Tuesday, June 29, 2010
How, you might wonder, are these three things related?  Well, they aren't... except they all happened to happen today! 

First of all, WADT.  I was supposed to take a picture of my friend and I today before we went to work after we swam this morning... but I forgot.  So, I took one when I got home, with my camera timer.  But it's still stuck on the camera so I will post it later tonight... when I get the motivation to get up off the couch.  But today's WADT featured a blue skirt from Nepal and a black shirt that was probably made in china or Indonesia.

Onto The Best Sandwich Ever (yes, it deserves to be all capitalized).  I was trying to figure out what to make for dinner that involved an avocado.  Why, you may wonder?  Because I had one in the fridge, and I wanted to eat it.  So I decided to make a Cajun shrimp avocado sandwich.  Note to you:  this would be better as a wrap, but I didn't have a wrap... I had wheat bread.  So that is what I used.  Anyway,  Here's how you do it.

Ingredients:
Raw shrimp (tails on or off), thawed (about 8-10 per person is plenty)
Avocado, sliced
Tomato, sliced (I used cherry tomatoes, because that's what I had... I recommend something bigger)
Red onion, sliced
Cucumber, sliced
Ranch dressing
Blackening seasoning
Wheat bread or other carb loaded veggie and shrimp carrying medium

Directions:
Preheat oven to 350 degrees.
In a bowl, toss the shrimp in a small amount of oil. 
Add blackening seasoning to the shrimp and toss until coated to your taste.
Cover cookie sheet with foil and spread shrimp into single layer.
Bake for 15-20 minutes, until cooked through.
While shrimp are baking, slice your vegetables.
When shrimp are done, cut tails off if necessary
Toast bread.
On bread, spread a thin layer of ranch dressing.
Layer veggies and shrimp: I chose cucumber, tomato, onion, shrimp, avocado.  You can choose a different order... it just might not be QUITE as good.
Cut.  Diagonally.  Because that's the only way to cut a sandwich.
Eat.
Get a fork to eat all the stuff that fell out.  That's why a wrap might work better....
Enjoy.  Mmmmmmmmmmmm.




Now, for the last part of this entry.  The serious part that is why I write this blog (contrary to popular belief, this isn't supposed to be about food...)  As I said a couple posts ago, I am on a rehab rotation right now, dealing with a lot of stroke patients.  One of the most common problems these patients are battling when they come to rehab is aphasia, or the inability to use language appropriately.  There are many types of aphasia, and it's complicated and deals with lots of areas of the brain, so I will not even try to give a detailed description of how it all works (mostly for fear of messing it up).  But there are a couple basic types.  Receptive aphasia means a person can not interpret language; they can not understand written or spoken words.  Expressive aphasia means they can not appropriately use words, even though they may know exactly what they want to say. 

I imagine that being aphasic must be one of the most horribly frustrating things to experience in the entire world.  Particularly for people with expressive aphasia who know what they want to say and may even think that the words that are coming out make sense, when in reality they don't make any sense at all.  When Sarah and I drove around the country (another story for another post... or maybe a book... which you should definitely buy), we stayed in Illinois with a man named Wally.  He'd recently had a stroke and was still having problems with his speech.  He could say most things he wanted to, but it took him a lot of time an effort to get them out correctly.  Every sentence was a struggle for him.  In his past life (before stroke and retirement), he'd been a PhD chemist for a huge chemical and pharmaceutical company.  He was smart... brilliant really.  He was used to being successful and accomplished.  And he'd been reduced to spending an entire minute to ask for a glass of orange juice.  You could see the frustration in his eyes.  I've seen many patients like that on my service so far this month.  They try so hard to get words out.  They think they are saying the right word, but to us it means nothing.  We have a 25 year old patient right now who suffered a HUGE stroke when his carotid artery was occluded for an unknown reason.  He was admitted a few months ago, and still has a long way to go in rehab.  Until this weekend, he hadn't made a single noise.  This isn't surprising since half his brain is essentially dead.  But to all of our surprise, on Saturday he started speaking.  When I saw him on Monday, he kept saying "chair".  He wasn't really taking about a chair, but that's the word that kept coming out, and it was clear he was trying to say SOMETHING.  We just couldn't figure out what it was.

