That's really all I have to say tonight...

I'm rehydrating after drinking coffee all day and spending an hour on the trainer.  And for whatever reason, water just tastes better out of a big plastic cup than a real glass.  The same is NOT true for milk or juice.  They are most certainly better out of glass.  But with water, it's all about the plastic.

I'm sure it has something to do with the added taste of BPA.  I'm willing to take the risk of developing cancer. 

For the sake of hydration, of course.

PS.  My computer consistently tells me that rehydrating is not a word.  But rehydrate is...?  That makes no sense.  If you can rehydrate, how can you not be rehydrating?  Are there any grammar gurus out there who can clarify for the computer that rehydrating is, in fact, a real word?

I have a presentation I need to finish tonight.  But when I look at PowerPoint for too long, my eyes start to bleed.  So I am taking a break to tell you about how I roll...

On my cyclocross bike, that is.

I spent a lot of time looking for an affordable set of wheels to replace the stock ones my cyclocross bike came with.  It was necessary to replace at least the front wheel because, well, it had a little run in with my rear bumper and the underside of my car...  Let's just say it was slightly beyond truing by the time I pulled it out.  So I spent time scouting out a few brands that would be affordable (and by that, I mean affordable on a medical student's budget... it's a different kind of affordable).  When all was said and done, I had narrowed it down to two companies: Neuvation Cycling and Revolution Wheel Works.  In the end, I really only chose Neuvation because of the price point.  Revolution Wheel Works is an INCREDIBLY good deal for the quality of the product you get, I just didn't have quite enough cash.  Neuvation turned out to be an excellent second choice, and for the money it's hard to beat!

I've moved out of my parent's house.

I pay rent for my own apartment.

I've got a lot of kitchen appliances... and I know how to cook with them.

I have a pet.

I have a Christmas tree.

I occasionally clip coupons.

But until now, something was missing.  Luckily, thanks to Shutterfly, I can officially become a REAL adult.

For the first time ever, I'm going to send out my own Christmas cards!  Okay, so maybe there really isn't that much about my life that people want to hear about.  When you're part of a family of five, it's pretty easy to fill a sheet of paper with news from the year.  But I am just one person, and don't really have THAT much news to share.  Thanks to photo cards, I don't really need to say anything, though!

Ahhh, the traditional American past time of having breakfast for dinner.  It's a pretty much fail-proof way to satisfy all hungry parties (ie: me) with little thought... and somehow even if there is no food in the house, you can always manage to scrounge up stuff to make pancakes or eggs. 

That was my plan, anyway.  I whipped up some pumpkin pancake batter and a couple scrambled eggs with cheese.  It looked delicious. 

Unfortunately, while my pans were sitting in the sink after I washed them, the hand soap fell into the sink and apparently spilled all over... everything.  I didn't notice.  Until after I'd cooked all my food, put it on the plate, and started eating.  And ate soap.  Seriously disappointing. 

I tried, very hard, to eat around the soap.  But the effort was futile.  It was destroyed.  And I threw it away and ate tuna. 

The tuna was not as good as brinner :(

Let's be honest.  The page of "things that make me happy" was made for a post about coffee.  Because, quite simply, it makes me incredibly happy.  Coffee is probably the strongest comfort food I have.  Lucky for me, as comfort foods go, it's pretty heart healthy (as compared to, say, ice cream, macaroni and cheese, and Doritos), and relatively benign, with the exception of the whole caffeine thing. 

I like my coffee black.  Rarely do I add anything to it.  Coffee is best in it's pure form.

I drink coffee at night.  In fact, I'm drinking some right now.  The caffeine rarely keeps me up, but just having it in my hand increases my productivity exponentially.  On some nights, that still leaves my productivity pretty close to zero.  But at least I still have the coffee.

I am not addicted.  I don't like the idea of being addicted to anything.  Once every one or two weeks, I make sure to go a day without any caffeine to make sure I don't get a headache.  It's not about the caffeine!  It's about the coffee.

