  And I love it.  For Christmas, I had a whole bouquet of poinsettias with white and silver accents.  For valentines day I had floating hearts.  When I was in Michigan, my grandma painted a long-stemmed rose with gold accents. 

So today, when Betsy and I went to get pedicures, I wanted to make sure my design lived up to the high standards set before.  Have no fear... it did.  In case you can't see it, there is a rhinestone.  I asked for a white and yellow flower.  I'd say that was accomplished.  I don't really know where they come up with the ideas for these things... it's a skill set far beyond mine.  But they never fail to impress me, and now I get to walk around with this on my toe until I mess it up or get a new one :)

What do you all do to relieve stress, celebrate accomplishments, or pamper yourself?  If you have no answer, I recommend a pedicure... and a crazy design.  

Sunday, July 11, 2010
it might look like this.

Why, you might ask, is this the mug that best portrays my life? (And why would I want to compare my life to a mug??)

Well, I'm comparing my life to a mug because I'm supposed to be editing my personal statement for my residency application, and I needed something to do to procrastinate... I settled on blogging.  And since the other things I did today to procrastinate include vacuuming, cleaning the kitchen floor, washing a wall, watering plants, taking out garbage, buying a new hand mixer (it's being shipped, so I have no picture yet), buying cat food, doing laundry, and making my bed, this mug is the most interesting thing I have to talk about.

And this mug exemplifies my life for any number of reasons.

1)  It's holds a lot of coffee.  I love coffee.  Black.  I'm not addicted, and abstain at least one day a week to make sure I don't get headaches (because I hate the idea of being addicted to something), but it's definitely my comfort food.  Which explains why I just made a pot at 9:30 on a Sunday night...

2)  It's blue and green.  Lime green.  As you can see from the color scheme of my blog, I like those colors.

3)  It was purchased (very sneakily and secretly), for me by my friend Tom the Australian.  His name really is just Tom, but he's from Australia (sad, I know, he should move here), and I have a lot of Tom's in my life.  Anyway, he came to visit for a couple weeks and we had a grand time playing tennis and eating Krispy Kremes and watching Arrested Development.  I love my friends are they are hugely important in my life, and since a friend bought this for me, it clearly exemplifies my life.  Clearly.

4)  It has a scooter on it, which has two wheels.  I'm not so much into scooters, but I do love bicycles, and since they both have two wheels, I'm going to pretend they are interchangeable in the world of mug art.  That one may be the weakest link...

5)  I have this thing about journeys.  I like to think I take a lot of them.  I saw this mug when Tom and I were in Starbucks one day, and commented on how I thought it fit me very well.  Aside from the fact that I planned and took a trip specifically called, "Experience the Journey", which could be it's own complete blog, I've taken many journeys in my life, and continue to think that each day is an opportunity for a new one.  I've taken international trips that have shaped a good part of who I am, I've had roller coaster-like relationships, I've spontaneously decided to drive 5 hours to DC or to the beach, or who knows where else.  Every day I wake up and don't know what I'm going to see or who I'm going to meet.  I love that about my life, and couldn't imagine it any other way.  "My Journey begins today" doesn't mean that all the other ones that are going on have to stop, just that there's an opportunity for something new to start.  The other day on the way home from Atlanta, I decided that someday I will write a book.  That journey as at it's VERY beginning.  Two days ago I decided I needed a new mixer (well, it decided for me by nearly imploding in my hand)... that journey ended today :)  Who knows what journey will start tomorrow.....

6) Did I mention it holds a lot of coffee???
Saturday, July 10, 2010
My friend Betsy and I cook a lot.  We also like Williams Sonoma a lot.  So it was not surprising that we ended up in Williams Sonoma prior to a cooking expedition.  Now, I'm perfectly capable of walking into Williams Sonoma and not buying anything.  That may be due to my unmatched self control... or it might be due to the fact that I can't afford anything in there except the occasional kitchen utensil "necessity".  I bought my garlic press there... it's lime green and spring loaded and perfect.  And definitely necessary.

One particular day, Betsy and I went in without plans to buy anything (we usually go around and pick up the recipe cards!).  We were perusing the kitchen utensil area of the store when I came across some silicone collapsible measuring cups.  Necessary, because I don't actually have a set of my own (all the ones in the apartment are my roomies).  But I wasn't sold on buying THOSE...  I mean collapsible is cool, but it is necessary?  I could buy some normal, space occupying measuring cups for less.  So Betsy, being the good, supportive friend she is, said "I'll buy this red silicone basting brush if you buy those cups!"  Done deal.  As we continued to look for more things we couldn't live without, I found a DIFFERENT set of silicone collapsible measuring cups (as if one wasn't enough).  These, however, were pastel colors AND came with a free set of matching silicone measuring spoons!!! (Which, coincidentally, I also don't have).  So, clearly, I turned in the red set for the pastel set. 

