Being Whole: Teapots

I have just purchased an item that I've been eying for years: an iron teapot! I love Asian tea, and all the accoutrements that come with it, from fancy porcelain teapots to whimsical, handmade ceramics to intricate trays designed for Chinese-style tea consumption to the fabulous, hand-tied teas I adore.



Iron teapots are lovely and functional, which is more than I can say for the ceramic teapots I love as well. Artisan ceramic teapots are often handmade, and they are very thin. In order to use them, I boil a whole pot of water, with the teapot and teacups submerged in the water to ensure that the whole piece is warmed evenly. Any bit of uneven temperature means that part of the ceramic expands and part doesn't. You have no idea how many teapots I broke in my youth doing that, but with my iron teapot, I can just dump in hot water and enjoy tea. Still, the iron conducts heat well, so I purchased an iron trivet anticipating just that.

Pediatric Check-Up: NICU or Neonatal/Newborn ICU

I'm currently doing night shifts in our baby intensive care unit, and though I hate being separated from Sunny at night, I am enjoying the experience. What do I like about this sub-specialty that Sunny's nicknamed "xeno-medicine"?

Firstly, I really enjoy doing procedures. In English, a procedure is a course of action or series of steps. In medicine, a procedure is usually a series of steps involving some kind of invasion into the body, whether that be a spinal tap, a knee joint aspiration, or in my case, umbilical catheter placement. I'm getting super-good at placing tiny tubes into babies' belly buttons, and I like it because a) no pain for the baby is involved, and I'm saving them from needlesticks b) it provides a good, reliable way to give nutrition and to get lab data. One of the things I really like about our residency program is that there are few fellows here. Fellows are doctors in training for a sub-specialty, and they often need experience with procedures. Even though our NICU has fellows, though, residents often get first dibs on procedures, with fellows supervising. I'm getting pretty good at this one, and soon I hope to become an expert at another common procedure here: intubation, or inserting a flexible, plastic tube to assure a good airway for breathing.

Other reasons to come!

About Albuquerque Life

I often get asked about Albuquerque: "Why did you move to Albuquerque? Do you like living there? What's in New Mexico anyway?". Considering that my relatives thought that I was moving to Mexico, it's not unexpected that most people are curious about Albuquerque itself.

I truly enjoy living in New Mexico. I contrast it to Nevada, where I lived most of my life. Northern Nevada is similar to New Mexico in that it has a great, high-altitude desert climate with most days sunny and bright. There is an amazing amount of outdoors hiking, climbing, skiing, fishing, and more to do, though personally I think that New Mexico's outdoor attractions are more interesting. In a prior post I mentioned that Sunny and I had gone sledding at White Sands, and we are planning on going to Carlsbad Caverns soon. Both states are predominantly rural states with a few population centers. Both of them look like endless stretches of sagebrush and highway as one drives through them. Yet they are very different to live in.

What I think is fascinating about New Mexico is that it has its own distinct culture as a state, and Nevada definitely lacks that. It starts with food. New Mexico has its own cuisine based on local products, especially chile, blue corn, and cheese. Next, art abounds; people here have a much more natural philosophy about art, that art can be produced by anyone, and many people create some form of art without hesitation or worry that they are pretentiously claiming to be "an artist". I am the proud owner of several pieces from a local part-time potter and hope to own more. The Native reservations are still very much alive and producing new techniques based on their traditional pottery, stonework, metal smithing, and weaving. Architecturally, many buildings, including my house, are built to appear similar to ancient Pueblo dwellings; I can actually look around in a suburb and know that I'm in Albuquerque and not, say, some random place in California or Connecticut. Finally, as a modern touch, New Mexico has a great density of scientific work and atomic history, such that Sunny is very excited to be working on his Ph. D. here and is in no way compromised by our location.

More specifically, I really love our part of Albuquerque. Sunny and I are all about living in a "live-walk" community where human-powered traffic predominates and neighbors actually socialize with each other. We live in University Heights AKA Nob Hill, and we can easily commute to school and work and grocery shopping by bike. A cluster of small businesses and great restaurants featuring Greek, Italian, sushi, other Japanese, Korean, Irish pub, and Vietnamese food lives on Central Avenue, three blocks north of our home. Plus, I have little problem finding most of my cooking ingredients as there are multiple Asian markets near by. Furthermore, There are a lot of young families as well as established families here. Greenspace abounds, with four parks and public tennis courts within walking distance. Finally, a library and a well reviewed elementary is 3 blocks south of us. We've been to several house parties on our block, and will probably host one next summer. If you're interested in moving here, leave a note with any questions!

Blog Moving...Possibly

Since deciding to blog more often, I've been posting the last 10 months of blogs on my website. For my latest exploits, visit me there!

Addendum: However, the software that enables my blog on my website has been becoming buggier (it broke just after I wrote the above), and I don't want to spend time doing the upkeep, so the blog may migrate back here depending on my level of laziness.

Addendum #2: Blog has migrated!