I want to visit Sweden.  I just read the book, "The Girl With the Dragon Tattoo", which, PS, I recommend reading.  It was excellent.  But, aside from the fact that it was a good book, it takes place in Sweden, and they drink a lot of coffee.  When you visit someone, the first thing they do it put a pot of coffee on.  When you wake up, coffee goes on.  When you make dinner, coffee.  I guarantee the word "coffee" appeared in the book at least 17 times more often than "dragon" and "tattoo" combined.  I can't say with certainty that this represents Swedish culture accurately, but I'm going to assume it does.  Also, because I'm part Swedish, it just seems natural. 

I love coffee.  And just for fun, I thought I'd do a brief blog picture recap of all the places it has inconspicuously appeared before...

I had big plans to tell you all about my weekend last night when I got home from Pittsburgh, but I didn't roll into town until after 1am and decided that I was just too tired.  So I went to bed instead.  But now, I'm ready to tell you allllll about my weekend of fun.

Friday I interviewed.  I'm making a habit of not talking much about them because I plan on figuring out what I think about them all in one weekend hidden away in a cabin in the mountains with a hot tub and a glass of wine.

In a sudden, tragic (for some people...) turn of events, the FDA is recommending that Darvocet and Darvon be pulled from the market, and are no longer prescribed for patients.

See here for the CNN article.

This is going to have some interesting fallout... There are some people who are very much attached to their Darvocet.  I'll be interested to see what kind of chronic pain medicine is used to replace it. 

Good luck to the people having to deal with THAT issue!  Glad I don't have any patients on Darvocet...

I'm sitting here in the airport... fiddling on my computer... drinking coffee... a little bored.

I cleaned out my email inbox.
I checked out facebook.
I checked out some blogs.
I did some online window shopping.

And then, I ordered a box of these:

It's been a while since I posted about something that makes me happy.  Don't worry, it's not because things haven't been making me happy!  I'm just busy being easily entertained and forgetting to write about it.  But fear not!  In my desperate attempt to procrastinate because I have to pack, I decided to organize my desk. 

There's not much I love more than a clean desk!  It just makes me WANT to be productive!  It's not often that it actually IS clean, but when I have something I need to do, it usually ends up that way.  Either I clean it to avoid doing what I'm supposed to be doing, or it has to be clean before I can sit down and focus on work.  Those may in fact really be the same thing...

Anyway, I hate packing.  I needed to pack.  So I cleaned my desk.

I was talking to one of my friends the other day about when we will be done with our last medical school duties before graduation, Senior Seminar.  This 2(ish) week "course" is mandatory, and he was concerned that it was going to interfere with Collegiate Road Cycling National Championships (I don't know why I capitalized all that...) in May.  Much to our relief, Senior Seminar will be done before nationals.  So (assuming he makes it, which he will), he and the other rock stars on our team will be able to go to nationals in Wisconsin.  Sweet.  Then he said that I should plan on joining them for nationals... to race. 

Hmmmm...  Is that possible?  I don't know.  Let's take a closer look at that.

To go to nationals, I have to race A's.  I've always raced B's.  The season that I semi-trained well, I did decently well in B's. 

My schedule for road season in the spring will be pretty light... I should be able to go to most/all of the races, meaning I can get points...

My schedule until then, while packed with travel, should allow me to train a decent amount.

Going to Wisconsin for nationals would be fun.

I like road trips.

I like riding my bike.

Hmmm...  Is it possible?

So, I have decided to set a goal.  A reasonable one.

I am going to race A's as soon as I am eligible.  I don't know how many races I'll need to cat up.  But when I can, I will.  Which will be by mid-season. 

So I will finish the season racing "A"'s.

And maybe qualify for nationals?

There are a lot of misconceptions about disorders related to mental health.  And frequently, the severity of them can be dismissed in flippant comments and the passing diagnosis of a person without real pathology. 

"Just get over it.  You don't have anything to be sad about."
"That's so irrational.  Why would you worry about it?"
"Oh my gosh,  You're so bipolar."

