Love & medicine

Mr. Inmabusiness: Are you married?
PGYx: No.
Mr. IMB: Why?
PGYx: [...]
Mr. IMB: Picky Picky!?

Ms. Freedom: Are you married?
PGYx: No.
Ms. Freedom: Good! Stay single!

Nurse Sweet: Have you seen that movie, No Strings Attached?
PGYx: No, but I heard it's good. What do you think?
Nurse Sweet: Yeah, it is, you should watch it!...The thing is, it's about residents and you remind me of Natalie Portman's character.
PGYx: [...]
Nurse Sweet: NOT that I'm trying to say that you have a lot of relationships with no strings attached or anything! I'm not!
PGYx: Thanks! I'll have to watch it. And for the record, I don't have a lot of relationships with no strings attached.

Dr. Andrew Weil is winning

Combating Depression With Meditation, Diet : NPR

"In his book Spontaneous Happiness, Dr. Andrew Weil writes of an 'integrative' approach to mental health, warding off mild and moderate depression with an anti-inflammatory diet, exercise and activities such as yoga and meditation, rather than antidepressants."

You can listen to the audio or read the transcript. Dr. Weil makes some great points about drawbacks of our reflexive tendency to prescribe antidepressants. I think our society would benefit from realizing:

1) Depression isn't cured by a 15 minute office visit and daily pill. Coping skills & positive outlook develop with time and effort. For a minority, antidepressant medications may facilitate this process.
2) Antidepressants --and all medications -- carry risks
3) Life's ups & downs aren't necessarily pathologic

We have good data to suggest antidepressants are no more helpful than placebo for a majority of cases of mild-to-moderate depression. It is a sad sign of our broken health care system -- and one of my greatest sorrows in my work caring for patients prone to depression -- that antidepressants have become a first-line treatment for mood disturbances that fall far short of severe clinical depression.

The quick fix lives up to only the first half of its promise.

Thanksgiving vacation!

Yesterday I bicycled up Mt. Local near my parents' house out West. I'm on vacation!

When I attempted the same ride a few years ago I'd never been on a road bike. I stopped at around the 1000 foot mark and nearly vomited from overexertion before getting hypothermia riding down the mountain. It was...fun.

Obviously I hoped for a better outcome this time now that I've earned the nickname, "Dr. Nature," from one of the custodians at work.

As it turns out, my n-of-one case study shows regular outdoor exercise leads to improved fitness: I made it 2200 feet straight up to the ranger station, where I met real cyclists before we headed back down.

Nose breathing & staying mindfully in the moment saved me on the way up.

Ate enough. Drank enough. No desire to vomit. Layered up/down appropriately and avoided over/underheating.

Used clipless pedals for the first time. I tipped over a few times, with ego & knee bruises to show for it, but wonder if I would have made it up the mountain without 'em.

Missed my comfy Jamis seat. Ouch.

Saw a group of quail, a hawk, a skydiver, plenty of pretty views, and regular installments of coyote poop precisely deposited on the side of the road.

On the way down, I accidentally ran over a tarantula(!). Avoided two more after that. Mildly questionable brakes + small hands equalled a swirling mix of exhilaration and crash fear.

Made it home. Plan to do it (or something similar) again soon.

Next up: Yosemite later this week!

I love my patients

PGYx: Sir, are you right or left handed?
Mr. Literal (adorable old man w/history of schizophrenia): Left handed.
PGYx: Oh, so do you consider yourself to be a creative person?
Mr. Literal: No! I'm not creative, not artistic. Not one bit! Why do you ask?
PGYx: Well, I've met a lot of left-handed folks who "think outside the box."
Mr. Literal: [without missing a beat] Well, I am schizophrenic!

We both immediately burst into laughter, which sounds inappropriate on my part, but it totally wasn't.

Mr. Literal: I knew I could get a smile out of you!

I look 12 (flattery will get you everywhere)

I made it through a long Hurricane Irene call shift with two nights of minimal sleep on a call-room bed that is more metal springs than fluffy mattress. When I returned [to my thankfully unscathed!] home, my elderly neighbor greeted me in the driveway for a little neighborly small talk.

Mrs. Cataract: So, you gonna start back at college soon?
PGYx: (in scrub pants & t-shirt) [laughing] I'm a doctor!
Mrs. C: Oh! Where you work?

In related news, not one but several patients and family members have commented specifically that I "look 12!" Not 14 or 16 or like a teenager, but that I specifically look 12 years old.

Now let me tell you, I don't think I look that young. I wish I looked younger. I've aged a lot since my early 20s, including gaining a few horribly wiry white hairs worthy of Alfalfa's cowlick.

I wear modest business-casual clothing -- not purchased from the children's section -- to work with sensible flats or Sanita clogs. I top off the ensemble with a long white coat.

