why the hell didn’t you go to med school?

This was what my primary care asked me yesterday evening at my appointment for what Mr. Patient has and I now have.  Yes, I now have it.  So it’s cups and tubes for me too.  😦

Mr. Patient’s c-diff toxins came back fine so PCP told him that he can take lomotil now if he wants to.  “Yeah, I’m the one who told him not to take that….” I said somewhat sheepishly.  “No, that’s good.  You were right.  You can’t take lomotil when you have c-diff or you’ll trap the toxins in.  Why the hell didn’t you go to med school?”

I explained that I already dropped out of a PhD program, don’t need to add dropping out of med school to the list.  “You dropped out of a PhD program?  Why?” he asked.  “Because I got sick.  And when I asked for accommodations, they were like ‘oh no, we can’t even consider accommodations in GRAD school because we just don’t do that in GRAD school…’ so I left and went into university disability services so that I can be part of changing that shitty attitude.  And I helped a student who is blind get through law school last year, so I think it’s a win.”

“So yeah, you’re doing good things.  That’s good.” he said.  Yep.  For as long as I can.

I’ve taken to looking at work now as something I am still doing while I can.  It helps with the work stress.  It helps me not panic every time I get sick and might not be able to work at 100% or at all.  (ok, truthfully, 100% is like 150% but that’s become the norm).  It also helps that I have a new therapist who herself has a chronic illness and is literally the first non-MD to whomI haven’t had to explain what gastroparesis is.  And speaking of therapy, I’m off to that now.

bad dream and blood sugar

Which came first?  The low blood sugar or the bad dream that woke me up this AM at a quarter of 5?  The outcome is the same – laying in bed after sleep-kicking my husband (hard, btw) and not able to ramp down and go back to sleep.  So I’m up, drinking sugary coffee and turning my brain away from the bad family dreams to doing crazy things with PDFs.  The PDFs are for a student I work for.

My husband asked me last week if I felt that my job was challenging enough, “You know, I mean intellectually.”  It is challenging in other ways, for sure, and I’m glad he realizes that.  Is it intellectually stimulating?  Well, I do miss the more scholarly pursuits that I had once been on track to do forever.  But I think even if there had been jobs to be had, I would have eventually felt like what I was doing was glorified naval gazing.  With my job now, what I do is a lot of problem solving.  And it’s problem solving that allows people to get to where I got, to get an education, to have the tools to discover and choose (at least to some degree) what they want to be “when they grow up”.  While I do like the helping people angle, I have to admit that this is probably secondary.  I am by nature a problem solver.  I like untying knots.  Christmas lights used to be my job as a kid.  There is something engaging and ultimately rewarding about finding the connections, tracing the path, removing the tangles.

Ok, so I’m up.  Coffee’s working, time to work.  Do something engaging.  Untie a knot that is workable.  The ones that exist in my mind and body can wait.


Reading, writing, and obfuscation

POP of Medical Mojave recently posted a link about a student in Florida who was denied treatment during an asthma attack at school.  I’ve read over a few news stories about it and it seems the school’s defense of first confiscating then denying access to the student’s inhaler was that the student’s parents had not signed a form.  One of the articles I read reported that “The school district said they encourage all parents to make sure they file the proper paperwork each year.” Ok, so I took a little trip to the school district’s website and thought “let’s say I’m a parent with a student who has a medical condition requiring medication” and looked to see if I could locate the appropriate paperwork and the policy for medication in school.  It turns out you can do it but not without a lot of digging.  First, you have to go to the Parents and Students tab

screen shot of blackboard based page at http://blackboard.volusia.k12.fl.us/webapps/portal/frameset.jsp?tab_tab_group_id=_103_1

Parents & Students tab

But it’s not under the heading of “Parent Links” which advertises policies and procedures and has various documents associated with it, like this one, titled “parent guide 11-12”, or the various documents linked under “Back to school guide“.  Not in the District Wellness Plan.  Silly me, I always forget that “wellness” is only for healthy people, not for us rejects with chronic medical problems.