We say some of these things without thinking about the ramifications of them, and without recognizing the suffering of people with true psychiatric disorders.  Now, I by no means am an expert on anything psychiatric.  And I have my own reservations about how certain diseases (psychiatric or otherwise) are sometimes treated.  But issues around mental health, and patients with these disorders, seem to have a hard time convincing the world that their diseases are real, and that they require treatment.  I think part of the problem getting the world to understand what depression, anxiety, schizophrenia, bipolar disorder, and others are like, is that it's extremely difficult to IMAGINE what it's like to have one of them.  Without personal experience, we don't really have a frame of reference to extrapolate from.  I may have never broken my leg, but I've injured myself before and can imagine what that pain might be like.  I've never had a small bowel obstruction, but I've been nauseous, and can imagine what it might feel like.  But I can't image what it's like to have a panic attack, or what it's like to be delusional. 

I've recently had a patient that presented with a new diagnosis of bipolar disorder.  If you've never seen someone with true bipolar disorder in a true manic episode, you can't imagine what it's like.  Prior to the last few weeks, this patient was a normal young man, functioning in his life quite well, without any problems.  He was totally "normal".  When he came in to see us, he was agitated, delusional, angry at certain people, but pleasant to us, unaware that anything was wrong, making up rap songs, sleeping just a couple hours a night, and losing weight.  If you looked at his bank account, I'd be willing to bet he's spent a ton of money on random things.  He cannot live like this.  That is real pathology.

That carries over into other diagnoses also.  Many people with depression or anxiety simply cannot get through normal daily activities.  Not because they don't want to, but because they can't.  I can't imagine how that would feel.  I also can't judge someone when they tell me that's how they feel.

I'll admit, there are many clinic situations when I have the urge to tell someone to just suck it up.  And I'm sure sometimes that's possible.  But sometimes it's not.  And just like some people with high blood pressure can fix it with exercise and diet, but some require medication, the same goes with psych issues.  Sometimes, they can be handled with therapy, but sometimes they require medication.  That's just how it is.

So next time you tell your friend with mood swings that they're bipolar, think about what it would be like if they really were, and rethink your comment.  Just tell them they're moody. 

And be glad they don't really have to cope with a mental health issue.

Usually, when I go out of town for a few days, I make sure someone checks in on Wyatt and feeds him (he gets wet food, spoiled bugger), so he doesn't get too lonely.  He's a people cat... yes, I know that is abnormal.  That's why I like him. 

This time, I decided to give him some food and water, and see how he did for four days.  I could hear him meowing through the door before I even got to the bottom of my steps.  I was impressed that he hadn't really destroyed anything though!  Nothing was knocked over to scratched up, and the only thing he's decided to play with that wasn't a toy was a pair of sterile gloves I'd left on my desk.  They were a size 8 anyway.  He can have them.

But I did notice that he started chewing on his tail again, which he only does when he's in some sort of distress.  And, as soon as I sat down, he did this:

Well hello there everyone!  Before I dive into today's gear post, I want to recap my so-far fantastic weekend! 

It started Thursday night when I hit the road right after work (and a crazy day it was...  literally.  I'll write about that another day!), and headed for Charlotte.  After a couple navigation snafu's, I found my way to the hotel I was staying at for the night, and met up with my fellow applicants for a night before interview dinner at a mexican place called Cantina.  Any place that makes fresh guacamole at the table is a winner in my book!  Then Friday, I went to CMC to interview, and then hit the road to Atlanta.  You can read yesterday's post for the description of how THAT went.  I'm glad I got here alive.  For the rest of the weekend details, head over to Sarah's blog!  She does a much better job of describing (and photographing!) the details than I do.

