|At the Still Point of the Turning World|
Thursday, June 30, 2005
IN OTHER NEWS
If you want to know what I was doing last weekend, read this.
Wednesday, June 29, 2005
ANOTHER REMINDER FROM MOTHER NATURE
Sometimes, when I'm working hard, I lose all sense of the seasons, of time and temperature and change. So it was a wonderful wake-up call to discover these new friends:
These are barnswallows, a mother and two of the four chicks who recently set up a mud/twig/horsehair nest on our front porchlight. I've been watching their progress through the fan-shaped window at the top of the front door, amazed by the rapid development of these little babies. The first day I sighted a chick, his head was nothing more than a little tuft of dryer lint straining towards his mother for food. Now they are so big, they have to rest their little chins at the edge of the nest, and from time to time there's a lot of tussling for position. Their mother is quite dedicated, flying back and forth and back again with regurgitated tidbits for her little flock. She must be doing well. All four look hale and hearty and on their way to fledging in a couple more weeks.
Tuesday, May 24, 2005
THE ERRANT BLOGGER RESURFACES
So it's only been twomonths since my last post, and I'm sorry. Blogging hasn't been my highest priority. Neither, for that matter, has been enlightenment, lovingkindness, or any of the other great virtues of the ages. Instead, I've been taking a crash course in the following professional issues I didn't learn about in residency.
1. Doctoring in a small town. Now, I thought Salinas was a small town, but now I've come to realize it was a growing suburb with a significant shadow population. I almost never ran into patients while I was running errands or dining out. However, 391 miles north of Salinas, here in Northern Humboldt County, California, I really am working in a small town. I can't remember the population, but even more notable is the small number of places to go to. For example, everyone shops at the local co-op, so if I drop by for a pound of organic carrots, it is more than likely that I'll run into a patient I've seen in the clinic. Ditto for evenings out--the last three times I've walked into a restaurant I've seen a patient of mine. Don't even get me started about the grocery store.
How to feel about this, that's what they don't teach you in residency. Is it supposed to be uncomfortable? Maybe. There's something unnerving about running into a woman whose baby you delivered, dining out with friends and family, and remembering her sweat, her cries of pain, or the stunned expression on her face when her baby was laid on her chest. Certainly it is more uncomfortable for those doctors who don't set clear boundaries for chance public encounters. One woman doctor reported to me that her patients used to approach her at the local farmer's market--a major community social event--and talk to her about their yeast infections, urinary incontinence, and other intimate medical malfunctions. Just use your imagination.
No one has approached me in public to ask me about their stool samples yet, but there is still something very...exposedabout popping into the local Safeway and seeing someone with whom you've just spent half an hour discussing presumably private health matters. It doesn't seem to matter if it is the significance of the Vioxx recall or the psychological underpinnings of erectile dysfunction--I feel put on the spot, as though I'm expected to stand by my opinion, right there next to the sale bottles of seltzer water.
And don't even get me started on how self-conscious I feel about being caught with my shopping laid out on the rolling checkstand.
2. On call at home. Now, you'll remember from my interminable reports from the front lines, that being on call used to mean 12 to 24 hours of house arrest inside the hospital. We never even left to pick up pizza. Of course, this was awful because you never get a decent night's sleep in the hospital even if you do find a few loose moments, but the one thing you get used to is being right there when something happens. I had more than my fair share of midnight sprints down the hospital corridors, on my way to respond to a Code Blue or a stat overhead call. Often I arrived, breathless and on the verge of collapse, and looking much worse than the subject of the code, but at least I was there.
Now, when I'm on call, I keep my pager and cell phone at the bedside and go about my real life until the pager goes off and the message is transmitted to my befuddled mind: ˆPrepare to get your butt in gear! What's nice about this is I often get to sleep through the night. Not so nice is the recurrent decision: Should I go in now, or wait? This comes up all the time when a patient is in labor. If it is early labor, I often go home and twiddle for a few hours, but once she hits eight centimeters of dilation, I go back to the hospital. The bigger problem is how often to go in and check on the progress of her labor, or, if this is her second or third baby, whether I dare to wait until the eight-centimenter threshold. Two weeks ago, I got called at 2:30am for a woman in labor with her fourth child. She was only three centimeters dilated, so I told the nurses I'd go back to sleep for a while. One hour later, I was called and told, "She's nine, and you should come NOW!" I broke the sound barrier to get to the hospital, and the baby was born three minutes after I arrived. You can imagine how I might become a bit hypervigilant when I hear the sound of that pager.
