TV shows and Travel Clinic

I've been watching a good amount of TV lately. I'm really enjoying getting netflix movies (I watch sometimes 3-4 a week!) and, with the fast (i.e. 2 day) turnaround, I certainly am getting my money's worth. Fourth year, we really do have a lot of free time. I had to ask Wendi for suggestions of "shows" I could get into to fill some of my free hours, as I've never been a big cable TV watcher :) My favorite shows of all time have included The Brady Bunch (classic!), Friends, Sex and the City (watched every episode, courtesy of EVB), and Scrubs. I do tune into Leno at 10:35 most nights of the week (Mondays are especially funny with Headlines; however, I've been told to give Letterman a try too...). And I've been steadily making my way through the seasons of Seinfeld that Brandon and Kristen loaned me (I do really enjoy that show as well-- currently on Season 3!). In any case, I was looking to diversify a bit (especially since I will soon catch up with all my episode-watching).

Anyway, Wendi suggested Prison Break (Mondays), American Idol (Tues/Wed-- I've seen some of this in the past), and Survivor (not on yet but one of the Kits' favorites). So, the past couple of weeks, I have been joining them for some of these. I saw Prison Break only one time, but I don't really think it's my thing. I tend to enjoy watching comedic sitcoms more than thrilling and gun-heavy shows... so I think I will pass on that one. I can't get into 24, another one they're (well, John and the Joneses) are hooked on. But Idol I do think I could watch regularly. I feel kind of sorry for the contestants now, because the judges are kind of harsh about non-talent. But I think I will really be entertained by the singers later on. I've also heard that some people are really hooked on Grey's Anatomy. Perhaps I should give this a shot too. Other suggestions, esp. from people who know my "style"??

Well, before you think I'm a complete TV junkie (I really am in med school!), I should write about something else. Yesterday, I went to my appointment in the Travel Clinic to get ready for the trip to Nigeria/South Africa in March-April. I luckily had gotten all of my required vaccinations (hepA, rabies, typhoid, yellow fever, meningitis, tetanus) back in 2005 before I went to Peru. I did get the flu shot at my visit, which somehow I have neglected to get so far this season until now. And I came away with prescriptions for Malarone, an antimalarial I will take for the entire trip's duration and for one week after, and Cipro (for traveler's diarrhea). There will be antiretrovirals (anti-HIV drugs) available over in Nigeria where we'll be in case of needle-stick/exposure which I hope very much none of us will need. The doctor I saw was very insistent about being "very, very, very, careful" with using needles, as she told me that it has been shown that medical students are at highest risk for needle-stick injuries when doing international rotations ("No learning how to start IVs over there, ok?" she instructed me.). She also told me to COME BACK RIGHT AWAY should I get stuck. Well. I'm most certainly NOT going to want to come back early from such a fun trip, so (with my clumsiness) I'll just have to be extra, extra careful. I can't believe we're less than 2 months from departure!

Laziness and Funny duck (say that three times fast!)

I don't have too much to report and am feeling especially lazy. I can't seem to get enough sleep -- both last week and this week, I've tried to get up in the morning to work out and and I just decide to get back into bed and sleep for another hour (perhaps it being FREEZING has something to do with it. I think it was -1 when I walked to the hospital this morning). And then, when I get home from my rotation (which was around 3 yesterday and 1 today), I've had to take a nap. I'm headed there now. Being a fourth year, the residents don't care that you stay all that late and basically shoo me out the door. I'm okay with that, despite really liking the rotation (nursery) so far. I'm just beat.

Anyway, since I can't think of anything interesting right now to write about (and my eyes are closing as we speak), I thought I'd share a funny story I recently read in the news about a duck with apparently more than two lives...

Plucky duck survives another brush with death

Wow! Cats may have some competition...

Timber Lodge

Saturday night, Rachel, Hans, EVB, Sam, and I got together at Timber Lodge Steakhouse in Rochester. I certainly hadn't had any steak for a while (although, after reading that Fast Food Nation book, I wasn't sure I'd ever eat beef again...), and I know EVB and Sam are also big fans, so we were thrilled to spend some time with the soon-to-be (well, in a year or so!) Sviggums and have some good beef. The beef was indeed quite good. The service, however, was something else. Basically, the main telling conversation of the night went something like this:

Erin: I'll have the 8-ounce Viking steak, please.
Waitress: How would you like that cooked?
Erin: Medium.
Waitress: Soup or salad?
Erin: What kinds of soup do you have?
Waitress: Wild rice and Clam Chowder.
Erin: I'll have a salad.
Waitress: What kind of dressing?
Erin: What kinds do you have?
Waitress: We have thirteen dressings!
Erin: Could you tell me what they are?
Waitress: Um.... you want me to name all of them?!
Erin (face getting red): Actually, yes.
Waitress: Well.. we have the basic ones. You know, ranch, italian, thousand island, caesar, raspberry vinaigrette...
Erin (in her head): That's only five.
Erin (aloud): I guess I'll have the raspberry.
Waitress: Potato or vegetable?
Erin: Potato.
Waitress: What kind?
Erin (somewhat apprehensively, expecting another bite-your-head-off response): What kind do you have?
Waitress: (Big sigh). They're listed on the menu.
Erin (in her head): Oh. Unlike the dressings.
Erin (aloud): I guess I'd like the garlic mashed.
Erin (after the waitress left): That was the most insulting waitress I have had in years!! Don't you guys think so? That is terrible service. She is getting NO TIP from me. You guys shouldn't give her tip either.

Although we (well, really only Erin) had some trouble getting water glasses filled in a timely fashion, it was a good overall meal after that encounter. It was fun to catch up before Hans headed to Jacksonville to do his Medicine subI.

Here are some pictures from the night (courtesy of Rachel):

Lot of eye problems in this one (Hans recuperating from an elbow to the eye, Sam apparently taking a brief nap but having a nice dream) although EVB looks good (HOT).

The girls (a.k.a. Eye Candy :) )

Yay! Sam opened his eyes! :)

Anyway, like I said... despite the service, it was still a fun time. I hope Erin has cooled down by now :) Perhaps you want to ask her how much she left for a tip...

Running, Cold, and Running in the cold

I have never been that big of a runner. I get kind of bored but did it occasionally for good exercise when ball-chasing isn't an option. I generally prefer to go to the gym and do the elliptical or something so that I can read at the same time :). Since moving here to MN, however, I have met some very serious runners. "Marathoner" Molly for one, but lots of other people as well. I still recall the first day of medical school, when we introduced ourselves to the rest of the class, mentioning where we were from, where we went to school, hobbies, etc. There really were a lot of "I'm _____. I went to college at ___________. I like to run." And then there was Natasha: "Hi. I'm Natasha. I'm from Macedonia. I only run when chased." As far as running-- marathons tend to be a pretty common thing from people around here. It seems like someone's always training for one! Except for me.

Here's a pic (I think it was from Wendi) of Kristen, Wendi, JB, and me before the Harvest Classic, a 5K we did back in September.

Okay, now onto the cold. As you know, I'm kind of a wimp. I complain a lot (but maybe not as much as Wendi does!) about the cold. She recently recounted some "cold" anecdote from EVB about snow (brushed from the top of the car) still being present, by the floormat, days later because it just doesn't thaw! Other things recently that have been getting me about the cold (and it hasn't even been that bitter-- i.e. teens and maybe even 20) include, firstly: my wet (showered) hair freezing out straight from my head when it sticks out even slightly from the hat I wear when I walk to clinic in the mornings. It thaws quite quickly, but this is just weird, and not very cute. It can't be good to have hair icicles every day.

Another thing is when the car window freezes so that it cannot be rolled down. This is really annoying when one wants to just quickly return library books at the drive-up book drop or get a parking ticket (or go to a drive-through bank!) and you have to open the door, get out of the car, do your business, and then come back.... At least I haven't had to pay any tolls when my car is in this frozen state. That would be really annoying. Almost as annoying as missing when I throw quarters with my left hand. Today, I went to fill gas because I know that it's not good to get too low when it's this cold. I couldn't get the gas tank door to pop open. Whether it was rusted or frozen shut is debatable, but, in any case, I had to get someone to help me (prying it open while I hit the "pop" button inside the car).

Okay, that's it on raw cold. Onto running in the cold, which is something I've also never been a fan of. Recall a posting ("Winter in MN") from November (and yes, it is for sure still winter now!) in which I lamented the freezing of my ipod on a fairly short run. I don't think I have really gone running when it has been much below 30. Nose hairs and digits freezing as well as lungs hurting is not my idea of a great time. However, on Friday, I bumped into Lisa, a friend of mine from church, and we started talking about running. Running in the cold.