White Sands National Monument and Trinity Test Site

This weekend, Sunny and I took a day trip around southern New Mexico. We started by heading to the Trinity Test Site, the site of the first nuclear device explosion in the world. It was pretty anticlimactic. The whole of the original crater has since been filled in by dirt, so none of the fused sand is visible except for some pieces in a display case. There are also some historic photographs, including an aerial view of the site that includes a view of the site of the 108-ton TNT explosion they used as a calibration so that they could measure to force of the atomic detonation. These pictures were interesting, though only a brief nod was given to how devastating the force of an atomic explosion is on life and non-living structures. The picture of the sign is at the gate to ground zero. I thought the distances were interesting given that the flash was seen from Albuquerque, and windows were broken in Alamogordo during the explosion.

Then, we went to the White Sands National Monument and sledded on the gypsum sand dunes until we were tired, and hiked a bit. Sledding in October! Hiking in bare feet (not us, though I was tempted)! On our way back we looped through Las Cruces and drove by the future home of the nation's first spaceport. Since I'm starting a food section to my blogging efforts, I'll have to mention that La Cocina, a restaurant in the town of Truth or Consequences and one that was well reviewed in a Frommer's travel guide, was awful. Billed as New Mexican, their enchiladas and chile rellenos were awful, my prime rib was unevenly done, the Blue Moon (on tap!) lacked an orange slice, and their “authentic” New Mexican chile wasn't even hot.

• Trinity Site web page: http://www.wsmr.army.mil/pao/TrinitySite/trinst.htm
• Trinity test on Wikipedia: http://en.wikipedia.org/wiki/Trinity_site
• White Sands National Monument: http://www.nps.gov/whsa/
• Don't eat the food: http://www.roadfood.com/Reviews/Overview.aspx?RefID=3912

Brief Check-In: Food Blog

So my newest project is to tour Albuquerque in the pursuit of food. Good food, that is. In brainstorming with Sunny, I've come up with a list of various food tours I could work on, including oysters on the half shell, flan, sushi, pho, microbrews, mead, and more to come. Yesterday we went to a local Red Lobster and tried shrimp, lobster, crab, and oysters. It was a decent baseline for what uninformed persons might consider good seafood, but I'll never go there for seafood again unless someone twists my arm. More on that later. Email me with any suggestions for a topic!

Cheers, Truc-Ha

Being Whole: New Things

I started medical school in Connecticut not knowing a soul for about 300 miles. The jumble of studying, New England snow, Eurocentric culture, and complete lack of friends made medical school a rough stretch of years for me, and I didn't adjust well. As I tried to grow as a person and as a clinician, I also clung to the few stable things I established in my life: calls to Sunny, my bedroom, my favorite books, and a few teachers I had longitudinal contact with through the three years. One of those teachers, Dr. Hom, is an experienced internist in Northwest Connecticut. I'm not sure if he guessed the extent of my disorientation, but we did speak often of how to balance a clinical career with a well-rounded set of interests. One of his strategies was to subscribe to a magazine on a new hobby every few years. When I started working at his practice, I think he was reading about chess.

This past year, there has been more new things than I can count. I'm now a homeowner and a cat keeper. I'm an MD with a paying job. I'm finally living with Sunny, and I have a partner I can share day-to-day work with as well as all the other lovely parts of a beautifully growing relationship. I have a new set of friends, though no new confidants yet. Still, as winter crashed the hospital with more patients than I could count, I found that sensation of disorientation becoming frighteningly familiar again. I will always remember my first winter with a pediatric service as a bleak, exhausting, and depressing time. Trying to avoid my usual habits of depressive episodes, I decided to try something new.

First, I started with yoga. Yoga is an interesting flip side to being depressed. A yogini still concentrates on herself, but on her musculature, balance, and posture instead of the roiling, confused mass of negative emotions that characterize me in a slump. I'd lost almost all of my Tae Kwon Do muscles and some of my flexibility by the time I came to Albuquerque, so it's been nice to work out while working on something. "Going to the gym" has always been a self-inflicted punishment of boredom for me. Yoga is fun, and as I'm naturally very flexible and non-violent, it fits well with me.

Next, I've started with more craft-type arts. I'm sculpting a tree out of copper and various other metals right now; the leaves will be out of origami paper. It was originally supposed to have origami hanging from it, but this one's too small. The next one, maybe.


I'm also gardening. I don't water consistently, so right now my tomatoes and squash are doing well, but I've managed to kill various bushes that should have been more drought resistant than the tomatoes and squash. My indoor plants are doing better. My kumquat tree has just flowered, and the whole house smells like its fragrant little flowers. I don't know how many fruit I'll let it grow yet, but since the tree looks pretty hardy, I might let it make a few.

Lastly, today I colored my hair purple! Not really an unusual thing to do, but my father has some old-fashioned ideas about that (something about changing your appearance means you reject your family; to see what I think of that, see this link ), and I am also generally conservative in my appearance. I now have purple highlights. I was originally going for anime-colored purple, but I decided on a very dark, almost black, purple so that I still look professional. Can you tell from the picture? It's hard to see; some day I will have hair like Aeon Flux.

No, we are not pregnant yet, but we're planning to start trying next year.

Pediatric Check-Up: Out Of Intern-ment

Part 1:
Back in World War II, the US government rounded up a good portion of Japanese Americans and sent them to detention camps simply because the Japanese had bombed Pearl Harbor. They were considered "security risks" based on their ancestry. During the scary days after 9/11, a good many of us worried a similar fate would befall the South and Middle Eastern Asians.