My sister wants to go into speech and language pathology.  God bless her.  It's work that I don't really understand... kind of like a magic box you send people into and then come out making sense.  Sure, you have to send them in a couple times a day for weeks to months.  But still, it happens.  Communication is one of those things I think we really take for granted, until it's gone.  Whether it be hearing or seeing or speech, or the ability to understand, we don't think about how important it is until it's gone.  Or broken. 

I don't really have a great concluding take home message from this... other than think about what you have and be glad.  Also, be glad I am not aphasic, or my blog might read "to the take a for me frog once her to the from a gone with what my how name to see the my?"

Tomorrow is Wednesday, which means it's bike ride a burrito day!  It's been a while since my friend Chris and I actually made bike ride and burrito Wednesday happen... but it was a summer staple last year!

Until then,
Kari
Saturday, June 26, 2010
I'm sitting here in Barnes and Noble, with a cup of ice formerly known as an iced mocha, trying to accomplish just two simple things.  I need to write my CV and personal statement for my residency application.  Seems simple enough... False. 

To Do:
    CV (I crossed half of it out because I made some progress, but it's far from done)
    Personal statement

Other stuff that may or may not have been done:
    Book campsite in outer banks
    Read old emails that are funny
    Listen to the entire best of Snow Patrol album
    Send useless, yet entertaining, emails
    Drink my mocha
    Look for a bike chain
    Look for work shoes
    Plan my tomorrow
    Twiddle my thumbs (yes, I actually did this)

Clearly, I have not accomplished what I set out to do.  But here's the problem.  To write, I need something to motivate me.  The last time I wrote a personal statement, it was for my medical school application.  I set a deadline to have the whole application done before I went to southern Africa so I wouldn't have to worry about it when I got back.  And try as I might, I just couldn't find anything good to write about and didn't get it done.  But then, on the plane during one of our flights around the country, I had a brilliant idea and wrote the whole thing in a couple days.  How could one not be inspired by little kiddos like this one?  Sadly, I don't have any inspirational trips coming down the pipeline, and the prospects of spontaneous motivation are dim.  It's not that I don't have interesting or unique things to write about.  I've considered writing about my time on the border in Arizona, or my time at camp in Massachusetts, or my trip around the country, or how I drifted from wanting to do orthopedic surgery to primary care sports medicine.  They are all good, workable foundations for a personal statement.  But I'm just not INSPIRED.  I do good work when I'm inspired.  But it I try to force it, my personal statement will come out sounding like the abstract to the world's most boring Journal of Plant Science article. 

So, what can I do to inspire myself???  I'm thinking of going back through my old applications and seeing if I can feed off that at all... not subject matter, just excitement and motivation.  I'm thinking of going for a run, because it's not 95 degrees outside right now, and maybe it'll help.  I'm thinking of listening to the Wicked sound track over and over and over again... mostly because it's fun to sing out loud.  Does anyone have more useful suggestions for how I can get from online shopping to awe-inspiring prose writing that will make me the most wanted family medicine residency application in the world??  I would love to hear it if you do... because I got nothing.

Now, I will search for motivation in a turkey and cheese sandwich with strawberries and milk.  I'm thinking I'm going to find it in the milk.

Searching for inspiration,
Kari
  
Friday, June 25, 2010
At the beginning of every season of The Biggest Loser, I am skeptical that there will be visible changes in the contestants over the 16 weeks the show runs.  Each week, they look the same as the last, and the change is barely noticeable at best.  But by the end of the season, the results are remarkable.  They are different people.  Hard work, and the tincture of time, get them from point A to point B, but from the outside we barely notice the time has passed.

The same thing often happens with our patients that are around for a long time.  Every day, I come in and see them, and I see little changes... maybe.  Some days we move forward, some days backwards, some days not at all.  This is especially true on my new service, Physical Medicine and Rehabilitation.  Most of my patients are on the neuro rehab side; stroke and traumatic brain injury patients.  Their day consists of at least three hours of dedicated therapy (physical, occupational, and speech/language) to slowly creep towards their previous level of function.