So, yesterday morning, we went for about a 4-5 mile loop around Silver Lake. It was in the teens. But I survived. It really wasn't too bad when we got moving! Although it really feels much warmer in the darker hours (due to lack of wind currents-- I was not making this up!), even with our daylight and a bit of wind, I didn't die. Of course, I was wearing leggings, sweatpants, a long-sleeved T-shirt, fleece, hoodie, a hat, and gloves. Good thing we didn't go today, when I think it was 2 degrees.

I talked to Lisa a bit about marathon-running. There are several in this area around May- June, which might be too hectic to try with graduation, weddings, moving etc. But I'm not even sure about the training. I don't really like to run two days in a row because my joints start to hurt (and that's not solely because of my shoes because I recently changed them!). How would I ever do 26.2 miles? Sometimes (and I think I remember Lesley saying this when she and David were training for their marathon a couple of years ago), I think some people (i.e. me) are just not built for running. I think I could do a half-marathon without too much trouble. But I just don't know. Lisa suggested doing more strength training of my lower extremities (I really do none now; in fact, I didn't really lift anything until a couple of years ago but now do some shoulder and upper body stuff), which could help with my knees. We'll see. Perhaps I may train for some distance race in a warmer city where I will move this summer. But, for now, I may be doing a good deal of running in the cold. Lisa and I have another running date tomorrow morning, when it is still dark....

Nerd Alert!

So a couple of things to write about.

Firstly, I read a really great composite article in Time magazine the other day. It was a series of writings on the brain, consciousness, stress and the like. Now being in medicine, these things (written for anyone to read), are of extreme interest to me, but I just wanted to mention a few of the things I learned so that everyone could benefit!

• I read about the "phantom limb" syndrome. In people who have lost an arm, leg, whatever, the cerebral cortex adapts so that sensory fibers representing the (former) limb grow over to areas representing other places. So, in these patients, scratching their cheek can reproduce the sensation of i.e. an index finger being scratched even though it is totally absent. Neat, huh?
• On depression: cognitive behavioral therapy (group, talk therapy aimed to develop more healthy reactions and responses, "mind over mood," if you will) tended to diminish overactivity in the frontal cortex of the brain, which is generally accepted to be the focus of reasoning, logic, behavior, as well as rumination about bad circumstances (the "catastrophizing [to quote Molly] center" :)). However, paroxetine (Prozac), a common antidepressant, actually did the opposite, raising activity there. Interesting how two different accepted depression treatments have such different (well, opposite) mechanisms.
• More heart attacks and strokes occur between 6-8 a.m. than at other times due to an early morning surge of cortisol, a "stress" hormone.
• People with low self esteem tend to be more vulnerable to stress and, anatomically, tend to have smaller-than-average hippocampi (parts of the brain involved in memory)...
• Quadriplegics have lower incidences of PTSD (post-traumatic stress disorder) than paraplegics, presumably due to a severed link between the brain and the adrenal glands (which are responsible for producing cortisol, epinephrine, and other "stress-related" compounds.)

Onto other nerdiness...

When we were elementary school, glasses-wearing was nerdy, was it not? Is it nerdy now? Is it equally as nerdy to want to wear glasses? Today, with my new lens-prescription in hand, I made a little expedition to Lens Crafters to check out my frame options. It was overwhelming! Never having shopped for frames before, I was quite perplexed, and it was good people kept coming to help me out. At first, I thought everthing looked horrible on me (but how do others look spectacular in their glasses?). But one of the salespeople pointed out that I needed narrow frames, and handed me one with tapered edges. Way better. They had to send away for lenses for my "serious" glasses, but here's a fun pair I got. I took these pictures of myself-- I have to say, I don't really like how I look up close. But what do you think of the frames?

Ophthalmology

This week, I have been on a one-week ophthalmology rotation, working with the resident (Curt) on COS, or the comprehensive ophthalmology service. It has been awesome. Curt is amazing-- super nice, brilliant, and a phenomenal teacher. My intention in doing this rotation was to get more comfortable with the funduscopic exam and with common eye conditions. I've definitely accomplished that (as well as learned how to spell "ophthalmology"-- there's one more "H" than I knew about and a silent "L")! Doing these specialty rotations now is great because the residents recognize that you've already made your career choice. So, rather than sitting there, listening while they try to convince me to go into ophtho (like Amy, my classmate who matched here [very competitive] at Mayo!), I'm just learning things that would be "good to know as a family doc," getting tons of exposure to common things like dry eye and meibomian gland dysfunction, as well as a lot of other varied ophthalmologic conditions, which have included such things as:

• corneal ulcers and abrasions
• chalazions
• conjunctivitis (pinkeye)
• subconjunctival hemorrhage
• herpes simplex and Staph marginal keratitis
• preseptal cellulitis
• glaucomatous discs
• diabetic retinopathy with flame and dot-blot hemorrhages, exudates, macular edema, and vitreous hemorrhage, treated with PRP (pan-retinal photocoagulation)
• posterior vitreous detachment ("floaters and flashing lights")
• retinal detachment
• retinal nevus (mole)
• remnant pupillary membrane
• uveitis
• pinguecula (conjunctival growth due to sun exposure)
• internuclear ophthalmoplegia (inability to completely move one eye medially or towards the nose)
• pigment dispersion syndrome (risk factor for glaucoma)
• benign episodic anisocoria (intermittent pupil asymmetry)
• post-cataract surgery posterior capsule membrane opacity (treated with YAG laser capsulotomy)
• diplopia (double vision) with congenital IV (nerve) palsy
• pseudopapilledema (swelling or fullness of the optic discs)
• conjunctival melanosis (pigmentation around the limbus, found in darker-skinned people)
• macular degeneration with drusen
• trochleitis (~tendonitis of one of the tendons of the eye muscles!)
• hypertensive changes (arterio-venous nicking, Drance hemorrhage)
• spontaneous periorbital hemorrhage secondary to coagulopathy
• dacrocystitis

These ophthalmologists are very good and very thorough, but I think a week of it is enough for me. I've found that they really like using these big words (lagophthalmos, pseudophakia, etc...) as well as abbreviations (BRVO [branch retinal vein occlusion], GCA [giant cell arteritis], RD [retinal detachment], etc...). And they always want to take one more "quick peek here." I feel bad for the patients with all of the bright lights being shined in their eyes again and again! But I've learned a ton, and the patients are very patient.

I've been meaning to get my own eyes checked for a while, as Mayo has something like $1000 (per year?) in a dental/vision account to reimburse you for dental and eye care. But, as I haven't needed glasses or contacts, this money is just sitting there... My fear is getting to residency and needing glasses i.e. the first week of intern year, which would just kill me because I didn't "make use" of the Mayo insurance. I also really love some people's frames and think that, if I could get myself some glasses, I might add a few years to my appearance and gain credibility with patients who ask me, "How old are you?!" So Curt did refraction on my eyes the other day.

It turns out that I have a slight degree of myopia (nearsightedness), i.e. - 0.25 in each eye-- which is not really that significant. I do have a small astigmatism in my right eye. News to me. But this qualifies me for some frames! Curt says it's okay if I don't wear them all the time, i.e. I'd be able to accommodate okay if I went "out dancing or to the beach, glasses-less." Ha ha. Like I do either of those things. In any case, I may go this weekend to see if I can get some stylin' frames. Call me (maybe, sometimes) four-eyes from now on...

Research Relief

Research drags on and on. Here at Mayo, we are required to do a research 'trimester' (3 months) during our third year. I did mine at the very end of the year-- i.e. April to June of 2006. It was actually quite an interesting project, although I seemed to have put in a lot more hours than some people (ahem, JB) during this time, which is generally viewed as a "break" from other responsibilities but which basically landed me in a "bat cave" of a room for many, many hours a day, staring at a computer screen.

I did a chart review project looking at the electronic medical records of adult kidney transplant recipients transplanted between 2001 and 2004 to evaluate the incidence and risk factors for herpes zoster (or "shingles," the reactivation of varicella or the chicken pox virus), which tends to be more complicated/severe in a population under high-dose immunosuppression after transplantation. The research was relevant in light of the development of Zostavax (Merck), a vaccine recently approved to significantly reduce the burden of illness of shingles in an immunocompetent population of 60 years of age and older.