Now, during this year of internships, I have not been locked up or had my civil rights violated by my program, but all the same, there is a sense of imminent release. I look back on a long, scary year of tremendous forced growth, and try to assimilate it into myself in the most useful way possible. I feel that I've grown, but am still figuring out where and where I have more growing to do.



References

http://en.wikipedia.org/wiki/Japanese_internment_in_the_United_States

Iron Chef: May 2007 = Strawberries

What is "Iron Chef"? Iron Chef has been described as a "game show", though I tend to disagree based on the fact that creativity and inspiration are what win the day, not just blind chance and regurgitation of facts. Iron Chef is a Japanese television show with the whimsical premise of an eccentric gourmand who has Iron chefs and guests chefs face off against each other. In each episode an ingredient is chosen as the theme for a meal of multiple courses. Crazy dishes as well as hilariously voiced commentary make this show entertaining, though unfortunately no DVD's of the show were available the last time I looked. If I could just subscribe to the Food Network, I'd actually watch TV.

At medical school, 5 of us started having themed cooking nights about four times a semester. While none of us ever went as crazy as squid ice cream, it was a fun way to get together and enjoy each other's company in a homey fashion. We never got around to having a competition since most of our houses didn't have enough kitchen space, but good times and good conversation were abundant. Since experience and good conversation are especially valued by Sunny and I, I'm hoping to continue the tradition in New Mexico. An added twist is to try and make the theme ingredient something seasonal. At some point in time we might add something like a conversation topic, and this last meeting we did a bit of origami. Hopefully Iron Chef will expand beyond the demesnes of Truc-Ha and continue even after I move on and out of Albuquerque, but I'll have three or more years to establish it, so we'll see.


Cooking, I've observed, is an artform that can be 1) avoided 2) dreaded 3) practiced daily 4) mangled. I personally do a lot of survival cooking that I use shortcuts to make tasteful and somewhat healthful. I have a lot of excuses. Part of my problem is that I don't really enjoy grocery shopping; going to farmers' markets twice a month is a fun and community-conscious alternative, but it doesn't provide for the rest of the month. I could go on, but sometimes I think about the philosophy of the endeavor. A cornerstone of daily life, I've often used the preparation of a nice meal as meditation practice. I don't chop well or evenly, but if I concentrate, it gets better, and I relax. I have to concentrate on planning everything out so that the scallops won't be in the pan long enough to get tough, and so that the salad won't wilt. I don't tend to have side conversations, and the house is usually quiet, waiting for the meal. The results are very concrete as well as mental. At the end of the two hours of standing meditation, I have a yummy reward for my endeavors. Either that, or my attention wandered, and I'm scraping the burned part off the chicken. As any meditation student, I also try to educate myself. This is a great justification for trying the cuisines of many ethnicities, as well as spending time at gourmet joints like Graze (thumbs down) or Ambrosia (thumbs up). Thus, I think that anyone can develop themselves as a capable cook (and should), and I'm have a lot of fun doing it for myself and with friends.

References

Iron Chef article on Wikipedia

First part of an Iron Chef episode

A Cat's Life: Weight Management

Today Ulysses has gone to the vet for some dental work. Trust me he hated it, but I was also a little worried about it because he has gained quite a bit of weight over the last year. When I got him, he was 14 pounds and looked well. Now he is almost 19 pounds and is a fat, slow-moving cat.

Psychologically, many people tend to see the obese as people who lack brain power. The train of thought goes like this: if they were smarter, they'd make better food choices or at least do something so that they wouldn't neglect themselves and look like that. For doctors, we tend to cringe even more as these patients have more medical problems, come to see us more, hear us talk about weight loss, and often have a hard time getting anywhere with the root of their medical problems. As a pediatrician, at least I can often talk about weight maintenance, since your average overweight Caucasian 10-year-old really should weigh more than 140 pounds in a decade, and they just have to hold the fat until they grow into muscular adults. I hope.

Anyway, with Ulysses, he's not smart enough to understand that he needs to diet, and he's obviously failed to self-regulate his own intake. He loves food, and I can certainly empathize with that. I've tried a few different regimens involving a mix of canned food, AKA “wet” food, and kibble, or “dry” food. I used to give him a lump of wet food (1/4 of the can) in the morning and let him snack on as much dry food as he wanted through the day. Then, after a significant weight gain, I tried limiting the dry food. Then I tried halving the dry food and increasing the wet food. Last week he was on wet food only and ate about 1.75 cans a day, begging for more.

I've done some reading. First, there's the problem that cat food packaging, which unlike people packaging, does not necessarily list the absolute calories it contains, and how much of those come from fat, protein, and carbohydrates. Instead it lists percentages, without stating how those percentages were calculated. Because of this, you cannot compare the percent protein on a kibble package (33%) to the protein on a can (10%) and conclude that kibble has more protein, which it doesn't. Secondly, cats' metabolisms are geared to protein and a mostly meat diet, though Ulysses likes some grass now and then. Thus, a high carbohydrate diet gives them a metabolic state similar to adult diabetics. To give you an example of the health risks of that, an adult human diabetic has the same risk of getting a heart attack as the risk of a second heart attack in someone who's already had one. Not good.