I wear a little bit of natural-looking makeup and have eye creases from smiling and laughing a lot. I'm starting to get two vertical lines between my eyebrows from chronically furrowing my brow every time I think, have a question, or feel amazed (i.e., ~16 hours per day). I'm told I have a very expressive face, so more wrinkles can't be far behind.

I never really had a growth spurt, it's true, but have no clue how anyone could mistake me for a day under 26. I don't act young and from a very early age have frequently been told I am "mature for my age."

Plenty of patients ask me questions like, "So, doc, in your experience, how often do you see [insert adverse effect]?" And I always have to toe the line between inspiring confidence in my clinical judgment and acknowledging that I'm a new physician-in-training supervised by much more experienced attending physicians. So it's not as though people are questioning my competence when they muse about my age.

One particularly lovely and loving family surprised me when they shared their curiosity about my age. We spent a long night together in the intensive care unit as I directed care for their loved one, unexpectedly gravely ill with sepsis.

We had a frank goals of care discussion during which they opted against cardiac resuscitation for an arrhythmia I told them they could reasonably expect. They understood that compressions and defibrillation would not meaningfully prolong her life. They seemed satisfied by my explanations and no one asked for a second opinion from someone with greater expertise.

The next day, the arrhythmia came. My attending indicated that we could cardiovert her. It was both an academic statement and a chance for her family to feel as though they tried "everything." Her husband, clearly upset, motioned for me to come over. He questioned whether his decision to withhold aggressive care was mistaken. "Would it change anything?" he asked, his pain palpable. "No, it won't change anything. It won't save her," I told him as kindly as I could.

"Is he the big doctor?" he asked, referencing both my attending's expertise and alluding to his small stature. "Yes," I replied, "He knows what he's talking about, but only you know what your wife would want for herself."

"How about you, how old are you?" "Yeah, we've been wondering all night!" his daughter chimed in with a smile. I paused a fraction of a second before answering, but felt he deserved an answer: "Thirty-three." "You look twelve!" he exclaimed without skipping a beat.

To this day, he remains the only family member with whom I have exchanged goodbye kisses in my role as physican. I will never forget him, his wife of more than 50 years, their children & grandchildren, or the fact that I apparently look 12 came up in this most unlikely of circumstances. I hope they're doing ok now. And selfishly, I hope I get to look 12 for at least a little while longer.

This could explain my humility

Texting with mom:

Me: [sends photo] My residency class!
Mom: Cool picture you r the best looking though
Me: You have to say that that because you're my mom.
Mom: All I know for sure Ur the best looking compared to the bald guy

And we're officially a PGY2! (life update)

Okay, so I became a PGY2 (post-graduate year 2) resident on July 1, but my life has been super busy since then! I had just about the worst move of my life thanks to Lenora's of Philadelphia (they actually get great reviews elsewhere, but here are some poor ones -- if you are at all inclined to use these folks then e-mail me first!). Fortunately, my parents made it all better by putting their noses to the grindstone for most of the next 10 days to get me settled in my new place.

They left me with just a few things to do after they left (bookshelf, coffee table, curtains) and surprise surprise, I haven't made any further progress. I still need to post pictures of the transformation, I know! I hit the ground running during residency and haven't spent much time attending to life details beyond laundry & paying bills. I'm just grateful we managed to install a faucet that accommodates the Danby portable dishwasher, which has drastically changed my life for the better.

I may still be curtainless (relax, I do have shades!) and awaiting arrival of my wooden bed frame from somewhere in Appalachia, but I did get a new Jamis road bike! It's entry level but works very well for me and I have been riding in a park near my rotation site with a couple of fitness-minded attending physicians. My attending jokes that's I'm not really riding because I'm barely sore after 12-18 miles, but I swear I'm riding as hard as I can! All signs point to me being a lot more cardiovascularly and musculoskeletally fit today than I was three weeks ago! I admit I have a hard time pushing myself to ride harder/faster/stronger for very long stretches but I'm working on that.

I've also started hiking on some of my days off. My new home is close to a vast array of gorgeous trails just waiting to meet my feet! Since I don't know too many people in the area I joined several groups of outdoor adventurers through Meetup.com. So far, I have met several nice & fun folks on the hikes. The only fishyness so far came from a guy who e-mailed me the same day he joined the site with an offer to show me "more private" hikes starting with a waterfall/swimming hole. I'll stick with the group, thanks!

In medical training news, I just got my Step 3 scores back and now officially qualify for my very own medical (non-trainee) license! With great gifts come great responsibility. I have to thank my favorite mentor (again) for reminding me how dumb it is to postpone board exams. I studied intensively for a few days, trusted internship to prepare me for the rest, and was not disappointed.

Finally, I love my residency program! I'm learning so much and everyone associated with the program is truly awesome. I'm also SO grateful to have completed what amounted to a sometimes brutally hard intern year. As I learned on my very first PGY2 call shift, my program prepared me well to be the only in-house physician (with phone backup, whew!) covering ~150 beds. Overnight call aside, I am reminded many times daily how lucky I am to have gained solid internal medicine training.