Once I clicked on back to school guide, I was taken to a page with a new set of sidebar links and one of them says “forms”, maybe it’s there!

Screenshot of blackboard based page at http://blackboard.volusia.k12.fl.us/webapps/blackboard/content/listContent.jsp?course_id=_795_1&content_id=_48162_1&mode=reset&courseTocLabel=Forms

Forms link

Oh, no.  It’s not. So back to the Parents and Students main page I go.  I scroll down…Under the “My Student” header, I see “Student Health Services“.  Surely this will get me to a place where the school district has made clear or at least mentioned their policy and has posted obvious links to the yearly forms that parents need to complete, sign, and place on their child’s file at school.  Well, immediately below is another screenshot of that page, and while that very important information is not directly on this main Student health services page, I am happy to say that any parent of a student needing medication is now only one click away from the policy* and two clicks from that all important form**!  Let’s see how long it takes you to find it, starting from the Student Health Services page itself.

Screenshot of blackboard based content from http://blackboard.volusia.k12.fl.us/webapps/portal/frameset.jsp?tab_tab_group_id=_103_1

Student Health Services

If you give up, here are the links and how one would get to them:

  • *Administration of Medication, on side bar.  Oh, on the page that describes their policy, there is no link to the form.  If you want the form, you have to…
  • ** click on “Health Related Forms” in the side bar, then click on the link to the “Authorization to Administer Medication” form  and congratulations, you have found it.  Now you just need to fill it out, have the doctor fill it out, and return it.  Once, right?  No?  Yearly?  That’s what the news stories said, but you know, I just don’t see that information on this form, so it must say that over on the “Administration of Medication” policy page.  Um….although I zoomed in to blow up the itsy bitsy font they used for the policy, I do not see that it actually spells that out.

Too much?  Well, I’ve got some time on my hands.  My husband is off visiting relatives in NY and the temperature is moving into levels that will make me sick if I try to go out and do much of anything.  And I guess the story of someone in distress while the people who are supposed to help – whose job it is to help – watch passively after having taken active steps to put the person in distress in the first place is one that resonates with me on a lot of levels.

As a child, I passed out on occasion.  Several of those occasions were at school.   All of those times involved me recognizing that something was seriously wrong with my body and alerting a school official who ignored it, dismissed it, encouraged me to do the same, and failed to respond appropriately during or after the episode.  All of them involved harm and significant risk of harm to me.

  • Once in third grade, I was 8.  My clearest memory of it is of the corridor to the nurse’s office.  First the abrupt sensation of the hard floor on my face – why am I pressing my face against the wall?  Resolving the orientation of myself in the cool, dark hallway by recognizing the coat hooks along the walls, I realized that I was lying on the floor.  I had passed out alone and woke up alone.  Being a strangely self possessed little person, I resumed walking to the nurse’s office.  I found it locked with the lights out, so being a typical child in terms of  my ability to develop contingency strategies for unexpected situations, I turned around and made my way back to the classroom.  To my knowledge, my parents weren’t called.  I was not given any medical attention.
  • I passed out again on a field trip in 6th grade – 11 years old – in the back of the tight, low ceilinged colonial era bedroom full of my peers and woke up to the empty room, lying on the colonial era bed behind the velvet ropes.  No parents, no calls, no medical attention.
  • There were two more…the last one involved my being dragged by my arms to the nurse’s office by the guidance councilor who had just moments before repeatedly denied me permission to leave lunch and go to the nurse.  I probably would have passed out anyhow.  Our school nurse was good though, she might have figured out what was up and been able to reverse it if I’d been able to get to her in time (a glass of juice would have been sufficient). I had about a 10 minute lead in terms of symptoms.  But regardless, I would at least have been in her office and, hopefully, laying down had the school official listened to and respected my judgement about my physical needs.