To complicate it further, I can't bear the thought of him starving, so I can sympathize with those moms of obese kids who don't have the heart to make their kid diet. That won't stop me from doing it, but I really hate it. It also drives me up the wall when he begs too.

So the solution? The ideal solution would be to feed him only wet food a few times a day. It is not ideal for us because I work so much and there's often no one around to feed him more than once a day. I really hate to give him dry food again, but we may have to go back to it. The vet is going to give me the number of calories he needs (I tried to estimate using the formula we use for premature babies…obviously wrong), and I've written our current pet food supplier to ask them just how many calories are in their products. Based on that, I'll be able to calculate how much food he really needs. It still won't be the correct percentage of protein, fat, and carbohydrates, but at least I'll stop overfeeding him for a time. Ulysses gets grumpy when he's hungry. I'm afraid I'll have to wear thick socks this summer or risk getting attack kitty marks on my calves.

Pediatric Check-Up: Mom's Quote 1

Doctors, especially doctors in training, like to bemoan that "no one understands" just what we go through other than our allied medical professionals. Now I don't agree with that completely, but I do agree that a large percentage of people do not understand the training pathway or just what our training consists of. So here's a funny quote from my mom this week while I was visiting Reno (translated): "So now that you're out of school, you're less tired, right?"

Er, that didn't sound as funny, but please reference my previous blog post from this January:

Current total hours worked: 101.5!
Current days working on this part of the job: 7 days

Here's a picture of a fellow intern that same month. Can you tell that we were delirious?

Philosofiend: Wealth (And Gifts)

Everyone knows a person it would be hard to shop for: a colleague with everything, in-laws with odd tastes. I've got a mother who doesn't make decisions on her own. How do you find a Mother's Day gift for someone without an opinion, especially if you detest insincere holidays such as Mother's Day? Luckily, my mother in-law is very "girly" and into various scented sundries as well as cosmetics, so I picked up a spa kit from my favorite, moderately Earth friendly boutique chain. Of course, most perfumes and colognes make me want to puke, so I chose something with very neutral scents and not puke-o-genic. Additionally we went to a spa for massages together once we arrived in her city, and made her a mixtape of music she likes and may like.

Now this course of action may seem very simple, but it is still philosophically driven. In giving a gift, we are not limiting ourselves to find something material that the person may like. For instance, there's a lot of souvenir kitsch that my mother enjoys and that I refuse to buy for her. Instead, we've expanded our idea of gifts to giving something that will enhance the person's enjoyment for the moment but also broadens the giftee's perspective or introduces them to a whole new skill set or set of experiences. We've given mixtapes, how-to gift books, de-virginized sushi eaters, and taught origami. It's a lot of fun for both parties in the exchange, and it suits our value system while also allowing us to spread something that we enjoy.

Of course sometimes it's still a case of "you can bring a horse to water, but you can't make him drink." I've bought a few different "how to use your Mac effectively" books for my dad, and also spent some time introducing my mom to computers, but there's still a beautiful G5 water-cooled Mac desktop idling in my parent's dining room using maybe 5% of its computing potential. But I digress.

I was thinking about the concept of wealth in our country. Currently, many (though not most) people enjoy a relatively decent quality of life. On home visits in the more disadvantaged neighborhoods in Albuquerque, people have heat, clean water, shelter, clothing, enough food calories, and preventative health care. In better neighborhoods people enjoy more consistent heat, greenspace and parks, safe neighborhoods, and better food. In my neighborhood, it's quiet, mostly safe, there's lots of young families nearby, and there's a good elementary school three blocks down the road.

So what does wealth mean in the context of Albuquerque, NM in 2007? For myself, what works is similar to an idea my father learned in wartime Vietnam: "they can't take what's in your head." In my context, where personal safety is less of an issue, I'd revise that to say "what's in your head makes you wealthy." In this context, the wealth I enjoy encompasses multiple skill sets, many wonderful experiences, and the ability to acquire more. Sunny and I have gone to Amsterdam, Saigon, New York, San Francisco, Hong Kong, and a really nice spa. I garden, and he codes. I troubleshoot medical instances, and he's made all of our house's doors fit in their jams. We're healthy and safe enough to continue all of that and more in a context of love, respect, and mutual values subject to discussion and tinkering. I think that even in less prosperous circumstances, this method of conceptualizing wealth would serve us well.

Being Whole: Training And Development

Recently, one of the testier attending physicians in the department was speaking with another intern who appeared to be at least five years older than me. In reference to this intern's increased life experience points and presumably more focused and ambitious career plans, this attending linked them together and rather casually derided “the folks who go to medical school and don't know what they want and halfway through decide that they don't want all this [waving at the hospital].”

Now I resemble this remark because I do not intend to find a job as a usual pediatrician or go into subspecialist training when I finish. I intend to chart my way off the beaten path that leads from medical student to practicing physician. I love the work some days, and it's a valuable body of knowledge that I can master. Yet I am looking for work that will allow me to use many of the skill sets I have, and also to continue to be a generalist, learning new skills as I go. Incidentally, I will also be looking for work that is more conducive to family life and to pursuing my wide range of non-career interests. Therefore, I disagree with the implication that I've wasted the seven years I'll have put into the medical career at the end of my residency.