And it would be enough if it ended there... But it doesn't.  I cam across a matching pastel set of mini spoonulas (spoonchula, spoonchala, I don't think there is a real spelling for this made up word...).  Anywho, there were three of them!  And they were the same colors and the cups and spoons!  How could I call my kitchen complete without them!?  So I added them to the mix.  Now I had MATCHING collapsible measuring cups, measuring spoons, and spoonulas.  Missions accomplished. 

I got to the register to check out, and said to the register man that I was getting these things because I needed some of them, and they all matched.  But I wasn't really sure what the use of the spoonulas were, I just thought they were cute.  He said they were perfect for things like getting the peanut butter out of the bottom of the jar and I was SOLD!  Maybe more necessary than the spoons and cups! 

So I hung all the matching tools on the wall, because they are just too pretty NOT to display.  And yesterday when I was making peanut butter cookies I got to use the spoonula for the first time.  Genius!  I've never saved so much peanut butter from the bottom of the jar EVER!  This utensil will probably save me tons of money just my getting the peanut butter out of the bottom of the jar!  By the time I go through, oh, 100 jars of PB, they will have paid for themselves!  I'll call it the good buy of the year.

And today, I get to go look for another kitchen appliance.  A new hand mixer!  I busted my old one last night making the PB cookies.  Quite honestly, it was an el-cheapo one from the grocery store that I got in college, and I'm surprised it lasted this long!  But armed with my monthly 20% off coupon from Bed Bath and Beyond, I'm sure I'll come home with something beautiful :)  Anyone have suggestions of the best hand mixer on the market???
Wednesday, July 7, 2010
In medical school, you see a lot of stuff; gross stuff, cool stuff, stuff you didn't know existed, and stuff you wish you could forget existed.  I've seen gun shot wounds, open skull fractures, shattered limbs, babies being born, and people dying.  I've held a persons intestines outside their body, and held someones leg up by the exposed end of bone.  None of these things make me even a touch queasy.

But there are two things that I simply cannot handle: Eyes and toenails.

Why?  Because they are gross. 

We will start with toenails.  It's not that I'm not particularly fond of my own toenails.  I treat them very well, get them pedicures every couple months.  And normal toenails on basically anybody I'm ok with.  But, there are a lot of people with toenail issues out there, and I would just as soon send them to a witchdoctor as I would take care of it myself.  There are two particularly gruesome problems that make me a little nauseous.  The first is when someone breaks/smashes/opens a door into the toe, and the nail folds up.  Eewwwwwwwww.... I am getting sympathy pain just thinking about it!  It makes my neck cringe and tears come to my eyes (not a difficult task, as I will describe later) and I just want to hide it under mounds of gauze and antibiotic ointment.  Which, lucky for me, is a pretty safe way to treat most toenail injuries.  Wash it and cover it.  And never look at it again.  The other toenail issue I cannot deal with is ingrown toenails.  Not the ingrown toenail itself, but the REMOVAL of said ingrown toenail is what really gets me.  I went through my whole family medicine rotation without seeing a single ingrown toenail removal.  So I thought to myself, "hmm, this is something I really should know how to do if I want to go into family medicine".  I went to the trustiest of trusty medical information sources, YouTube, and typed in "ingrown toenail removal".  The 5 minute video that came up was... horrifying.  It looks innocent enough; a toe, a scalpel, some gauze... nothing I haven't seen before.  But as I sat in the corner in Starbucks, hunkered down with my hoodie and my headphones, I felt the color slowly drain from my face as the doctor in the video (a wanna be actor with a shiny dull butter knife for all I know) make a teeny tiny incision along the toenail bed.  Like really teeny tiny incision... and a single drop of blood.  Buuuuut, I just couldn't take it.  I felt weak and nauseated, and had to turn it off.  This is why we in medicine have colleagues.  I will take a burn patient or dislocated joint any day, and will pass off all the ingrown toenails to someone stronger than I.

Now comes the eye.  Here's the deal with eyes.  I have a problem with reflexive crying.  Anytime something happens to someone else's eyes, mine water uncontrollably.  If someone cries, I cry.  If someone gets something in their eye, I cry.  If we talk about eye surgery or getting poked in the eye, or really anything involving eyes, I cry.  I can't control it.  So, needless to say, actually DOING something to a person's eye is completely out of the realm of possibility.  I would really like to have Lasik at some point in my life (because I have terrible horrible no good very bad vision), but I think they would have to completely sedate me to get within 15 ft of my eye, and rumor on the street is they make you stay awake.  I'd prefer to wear monster-contacts.  When patients come in with eye injuries, I can hardly see through my tears long enough to actually see the injury.  The eye is an amazing little structure.  It's very important.  I'm glad mine work, and I'm glad there are people that fix them when they don't work.  However, I'd be ok if I never saw an abnormal eye again. 