While the data collection part of the project ended in June, I have spent the past 6 months or so preparing the manuscript, which has been a long (and, at times, frustrating) process but from which I have learned a ton. I have never written a paper of this scope by myself and haven't had this much exposure to statistical analysis before either-- there are a lot of things to think about when trying to discuss this data! But I have had great guidance from my advisor, Robin, in Infectious Disease as well as from the people in the statistics department. It has been hard to do this in bits and spurts, especially since I have been on the road for much of the past few months. But the paper is submitted!

Today, I sent it ("Varicella Zoster Virus-Associated Disease in Adult Kidney Transplant Recipients:Incidence and Risk Factor Analysis") in to the journal Transplant Infectious Disease for review for publication. I have no idea what the process is like from here on out-- I expect that it will be reviewed, rejected, or recommended to be revised several times, but I feel (I really hope!) that the hardest work is behind me. It's nice to (finally!) have this off my chest/out of my hands for a while (Lesley, get cracking!).

I had a little episode of panic yesterday. I realized that, back in November, I submitted the abstract for this paper to the American Transplant Congress meeting in San Francisco from May 5-9th. Since then, we have bought our tickets to/from Africa, which return us to Minnesota on May 5th. So, if my abstract is accepted (I think I'm supposed to hear in the next week or two), I may be flying straight to Cali from MN. We'll see. Honestly, I have no idea where my mind has been this last month or so. Not where it should be, obviously. I hope this, too, all works out.

Caffeine intoxication?

I did not drink any coffee yesterday. Neither did I imbibe any caffeinated tea or soda (note that I did not say "pop"). And I cannot believe that I was soooo well rested that I just "didn't need the sleep." However, I had major trouble sleeping last night, i.e. I woke up every 2 hours or so. When the clock read 1:51 a.m., I was sure that it was wrong and that more time had passed than that. Generally, this makes me thrilled that I have "more time to sleep"; however, I woke up again a couple of hours later and was less than thrilled. When, the next time I looked, my alarm read 4:15, I was sure my clock batteries had gone dead and I went in search of my cell phone to recheck the time which I confirmed was, indeed, correct. I lay in bed until about 5:15 or so, at which time I thought about getting up and going to the gym. But I somehow dozed off again and awoke about 20 minutes before my alarm went off around 7. It was not a fun night. I know that I really take sleep for granted. For someone like me who is consistently asleep about 45 seconds after my head hits the pillow (or couch cushion, etc... :)), not being able to sleep just drives me crazy. I don't know how people can struggle with insomnia night after night, for one night of it just about killed me.

I was wondering what the culprit was.... and, finally, it hit me! EVB had brought over coffee ice cream to the Kits' so we could do our own home Cold Stone with crushed oreos and all. I had no idea if there was enough caffeine in ice cream to do it, but here's what I found out online (Caffeine-related disorders):

The caffeine content of various food items and medications is as follows:

• Brewed coffee, 8-oz cup: 135–150 mg
• Instant coffee, 8-oz cup: 95 mg
• Powdered cappuccino beverage, 8-oz cup: 45–60 mg
• Tea brewed from leaves or bag, 8-oz cup: 50 mg
• Iced tea from mix, 8-oz glass: 25–45 mg
• Snapple iced tea, 8-oz glass: 21 mg
• Mountain Dew, 8-oz glass: 38 mg
• Dr. Pepper, 8-oz. glass: 28 mg
• Diet cola, 8-oz glass: 31 mg
• Root beer, 8-oz glass: 16 mg
• Coffee ice cream, 8-oz serving: 60–85 mg
• Coffee yogurt, 8-oz serving: 45 mg.
• Dark chocolate candy bar, 1.5 oz: 31 mg
• NoDoz, regular strength, 1 tablet: 100 mg
• NoDoz, maximum strength, 1 tablet: 200 mg
• Excedrin, 2 tablets: 130 mg

Well, I definitely had more than one serving of coffee ice cream. Maybe even more than two. So there you have it-- a late afternoon dose of more than a cup of coffee (more than 3 Mountain Dews!). JB also had trouble sleeping, so I think my theory is confirmed. Next time, we will have to have a different flavor--that is, if any of us want to get some rest (and so Wendi can partake too!).

S'more from the weekend and a snowy Sunday

I have some pictures from last night at Molly's. Felix was in town and cooked an awesome Taiwanese feast for us. I'm not sure what everything was, but there was rice, some sort of stir fry dish with tofu and Japanese eggplant, fried tofu thingies, rice-stuffed bean curd paper, and a couple of vegetables I'd never had. Apparently he got it all from the Asian grocery store in Roch, which is quite impressive! It was all extremely tasty.

Here are Lisa (Molly's neighbor) and Felix smiling for me

EVB poking (truly) fun at my "drinking problem"-- somehow I managed to spill wine on my shirt. This bottle was almost done anyway. Seriously.

Natasha and her super hubby, Nikola. She had just gotten back into town from Boston and is exhausted from Derm interviews (might win the award for most miles traveled!). But she took the time to come hang out with us, which was entertaining as always. Wish her luck as she goes back on the road and pushes through the last couple of interviews.

Britt and Natasha making s'mores by Molly's fire. Did I mention I love fireplaces??! It was so cozy.

Today, EVB and I were over at the Kits' for like 7 hours watching the NFL playoff games (and playing Mexican Trains, of course!). What awesome games (the football in particular)! Erin was very into cheering for the Bears, who crushed the Saints without much of a problem. We weren't paying too much attention to the second Colts-Patriots game until it started getting exciting with the Colts coming back from being down 3-21 to tie the score. But what an exciting finish to that one as well, with a Colts TD with 1 minute remaining and an interception to end it. I was just saying that I wanted a Superbowl filled with animals playing eachother, so I'm happy (although EVB might kill me if I root for the Colts). Not so happy about the Mexican Trains, though. Erin, a competitor as always, easily won. And JB set some sort of record by having over 400 "points" at the game's conclusion. So I didn't lose, but was far from first. One bad round can really do it for you (ask him for details).

As far as weather-- we got more snow today. I woke up to go to church at 9 and realized I would not be able to get out of my unplowed parking lot without a lot of trouble. I didn't want to risk it. I ended up catching a ride with John and Wendi to the second service, but the roads were not good. I think we got about 4 inches, which is not a ton, but the boots were definitely out. It's so nice to not have to really need a car for that much of anything here-- i.e. I can walk over to their place just fine and also to both the downtown Clinic as well as Saint Mary's Hospital. Snow doesn't stop anything here! :)

I'ts okay to just chill, and.... a slight Mexican Train obsession (not mine)

This may sound like a really dumb title for a post. I mean, of course it's okay to just relax and hang out. But it's not always that easy! My parents have told me that I am quite "high strung." Perhaps. I know that, in college and when I started med school, I was really, really driven. I found it hard to just hang out and not do anything, for I felt I was going to get behind in something... When I have travelled in the past, I tended to tire people out because I want to see and do everything (sorry to all of you!).

I think that has all changed. This past interview trail travel trip consisted of a lot of traveling, but I was not very concerned with seeing things but rather with seeing people. It really is people that keep me happy. And I've gotten very good at just "hanging out."

I sometimes (okay, often) complain that there isn't much to do in Rochester. It seems like kind of a dead town a lot of the time. When other people (planning to come visit, etc.) ask me what there is to do here (or what I do here), I tend to shrug my shoulders. What do I do "for fun" here? What I do is hang out with awesome people. The more the better.

I had a great last week despite worrying about experiencing the "back to Rochester" blues that sometimes hit me. The Kitsteiners are probably totally sick of me and dreading that they will have to endure another 6 weeks of me when we go to Nigeria/South Africa in March, but I definitely saw a good amount of them this week. Sunday at my place, Wednesday for American Idol (this show is so harsh!!! I can't believe how much they make fun of some of these contestants!), Thursday at Bible Study, and again Friday night, when EVB decided that we had to eat (we got Thai takeout) and play 'Mexican Trains' again. Hold that thought for one minute. Tuesday was Erin's birthday party with Tia. Thursday, I was over at Molly's, hanging out with her and Mama Gross by her fireplace, making s'mores. Really, with a fireplace, food, and good friends, what more does Rochester need? It's been fun seeing people again after being away for so long-- finding out where other classmates are headed, etc... And with the people here, Rochester does really feel like home.

Anyway, onto EVB and Trains. I don't think she'll read this because, being "back in my life" (i.e. back in the same city), I don't think she feels the need to catch up via blog. And she doesn't really like to read stuff. So I can pretty much say whatever. Anyway, she is very unique. She is one of those people who really knows what it's like to "chill," and from whom I've learned a lot! She is totally self-sufficient and doesn't "need" other people to have a great time (she loves hanging out on her couch, channel surfing, watching Sex and the City, etc...), but is always up for hanging out in groups too. And with her finally being back from Cali, we can do it a lot! It doesn't matter what we do. We usually eat. Sometimes watch TV (it is football tomorrow). And, lately, we have to play Mexican Trains.