I used to think of these episodes as my problem and I still do outside of an institutional context.  That people in the restaurant where I passed out in 1997 didn’t know how to check my pulse or to put my head down and my legs up was not great but also, it wasn’t their responsibility either to ensure that the environment was controlled to avoid triggers for passing out (or, say, to avoid triggers for an asthma attack), or to assist me when I did pass out.  But in many institutional contexts, it is different and I believe there is shared accountability.  E.g., I can choose not to shop in an overheated store or not to eat in a restaurant that makes me wait so long for service that I go into a hypoglycemic stupor.  But I cannot choose not to work.  I cannot choose not to go to school if I’m a 17 year old who hasn’t graduated yet.  In those contexts, there must be mechanisms to accommodate the legitimate orgnanism based needs which are conveyed to the people who regulate and administer the institution-based factors like when and where people can eat, whether they can carry or have access to medically necessary medications or interventions. And there must be mechanisms which allow for  appropriately addressing the results of failures to accommodate.

We inhabit these glorious feats of complex engineering.  They share many common features among them, allowing us to be grouped into sets like species, sex, race, age.  Classifications like runner, swimmer, diabetic, and dancer, but which also sometimes put us into small sets like eight year olds with undiagnosed hypoglycemia and orthostatic intolernace or 22 year olds with dyslexia, OCD, and a congenital heart defect.  Or not so small but still marginalized sets like 17 year old boys with asthma.  Because of the many embedded levels of variety, a good number of the systems and contexts in which we must operate cannot practically be organized in a way that will always allow each of us to function to our best ability at all times.  But I think it is reasonable to expect a minimum of two things of those systems. One is that they will not be organized in a way that causes harm, maximizes risk of harm, or imposes unnecessary burdens on people who try to mitigate any negative effects their bodies experience in some less than ideal environments.  The other is that they should be flexible.  A system that is inflexible will most likely over-rely on a template, e.g. the template student with no medical conditions, and this creates a host of problems including the seemingly absurd but true scenario of administrators allowing a student to enter into a respiratory crisis rather than break a rule or violate a procedure that the parent and student are literally begging them to do.

The school in Florida certainly failed on both accounts.  The website alone is evidence of their failure:  the information is buried and the content, once you find it, is impoverished.  It’s clear that students with medical conditions were not considered part of the standard (and probably largely unexamined) construct of “student” when this site was laid out.  They were added on after the fact, a little “oh, we should post that online….let’s see, where to put it…” addendum.  Moreover, the process described for obtaining access to medication while at school is burdensome – a note from your doctor every year for a chronic lifelong condition?  really? When those factors combine with environmental triggers that are hard to control in a school (e.g., dust, mold, open windows instead of central air, chemical fumes) the  result is an an environment where the non-standard, template defying student is at risk of harm.  And because there is no systemic flexibility, there are no mechanisms available or accessible which will allow any of the participants to mitigate that harm:  not the student, who is treated as all students tend to be treated – with little to no respect for even age appropriate individual awareness, self-sovereignty (of body), dignity, judgement; not the nurse, whose motivators and thought process we can only wonder about but which must have included a strong belief that she had to follow the rules above all else; not the school administrator who apparently came on the scene and also failed to call 911, to authorize dispensing the medication, or to take steps to not exacerbate the student’s feelings of abandonment and helplessness (they locked him in a room).

I’ll buy that you can’t always arrange everything so it’s ideal, or immediately accessible, for every type of person, every type of “disability” if you want to call it that.  I’ll even buy that an institution needs to have mechanisms in place like the permission for medication.  But what I don’t buy is that it has to be so burdensome for the individuals with these needs, that the class of “student with medical needs” is so narrow and small that the school district can justify burying the very important information that is necessary for these students to enjoy the benefits of an education without risking life and health, and that the system has to be so god damned rigid that the administrators cannot formulate or execute prudent decisions in an evolving and increasingly urgent situation.  It is not that rare for a student to have medical needs, and even students who don’t have chronic conditions could develop a need.  With a system this rigid, I have to wonder how those are handled.  Is it really still as bad as it was when I was in school 20 to 30 years ago?  I suppose all the parents of students in this district should take a moment to track down and fill out the  “Special Medical Procedures” form just in case their child experiences an acute medical situation, because otherwise the school isn’t going to be able to do anything better than lock the kid in a room and stand around reassuring themselves that they are just following the rules.