I realize I may have some out of proportion reactions to the severity of these problems, but I figure if I can take care of stuff other people find gross, it's ok to pass off these two. problems to other people.

I like to call it teamwork.
Tuesday, July 6, 2010
So I never did get around to posting my picture from last week's WADT... Sorry!  This weeks WADT selection is one of many purchases I made this weekend while in Atlanta with Sarah and Bruce (so Bruce maybe didn't participate so much in the shopping, but he smiled graciously when we came home with LOTS of bags...).  Anyway, this dress was originally $65, and I got it for $12.  Yay me.  I also got a $99 dress for $20, and a $75 dress for $15.  The cheaper one you may see in another WADT post... the pricier one wouldn't qualify for school appropriate, but if you'd like to take me out for a nice dinner, I'm sure it might make an appearance.  I'd also like to thank my friend Elizabeth who I frequently recruit to take pictures on Tuesdays, usually right before we go to the gym! (Proof: Lockers and a loofah in the background.)

WADT delayed a week:  I had no assistance on this picture... so five attempts later, I finally got a shot using the timer with MOST of me in it...  I couldn't settle on a dress this particular morning, so I went the skirt route.  It's from Nepal, by way of a small shop in Saratoga Springs, NY.  Unfortunately, the shop has since closed (very depressing for me and my sister).  But before it did, I snagged this blue skirt with a nifty lacy bottom.  I suppose I'll just have to go to Nepal if I ever need to replace it...

I owe you a long weekend update, but I'll instead like you to Sarah's blog about it.  I'll sum it up with a bunch of random phrases.

Dunkin donuts coffee (x2), Swedish meatballs (and Ikea), KitchenAid ice cream makers are expensive, dress shopping, Vera Bradley, beef tenderloin is EXPENSIVE... but tasty, NCIS marathons, tailgating and smoked hamburgers, the Braves lost but the fireworks rocked, dude stole our cooler (more importantly Turkey Hill iced tea, Pyrex, and silicon muffin cups), we laughed a LOT, The Flying Biscuit, botanical gardens, I don't want to go home :(.

The end.
Thursday, July 1, 2010
I spent a lot of the first two years of medical school saying, "I just don't memorize well.  I'll be better when we're actually DOING things!"  I did okay during the first two years, but it was nothing to write home about.  And I probably could have done better if I was willing to do nothing but study all the time, but I wasn't willing to do that.  So, I got through it unscathed, but didn't really thrive. 

At the end of the first to years of medical school, you take the first of a three part series of licensing exams, creatively names Step 1, Step 2, and Step 3.  So, we get 6 weeks or so to study for Step 1.  I set up my study schedule and stuck to it, but really didn't ever have much luck grasping all the "concepts" that were really just factoids.  I was a biochemistry major in college, and could tell you exactly what happens to turn a PB&J sandwich into energy, and actually would enjoy it.  But biochem in med school was just memorization without context, and I hated it.  I basically hated most stuff that didn't have context.  So, like the first two years of classes, I survived, but far from aced Step 1. 

So, I went into third year hoping that I was correct in saying that I learn much better by doing, by having context and seeing patients and treating illnesses.  And luckily (and much to my relief!) that basically turned out to be true.  My grades were much better, I got good evaluations, and I felt like I was actually learning things and retaining them.  I can't remember any immunology, but I can tell you what's wrong with every patient on my service, how we are treating it, and when they are going home. 

So, the real test to prove that clinical knowledge really is my forte is Step 2.  It's a much more clinically based exam than Step 1.  You also have less time to study and it's not as hard.  The average for Step 1 nationally is around 220, and it's about 230 for Step 2 (those numbers don't mean anything to most of you, but that's ok!).  Anyway, I felt much better studying for Step 2, but was still afraid that it wouldn't translate to a decent score.  Well, we got our scores back yesterday, and I did WAYYYYY better than I did on Step 1, well above the national average.  My hope is that this score will stand out above the Step 1 score  and (along with my 3rd year grades), will be helpful in getting me interviews at the programs I'm most interested in, which all happen to be top 10 programs.  I finally felt like my harping on learning clinically was finally proven true.  At last, academic vindication that I thrive in the real world!

And it feels so good.

About Me

I am a Family Medicine intern at a community hospital in Indiana, navigating the new world of being a physician. I am privileged to work in a field I love, where every day is a new and unpredictable challenge.
I am not only a doctor, but also a cyclist, runner, DIYer in the making, lover of the outdoors, traveler, and human.
Human, MD is a glimpse into the world of a young doctor who is just trying to stay true to herself through the grueling whirlwind of residency.


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