When to leave, and when to relax--these were decisions I never faced when I was an inmate at the hospital. Now they are the drama of my call nights. What I miss is the rhythm I used to have with call, even though it was always chaos and pandemonium. So far, I don't have that rhythm, with this new process of call. Instead, I twiddle randomly, and wonder, is that the pager going off?
Oh yes, there are more lessons I'm learning for the first time, but they'll have to wait for the next post. I promise it won't be a two-month wait.
Tuesday, March 22, 2005
HOW VERY UNBLOGGY OF ME
You may well be asking, "Why isn't Theresa updating her blog now that she's actually FINISHED residency and on easy street as a REAL doctor?" Well, the truth is, I've been too busy sleeping on the recliner by the pool to get near the computer and all these Shiatsu massages I've been getting impede my typing hand.
Or, if I'm honest....This real doctoring gig is not as easy as one might think. I started a full-time clinic job in January and have been seeing 80+ patients a week since then, which is not all that many in the scheme of things, but they've all been new to me, and that means familiarizing myself with their entire medical history, medication list, treatments tried and failed, etc. etc. This is the most difficult part of clinic doctoring: establishing care, getting to know the person within the patient, laying down the basic vocabulary of familiarity that will later serve as a kind of shorthand between the two of us. What will take only a couple of sentences to convey a year from now takes a half an hour of full paragraphs right now. I imagine we all go through this stage when getting to know people. It's just that I have to get to know about a HUNDRED people a week in this early stage of the new job, and for a fundamentally shy person like myself, this is truly exhausting.
I've also been learning a new system. In many ways, the services here in Humboldt County are much better than they were in Monterey--much more behavioral health and educational resources, and better access to specialists. The down side is learning the paperwork and how to get through all the hoops needed so that Joe Schmo can get into physical therapy or the MRI scanner. Luckily the clinic I work for has a fantastic staff and they do all the gruntwork for me. Having all this help is new to me--as a resident, I did everything myself--and takes some getting used to.
Then there's the joy of obtaining privileges and credentials with the local hospital and health plans...tons of forms to be filled out, a million copies of my medical license, diploma and board certification transmitted via FAX, modem and snail mail, all so that I, mere family doctor that I am, can order a simple mammogram or write admitting orders on a hospital patient. All of these things I used to do without any brouhaha at all, because I was a mere resident and my qualifications didn't matter.
Sometimes I miss being a resident...I miss working within a team, the security of knowing the attendings were standing behind us. I'm told these are mere growing pains, but I feel them nonetheless.
Saturday, December 04, 2004
ADVENTURES IN THE KITCHEN (OR, A KAFKA-ESQUE EXPERIENCE)
Scenario: Theresa's vegetarian DSO is away for the evening, so Theresa decides to roast a chicken.
Backstory: Theresa has actually roasted a chicken in the past, but it was about 10 years ago, before medical school, so the knowledge has now been usurped by things like vaccination schedules and the American Heart Association's cardiac risk stratifications.
Plot: Theresa consults Fannie Farmer, The Joy of Cooking and The Silver Palate. Each has different ideas about how to roast chickens. On a whim, Theresa checks a copy of Roasting: The Simplest Art by Barbara Kafka. She is convinced by Kafka's decisive writing on the subject. Theresa decides to use Kafka's high-heat method.
Build-up: Theresa rinses and wipes clean one 4.3-lb organic chicken. She remembers to remove the bag of giblets from the cavity. She seasons the chicken inside and out with kosher salt, pepper and fresh tarragon. She stuffs two lemon quarters and two tablespoons of unsalted butter into the cavity and ties it shut. She does NOT tie the legs together. While all this is going on, the oven is preheating to 500 degrees (remember: high heat roasting).
Action!: The chicken goes into the hot oven. Theresa jiggles it after 10 minutes of cooking, as instructed, to prevent sticking. She then sets the timer for 40 minutes. After 20 minutes, the smoke alarm in the dining room goes off. There does not appear to be any obvious fires in the house. The cats are mildly alarmed. The offending alarm is about 20 feet above, in the cathedral ceiling. Theresa turns on the fan above the stove, and the alarm stops.