Oh, one last thing I wanted to add.  Just in case anyone local to this school district wants to drop in to share their thoughts on institutional flexibility and inclusion for students with medical conditions:
Regular Meeting: Tuesday, June 5, 4 p.m., DeLand Administrative Complex, 200 N. Clara Avenue, DeLand
During school board meetings and workshops, a live audio broadcast can be accessed from the School District of Volusia County’s website at http://myvolusiaschools.org.

“Perfect patient”

“I’m going to tell people you said that,” I told the Oral Medicine doctor who said it to me today.  I am sure she said it in jest, but I don’t think she realized just how funny it was since she lacks the context to appreciate the full irony.

Her reason for declaring me the perfect patient was that since this is an intermittent thing that comes and goes, I’ve started taking pictures of it.  And I brought those pictures, on the iPad…not the phone.  Which was good, because since it was an appointment at a teaching hospital (one of the local B.A.T.H.s), this meant the intern, med student, and ?resident? who I allowed in for the appointment didn’t have to strain their eyes to see the pictures.  I like my phone (did I mention I got a new phone for christmas?  An iPhone.  It’s neat.) but it’s not the best for more than personal use.

“Look at the red dots on the soft palate…” she instructed her charges as we scrolled through the pictures labeled “March 2011, severe”.  Ahh, the red dots.  Yes.  However, I personally found the two big ulcers on the hard palate much more compelling, but what do I know?

“Can you send me those pictures please?  The one of the blister too…” (October 2011, mild)  Yes.  And I can return when I am symptomatic for a biopsy.  Done and done.  And relatively quick and painless.  She wasn’t bad, interpersonally, not this time anyhow.

prepping for your prep

So.  Bowel preps.  They suck.  Thankfully, the prep for the capsule endoscopy wasn’t super aggressive, i.e. I didn’t have to drink 4 liters of foul tasting gunk.

However, with any bowel prep, there is wear and tear, emphasis on tear in my case.  So I thought I’d post a couple of tips – most, unfortunately, learned the hard way.  As a bit of an aside, I think it would increase patient compliance with the prep if these tips or ones like them were discussed in advance rather than relying on the generic instructions given remotely to the patient.  E.g., my prep instructions were communicated to me via a not terribly well written one page instruction sheet sent by snail mail.  They left me with questions like “it says I can have a ‘normal breakfast’ the day before the procedure then switch to clear liquids after breakfast.  But I’ve been instructed not to eat breakfast – I snack starting at about 11:00 AM on things like rice crackers and yogurt.  What actual time does ‘after breakfast’ translate to?”  The last colonoscopy someone tried to schedule for me involved the doctor’s office INSISTING I do the 4 liters of gunk prep.  “But I really don’t handle large volumes of anything in my stomach well.  I’m worried I’m going to puke it up”.  They just gave me a script for two bottles, you know, so I could drink MORE of what made me vomit and told me to try to drink it slower.  Seems it was a one size fits all bowel prep, and the size we were using as the standard was an obese 65 year old man with poor kidney function and a history of heart problems (hence no more of the much more palatable Fleet Phospho-soda prep).

Regardless of what prep you’re given, there are some practical self care tips I wanted to share.

– Prepare your surroundings.
You need access to a clean, well stocked, well working bathroom.   Access means, if your surroundings allow, your own dedicated potty for the duration.  If not, then see “prepare your loved ones” below.  Well stocked means buy extra toilet paper – splurge on the soft stuff; some air freshener (I like the “pure citrus” brand ones); and I also recommend getting some wipes.

picture of a double pack of Charmin flushable wipes from Drugstore.com

Double pack - a good idea.