That's all for now -- I'm headed out with a new acquaintance for another 15 miles on the bike! All this activity makes me feel almost athletic.

Rawrrr!

Attending: Do you ever get jealous of all the guys looking at your wife?
[Adorable woman in her 80s sits nearby, smiling sweetly]

Mr. Lucky: No. [Pauses] She's a cougar.

[Stunned silence with wide-eyed looks and threatened giggle loop exchanged between the residents & attending]

Mrs. Lucky: It's true, I am a month older than he is, haha.

[Entire room erupts into extended laughter & guffaws]

My new home!

After an agonizing search filled with long drives, dead ends, and abundant reminders that descriptive adjectives in apartment ads are open to WIDE interpretation, I'm thrilled to report I have found my next home!

My search wasn't all sunshine & roses -- I definitely grew demoralized as I plumbed the deepest recesses of sites like Craigslist, Rent.com, and Zillow into the wee hours of the night. I sent countless e-mails to check availability and introduce myself as a clean, quiet, smoke-free resident with excellent housing and professional references. Finally, I advertised myself on Craigslist -- through a housing wanted ad, what were you thinking? -- and described my ideal apartment. This yielded several really nice housing options as they were tailored to my want list.

I passed up a more conventional (though comfortable!) apartment with an actual waterfall & swimming hole on the premises in favor of a charming unit in a 4-unit home built in 1920. It boasts newly sanded and refinished hardwood floors and chestnut trim, great light, original stained glass windows in living and dining rooms, and antique fixtures in the bathroom. It includes laundry and storage in the basement plus garage parking to save me from having to scrape snow off of my car during the winter. Epic score!




The only downside is that it has no dishwasher, but I'm considering one of the portable/rolling units. The landlord and his daughter, who is around my age and lives in a neighboring unit, are truly wonderful people. My residency program coordinator made the excellent point that it will be good for me to live in a place where others will notice if my lights are on when I'm at work or if I go missing.

Anyway, the place is adorable and I will post photos after it is ready for move-in complete with finished floors and a few more finishing touches. I hope I can decorate it so that it feels like a real home. Since I failed to inherit the decorating gene from my mother (oh how she struggled to impart her ways!), she is going to fly out to help me get settled.

I remain moderately ashamed of my inability to choose things like area rugs, window treatments, and wall hangings. I view accessorizing as a mysterious black box -- much as a person with Asperger syndrome cannot fathom the nature of others' emotions and motivations.




The concept of creating a cohesive decorative theme with several items purchased from different stores on different days overwhelms and mystifies me. Is linen better than chiffon? Do I prefer piglet snout to dusty rose, or would I perhaps appreciate the tasteful elegance of simple wheat or Cream City brick? What about patterned fabrics? Add throw pillows and I turn into a lost lamb crying for my mommy.

At least I can accurately diagnose a decorating misstep, but only in hindsight. As they say, those who can, do, while those who can't, edit. I am perfectly capable of filling in gaps with one or two basic items and am quite proud to have purchased new towels and even an antique end table all by myself, thank you.

But as much as I want to be like Dr B. Culp, beautiful surgical resident by day (and, er, night) and decorator extraordinaire during times she has every right to be asleep(!), I cannot fathom putting something like this together. How does she do it? For goodness' sake, the flowers match the pillows! I quite love it, but it is not my fate to be able to create it.

I'll be over here, admiring her talent and waiting for my saint-like mother to bail me out. Again. Thanks, mom!

The best moments?

I saw this on Healthy Librarian's wonderfully inspiring, informative, and fun-to-read blog. It sums up how I feel about my internship experience better than anything I could write:

“The best moments usually occur when a person’s body or mind is stretched to its limits in a voluntary effort to accomplish something difficult and worthwhile.”

--Mihaly Csikszentmihalyi

I also ran across this similar sentiment in the Dalai Lama's book (on CD), How to Be Compassionate: A Handbook for Creating Inner Peace and a Happier World:

"In my own life the most difficult periods have been the times when I have gained the most knowledge and experience. If every thing is going well, you can maintain the pretense that life is a smooth ride. However, when you face really desperate situations, you have to face reality."

I have become intimately acquainted with reality over the past year or so. In retrospect, chronically pushing my physical and mental limits this year has been worth the sacrifice to gain some priceless experience. I'd change only a few small things if I could.

On the other hand, sometimes I all I really want is a nap followed by a nice cappuccino, a copy of the latest New Yorker magazine, and a sunny day to walk the dog I haven't adopted yet.

Time is flying by with just 29 more days before the next step, with moving, boards, and a little relaxation squeezed in for good measure! Soon, it'll be time to stand high on my toes again. How do people manage to do it all?