For those of you not in the Rochester circle, you are missing out! This really fun game involves making a sequence of dominoes from one end on your own "spot" (or playing on the "free for all" Mexican Train) until all your drawn dominoes are out (Rules here). You can play doubles and try to screw the other players, etc., but winning does require a good amount of planning and strategy as well as some luck (i.e. Wendi drew practically NO doubles last night, leaving her generally with more pieces). You play several rounds, adding up the point (dots) totals each round for those who didn't win the round, in order to come up with a final winner. Anyway, other games, like Time's Up and Waterworks (which Rob and Katrina in Oregon love) are fun too, but this one is really addictive, particularly to Erin (who actually hates Time's Up). She played for the first time only on Sunday but, last night, was kicking all of our butts for most of the night! She learned really quickly and played up to speed right away (unlike me, who always took really long with setting up my moves until I got better!). And she wants to play again tomorrow! Phew! Don't know if we can keep up with this :) Anyway, here are some pictures.

Erin concentrating hard on her "train" sequence. I think Wendi will be mad I posted this picture, but try to ignore her in the corner.JB with his pieces in cute pairs

It's soooooo nice not having more hard call rotations. The worst (well, of med school) is behind me! And it truly is a luxury to have weekends free (you people with normal jobs have it NICE!). Today was really a really relaxing Saturday. I watched Born into Brothels, a documentary on teaching photography to kids growing up in Calcultta's Red Light District, after I woke up this morning. I made it to the public library to stock up on more reading materials, to the gym, to the grocery store, and also to the Rochester Art Center, which I've been meaning to visit for a while and am glad I finally did! It had a very cool exhibition called Scalpel to Sketch: The Science and Beauty of Medical Illustration at the Mayo Clinic, which had many Netter-like anatomical sketches and drawings (some i.e. from Max Brodel, a special artist that the Mayo brothers repeatedly tried to recruit from Johns Hopkins!), as well as a special part on the anatomy of the Carlsen (conjoined) twins who were separated here May of last year. I recommend it (free with your student ID!) for people here. Even to Erin (who also is not a big fan of museums or exhibits :)).

Anyway, tonight, I'm hanging out with.... (wait for it)... Erin (as well as Molly)! :) Molly's friend Felix (who I stayed with in Madison) is in town, so we're headed over to her place for dinner. I think Natasha was supposed to come back today, so maybe she will come too. Another night of chilling is in store for me :)

Foleys, Phlebotomy, and Freezing

This week, rather than starting a new rotation, I am making up "required" procedures that I was supposed to have done while on my ER rotation earlier this year. I was in Portland, however, and I found it difficult to juggle the patient care/discussions with attendings (who were evaluating me) with doing the things like IVs, blood draws, and catheters on patients (not even necessarily mine) that needed them. So I thought I'd hold off on scouting out the procedures and just concentrate on patient care while working in the ED.

Which is why I'm now doing remediation :) I spent a few hours on Monday through Vascular Access Education first practicing blood draws on a mannekin's arm and then working with one of the phlebotomists in the subway level of Hilton to get some more experience on real patients. It is amazing to me that we can get to this fourth year of medical school without really feeling "comfortable" with these procedures. I mean, we (as doctors) would rarely have to do any of this (although the Mayo way of specialization may be more extreme than at most other institutions), but we really should feel competent at it! And, if a nurse is not able to start the IV, who do they turn to? Yup, the person (resident, physician, whatever) with far less experience. Maybe my classmates feel really comfortable doing all this, but I haven't done enough to really feel confident. I sort of wish sometimes that I went to one of those throw-you-into-the-fire medical schools where you are forced to learn by doing; however, we here are quite sheltered.

We learn IV-starting 2nd year and then go a year or so without doing one. We have some opportunity on our surgery rotation 3rd year to do IVs, phlebotomies, foleys, etc., but how much you do depends on the people you work with and your overall proactivity. I tend to be quite passive. Which is why I'm in remediation.

On Tuesday, I passed several hours with the Urology technicians (or the "Cath team") at Saint Mary's Hospital. I practiced doing Foleys on pelvic models and then went to work on "real" patients. It's actually quite fun! I feel WAY more comfortable. I don't really like urine enough to want to do this all the time, but I liked getting the experience. And (contrary to what one might think, because the female bladder is much closer to the urethral meatus than it is in men), males are WAY easier. No hunting around for the "winking" urethral meatus after iodine application. There is one hole. Perhaps that was too much information. In any case, it was a very valuable experience and all of the techs were great to work with.

Today, I passed the day in the Saint Mary's ED doing IVs and blood draws. I will likely have to go in tomorrow as well-- it was a bit slow. I don't really understand why they don't hook us up with the IV team (yes, there is a team for that at Mayo as well!), which I am looking into. Mayo has this crazy amount of division of labor that can, at times, be frustrating. I read about four magazines sitting around the ER waiting for people to "need" IVs. It is incredibly low-yield. But everyone was really nice and patient with me.

Lastly, about the weather... it's been COLD. I came back on Sunday to see it snow about 6 inches that afternoon and evening. And then, on Tuesday, it was -12 when I woke up. WITHOUT windchill. I think it may have gotten up to 10 that day, but I'm not sure. I was swearing that I was going to move to California. Check Wendi's blog from the weather report captured straight from the internet. It's scary that, when it gets into the teens or a high of 20, that is considered "warm." But today definitely felt warm. Eesh. Well, I'm about to put on my "getup" to venture back into the outdoors, so wish me luck :)

Eating, Reading, Food and Friends...

I'm a big fan of eating, as most of you know. And friends. Luckily, they often go hand-in-hand. I also love reading. And lately, I've read some interesting things about food I thought I'd share. Isn't it great how interconnected everything is? :)

First, about the friends. Sunday night, JB, Wendi, Hans, Rachel, and EVB came over for some dinner at my place. I owe the Kits many, many dinners and so it was definitely my turn to cook. I made chicken enchiladas (a recipe Laura gave me a couple of years ago-- thanks, babe!), and they were a hit, even with our resident Emeril, Mr. Kitsteiner. Rachel and Wendi asked for the recipe (which is really easy!), so here it is:

Chicken Enchiladas (serves 5-6 depending on what kind of appetites [ahem, Hans] you have)

10 flour tortillas
1 can (10 3/4 oz) cream of chicken soup
8 oz sour cream
1 c Picante sauce/salsa
2 c cooked chicken
2 tsp chili powder
1 c. shredded Monterey Jack (or Mexican) cheese
1 medium tomato, green onion if desired

1. Preheat oven to 350.
2. Mix soup/sour cream/ picante sauce/ chili powder/cheese; reserve about 1/2 cup.
3. Add chicken to mix of stuff.
4. Roll about 1/4 cup o' stuff in tortillas, place, seam down, in baking dish. Sprinkle remaining (reserved) sauce and additional cheese (if desired) on top.
5. Bake for 40 minutes at 350.
6. Top with tomato/green onions.

More on friends... It was Erin's birthday on Tuesday and so she, Tia, and I had dinner at the Macaroni Grill. Erin, more than some of my friends, is always up for a good meal, and Macaroni Grill is a great place to go for people's birthdays (esp. on Tuesdays, where there is no crowd), as they give the birthday person a free chocolate cake dessert that is big enough to share (and someone sings 'Happy Birthday' in Italian!)! Mmm. It was a fun time to catch up and hang out. Here is Erin with her cake.

Old roomies- me and Tia

As far as eating and reading: I recently finished Eric Schlosser's Fast Food Nation. It was a great book (a nice change to my normal choice of fiction), which tells the story of our fast-food industry from its inception in the early part of the 20th century onwards (greatly popularized in the 1950's with McDonalds). There are some really horrifying parts-- i.e. the description of the slaughterhouses and the injuries that occur. I learned things such as how the cows are actually killed (stunned with a gun before their carotid arteries are slit!), and what sort of things go on in the plants. I learned about the flavorings added to food to enhance taste (chemists called "flavorists" develop such compounds that can, remarkably, exactly mimic the aroma of things like apples or grilled hamburgers! Cool!), as it's really our sense of smell, more than taste, that is responsible of the "flavor" of foods. Another shocking fact that stuck in my mind: 1/5 of the nation's toddlers drink soda. Can you believe this??! And in 1991, only four states had obesity rates of 15% or higher; today at least 37 states do. Wow. I think this has (or is) coming out as a documentary, which may be worth seeing. I'd highly recommend the book, though.