The wipes to get are usually found next to or near the toilet paper.  Charmin and Cottonelle make them, and there is usually a generic – I go with Charmin because it’s the one that doesn’t have Aloe (which I’m allergic to).  Although the packaging proudly declares that these wipes are flushable, I wouldn’t recommend it.  The last thing you want is a clogged toilet in the middle of your prep. To dispose of these, I recommend either something like the Diaper Genie or (if you don’t have one) a dedicated small trash bag that you will tie off and dispose of promptly when needed.  If you don’t have one already, a night light in the bathroom and en route to the bathroom is key.  You may end up needing to go after bedtime.  If you’re like me, you won’t want to turn on all the lights and wake everyone up if you don’t live alone.  But you’ll be in a hurry and hurrying + unsufficient illumination = fall-down-go-boom.  So get a nightlight (i’s a good idea to have it in general) or keep a flashlight by your bed.

– Prepare yourself.
Mentally and physically, you will need things to get through this intact – and oh yes, I do mean intact.  Mentally:  You’ll need something to keep your mind occupied and it’s best if you have something that is portable since you’ll need to take it on the road so to speak.  If you have an iPad, smart phone, netbook, or other portable device that will allow you to access media, plan to use it.  Stock it up with TV shows, movies, audiobooks, digital books, games, something.  You’ll be using it during your many stays on the toilet.  You can also just go the old fashioned route and get a book, some magazines, or a set of crossword/sudoku/etc. games.

picture of a sitz bath in place on a toilet

you can use the tub instead, but this is quicker.

For physical prep, look into getting a sitz bath. If you don’t use it during, it still might come in handy after if your delicate bits take a beating.

tube of A&D ointment

get some

I also cannot stress enough how important it is to use something like A&D ointment during your prep. I didn’t and ended up having to do sitz baths + vitamin E oil application for a week after on account of a fissure.  Fissures hurt.  A lot.  My post prep care includes sitz baths 2x a day (I’d do more but I really just can’t do this at work) and vitamin E oil (topical).  This has helped considerably, but it would have been better to have not needed to do that.  And this is what I get for being lazy about my prep.

– Prepare your loved ones/cohabitants.
The really nice thing for them to do is to not eat in front of you or cook food while you’re around and prepping.  The night of my most recent prep, as I worked away with resignation at my second clear liquids meal of the day, I asked my husband if he was going to eat anything.  “I did,” he told me.  “I surreptitiously scarfed down a pb&j wrap in the kitchen.”  It was so sweet that I nearly cried.  Unfortunately, he made up for that later by eating nuts in front of me…but truly, I don’t much like cashews so other than the mouth noises (which made my stomach grumble), it was pretty tolerable.  Which brings me to another point.  If you’re the meal planner, then either plan for the rest of the family to eat something you detest or, better yet, to just go out and get pizza.  The only rule is they must eat it all at the restaurant and NOT bring any home.  You don’t need that sort of appetite trauma.  I’m not going to get into what you can and can’t eat – that one seems to be covered relatively well by the standard bowel prep instructions given out by doctor’s offices or endoscopy centers.  I will point out that College Inn makes chicken, turkey, and vegetable broth in a box/carton package now.  This was much more convenient for taking to work to heat up for my clear liquids lunch (microwave in coffee mug).