When I started this rotation on Monday, I was given 5 patients to take care of.  Much to my surprise (and delight), one of the patients I was assigned was a patient I had taken care of for almost my entire month on the PICU.  He is a 16 year old kid who was in a serious car accident over two months ago.  He suffered a very serious brain injury, pelvic fractures, a humerus fracture, kidney laceration, and other internal injuries.  I took care of him for over three weeks on the PICU, where each day we crept along, adjusting his feedings and regulating his temperature and treating his fractures and hoping his brain would recover.  He progressed from being ventilated and unable to breath on his own to breathing on his own.  He progressed from not responding at all, to moving his right side a little, and occasionally following simple commands.  He moved from the PICU to the regular floor right before I left, but no one knew if he would have any meaningful recovery.  We took a lot of baby steps, and there was progress.  But it was very hard to see.

When I saw him in the rehab unit this week, just over a month after I had last seen him, he rolled out on his own in a wheelchair to tell us that Portugal was winning their world cup game.  He was awake, alert, able to carry on a normal conversation, able to make sarcastic comments and act like a normal 16 year old boy.  His legs were weak from not walking for two months, and his left side was weak from the brain injury.  His voice was hoarse from being intubated for so long.  He still has a ways to go before he completely better, but in the month that I didn't see his baby steps of progress, he was leaps and bounds above where he was when I last saw him.

On Monday, he stood for the first time since the accident.  On Tuesday, he walked.  On Wednesday, he walked outside, up hills and through grass, and we took away his wheelchair.  On Thursday, just over two months after the accident, he went home.  I remember the first few days I was taking care of him in the PICU, I didn't have a lot of hope that he would do well.  But the brain is a funny thing, and sometimes the tincture of time is the best medicine.  He did most of the work, wanting to get better and go home and be a kid.  And every day, he made progress that was barely noticeable to anyone.  But he came in one day, unconscious with scrambled eggs for a brain, and walked out with no help and an excellent prognosis.

I can't tell you how rewarding it was to see him again, better.  We plug along each day, hoping our work is doing something to help someone get from where they are to where they want to be.  But often, the progress isn't visible.  We spend a lot of time looking ahead to how we can make the next day better, and not much time looking back to see how far we've come. 

But sometimes, looking back is just the motivation we need to believe that working for tomorrow is worth it.

Keep plugging,
Kari
Wednesday, June 23, 2010
Yes, I realize it is not Tuesday.  But by the time I was finished with the grand vacation update last night, I was too tired to write another post.   So I saved it for today.

I would like to introduce you to Wear A Dress Tuesday!  It is the brain child of my college roommate, Sarah, who has been doing WADT for a long time now.  Since I've spent the last two months wearing scrubs, I haven't really had a reason to participate until now. 

Here's the scoop on WADT.  Every woman deserves a reason to wear a dress and make themselves look pretty, feel special, and walk with their head held high.  Tuesday is as good a reason as any to do it!  When Sarah started WADT months ago, she didn't have many (any?) followers.  But as time passed, people realized that they too wanted a reason to wear a dress, and it's caught on with many of her friends, readers, family members, their friends and family members, etc, etc etc.  I figured I would share the wealth to all of you!  Here is the first WADT picture I have to post... look for more each Tuesday, and spread the word that Tuesday is a reason to look pretty!  Also, send pictures of your WADT outfits, and I'll post them on Tuesdays (or Wednesdays....) with mine!

Enjoy the rest of the week!
Kari
Tuesday, June 22, 2010
Clearly, I was not very good at keep this updated while I was on vacation.  It's hard... I was very busy!  I'll give you the quick and dirty of all the fun we had, with occasional pictures.  Last I left you, we were eating...