Another interesting story about food (from a Dec. issue of the American Family Physician magazine):
"Let them eat carrots? According to the Chicago Tribune, some California schools have limited unhealthy classroom treats, such as cupcakes on birthdays and holidays, to only three times a year out of concern about childhood obesity. Some school districts have banned celebratory snacks altogether. Texas, however, passed the "Safe Cupcake" amendment, which guarantees parents the right to bring in non-nutritious treats on special occasions such as Valentine's Day, Halloween, or their child's birthday. Other schools have opted for nonfood items such as special clothing or seat covers to help celebrate birthdays. Experts warn, however, that moderation--not elimination-- is key, because the more these sugary sweets are restricted, the more desirable they become to children." - Chicago Tribune, Oct. 1, 2006.
"Safe cupcakes," eh? What will those legislators come up with next?!

A story in the news regarding restaurants' avoidance of the use of trans-fats: Doughnut shops next front in trans-fat war. Funny, as Seattle's Pike Place market had some of the largest doughnuts/fritter thingies that I'd ever seen. Definitely with trans fats. But as far as being anti-donut: Rochester couldn't support a Krispy Kreme, which opened and closed within the span of about (I think) a year or two (?).

As far as food.... MODERATION is good. I won't be giving up chocolate anytime soon, but think I could do without hamburgers or fries after reading Fast Food Nation... Let's just say, eating is good, but exercise is good, too.

Life and Death

“Life is not measured by the number of breaths we take, but by the moments that take our breath away.” - Unknown

There are many birthdays to celebrate in January. My Mom's was on Sunday. Inara (my godmother) and EVB's birthdays are today, Mindy's (and my late grandfather's) is on Thursday, and I believe JB's is maybe the 24th (Wendi?).

However, while we also celebrate birth, we also celebrate a life well-lived. Agnese, my godmother's mother, passed away yesterday in Virginia, 2 months short of her 99th birthday (She and my Dad share the same birthday, 40 years apart). Agnese suffered a considerable stroke just before New Year's Day, and became less responsive over the course of these past couple of weeks. It is sad, especially for Inara, Baiba, and the rest of her family who have spent such quality (and so many!) years with her. And it was difficult for me to see her while I was home, being consulted as a soon-to-be medical "professional" about "what I thought"/decisions about her care and also just because she was not herself. However, it is remarkable and I think we all need to be thankful that she lived so many great years. She was in good health and completely lucid just before the event, even going on international trips with John and Inara and attending my sister's college graduation this May. I think most people would agree that almost 99 good years would count as a wonderful life.

As Abraham Lincoln said, "In the end, it's not the years in your life that count. It's the life in your years." She had both the years and the life in those years.

I'm often pondering the "meaning" of my own life and whether I'm doing all that I should be doing to live it to the fullest. I think we do need to live each day like it is our last-- to love without expectation, to laugh, and to enjoy every day we're around. I think it's really important to remember this as the milestones of "birthdays" come up. Let us continue to celebrate birth and to celebrate life. Let us remember Agnese and wish a happy birthday today to Erin and Inara.

Carpe Diem.

Reflections on Residency

Job 3:26: I have no peace, no quietness; I have no rest, but only turmoil.

I do not know how the heck I am going to get through the next month. I am now done with my (10) interviews and it is time for "contemplation" over where to rank. It is now the 15th of January. Here's the "shortlist" of the timeline for the next months:

• January 15, 2007 (TODAY!!): Rank order list entry begins. Applicants and programs may start entering their rank order lists at 12:00 noon eastern time.
• January 31, 2007: Quota change deadline. Programs must submit final information on quotas and withdrawals by 11:59 PM eastern time.
• February 21, 2007 (a.k.a. FREAK OUT DAY FOR TARA): Rank order list certification deadline. Applicants and programs must certify their rank order lists by 9:00 PM eastern time. Staff will be available to answer your questions during the final deadline hours. CERTIFIED applicant and program rank order lists and any other information pertinent to the Match must be entered in the R3 System by this date and time.
• March 12, 2007: Applicant matched and unmatched information posted to the Web site at 12:00 noon eastern time.
• March 13, 2007: Filled and unfilled results for individual programs posted to the Web site at 11:30 am eastern time. Locations of all unfilled positions are released at 12:00 noon eastern time. Unmatched applicants (I HOPE THIS IS NOT ME) may begin contacting unfilled programs at 12:00 noon eastern time.
• March 15, 2007: MATCH DAY!! Match results for applicants are posted to Web site at 1:00 pm eastern time. At Mayo, we have some sort of Match Day dinner where our classmates (and, of course we, too!) all find out where we're going!
• March 16, 2007: Hospitals send letters of appointment to matched applicants after this date.
• Around the end of June or so: Intern year/orientation starts!!!!

I really have no, no, idea how I'm going to do all this ranking stuff. I feel pretty lost. I really liked almost all of the 10 programs I interviewed at and will probably rank 8-9 (we are to rank all places which going to would be preferable to not matching!). But in what order, I have no idea. I'm not sure about university or community/unopposed, big or small, 3- or 4-year (UC Davis FP/OB), hard-core or warm and fuzzy... I really feel that, by matching at one, I'd be missing out on all the others! Boo. But I'm not sure I could juggle 8 internships at once:) I'm looking for some guidance here!

I have TOO MANY OPTIONS. I actually had two more interviews scheduled-- one in Vancouver, WA (a northern suburb of Portland) and the other in Tacoma, WA, which is halfway between Olympia and Seattle. But I ended up cancelling them for a few reasons-- I was struggling a bit on the road and kind of wanted to go "home" to be around good friends, I needed no more confusion to add to my current perplexed state and feel I have enough really good options, and I heard Tacoma smells.

I mean, the odor wasn't the only reason I cancelled the interview. I heard that Tacoma was not that nice of a city to live in-- it's quite industrial, and I also heard that there are some dangerous parts with gang activity and whatnot. But someone did say that it smells (from paper mills or something). As I was driving south on I-5 from Seattle down to Olympia (and back the other day), I did roll down the window and take a whiff to check it out myself. And (,Lesley!) it did have some sort of odor, although difficult to describe.... As far as the SW Washington program goes, I figured that, if I was going to be around Portland, I might as well as try to go to OHSU, which I already knew I liked. So that was that. And I got to return home (to see it start to snow!) a week before I had previously planned to.

HOW AM I GOING TO DO THIS???? I have had episodes of feeling near-panic. I have about a month. I KNOW that I'm in a good position in that I know I will end up where I'm "supposed to," at a program I really like. That's comforting. I really feel that after this rank day (2/21), I will feel so much more happy and at peace because things are no longer, in any way, in my hands. I know I don't have ultimate control and that God will put me where I really belong to be. Lesley sent me verses to remind me of this fact:
Proverbs 16:9 In his heart a man plans his course, but the Lord determines his steps.
Proverbs 16:33: The lot is cast into the lap, but its every decision is from the Lord.

However, I feel like I have some control now in the rank list and I DON'T WANT IT. Do you think that the Holy Spirit will enter the NRMP website for me and click on the programs for choices 1-9 (paying particular attention to choices 1-3)? :)

I'm trying to view this as a win-win situation (and, as a resident told me, "You really should be thrilled. You have great options. It's not like you're in a lose-lose situation trying to decide between amputation and chemotherapy or something." Eesh. Good point.), but I'm just confused. I also feel very alone in this whole thing. Like I'm going to make this huge life-changing decision but I'm going to do it all on my own. I could end up anywhere. Would it be better to start completely over fresh in a place like Sacramento, where I know no one and would really have to rely on myself for happiness and support (initially)? Or should I try to go somewhere where I have some friends.... like Denver or Portland, realizing that intern year is going to be tough and could be even more so without a built-in support system? I really just want to belong somewhere! It's scary feeling like I don't quite fit in anywhere to settle down... yet.

I wish I had a significant other to be able to "veto" certain locations or cities despite them having good programs (there are other good reasons for being with someone, but this is the role I need right now!). And what makes this hard is that I only applied to programs in towns and cities that I thought it would be great to live in. So this is not helping me now. But among those: is sun (but with the potential for very large blizzards!) really that important? Could I live somewhere with 5 months of rain? A resident I met recently jokingly offerred to make my rank list for me. Anyone else want to step up to this plate to do me this service? :).