Okay, now onto the gear part of the show.  Today I'm going to tell you about shoes.  Not just any shoes, but Keen shoes!  When these little gems first came out, the most popular model by far was the sandal (Newport).  Lots of people thought they were ugly, but when they tried them on, found them to be just too comfortable and functional to pass up!  I tend to agree, and have since added two pairs to my repertoire of gear.  Here they are:

Dear Lincoln Navigator Driving South On I85 Towards Atlanta Tonight At About 5:30pm,

Then, as traffic on a Friday night outside a city tends to do, everyone slowed down.  Why?  I don't know.  But they did.  And you, having no buffer between you and the car in front SLAMMED on your breaks, swerved off the road, honked (wft?), and probably caused a touch of cardiac damage to your always stressed body.  There was the potential for Final Destination-like crash/bang/explosion/pile-up.  I can see it in my imagination, how the scene would have played out.  Luckily for you, I was following at a reasonable distance, and didn't smush you.  Instead, I braked.  And slowed with plenty-o-time.  Almost like I'd planned for it.

Then, you proceeded to do exactly the same thing... until you wanted to exit, got in the right lane and tailed a truck (while being tailed by an Escalade apparently going to the same place as you) until you got off at your exit.  And I passed you before you got off the exit. 

It's a good thing you spent all that energy getting in front of me.  It certainly paid off for you.

I don't understand drivers like you.  All stress, all gas, no common sense, and no idea how traffic works.  It's simple, really.  There are not very many rules.

1)  Use cruise control.  I'm sure your Lincoln Navigator has it.  In front of the entertainment system, to the left of the GPS, and above the fridge/pizza oven.  Use it.  You can set it fast, even manly-man fast.  Just use it.
2)  Don't pass on the right.  The only exception is if you've been following someone for a long time, there is no traffic, and they clearly aren't going to move over to the right.  Other than that, just stay in the flippin' left lane until they move!  Otherwise you mess up the flow of traffic, people can't move over, you get pissed because your stuck behind someone else, you try to switch lanes, people collide, and we return to the scene from Final Destination.
The end.
Kari

I need an intervention.

I have an addiction.

It interferes with my life.

I use it to prevent having to do work.

I ignore things I should be doing to do it.

I continue to do it despite adverse outcomes (my eyes are dry, I have to squint, it's just not good.)

I have an addiction.

To minesweeper.

Hallelujah!  I will once again be able to watch The Today Show.  At least for a month or so.  My new rotation started today, and I found out my hours will be a comfortable 10-6.  10am??????  In burn unit time, by then I would have already gotten to the hospital, changed into scrubs, seen all out patients, gotten coffee, gone to conference, eaten breakfast, and been in the OR for like 2 hours. 

I am confident with a start time of 10am, I will actually be able to be productive in the mornings before heading to work.  I can do the normal evening tasks like dishes, laundry, vacuuming, etc.  All that can be done while watching The Today Show!  I do realize that July marks the end of my Today Show watching... basically forever.  So I plan to soak up every minute of it while I can.  It also means that I can potentially run in the mornings BEFORE turning on my morning entertainment.  Ahhhhh, bliss. 

I'm very excited. 

In addition to The Today Show, this month will bring Thanksgiving, and three interviews.  It's gonna be busy!

But I like busy.

I spent a lot of time this week researching coffee makers for my friend Sarah.  She wants to get a new one when she moves, and I offered to help peruse the dozens of options and narrow it down to a few good choices.  Before I go into the details of the horrible discovery I made, let me show you one of the top three choices.  We like this one because it's red.  It has all the right features also... but mostly we like the red. 

For those of you who know me, you know that sometimes I speak in letter form.  For instance, "Dear person driving the Honda in front of me, Please move over to the right lane.  Love, Kari", or "Dear Rain, Please stop.  You are making my plans difficult.  Love, Kari".

I haven't written a letter here since the letter to the person who smoked inside the public restroom, so I decided it would be an appropriate form to say some goodbyes.  Some are sad.  Some aren't.  They are all letters.  Because letters are cool.  So here we go.