We did that a lot, as you will see in the pictures.  It was nice to have a big kitchen, lots of space, and hungry people (other than ourselves!) to feed!  I think Betsy's mom liked having us there...  When we weren't eating, and cleaning up our messes, we were out galavanting around Ann Arbor and Saline.  We took a trip to Cabela's and Betsy got a tent for her Birthday!  It's inauguration is planned for the 4th of July.  I got a new jacket (which I didn't need, but it was on clearance, and a pretty color), and a CamelBak, which I did "need" and have been shopping for for a while.  We also went dress shopping, and both Betsy and I came home with a few new dresses for the summer.  AND they were all on sale.  Perfection.  There was more shopping involved that day, but I can't remember where all we went... lots has happened between now and then.
We spent one day walking around the University of Michigan campus.  Yes, there was a TINY bit more shopping, but mostly we wandered around looking at the buildings and getting lost.  We met one of Betsy's friends from swimmming for coffee, and gave her some sagely advice about Step 1, which she took TODAY!  Congrats! 
On Wednesday, we spent the morning at Betsy's grandparents house, where she (and her mother) spent much of their childhoods.  I got the grand tour of the house and back yard, learned where all the candy bowls were hidden, and had a delicious pumpkin lasagna and strawberry pie lunch (ok, there was more to it than that, but those were the highlights!).  After that, I hit the road and drive to my grandparents house in Ludington.  It was SOOO good to see them!  I saw them last year at my brothers wedding, but it had been years before that.  We used to go every summer and spend a week at Lake Michigan, but since I went to college that hasn't really happened.  We had a great visit and I got to relive a little of my childhood :)  Wednesday night my grandpa and I went to DQ to get ice cream, and then went to watch the sun set over the lake.  I proceeded to drip ice cream all over one of my previously mentioned newly purchased dresses.  It was totally worth it. 
Thursday grandma and I went to get pedicures!  Relaxing and fun!  The timing was a little bad and I was practically done before she got started, but it was still fun :)  Then we went to House of Flavors for lunch, and I got grilled cheese!!!  It's like the best grilled cheese ever.  I was afraid my childhood memory of it's extreme deliciousness was a bit exaggerated, but it wasn't.  Pure heaven.  Topped off, of course, with some hand made House of Flavors ice cream.  Grandma and I took a walk that night out to the lighthouse and watched the car ferry come in.  It's a BIG boat that shuttles people and cars across the lake to Wisconsin.  When we got back, grandpa had cooked us dinner!  I'm telling you, vacation is the life.
Friday grandpa and I watched some soccer and we relaxed a lot.  It was fabulous.  We went out to dinner with some of their friends, and then took a drive through the country and saw a teeny tiny baby fawn!  She was soooo cute and tiny!  After dinner, grandma and I went over to some friends house who we used to see every summer growing up.  Their boys had a fort built in the woods that we used to go play in.  I hadn't seen them in YEARS so it was good to catch us.  We went over because Kris had a picture of my grandpa from the Relay For Life survivors lap.  It's a fantastic picture that I can't wait to frame and put on my desk. 

Saturday I drove back to Betsy's house after my grandparents hooked me up with the Michigan necessities: Maple syrup, sweet cherries, strawberries, and venison.  We went out for dinner, then out to Ann Arbor for some live music and salsa dancing!  We didn't dance... we watched.  It was more fun that way!

On Sunday, we had to pack to drive home :(  We did that first, so breakfast wouldn't be spoiled by packing.  Then Betsy's grandparents came over and we made a father's day carrot cake pancake breakfast.  They were DELICIOUS.  Highlight of the feast was realizing that the shred attachment to a food processor was WAY more efficient than me and a cheese grater and some baby carrots... We also premiered my "congratulations to me on finishing a 9 hour test" present, the Williams Sonoma Breakfast and Brunch cookbook by making blackberry champagne.  The day was spoiled by the fact we had to leave to drive home. 
So, we loaded the car with WAY more than we came with, said our goodbyes, and drove off into the sunset.  The drive home was off to a good start when neither of us was paying attention through Toledo and ended up on a small country road... which we decided to take the whole way through Ohio because it was pretty.  As good a reason as any to take a road as any!  Roadtrip are one of those things that, if you weren't there, don't make sense to people who weren't there.  I'll give you some of the highlights!  Zero G mountain turns, smurfs, Lily's seat-belted in the back seat, iPod battery death, singing Defying Gravity over and over and over again, Cracker Barrel (which apparently doesn't exist until AFTER Charleston, WV), poorly timed pee breaks, and the new Sim Cities of cholelithopolis and nephrolithopolis.  Yes, I know none of that makes sense.  That's the point!  We rolled into town a little before 11 PM, unloaded, unpacked, and cried tears of ended-vacation sadness :(