In the gaming world a player's character gathers experience points in each battle, whether the beast is slain or not. I can stretch a simile and suggest that each endeavor, each moment in life, garners myself experience. Though I do occasionally regret a choice, usually I get over the unnecessary emotion and view the moment as a learning experience. Similarly, while I could have chosen to take more of a risk and just moved to San Diego with Sunny to look for a job instead of going to medical school, and perhaps been happier finishing a Ph.D. program in English, I made the best decision I could at each step of my path between entering medical school and finishing my intern year in a pediatric residency. Thus, I am now endowed with one of the rarer professional degrees one'll see in academic research, and I also have a large body of knowledge on how children might be raised, though not the experience of course.

I have always pictured myself as a person who constantly evolves and develops herself. Though this stage in my growth may seem very masochistic to others, it still serves as a stage of dramatic growth. It is very narrow-minded to consider it a waste of time despite the fact that the outcome is not the expected one.

Pediatric Check-Up: Friends' Babies

I have very prolific and fertile relatives, and many of my aunts are young and still contemplating further babies. Also, my friends are starting to drop babies, though thankfully not many. The first pregnancy in my cousins has been announced, and in any pediatric setting, you'll find lots of colleagues with fetuses or babies. The fertility boom makes it an awkward time to be a pediatric resident interested in sleeping at night.

Now, I am fond of babies, especially that class of babies that I can return to their mothers when they start crying or pooping. Still, the climb in pregnancies is making me slightly alarmed. I have your typical close, big, extended family that gossips constantly amongst itself. One misinterpretation of my grudging advice by someone, and then everyone will leave me alone...which is an attractive thought.

Homesteading: Xeriscaping, Zeroscaping

Landscaping a home doesn't necessarily result in monetary returns once the house is sold, so our home was perfunctorily landscaped in the front and not at all in the back. The front yard is definitely dated; it's two mature trees and a flat grass lawn with a few smaller trees. It brings to mind the white picket fence era, circa 1950, when the home was first built and municipal water didn't cost so much. It looks cute...when it's green. And at a mile high in the desert, it doesn't look green often.

Therefore, I'm looking at redoing the front in two years to be a multi-level xeriscaped succulent garden with a path going through it. Points of interest will be rocks, colorful shrubs, or groups of bulbs or colored grasses. I'm trying to use Google SketchUp for planning, though I'm currently figuring out the controls.

Succulents interest me with their variety of shapes, not all prickly, and range of colors. Additionally, like orchids, they tolerate my irregular watering habits well, which is why I've switched from orchid acquisition to accumulating small, brightly colored pots of varying varieties, including jade. Watch for pictures to come!

Xeriscape Council of New Mexico, Inc

http://www.highcountrygardens.com/

New Mexico Water Conservation Program

Citizen Of The World: First Tax

Ick, income tax filing. After four years of medical school, when I racked up debt and didn't have to file, it's an unpleasant experience to wade through the 1040 instruction manual again. Why does it have to be so convoluted, confusing, and difficult? Some would argue for a VAT (value-added tax) on all goods and no income tax, but among other things I'd be very concerned for the poor, having been from a previously low-income family. And why does the government tax two people differently if they are single as opposed to married to each other? Why should the tax code be so difficult that it takes up hundreds of thousands of dollars just to be codified and written each year? Flat tax can also hurt the poor, but it makes a lot of sense in cutting down bureaucracy.

Currently my solution is to provide Sunny with all of my documentation, and cook and clean while he does the taxes. Not the best one, but until I know enough to have an educated opinion.

Federal tax forms for individuals

2006 New Mexico tax forms for individuals New Mexico's state tax forms "piggy-back" on the federal form, like most states'.

Being Whole: Movement

Three days ago I took a yoga class at a local school chosen from the surprisingly high number in the area. It was wonderful to take the time to sit correctly and breathe fully. Under stress, many people tend to take quick, shallow breaths, and during this hour and a half hiatus I suspended stress and breathed.

I have a curious relationship with exercise. I've been a mid-level athlete before, but I rarely have enjoyed competing. Though I have been a regular at the gym before, I don't enjoy repetitive movements, nor exercise for the sake of exercising. I don't like any sport that brings me near cars or near to where non-participants can watch me. What I enjoy, I often think of as studied movement. I enjoy those sports that allow me to study my relationship between my will, the execution of that will into my body, and various forces of physics including inertia, force vectors, and momentum. Thus I usually find myself dancing, rock climbing, practicing yoga or doing martial arts forms.

It feels good to be sore again, and to be correctly aligned. I'm sleeping better, and am slowly recuperating from a month of overwork followed by a month of one virus after another inhabiting my respiratory tract. For those in the area, let me know if you'd like to go the the next class!

Pediatric Check-Up:Passing Disease

One big issues with having a centralized institution for the care of the sick is that there are naturally a lot of sick people there. Furthermore, they're sick with different things. In pediatrics, this translates to clinics and floors full of infectious diseases that can be passed from patient to patient, from patient to staff, and vice versa.