At 24 minutes, the smoke alarms in the dining room and the hallway go off. The cats jump to attention, their ears folded back. Theresa drags a chair to the alarm in the hallway and tries to deactivate it, but it seems to be sealed shut with cement. She then runs to get the big fan from the closet and aims it upward, to dissipate smoke. Eventually, the alarms stop. Theresa keeps the fan on.
At 31 minutes, the smoke alarms in the dining room, the hallway and the master bedroom go off. Theresa opens the back door and the windows in the family room and kitchen. She repositions the fan. The reassures the cats and the poor, befuddled dog. The alarms eventually stop. Theresa closes the bedroom door to prevent smoke from spreading in there and setting off the alarm.
At 38 minutes, the smoke alarms in the dining room, the hallway and the guest bedroom go off. Theresa runs to get the small fan from the master bedroom and aims it at the alarms in the hallway and nearby guest bedroom. The cats are truly wigged out now, and the dog follows at her heels with a look of oppression and discontent on her face. After holding the small fan up to the hall/guest bed alarms, they finally stop, followed by the one in the dining room. Theresa decides to close the door to the guest bedroom as well, to contain the alarm in there. First, though, she opens the window in the guest bedroom and scoops up all four cats to bivouack there until the chicken is done. The dog gets enclosed in the master bedroom by herself, because the dog is afraid of Shroom and Zafu.
At 43 minutes, Theresa re-reads Kafka's cooking directions and notes, for the first time, that the recommended cooking time per pound of chicken is 10 minutes/pound, not 20 minutes/pound as it is for lower-temperature methods. It occurs to Theresa that the correct amount of time has passed, so she takes the chicken out to check the temperature. Amazingly, opening the oven door does NOT set off any alarms, but the internal temperature of the chicken isn't hot enough (remember, it has lemons in the cavity), so the chicken goes back in the oven.
All is quiet for about 10 more minutes, and Theresa takes a chance to open up the doors to the guest and master bedrooms so that the creatures can venture back out. She turns off the small fan in the hallway. When she opens the doors, the cats look at her balefully, and the dog bounds into her arms. Then the hall alarm goes off again. Theresa ushers the dog back into the master bedroom, closes the guest room door, and turns the small fan back on again.
Denoument: At 58 minutes, Theresa takes the chicken out of the oven and checks the internal temperature, which is perfect:
Theresa releases the animals from their captivity. They slink out suspiciously. After resting the chicken, Theresa eats some, with rice (she is too traumatized to make any vegetables). Delicious--juicy, with a crispy skin and a light lemony flavor. The dog gets a treat. The cats get catnip.
Will Theresa ever roast a high-heat chicken again?.......
Wednesday, December 01, 2004
JUST A BURST OF COLOR
I've finally located the cables for my digital camera, so here's a pic for all you patient souls:
These are the merino and merino/tussah rovings I painted in Deb Menz's color workshop at SOAR. I rediscoverd this photo tonight, while transferring my vacation snaps from my trip with Clara.
Amazing how just a few weeks ago can feel like a vast expanse of time. I've been home for four weeks, and since then DSO has had a major shoulder surgery (planned) and has been convalescing nicely. I've been unpacking our new rental house and cooking a lot. I joined the local library and food co-op and am learning about my new community, all of which feels slow and ordinary and good. This slow pace of life hasn't been much fodder for blogging, if you haven't noticed, but it has been most restorative for this recently ex-resident.
Saturday, October 16, 2004
JUST THE HIGH POINTS
I have been completely underwhelmed by blogging lately, even though events have been lively and stimulating Chez Theresa over the past few weeks. Here's the Cliff Notes version:
Moved--yes! Lock, stock and spinning wheels, completed on September 21st.
Unpacked? NO! There is nothing more demoralizing than feeling compelled to unload the boxes you so tenderly packed only a few days before. Unpacking brings its own share of disasters, more on that later.
SOAR? You betcha! I flew to Maine on October 2nd and hooked up with Clara of Knitters Review. Together we made the seemingly endless drive to Pocono Manor, PA. (New Englanders: you've got a lot of states out here). I am not doing a big SOAR re-cap this year, because Clara has done such a great job of it here. I will say I was lucky enough to be in Deb Menz's "Never Enough Color" class, where I learned to paint rovings with synthetic fiber-reactive dyes. Yes, I do have a photo of my efforts and yes I will eventually post it here.
SOAR was followed by a week of spinning at Clara's house, and now we are both in NY for Rhinebeck. My Dad drove from Ontario to meet us here, and attend his first sheep and wool festival. That will deserve a post of its own.