Overall, we drove over 1700 miles.  Not too shabby.

This post was kind of like a huge novel, and I'm sorry for that.  Tomorrow will bring a post about my new rotation, Neuro-Rehab, and will herrald the return of meaningful thoughts.  I hope you've enjoyed the last month of food and fun!

Until tomorrow,
Kari
Monday, June 14, 2010
If you are one who reads my facebook page at all, you know that I frequently have status updates related to food.  Cooking, eating, driving to get it, planning to make it; you name it, I've talked about it.  One of my faithful followers is Betsy's mom.  She was hoping that when we came home, we would make one of our infamous delicious dinners.  Last night, Betsy's grandparents came over, and we cooked everybody dinner!  The menu may sound familiar; we made something similar a week ago with leftovers from our fridges.  Last night, we definitely improved on it though...

Spinach salad with pear, walnuts, strawberries, and Gorgonzola cheese.
Caribbean rice and beans.


Grilled blackened chicken.


Pineapple and peach chutney with mint and cilantro.

Table set and ready to eat.

Here's how you do it.  Rice n bottom, chicken in the middle, chutney on top.

Ginger ice cream with fresh peach sauce.


Overall, dinner was a HUGE success!  It was delicious.  We decided that we should write a cookbook for medical students based on our random dinners with stuff from the fridge. I think it would be a winner.  On the menu tonight is tofu Panang curry... we've got to do something with the leftover coconut milk!

Question of the day:  What is the difference between a salsa, a chutney, and some diced up fruit in a bowl?

From Michigan with love,
Kari
Sunday, June 13, 2010
I'm a bit short on time right now, but I wanted to post something so no one things I've fallen off the face of the earth, or into a ditch somewhere between NC and Michigan.

On Friday, I took the USMLE Step 2 exam, which I think went well, and more importantly, I'm glad to be finished with.  9 hours of sitting in a room taking a test on a computer can suck the life out of a person.  Afterwards, I went to pick up a few last minute things for the trip, including a "I just took a 9 hour test and think I deserve a reward" present: the Williams Sonoma Breakfast and Brunch cookbook.  I am SOOOO excited to try a few things out.  Good thing I'm on vacation and have lots of people to cook for!  After shopping, Betsy and I went to Olive Garden to celebrate, as it has become out "end of something to do with med school" tradition.

Yesterday morning we were on the road by 6:30 and made great time to MI, even with an unmentioned large number of stops along the way.  I think our progress was helped by the completely random selection of music we listened to, including but not limited to: James Taylor, Ludacris, NSYNC, Tim McGraw, Jamie Cullum, Celine Dion, themesongs from Cheers and The Jetsons, the Wicked sound track, and others.  We got to Betsy's house by about 4:15 and spent some time with her family before crashing last night.

Hopefully I will give you some better updates during the week, but if not, here's what we've planned so far:

Visiting bunches of Betsy's friends from home who I don't know, but soon will!
Tour of University of Michigan
Kayaking, maybe.
Making dinner for Betsy's grandparents
Buying and watching movies that have been on our list to buy (which all seem to have to do with unintended pregnancies... Saved, Juno, Knocked Up.)
Sitting in the sun.
Reading in the sun.
Napping in the sun.
Driving to Ludington to visit my grandparents, which hopefully will include the world's greatest grilled cheese sandwich... in the world.

That's all for now, stay tuned for vacation updates!  Is anyone else taking a much needed life break soon?  Where are you headed?

Until next time,
Kari

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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