What is very unsettling is that I'm not sure what all is going to change in this month's time. Are things going to suddenly become clear one day? I may need to go back to the notes I wrote about these programs (this blog has been good for that!). I may need to focus on enumerating the negatives I found (there are fewer of those than positives). I may need to get back in contact with the residents I met. Some places have second look weekends, which I'm not sure I can attend (I don't want to take any more flights in a long time!). I may need to just poll friends and family :). Other suggestions?

One person asked me if I had heard of "The Grid System" for figuring it out. I was told to make a list of all of the programs and then decide what 5 things or so are really important to me. Then I was told to rate each program with a 1-5 based on those factors, add the numbers up in a blind style, and then arrive at an objective number. Some people included a subjective "how did you feel while there?" factor as one of those 5 criteria, which really does make sense although it seems somewhat contradictory to the "objectivity" aim of the exercise. Someone else said to write the programs' names on slips of paper and draw them, one by one, out of a hat, gauging my reaction to having (hypothetically) "matched" there. Hmm.

I know that this will be on my mind daily for the next month, but perhaps I should limit myself to weekly "contemplation times" (i.e. on Mondays or something) and not let worry cloud the rest of my weeks. I DON'T KNOW!!!!! AARGH!!!!!!!!!

Matt. 6:27, 34: Who of you by worrying can add a single hour to his life?... Therefore do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own.

Ps 29:11: The LORD gives strength to his people; the LORD blesses his people with peace.

I sure hope so. :) I will be praying hard for clarity and peace in the next few weeks, as well as for clarity for many of my friends and classmates who have some big decisions on the horizon. It will all work out, right?

Snippets from the last weekend on the road! (Mt. St. Helens, more strangeness of Seattle, etc...)

I am writing this post as I conclude my one-and-a-half-month-or-so travel journey around much of the country and continent (yay Mexico!). Phew. Many thoughts are going through my head. Lots are about residency. Lots are reflective of what a good last two months I've had, being fortunate to meet up with so many wonderful friends. I've definitely had some travel adventures with flights. And I've gotten to see a lot of new, beautiful parts of the country. I realize that I managed to get through this whole interview journey with staying in only one U.S. hotel (that one being in Chicago before my C.S. exam-- so that one wasn't even for an interview!), thanks to some incredibly gracious hosts (thank you, Erin and TJ, Eric, Cathleen [my christmas buddy!], the Petkuses, Sarah and Phil, Tom and Anne, and the residents [Angela and Adam, Ian and Ali that were also so kind to open up their houses for me]).

This quote is one I recently read in one of those travel magazines on some plane:

"A journey is best measured in friends rather than miles" - Tim Cahill

It really made sense to me. This has been an incredible journey, just because of how many wonderful people I have met and seen. And whereas previous travels of mine have tended to be a bit crazy with sightseeing, on this one, I just focused on spending time with people whose company I enjoyed. But I got to see and do cool things as well. It was the best kind of journey.

As far as last interesting things in the Pacific Northwest:

Friday, I drove from Portland to the Mt. St. Helens visitor center to learn about the volcano and the blast of May 18, 1980 that surprised everyone. It was actually a really beautiful day in the Portland/Washington area and a lovely one to drive up through the evergreen forests towards the mountain. I didn't go all the way to the base-- there were several visitors centers that were closed because of the time of year and I wasn't sure how the roads would be with the recent snow, but I did get some views. It would be awesome to go in the summer, where you can visit the pretty lakes at the mountain's base, go on tons of hikes, visit the observatories, and even explore these Lava tubes, which are caves in the mountain formed by the molten lava flow of the past! I traipsed around in the woods a bit but then decided that, being out of cell-phone range, cold, and alone where bears or some other wild animals could get me, I better not spend too much time out there :) But here's one pic I got from the Sediment Dam viewpoint.

I headed back to Portland to meet up for dinner down on the waterfront at the Old Spaghetti Factory with Tom, Anne, Sean, a friend of Sean's from college (?), and two of her friends from Peace Corps in Moldova. It was an interesting group, and the food was great! The restaurant's "dinner" meals include a drink (I got hot tea!), salad, the pasta dish, as well as spummoni (sp?), a gelato-like treat. Tom and Anne were nice enough to let me sleep on an air mattress in their living room (I'd already said goodbye to Phil and Sarah before this change of plans and so felt a bit embarrassed about going back to their house..... ), and this morning, we all had waffles (yum) before dispersing for the day. Sean, Tom, Anne, and Daisuke (another OHSU FM intern from Japan!) headed out to the Oregon Coast while I headed back up to Seattle.

I drove down to the Pioneer Square (historic district) area and went on an Underground Tour, which came recommended by way of Ed. It was really neat! Seattle used to be much more low-lying (and "crappers" used to erupt everywhere when came high tide!) but, after a fire in the 1880's, the city was rebuilt.... higher. It was interesting how they actually rebuilt the new buildings on higher ground and then, later (I know! It seems backwards), "raised" the street levels by filling them in with sawdust, dirt from the hills (so the hills of Seattle are really less steep than they used to be). For a while, pedestrians walked around sidewalks which were way below street (building) level, like a moat! Anyway, we had a very amusing tour guide the entire time. Here's the original water system.

I then found my way to Ye Olde Curiosity Shoppe by Pier 54 on the Seattle waterfront. It was a really neat place. They sold all kinds of souvenirs, but what was the most interesting was the curio that they show in museum-like glass cases. I think the place has been there since 1899 or something (so it really IS olde!). They have such varied things displayed as: whale eardrums, four-legged (stuffed) chickens and two-headed goats and calves, shrunken heads, mummies, and more. Here are some photos I took: This is Sylvia :) This RIPLEY was crazy! You look through a magnifying glass and there it is: "RIPLEY" in capital letters written on a translucent hair! The pinhead prayer was also impressive.

This was perhaps my favorite thing to see: A "Freak Pig" with (as you can see from the sign) about a couple more of every body part than it should have had...

Some more curiosities of Seattle:

• Just before returning my rental car, I went to a gas station to fill up the tank so I wouldn't get charged the $6 a gallon or whatever it is if you let them do it. It did not take credit cards. Not outside, not inside. Only debit or cash. Interesting. Quite annoying, actually. I'm not sure I've seen that before (and Wendi, no comments about how this is like those drive-through bank tubes, please). I just drove down the block to a different station but was scratching my head on the reasoning.
• Seattle is a really hip city. I like the downtown feel a lot. It's very "earthy" and there are a lot of neat coffeeshops and bookstores to visit (Elliot Bay by Pioneer Square was awesome, and I also walked through one devoted exclusively to mysteries). I was in a bit of a funk last weekend, which I know because I wasn't that gung-ho about doing much of anything, but I was glad that I came back today to see a couple of more things. I hear great things also about the Experience Music Project (an exhibition part of the Seattle Center, where the Space Needle is), but didn't make it there today because of the limited winter hours (next time!).
• Traffic here is weird. It is supposed to be bad, but from what I hear, the badness comes from just being totally unpredictable. Lesley had an interview at U.W. on Monday and left ridiculously early, but there was virtually no traffic. And it was smooth sailing for me all day today, downtown, and in and out. Very doable. I think I may have also lost some of my fear of navigating cities larger than Rochester (does Roch even count as a city? :)), which makes travel much easier. I was impressed by Seattle sans trafic :)
• I like the idea of red-eye flights. I'm in the airport now, really just killing time before my flight at 12:50 a.m. Yes, that really is 12:50!!! But I had this whole day to spend doing anything I wanted to. And I'll have a full day tomorrow back in MN to enjoy with unwinding and dinner with friends (my flight gets in around 6 a.m., CST). I feel like it really minimizes the wasted time of travel. Perhaps I'll feel differently about the idea after actually taking the flight (although I generally sleep quite well on planes), but I think I could get used to it. There's something also peaceful about being in the airport late at night. So perhaps this is a reason to move to the west coast (the other thing is that flying to the west coast buys you time because of the time change! :)). Hmm...something to think about while trying to decide on residencies....

For now, though, I'm just happy to be finally going "home"....

It's OVER!!!! OHSU (Interview #10) and Oregon (visit #2)

I arrived in Portland on Tuesday night, after my Olympia interview. It was really weird coming back into town, after having spent a month (Sept-Oct. of 2006) "living" here doing my ER rotation at OHSU. I thought I'd get lost getting of the highway or something, but found Sarah and Phil's house (Sarah's an OHSU med student who, back in September, trusted me with house and dog sitting without having met me!) with no problem.