On a systems level, that means that everyone is generally treated with "standard precautions", which include hand-washing before and after every patient contact, and not eating in areas where we care for patients. That second part is generally why I am usually dehydrated. For unlucky hospitalized patients, there are also "contact" and "droplet" precautions. The first is for those patients who have an infectious but not respiratory illness, in general. The second is for everyone who has a cold. There's even further levels of precautions for people who might have tuberculosis or pertussis, but fortunately we don't see more than a few cases of possible pertussis patients in a month. Precautions are for everyone's safety, however they do have an emotional impact on our "chronic" patients: those children with chronic diseases who are hospitalized often, and for long periods of time. These patients are often left in the hospital by their families. The staff of the inpatient unit is often like a second family to them, but when they are placed on any protocol above standard precautions, they are usually isolated in their rooms alone other than the two to five hours that their nurse or the Child Life workers can spend with them. Spend some time listening to a three-year-old sobbing "mommy daddy gone" when you haven't the time to spend comforting her, and you'll know why hospital staff hate taking certain precautions even though we know why we have to.

On a personal level, this being my first winter in pediatrics also means that on top of my resolving lack of sleep, I've also been flat on my back with rather violent viruses, one of which has recently migrated to my eyes, giving me the all-to-gruesome "pink-eye". It's really hard to drive when your eyes are full of gunk, I've noticed. However, I am making a come-back, and next week is the three-day Intern Retreat in Taos, New Mexico. It's a rural town famous for artists (and some art), an aggressively organic lifestyle, a world-class ski resort, and yes, there really is art there. I'm looking forward to it, and my second vacation of the year starts after it!

Pediatric Check-Up: Hours

Current total hours worked: 101.5!
Current days working on this part of the job: 7 days

Pediatric Check-Up: A Time of Advocacy

From Merriam Webster Online

Support: (1) : to promote the interests or cause of (2) : to uphold or defend as valid or right : ADVOCATE (3) : to argue or vote for

So one of my ideas for my advocacy project was to build a website for the local GLBTQ (gay, lesbian, bi, trans, queer) community. This website would function much like an information and triage desk. It would list available resources, as well as providing enough information to give people an idea of where they should look next to find real people to do things with, such as volunteer, advocate, or just plain drink with.

In speaking with some community members who are active in various organizations providing services in the area, this website is needed, but not only as a website, but as a comprehensive online community. This is interesting to me as this is a variant of what Sunny and I are trying to do with http://poeticpublishing.com and http://davinciconcept.org. While with those sites we've built a site and are trying to recruit members, in this case a group already exists but needs a virtual home. For the online communities we've already built, Sunny and I already have capacity for email, forums, and serving content. To build this one, I would probably use a wiki as well, though maybe I'd use DokuWiki instead of MediaWiki as the collaboration on content would not be the focus of this group. For emailGmail, I would also use and then for listserve management, I would try Google Groups. For community calendaring, Google Calendar, of course.

Why all the Google use? It's free, it works, it's meant for multiple users, and I don't have to host or manage it. Furthermore, the text ads are very unobtrusive, and it's a small price to pay for all the work that I don't have to do myself. Same thing with the wiki use. I'm familiar with DokuWiki and MediaWiki, and though I don't currently understand the nuts-and-bolts of installation and of upgrading these two, I have watched Sunny upgrade this site, the content of which is managed and displayed by DokuWiki.

Now, of course, this online community would not be the same as the real-life community it serves. There are plenty of people without access to the internet and computers. However, I think that the majority of the population have access to either libraries or their own computers, and that reaching out to the less technologically privileged would be a project that can be fulfilled by one of the current organizations.

In terms of this working as my advocacy project, my residency director thinks that it's a great project, and I'm looking over the CATCH grant paperwork to see if they might fund the learning curve that I'll need to undergo in order to do this properly. Let's hope that it does!

A Cat's Life: Toilet Training

Cat feces carry a risk to both pregnant women and immunosupressed people. They can transmit the pathogen Toxoplasma, of which cats are not the only carrier. Besides being infectious, cat feces and urine are just gross to deal with, so Sunny and I have been planning to train Ulysses to use the toilet for a long time.

Firstly, I looked around on amazon.com to see what was available, and then read some reviews. I found that I needed a training device, though some people have used plastic wrap, like Saran, for a trainer. Then I needed flushable litter. Though I had a device picked out on amazon, I ended up buying Doogie's Litter Kwitter at the local retail pet store so that I could return it if it didn't work. So far Ulysses is making a mess, since the training seat isn't deep enough to hold a lot of litter, and Ulysses is a big cat. Litter gets all over the bathroom floor, and sometimes there's poop too. Eew. But hopefully the mess will be offset by future freedom from sifting through kitty litter for cat poo. And no toxoplasmosis when I'm pregnant.

Pediatric Check-Up: Sleep, Rounding, and Sign Outs

I've often been asked how much sleep I get as an intern; it's an understandable question because on certain rotations I work 30 hour shifts. What really bothers me, though, is not necessarily how much sleep I get, but when I have to get up. Generally, when I was on the inpatient service in August, I hit the floors around 7AM. However, now that it's the wintertime, I'm really facing a wake-up time of around 5:30AM and an arrival of around 6AM to get the work done in time to present patients to the team for the morning's planning session, generally known as "rounds". It sounds very, very painful to me. I used to be a night owl and still relish staying up as long as I want when I can. Furthermore, Sunny's a night owl too and likes to go to bed around 1AM. I can't do that with a 5:30 alarm bell.