Dear burn  patient with the hands,
     Yes, I realize that all the patients in the burn unit have hands, but yours are the only ones I wrote about.  But that's beside the point.  You died on Saturday.  Even though I wasn't there, I knew it was going to happen because your family chose it.  They thought that you wouldn't want to live like you were.  The odds were against you from the start; we all knew that.  You only had a 25% chance of surviving, and that didn't take into account your functional status should you survive.  Functional status?  That sounds too medical.  The fact is, your life could never have been the same.  When we got into the OR and saw your hands, especially your right hand, we knew that they would never do much.  You probably would have ended up losing  many of your fingers.  And you hands, arms, back, they would have all been scarred, stiff, contracted.  Maybe if you'd been younger, or not had the stroke a few years ago, things would have been different.  But you would have been wheelchair bound, completely dependant, living at home at best, and in a nursing home most likely.  Your wife, you sisters, your mom, they all agreed that this was not you, this was not what you would want.  I admit, it was hard to give in, give up.  Not 24 hours before they chose to withdraw care, we'd spent 8 hours in the OR with you.  We could have kept going.  It wasn't my choice, or any of our (your medical teams) choice.  But we are trained to treat.  We are trained to do the things to make your survival most likely.  Surgery, fluids, medications, procedures, therapies.  We could have kept going.  The result in the end would have most likely been the same, but then we could say we'd done everything possible.  You were the first real burn resuscitation I'd seen.  The medicine, the critical care, the surgery involved in it was academically fascinating.  We can save people that, 20 years ago, would have had a 120% chance of dying.  Yes, that's > 100%.  Crazy, I know.  I admire your family for letting you go.  I don't question that your life would not have been anything that you'd have wanted.  But I don't know if I could choose it.  It's so... final.  We found out on Friday night that the plan was to withdraw care.  We switched everything to comfort care.  We planned to extubate you the next day, when all of your family and friends could be with you.  I wasn't there on Saturday, but I know it was a sad day.  Even when you know something is right, you still hurt.  Especially your mom.  But I think she hurt more watching you suffer for the week and a half you were with us.  From what I heard, you went peacefully.  Your family was there.  They told you they loved you, prayed, they cried, they said goodbye.  There's not much else to do. 

Rest in peace,
Kari

Dear toughest 86 year old lady I've ever met,
   You would get sent home from rehab early, wouldn't you?  You're that kind of lady.  I'm glad I got to see you before you left, with your hair all done up, real clothes on, walking (although somewhat unstably...).  I am so proud of you.  I know the last 6 weeks have been hard, and I don't know how you've managed to keep a positive attitude and a smile on your face.  But you have.  You never complained, even in all the indignities that we put you through in the burn unit.  You always read, more books that I've read all year!  I bet you are a smart lady.  I wish I'd had time to sit down with you and listen to your story.  I know you had a good one.  I also wish I'd had time to ask you about your husband, and your dogs.  I know you must miss them terribly, and I can't imagine what it's like to lose your home, your family, and you Independence all in one night.  Many of the patients in the burn unit have a story that makes you say, "well I could have seen THAT coming!"  Not you, though.  You were just the unfortunate victim of a house fire.  And you lost everything.  But you were so POSITIVE!  I guess that's how you go on.   You even had to spend your birthday in surgery!  I know it was lonely with your family up north.  But I'm unbelievably happy that you get to go live with your sister.  I bet you two made trouble back in the day ;)  You probably still will.  It's patients like you that I wish I could follow up with, call in a couple months and see how your doing.  But you have to go on living your life, and I have to go on to other patients.  I know you'll do well.  Better than well, you'll thrive!  When I'm 86, I'd like to be like you. 