Another important part of preparing your loved ones and/or people you otherwise live with is to make it very clear that you require “dibs” on the bathroom if there is only one.  They need to check with you before going, and they need to make their use snappy.  No lingering about.  If you have evening showerers in your home, I recommend that they take their showers PRE-prep.  And lastly, while it might seem like a good idea to plan a movie night or to watch shows during your prep (because you’re stuck at home and going for a bike ride or even a walk around the block is not an option), keep in mind that you’re going to be up and down a lot.  My husband and I came up with a sort of protocol about pausing the movie we were watching, but still, it became pretty evident that I just wasn’t going to be able to watch this movie unfragmented.  Accept that in advance, maybe pick something you’ve already seen but don’t mind watching again, and everyone will be happier – believe me.  Lastly, no calls.  If you have the kind of touchy family that I do, maybe let them know that you will be indisposed that night so they either won’t call or won’t be offended if you don’t answer.

done, for now

Well I’m all done with the three specialists that my primary care referred me to.  Liked two, disliked one.  The cardiologist was nice, I blogged about my appointment with her already.  The nephrologist was, well, I blogged about that too.   And yesterday was the endocrine appointment.  The attending was decent.  Moving slowly, he wants me to keep a food diary and record my symptoms and blood sugar.  Not surprising.  Last night, my husband and I went looking to see if “there’s an app for that”.  Yep.  The ones we found were more for exercise/weight control type stuff, but I think one can be adapted to suit my needs.  Exportable data for Excel format too, which is neat.  Follow up with him in 6 weeks, at which point he’ll decide if it’s worth putting me through tests that actually kind of suck (my AM cortisol was a wee bit low – what they do beyond that involves putting your adrenal glands through a probably unpleasant work out, from what I understand).  So yeah, I’m ok going slower on that.

What was remarkable about the endocrine appointment was the very good experience with the 1st year resident at the B.A.T.H. endocrinology clinic who took my history.  For a guy who’s been a practicing physician for at most one month, he did a stellar job.  Hell, he’d rank as stellar when put up against some people I know who’ve been practicing for 20+ years.  I’m planning to write to the folks at his residency program to tell them this (maybe minus the dig about the 20+ year people).  I was a little concerned that praising a resident for being able to respectfully and compassionately navigating a complex history from a historically, um, high maintenance patient would set him up to be seen as somehow too “squishy” for medicine.  That concern is somewhat influenced by what I saw in grad school – PhD students who cared about teaching and students sometimes found that care used against them as a reason for why they were not where the faculty thought they should be in things like research and publications.  This was a seriously raw deal, since most PhD students are chronically underperforming in those regards when there is no research money to be had and only teaching stipends, but this didn’t seem to deter some of the more obnoxious faculty.  I also was thinking of my experiences working as a unit secretary, which admittedly were usually on surgical units and thus may not transfer well to internal medicine residency programs.  Before you shake your head and tsk tsk, keep in mind that I did marry one of those bastards so it’s not like I went in with prejudices, i.e. thinking all surgeons and surgical residents are assholes.  And I still don’t think that.  But I had plenty of opportunity to see the culture, to see nice residents bullied for being too nice, to see women on the orthopedic surgery service teased and hazed, to see the bitterness that can come out when idealism-based traits clash with the sometimes very cruel realities of residency.

So what did I do?  I asked an MD, because I figured he’d have a decent idea about whether the culture of an internal medicine residency program would be receptive to this sort of feedback.  And I’ll also be asking my primary when I see him next.  Which brings me to…

Thursday night, I had an appointment with my therapist (psych).  We spent a big chunk of time talking about how shitty I’ve felt this entire month.  The dizzy/vertigo/off balance thing has plagued me nearly every day of July.  How horrible!  Truly.  It sucks.  I had been struggling with whether to call my primary and say “hey I know I’ve got all these appointments and tests and shit to deal with the intermediate-long standing crap that’s up but right now, I’m having this new thing and can you help me?”  My therapist thought that was fine to do and encouraged it.  We talked about why I was struggling with this (afraid I’ll be “that patient” who’s always got a new complaint and what that means for me, afraid there will be nothing they can do) and after going over some “how can I say this/what’s the best way to express what is going on and what I want from them?” scenarios, I decided I’d call the next day.  On my way out of the therapist’s office, literally, I was halfway down the hall, my phone rang.  It was my primary care’s office. “We’d like to see you,” said the nurse.  “Wow, I was just going to call you tomorrow!”  “Well great minds think alike,” she said.  “What time do you have next week?”   So I have an appointment on Monday.  Here’s hoping that it’s not just “we looked at everything so far and there’s nothing new to say or do.  You’re just fucked.  Have a nice life.”  They haven’t given me any reason to think that they would take the attitude expressed in that last part, but many other doctors have.  And the first part, well that’s just my chronic worry about all this rotten health stuff.