What makes tonight even more interesting is that each team is switching personnel. All of the interns are coming from other rotations to pick up the current team load. Furthermore, the team I am switching to is admitting patients tonight, resulting in uncertainty of how many patients I'll need to see by 8AM tomorrow morning, which is when rounds start. I don't like it, but there's nothing I can do but try to make it in by 6AM, a feat I've never accomplished unless I was already in the hospital.

Pre-rounding, that is getting the data for rounds, is always an adrenalin-laced experience for me, and I don't really like it. For pre-rounds, I record a summary of all my patients' vitals, lab values, and general events from the 24 hours since we rounded last. This includes a bedside visit and exam. For new patients I am generally slow, hopefully due to me being thorough vs. some kind of intrinsic inefficiency.

Generally, though I know my patients and know exactly what to look for to see if they are getting worse or better. On a switch day, though, the quality of the information from the departing intern tries to fill in for that familiarity. The passage of information is called sign out, and it's a process that desperately needs some troubleshooting.

In an effort to decrease medical errors, residents across the nation have had their work hours limited to an average of 80hr/wk each month. This is similar to work hour limits in fields such as aviation (pilots) and other crucial errors. However, preliminary data suggests that the increased mental rest residents are getting is being offset by errors made by cross-cover teams due to sketchy sign out. I'm still in the process of reading up on this, and I hope that further studies continue not only to track the numbers, but to also test ways of making sign out more efficient and information-laden.

Occasionally, I am irked, as today, with the quality and thoroughness of sign out. One person just left and didn't bother to sign out to me. Another describes a 3 week hospital stay that included an ICU stay as "simple". Such things suggest to me that there is a systems issue that needs to be addressed by a policy statement to clarify things. My current personal policy is that whenever I leave a hospitalized patient for another rotation, I tend to leave a summary of their stay under my care, so that the next person doesn't have to flip through a whole book of notes to try to figure out what happened. I also intend that when I am team leader to clearly verbalize criteria I expect for this kind of major sign out, and make sure all of the team members understand what I am expecting. It might just be easier and less bossy to get the whole caboodle in writing, or find out where it is written, and just email it out.


References:

Editorial: Is 80 the cost of saving lives? Reduced duty hours, errors, and cost.

Residency work-hours reform. A cost analysis including preventable adverse events.

Disclaimer: I'm still reading the literature on this.

Writers' Cafe: A Diamond Age

This Sunday to Monday night marks the transition to the last day wherein I can work on my entry for the 2006 writing marathon I started on Poetic Publishing, the online art development and publishing site that Sunny and I are developing. For my entry, currently titled "The Grotesque", I'm trying to write fiction, a new thing for me, and the piece sits nicely in the genre labeled science-fiction.

My problem, other than my inability to come up with a plot, is that though I have emplaced my story in a sci-fi world that Sunny and I have been developing on and off for over a year, the world's not done yet. Most irksome for myself as a primarily poetry writer is the fact that we haven't named most of the technology we're talking about.

In contrast, Neal Stephenson, author of Snow Crash, a book well-known in techie and hacker culture, builds worlds that are not only colorful extrapolations of now but are also well populated with contraptions that are superbly and uniquely named.

Today I read another book by this author The Diamond Age: Or, A Young Lady's Illustrated Primer. Though off to a slow start for the first hundred pages as Stephenson describes a world saturated with nanotechnology, the plot thickened eventually, and explorations into basic programing, cultural warfare, and parenting provided enough human significance to give the book a rating of 3.5 out of 5 overall.

Now, though, I feel totally screwed. My main character is a designer whose creations are given life by nanotechnology. It's going to take a while to wash the lingo and made-up tech of A Diamond Age out of my system enough to make me feel that I'm not obviously crimping someone else's style. Then again, the whole point of the marathon was to let go of the editor and just let the words flow. Furthermore, the development side of Poetic Publishing, also known as Poetic Authoring, is private and secure. So, if imitation ends up being the sincerest sort of flattery in this case, no one not of the community will have to see and laugh at it.

So here's my concise review of A Diamond Age: it's the pleasure of reading a solid writer break new ground in an interesting nanotech world mixed with the pain of being a nanotech writer trying to break into a new area without copying anyone.

Pediatric Check-Up: Crazy Saturday

I get asked what my life is like fairly often, as I'm undergoing a type of training whose rigor is renowned. In J. Ruth Gendler's book, The Book of Qualities, I like how she describes how some people seek out suffering and are proud of having suffered. Some people avoid it. I sit somewhere in the continuum, but towards the avoidant side. I don't buy the idea that suffering automatically makes the sufferer noble. In my totally unresearched opinion, that's a religious tale they sold to some peasants to make them feel better about themselves. Yet, if an education or an experience is valuable enough to me, I'm willing to work to get it.