Goodbye,
Kari

Dear Burn Unit,
    Well, we've made it though another month.  This will be the last, though.  You've taught me lots.  This month was much more eventful that last month.  You taught me the normal lessons:  don't smoke on home oxygen, don't blow up meth labs, don't hunt bears while high, don't throw gasoline on a fire, TNT is bad for hands.  You also taught me harder lessons, but I think I covered those pretty well a couple letters ago.  I saw a lot more critical care medicine this year.  I also spent a LOT more time in the OR.  We set records, although they probably are not appropriate for mention here, but we'll just say we worked very hard for them.  I ate a lot of chocolate ice cream, to make up for the calories burned in a 104 degree OR.  This is my last surgical rotation.  So it's a goodbye to surgery also.  I will miss it.  But I can't do everything.  Sad, I know.  So adios, burn unit.  I will miss you, your friendly nurses and therapists, your PA's, your nutrition room always stocked with ice cream, your fridge with space, place to put my bag, par stock room with mastisol, and hard wood floor that always makes me trip over my crocs. 

Adios, but I promise to visit.
Kari

Dear hospital,
    You've gone by sooo many names in my tenure, and I think your name is about to chance again.  So I will just call you "hospital".  Not only is this my last surgical rotation, but its my last rotation in the hospital.  From here on out, all of my rotations will be outpatient.  Some will be at the undergrad campus, some will be in clinics, but none will be within your walls.  Don't worry, though.  I'll come back to visit for meetings and appointments.  It seems like just yesterday that I was walking onto the floors, completely lost and confused as to where I was, terrified to walk into a patients room because I didn't know what to say.  The only landmark I knew was the red wooden tower outside the window.  I don't even know where it was, I just knew it meant I was going the right way... I feel like I've just figured you out!  Seriously, you have too many hallways.  But really, it's taken all of the last year and a half to figure out how to get around efficiently.  And now, I'm leaving.  It's bittersweet.  Sometimes I get sick of the undertones of politics and hierarchy that ripple through your hallways.  But it's also impressive to see the machine that is a big academic hospital.  I know this is not goodbye forever from that setting.  I still have residency, after all!  But who knows where I'll be for that.  Maybe here.  Maybe not.  But for now, I'll miss you.  I'll miss Christmas Coffee and Einsteins, and seeing the friendly transportation guys, and using my new found knowledge to direct lost patients to their destinations, and walking onto a floor or into a unit feeling like I actually know whats going on.  I won't miss the carpet with two patterns and randomly placed triangles on one side of the wall.  I won't miss that AT ALL.  Who decided that was a good idea, anyway?  Okay, so besides that, it will be strange to not rotate in the hospital again.  But I think I'll live.  I'll see you around, but only occasionally.

Goodbye (for now),
Kari

On Monday, I start a student health rotation, and next week I also start my interviews.  New roads lie ahead. 

Drive on,
Kari

I love organization.  I don't necessarily always get there, but when I do, it's bliss.  And anyone who likes organization knows that you need certain tools to accomplish it.  These can range from fancy electronics to new shelving units to lots of hooks to, in my case, yellow legal pads. 

For whatever reason, when I make lists, they get done faster when written on a yellow legal pad.  Now, there is no randomized, double blinded study to prove this claim.  But I know if there were, it would show the same thing.  My productivity goes up when the things I need to do are displayed on lined yellow paper. 

Sometimes, I forget this.  I pretend it isn't true, and spend a fruitless few months writing things down on post-it notes, in my outlook calendar, or plain old white paper.  You'd think by this point, I'd learn.  And eventually, I wander back to my true love, the yellow legal pad.  And I am once again a productive person. 

Do you see this list?  See how many things are checked off?  Some of those things have needed to be done for MONTHS!  And then they made it to the yellow legal pad, and got done.  Magic.

PS.  This "Things That Make Me Happy" post could also be about espresso glazed walnuts, because they are life changing.  But I always write about food.  Just keep them in mind.  Life changing.

Yesterday, I decided to try to find my inner Italian.  In a book I just read called "The Recipe Club" (yes, I know it's not on the reading list, but I grabbed it at Walmart in a bookless roadtrip pinch), there was a recipe for "Lovelorn Lasagna" (you'll have to read the book to find out why it's called that!) that included a recipe for homemade sauce.  And I've always wanted to make my own sauce.  So I decided to give it a whirl!  I started with tomato paste, a bay leaf, and a prayer...