Tuesday, I hung out with Rob and Katrina (Katrina graduated a year ahead of me at Mayo, got married the day after graduation, and moved out here with her brand-new and awesome hubby to start FM residency last year). She's been on ICU with a grueling q3 call schedule, but had the day off! We went out to eat at Jopa, a "Northwest Grill" that Katrina brought me to for my first meal in OR back in Sept., after picking me up at the airport. The food is great, as was the dessert (we shared a Cup o' Lava, not to make you jealous or anything, Wendi :)). Wednesday was a day of relaxation, with some laundry-doing, running, reading, and research paper-editing. Still trying to finish that up. In the evening, I went with Rob (Katrina was on call) to a bible study at the house of a OHSU couple (Heidi in FM, Travis in EM) that I'd met during my stay here in the fall.
I had my OHSU interview today. It was interesting to see it from a "formal interview day" perspective, because I've learned a great deal about the program and institution from both rotating and spending a month here and also from talking a bunch to Katrina and Tom (another Mayo grad here for FM), as well as to other residents I've met in the process. I wasn't at all nervous, as I'd been through "this all" before (and 9 times before, at that!). I had the option of interviewing back here in Oct., but I wasn't ready then and do feel that it was nice to come back after having seen a bunch of other places to see how OHSU compares. It was a great finish to the season. I am SO GLAD to be done!

Here's the LAST bullet list (well, with regard to programs' strengths) that you will see from me:)

• This is an amazingly strong FM program. OHSU has an excellent reputation for not only medicine in general, but primary care in particular. While an "academic center" and thus officially "opposed," family medicine is really well established and well respected here and there are no "turf wars."
• The residents (12 per year) are extraordinary. Many people have said that they tend to "outshine" the residents in other fields while rotating on their services and are "freakishly smart"! Many of them have done a ton of international work as well as varied other interesting things before coming here. Interestingly, as an R2, you actually run the inpatient medicine service, supervising medicine interns and working under an internal medicine attending!
• The hospital and facilities are beautiful. All are up on Marquam Hill and the complex is actually quite sprawling! I feel very little walking around everything and everyone. But there are incredible views of Mt. Hood (see the sunset pic below that I took; Lesley may make fun of me b/c I took my camera on another interview, but when you go places as beautiful as these, I like to have one around just in case...) and Mt. St. Helens, which were out today, from the call room, roof of the FM building, and the skybridge connecting the OHSU hospital and the VA hospital. Doernbecher Children's Hospital is also really nice and where residents do their peds inpatient months.


• Good OB training, esp. for an academic institution. There is a total of about 5 months of OB, some on a Family Medicine Inpatient D (D for delivery!) service, months on L and D, and more high-risk OB at another hospital in town (Emanuel). There are opportunities to also be primary on C-sections, and several graduates have gone onto have C-section privileges without having to do a fellowship.
• Rotating on a Family-Medicine inpatient service, which is longitudinal and gets you inpatient experience in both adults, kids, and the occasional antepartum patients/deliveries that happen overnight, so these experiences are not really compartmentalized but rather sprinkled throughout your time.
• As it's an academic center, teaching is excellent. There is a real emphasis on evidence-based medicine and I've heard that all of the attendings are great about stressing education in every field. There are also lots of other fun residents to meet, without any sense of opposition or competition, which I think is a real plus!
• Interesting away/rural rotations in surgery (R1; Ontario, OR, a small town on the eastern border) and in rural FM (R2 for 2 months) which are great learning experiences
• Elective time 2nd or 3rd year to do international work, if desired (about 1/3 of residents do go abroad). There is a longstanding relationship with a university in Japan, where, if you go, you are housed for free! Japan is one of my top 3 places in the world I'd like to visit! You can also set up something anywhere else of your choosing.
• Brand new South Waterfront clinic area at the bottom of the hill which you can access from a lovely, brand-new tram (a pill-shaped gondola) that runs up and down all day. We didn't get to ride it since it's currently only open to employees, but I hear it's really neat!
• Gabriel Park and Richmond clinics are the other two outpatient sites-- you allocate "points" to try to express your preference of where you'd want to be. Gabriel Park is very heavy in procedural opportunities and has a more geriatric population/good amt. of prenatal care. Richmond has more underserved patients and lots of prenatal care for Clackamas Co. and there is ample opportunity to use Spanish (this is where Katrina is and where I think I'd like to be if I were to match here)!
• Unique tracks here such as Preventative Medicine (Katrina's doing this) as well as Integrative Medicine, which is an interest of many faculty.
• Electronic medical record system in place for the clinics so that you can enter your notes while speaking with the patients! The hospital is getting there, but labs and xrays, etc. are already all on the computer.
• Unique "Orientation" block in October or so of intern year, where people are needing a bit break and time to "reconnect" with classmates. There's also a resident retreat where residents go to really nice places nearby to bond!
• Planned state-of-the-art Simulation Lab
• There is night float!
• You get a meal stipend

Portland, as I figured out several months ago, is an awesome city. It supposedly has the most restaurants per capita or something, is great for biking (I was in great shape after my rotation here!), is so green and progressive, and has lots of opportunities to pursue outside interests. I t has one of the most amazing bookstores I've ever visited, Powell's, right downtown. Plus it is really close to all kinds of beautiful scenery and outdoorsy things. Below are some other pics of Oregon from the past. The first is one of Mt. Hood by Trillium Lake (doesn't it look like a postcard?!) that Rachel sent me after her and Hans's weekend in October (Rachel, I hope it was okay to use it! It was drizzly and cold the weekend I went out there and I got no good pics!). Oregon has GLORIOUS weather in the summer and fall.

This one, which my Mom loves for some reason, is one I took of the Oregon coast when I drove out there one day. Many people are surprised that Portland isn't actually on the coast (it's about an hour and a half inland), but the coast is really beautiful.

This evening, I went to a dinner at Heidi's house for applicants (and many current residents were also there). I feel very comfortable around the people here and in Oregon. It has been great connecting again with Katrina and Rob, Tom and Anne, as well as a number of other really special residents-- it would be great to live somewhere where I felt so welcomed and with so many familiar faces. It's so sad to have to leave (again), although I am looking forward to going home and having a "normal" life for the next couple of months:) I may visit Mt. St. Helens tomorrow if I can swing it before I have to fly out of Seattle Saturday night.

Interview #9: Providence St. Peter (Olympia, WA) and onward to Oregon

Monday was a travel day from Bellevue down to Olympia, WA, which was about an hour's drive south. The resident I was staying with, Ian, and his wife Ali had generously left me a map and some "ideas" of things to do during the afternoon I was there before I headed to the resident dinner that night at the house of the program director (they served Thai food- yum!).

I had my ninth interview today. It was a good time! Overall, I have started to tire of being on the road, but I still really love meeting people during the days and learning about these programs. For some reason (which may seem odd to some), I also really enjoy the hospital tours! And this one had a great one! Providence St. Peter was a very, very strong FM program. Highlights:

• Unopposed, community-based hospital where the residents get to do everything. They are taught by competent and considerate faculty in all the departments and get to take part in all the deliveries or other procedures that need to happen.... There are lots of didactics to attend, including noon conferences, M & M, and morning reports.
• Catholic, mission hospital which aims to serve the underserved, with approx. 50% of the patients being Medicaid.
• Training for broad-scope family medicine, traditionally training physicians for rural practice in SW Washington or elsewhere.
• Really, really nice, solid, and friendly people. There are very collegial relationships among residents (6 per year), faculty, and staff. Everyone is family here and immediately made me feel welcome. I hear even the surgeons are nice here! I bonded with people who also shared strong interests in international health and in outside activities including music performance!
• Strong in OB and maternity care, with residents able to get C-section privileges without having to do additional training/fellowships (if you're aggressive!) and an interesting adolescent OB clinic
• Night float system, including in the first year, which is, in the words of one resident, a "beautiful, beautiful thing."
• Resident-driven, dynamic curriculum and a very receptive program director willing to make changes that the residents feel would be beneficial for the program
• Longitudinal medicine/ICU service and then a combined Peds/OB service that ends up giving residents lots of deliveries overnight.
• Good procedural training, including IUDs and vasectomies despite the religious affiliation (residents go across the street to urology for this experience) and hands-on workshops.
• Very good simulation center with opportunities to practice on dummies for high-risk OB as well as resuscitation
• Clinic which is right across the street from the hospital-- NO COMMUTING! I love this. And good precepting ratios.
• Fun Peds ER rotation at Tacoma Children's Hospital during the R2 year, which residents say is awesome for its teaching
• Good practice management training to prepare residents for clinical practice after residency
• 1 month per year of rural/away rotations, which, 2nd and/or 3rd year can include international ones. Residents have recently gone to: El Salvador, Ukraine, Madagascar, and Nepal! And a LOT of these residents have gone to/ are going to Alaska to practice/rotate. Alaska is among my top 5 places in the world to spend some quality time. What an opportunity.
• GORGEOUS hospital facilities. This hospital is beautiful. And it has amazing, big windows in the rooms, which are arranged circumferentially on the floors. I stopped dead in my tracks while we were walking on the 11th floor and I glimpsed Mt. Rainier (the first time so far on this trip!) through a patient's room! We went to an adjacent room and I (nerdily) took this picture, which I hope comes out. It was amazing (again, I'm not sure the pic does it justice...)!
• The call room is also really great. There is a "call lounge" with a stocked fridge, computers, etc. I enjoyed reading the "records" whiteboard, which really had some interesting ones!
• Great benefits, including free fitness membership (there is a really nice gym right in the hospital), insurance, free parking, meal stipend, educational stipend, travel reimbursements/grants, free PDA, relocation reimbursement, and more...
• EMR in the clinic and (soon to be) in the hospital. Now, labs, images, tele, etc. are on the computer and even accessible from home.
• Affiliation with the (reputable) Univ. of Washington, with access to resources such as Up to Date