Currently, I'm an intern at the Pediatric Residency Training Program at the University of New Mexico Health Sciences Center, which is a lot of capitalized words. What it means is that I am in my first of three years of training to be a general pediatrician. The curriculum varies somewhat from program to program, though all programs must meet criteria to be accredited, so core facets remain similar across the country. Our year is divided into 13 four-week blocks called rotations. Each block we operate within a different part of the pediatric medical world, going from inpatient (hospital) service to outpatient to emergency to critical care to different types of specialty care.

This block I'm doing is called PARC: Pediatric Advocacy, Rural and Community. It's a relatively light block in terms of hours required. Scheduled activities are half-days at the most, with the rest of the time for self-study. The goal of the block is to educate pediatric residents in the process of advocating for our patients. This is a fluid target. "Our patients" could involve a specific patient, a family group, a certain ethnic or minority group in the area, or even creating change on a national level. "Advocating" can involve helping find resources to pay for a patient's chemotherapy, or making seat belt laws physiologically make sense for children, or writing a column, or teaching children how to safely approach a dog. Pediatricians as a group tend to be active advocates, though the issues and the populations we speak for may be very diverse. This month rests us (interns) from our labors, broadens our education, grounds us back in who we are, and gives us quality time with whatever we choose.

During this month, we also cross-cover (meaning serve where we are not working full time) the hospital urgent care clinic. Whomever covers the clinic also takes phone calls from worried mothers at night. Normally Saturdays are pretty light in clinic as we are only open from 9 AM to 2 PM, and I think that most patients don't know that we're open and don't want to go to the doctor on a weekend anyway. So what's a Saturday in the life of a resident like? Today, there was a rush of patients from opening to closing, and I was taking phone calls during clinic hours as well. I bought a coffee and biscuit for breakfast at 9 AM, ate the first bite while standing up at 11:30 AM, at the last bite while standing up at 3 PM, and left at 4:30 PM while starving for some linguine. The unpredictability of patient care is why I never commit to anything during work days when the time I leave is scheduled as "when the last patient is done". Not even food, my first and foremost romantic partner on some days, is exempt from this. I estimate that the last patient left around 5PM. I'm still taking phone calls. Crazy.

Skin and Bones: Car Seats

Today, Consumer Reports released a paper saying that the car seats they tested failed side-impact testing. These were rear-facing, snap in car seats. For those of you with children, you may be really mad at me because I've been having the following conversation with my patients' parents all year long:

"Do you have a car seat for your baby?"
"Yes."
"Which way does it face: the trunk or the engine?"
"The trunk."
"Perfect! Is it in the front seats or the back seats?"
"The back."

The testing did not compare rear-facing car seats versus seats facing any other direction. So I'll continue my little quiz and recommend car seats over flying babies.

Dictionary Day: Baraka

From the Merriam-Webster Open Dictionary Project:
baraka (noun): [ba'ra-ka] [arabic] - a state of heightened consciousness or grace achieved through religious fervor involving prayer and dancing; a blessing that can be carried and transferred from one person to another or from an object to a person (usually one who has made the hajj); the blessedness possessed by a person of character, courage, and selflessness
Muslims who have completed the fifth of the five pillars of Islam are often endowed by Allah with baraka that may transmit to those around them. —christopher j moore, book In Other Words: A Language Lover's..., 2005.

Dance! Dance is one of my favorite art forms, and one I don't hesitate to participate in. Give me tango, waltz, cha-cha; jive with me during some happy hardcore, if you can, or let's jump around to some dark progressive house music. Give me some vocals; add a little electronica, spice it up with some South Indian beats and a good soprano, and we are set!

While I am not someone with decades of experience in Modern dance or ballet, I do have a background in studying movement that comes from decades of experience in the martial arts on top of my amateur ballroom dance studies. In the realm of my own experience, dance can endow the participants with a state of exhilaration and even ecstasy, without recourse to drugs, legal or otherwise. My current theory is that the effect of fervent movement and the joy of expression is akin to the phenomenon known as "runners' high". Add strobe lights, and it's a potent experience.

Where does that leave those who join religion and dance? Religion is a private matter, and I don't engage in such activities, since I prefer to spend my energies dealing with reality and real people. Dance is a beautiful set of activities on its own, with meaning assigned by choreographers, ravers, and your own personal self. Religion and faith don't have to be part of the equation for it to be a transcendent experience full of the vigor and ecstasy of enjoying life. So, love, live, and dance!

Links:

http://en.wikipedia.org/wiki/List_of_electronic_music_genres

http://www.m-w.com/dictionary/transcendent+ I meant definition "a" or "b". Kant likes to make his own mental Möbius strips, and I don't participate in that.

Dictionary Day: Agoraphobia

From Merrimam-Webster Online:

Agoraphobia: abnormal fear of being helpless in an embarrassing or inescapable situation that is characterized especially by the avoidance of open or public places

In psychiatry, one can have panic attacks with and without agoraphobia on top. People stop going out into public places because they fear that they might have a panic attack in public.

Personally, when I'm at a place where I can spend an extensive amount of time at home reading, studying, and writing, I notice that I also start avoiding the public. This is especially odd for me to experience as I work in an industry known for public exposure: medicine. However, I am more on the introverted side of the Myers-Briggs scale, and at times, public exposure tires me out. I thought that this would qualify me as an agoraphobe, however, as I'm not actually afraid of being helpless, it doesn't count.