Tonight, I have a sleep study.  And Thursday, I have the capsule endoscopy.  And then maybe next weekend, the fluid deprivation test that the nephrologist ordered – maybe.  And then maybe I’ll be done for now, maybe no more filling up jugs with pee or passing out on tables for a little bit while I celebrate my husband’s 30th birthday (yes, he’s a young’un).  Wouldn’t that be nice?  Ah well, this is what I signed up for when I said “work me up”.  Let’s hope it leads to some answers and/or treatments.

good and bad

The Bad:  The doctor’s appointment.  Not all bad, but I left (a) super hungry (bit of a wait before hand and it ran into dinner time) and (b) not super happy.  Too much talk of Lyme, Lyme left overs, Lyme-you-don’t-still-have-it-but-it-might-have-fucked-you-up-forever-the-end, etc.  Not by me, mind you.  To me, by him.  And to me, it’s like that annoying song that apparently everyone but you loves because you keep hearing it everywhere.  It’s like the medical macena.  He also played me the runner up for most annoying thing I hear over and over from doctors category:  “Has anyone diagnosed you with chronic fatigue syndrome?”  God damn I hate that question.  Because the honest answer is something like “No, but they sure like to bring it up!  So, do you want to be the first?  Step right up!”  Instead I say something like “No, but doctors have mentioned it.  They’ve also said ‘chronic lyme’, ‘post lyme chronic fatigue’, ‘post lyme syndrome’, ‘treatment refractory lyme disease’ and a lot of other stuff.  But no one has officially diagnosed me with any of it.”  And I feel like I sound super defensive and cranky.  Probably I do.

The Good:  A student with Asperger’s syndrome made eye contact with me today.  My first two meetings with him involved him looking nearly exclusively at the floor about a yard away from his right foot.  Today, blam, he looked me right in the eye.  I’m somewhat ashamed to admit, I can’t remember right now what he said.  I was so, well what’s the right word?  Not surprised, not pleased….um, pleasantly engaged in the contact.   I’m hiring him in the Fall because he seems like a nice kid, because he kicks ass with computers (kid’s running windows as a virtual machine on on old macbook he’s nursing into its “golden years”), and because he said he wants to work on campus, “maybe at the library.”  I suggested he could maybe work for me – I’m always on the lookout for nice people with computer skills, and I have a soft spot for people whose social confidence and/or network might be helped by working for a boss who is very direct, very empathetic, and who takes an active interest in mentoring and providing skill learning opportunities, i.e., me.

He said he would think about it, then returned the very next day with a print out of his schedule saying his parents and instructor said they thought it would be a good idea so he thought about it and he would like to work for me.  Very cool.

So I’m just going to focus on that, my friend coming up, mani/pedi day, iced coffee on the beach, and a four day weekend.  And the hell with the other shit.


Medical Resident at IdopathicMedicine.wordpress.com (A medical resident’s journey) recently blogged on The Dangers of July in the Hospital. Medical Resident’s post was in response to this article outlining regional July spikes in (fatal) med errors mediated by # of teaching hospitals in the region.

For those of you who don’t know about the July phenomenon, July is when the brand new interns and residents come in.  Residents and interns change service about once a month (I do recall some times where there would be back to back in one service, resulting in two months rotation – e.g. my ex-husband’s trauma rotation).  In July (sometimes late June), it’s that change plus an infusion of all new medical staff.  Needless to say, there can be some problems.

Here’s my take on it, from July 2008 – a reflection on the July chaos from the patient/family side.