Olympia is a very cute town. It actually reminds me a lot of Rochester. It is similar in size, very comfortable feeling, and easily navigable. Cost of living is very good, with many residents easily buying houses in town. But it's also really pretty! It is right at the southern tip of Puget Sound with easy access to Seattle as well as the Olympic peninsula (north and west) and beaches, Mt. Rainier and Mt. St. Helens. It is a very "granola" city, with lots of tree huggers that I'd fit well with. It is home to not only the State Capitol but also to Evergreen State College, a very liberal four-year school which does tend to influence the culture and "feel" of the town. There is a great farmers' market, lots of organic produce, independent bookstores and coffeeshops, good Asian (particularly southeast Asian) food, an indie theater, quirky stores, lots of "natural" medicine facilities that include massage, cheap spas and pedicure places (this really caught my attention!), and lots of other downtown hangouts. There are lots of nice trails for biking and running (I drove up to Boston Harbor and Priest Point Park) too. And did I mention water? And mountains? :) I really can't imagine that there are more beautiful places in the whole United States than the Pacific Northwest in the summertime.

It's whether I can take the rain..... (and, believe me, it rained again today). The people tell me, "You have to embrace the rain!" and "There's a reason we're called the Evergreen state." Hmm.

I made it safely to Portland this evening (less than 2 hrs from Olympia). I'm in the home stretch!

Scoping Out Seattle

It's been really fun getting to know the Seattle area a bit more in the last few days. The family I'm staying with, the Petkuses, are doing a fabulous job of selling the region to me. I've spent a bunch of time with their family over the past few days-- going out to dinner, to see the movie Apocalypto (fitting having returned from Mexico recently), having breakfast, and talking over other long hangout sessions--and they've all but convinced me that this truly is one of the most desirable and unique places in the U.S. to live. They tell me, "if you like outdoors activities [yes], music [yes!], great food [um, yes], coffee, and reading [my favorite!!!], this is an awesome place to be." There are a ton of coffee shops, bookstores, arts opportunities, smart and young people, and a wealth of beautiful scenery (lakes, San Juan Islands, British Columbia, Mt. Baker [which, I hear gets the most snow of anywhere in the world!], the Olympic mts., the Cascade mts., Mt. Rainier) within easy exploring distance. They also reassure me that the sunny days on which you have great views of all the surrounding mountains are totally worth the months of rain. And that being wet is better than being cold. A good point. Here's Alex (the oldest Petkus son), his girlfriend Emily, and Brenda hanging out at their house in Bellevue (the "Eastside").

Lesley and David were in town for the weekend for residency interviews at the University of Washington and so we got to hang out quite a bit. While David was at his ortho interview on Saturday, Les and I explored some of Seattle. We first went to the International district, with lots of Asian food stores, shops, etc. It was kind of funny-- Les and I are both so cheap (or money-conscious, let us say-- I hope she's not offended that I said that!) that we were excited to park in a lot by the Japanese grocery store, Uwa Jimaya, because we saw that it would be free with validation from having bought something. So we bought, between us, approximately $7 worth of goods to make the parking free. But we realized that street parking would have been about $1.50 per hour anyway. But at least we got something to show for our money by doing it our way :)
Here's a pic of us by some lions and then the Asian grocery store (I love the dragons!).
We drove by the Seattle Center, which has the Space Needle as well as other attractions including an interactive music exhibition and science museum. David had remarked (and we agreed) that the Space Needle actually looks really small compared to how it appears in most photographs (likely due to its position in the extreme foreground of most photos). And Alex was telling me that it actually can bend all the way to where the top is only 15 ft. from the ground! Hard to believe.

We missed a bridge but then took a trip out to Discovery Park, a large green area on the peninsula between Puget Sound and the neighboring bay. There was a neat lighthouse and great (the pics don't do it justice) views of the mountains. I can only imagine how nice it must be on a bright, sunny day (weather has been a bit cold and rainy).

Seattle has all kinds of neat little neighborhoods with their own "feels," including Capitol Hill, Fremont, Belltown, Queen Anne, etc. It would take ages to explore them all, but we did the drive-by of some :)!

David was done with his interview around 3 and then, after picking him up, we left the U. Washington ("U- dub" as it's called here) area to head toward the Waterfront, where we (luckily) found parking (there was a Seahawks-Cowboys playoff game about to start, which had a really amazing finish, by the way!). We wandered to Pike's Place Market, which I was told was a MUST SEE for Seattle. It was really neat! I always like visiting local markets anywhere I go, and this one was a great one. They have lots of fresh fish stalls, HUGE donuts (I think they've got to be about 9 " in diameter!), jewelry stands, fruit stands, as well as lots of other cool stuff.
Across the street was the ORIGINAL (first) Starbucks store, which is actually not that noticeable or flashy-- Lesley said they've tried to maintain some of its "original" character. Here's a coffee thermos thingie and Lesley ordering some drinks.
We stopped for dinner at this place within the market, the Athenian Inn, where one scene from Sleepless in Seattle was filmed (now having visited the city, it would be neat to watch that movie again). Lesley and I both tried this seafood soup called Sinigang, which was good! We figured that, while in the Pacific NW close to so much water, we ought to eat the seafood.

Some interesting Seattle numbers I got from a magazine:

• 1: Ranking of Seattle among U.S. cities with the largest percentage of library card holders
• 1: Ranking of Seattle among fittest U.S. cities, according to Men's Fitness magazine, Feb. 2005
• 2200: Number of restaurants in greater Seattle
• 1: Ranking of Seattle among U.S. cities where citizens buy the most sunglasses per capita (ask me for the explanation for this one)
• 3: Number of Nobel Prizes in medicine won by Seattle researchers in the past five years
• 25: Number of public libraries in Seattle
• 1: Ranking of Seattle-Tacoma among U.S. metropolitan areas with the most arts-related businesses and organizations per capita, according to Americans for the Arts

Need I say more?! WOW!

Today, the Joneses picked me up and we drove east for a few miles to North Bend, where David's Aunt Viv and her husband Pete live. We went to the church service where Pete is the pastor and then chilled out at their house for a bit, which was nice. They have a fireplace (I LOVE fireplaces :)), and we just drank tea/coffee and "visited." I really enjoy meeting friends' families-- I feel like it lets me get to know them better. And they were so friendly to me even though I was not in any way related to them and was some random person Les and David brought along:)! Anyway, they live right up against these HUGE mountains (Snoqualmie something or other), which, today, were partially obscured with clouds and rainy skies but which, I'm sure, are breathtaking on clear days. We could see snow at the very tops. I had to find a picture because the area was STILL really beautiful despite it being kind of nasty outside today-- this is from a site: rlerallut.free.fr/backgrounds.php. Doesn't it look unreal? Washington is really, really beautiful.

Lesley and David dropped me off not too long ago. Les has her interview at U.W. tomorrow and has to get an early start because traffic in Seattle is fairly horrendous (the one real drawback I've heard so far). I'm pretty tired (I think it's the weather!) and am going to make for myself a low-key evening of reading and probably crashing early. Tomorrow I head down to Olympia, WA (the state capital but a much smaller city) for my interview at St. Peter's on Tuesday.