
Tuesday, July 10, 2007
Goodbye, sun?

Sunday, July 8, 2007
Weekend news
- Saw Sicko on Friday at the Tower Theater, a historic theater here that has been operating since the 1930s. The movie actually opened to a small audience of doctors and nurses here in Sacramento on June 12th, before it was shown anywhere else in the country, as Michael Moore was here in town testifying at a hearing held by Senator Sheila Kuehl regarding a single-payer health system. The movie, which laments the pitfalls of our current healthcare system, was excellent--it was definitely one of the best movies I have seen in a long time. It was thought-provoking, funny, and heartbreaking all at the same time--I both cried and laughed out loud in the theater, which I rarely do. GO SEE IT as soon as you can.
- Discovered the Natural Foods Co-op near my house. I think that their vanilla-almond granola and whole dried pineapple rings (bulk foods section) are the best I've ever tasted!
- Did various important errands like going to the post office and going to the bank to deposit a few checks, including my first paycheck. This was very exciting, despite my not having yet figured out all the "investing stuff" with the percent that is automatically withheld.
- Went to the local AAA office to transfer my membership to California and came away from with about 20 maps of various parts of the state (free :)) for my (future) travels. I love free stuff!
- Visited the dollar store (I had to get a backup pair of sunglasses), where I came away with a few other steals. Cheap stuff is almost as good as free stuff!
- Got to chat and catch up with a bunch of people on the phone including Cathleen, Wendi, Tia, Natasha, Matt, Justin, and Kyla. Free weekend minutes are wonderful (and don't forget free!) :)
- Took my rental contract to a local coffeeshop (Temple Coffee & Tea) to get a free $10 gift certificate they advertised in a "Midtown Grid" welcome handout and used it to get some Guatemalan roasted coffee. Okay, I think that's all the free-ness I will talk about for the rest of this post.
- Thoroughly cleaned my apartment (including kitchen, bathroom, and doing laundry). It's quite impressive how much mess one person can make and I would have been embarrasssed to have anyone over in the state my place was in; however, the situation has now been remedied. I'm going to do my best to keep it this way.
- Saturday evening, went to Sarah's (just graduated FP/OB) summer graduation/celebration party where we had wonderful cheese, fruit and veggies, kabobs, wine, yummy lemon cake, and more (she and her husband Matt are trying to buy/eat all "local" stuff-- i.e. things grown/made within 100 miles, which is commendable and definitely very doable here). Although some of the families, including two lesbian couples and their respective children (which I think is so, so neat-- something that would be very rare to come across in MN), left fairly early, Sarah, Matt, Kate (they all knew eachother from MN) and I hung out for a while afterwards.
- Found out from Matt that there is an Ultimate Frisbee league in town that plays at Curtis Park on Saturday mornings, which I may have to check out.
- Was loaned (by Sarah and Matt) A Thousand Splendid Suns, the new book by Khaled Hosseini (author of Kite Runner). Earlier in the day, I had tried to get it through the library, but found out that it's only on lease right now. I just read a few pages today, but think it will be a great one.
- Watched Venus and Federer win Wimbledon. I'm become a real slacker in tennis-watching (and playing... my Mom suggested I scope out the local USTA leagues), but always enjoy the finals of the Grand Slams. I was very grouchy this morning because I got up (breakfast at Wimbledon starts at 6 a.m. on the west coast!) to watch the men's final and HAD NO CABLE reception. I went for a run, hoping it would be functioning when I returned. No luck. I called Comcast and they thought they'd be able to sent someone Wednesday (I've been having some poor morning access) to check it out and didn't have specific area outages or anything, but that wasn't going to help me today. Grr. I finally got reception at the end of the third set and was ecstatic because I was able to watch till the end--what a great match! I often root for the underdogs, but I really like Federer... and continue to be amazed what a smart, collected, and mentally-tough player he is. Nadal can win on clay as much as he wants, but I think Federer deserved to take the Wimbledon crown.
- Finally repainted my toenails. Before going to Africa, Wendi and I got pedicures because of all the sandal-wearing we anticipated doing. That was in March. I hadn't done a thing since then. It took a patient telling me last week, "You know your toes are only half-painted" to really get my butt in gear. So I took off the gold (the half that was left ;)) and put some magenta polish on today. I hope that wasn't too gross for the blog.
- Went back to Arcade for Sunday morning service. I have to get used to the services being about an hour and a half (Matt, who is a pastor at a Methodist church here in Sac was saying that he gets "congratulations" for keeping services under 60 min!), but so much of it is filled with music that it is worth it! I realize that in order to get connected there, I have to be more outgoing and actually say hi/talk to people (rather than just making it there for the service, sitting by myself, and leaving immediately afterwards), but I haven't made the effort yet.
- Think I've figured out the highway entrances/exits. Previously, I did a lot of driving around, trying to figure out where to get on, and then, after taking an exit whose street number looked familiar, would just find my way back to my apartment (or to wherever I was going). Now I actually know where the exits put you off so I can choose the exit that best matches my destination. Sweet :)
- Tonight, went out with some FP classmates (and friends) to Gaylord, the first Indian restaurant in town that I've tried. It was very yummy and a very fun time! Here are some pictures from the night.
Adeel DOES have a family! Here is him with his wife, Fizzah, and their 6-month-old baby Fahtima
Adeel, Fahtima, and Oliver
The group. From left: Adeel, (Oliver-- not visible), Phi, me, Michelle, Anika, Mahsheed, and Brenden
Some of the food we truly shared, family(medicine)-style... including two chicken tikka masalas, tamarind chicken, tandoori salmon, and more...
And this is completely random but, in the spirit of Wendi, I thought I'd share some furniture pics too. It's not as fancy, but here is the futon/sleeper thingie that you could have the chance to slumber on should you come visit.
Adorning the walls of my bedroom are some photo-montages I made from our Africa trip (I am into pictures of pictures :)).

And yes, call me strange, but I do keep my bike in my living room.
Saturday, July 7, 2007
My Golden State (geography lesson)
I've recently been doing some web-surfing regarding things to do in/facts about California and also am very into maps, so I thought I'd share a few. Above is the Cali state flag (the bear is kinda cute, is it not?) :). Before I started looking at residency programs, I'm not sure that I had a great conception of western US geography (Colorado is way closer to MN than I previously thought! It's practically midwest! And, on a side-note, I also just bought some dirt-cheap used guidebooks of these western states [i.e. costing $0.35, $2.20, etc. from Amazon!] so that I can get out and explore). Before traveling out here for interviews last December, I also had not realized that "northern California," which includes San Fran, Sac-town, Napa, and more, is really more central in location. California has a a lot of land between here and Oregon, so I'd encourage you to check out the maps below that point out some cities' locations. For the record, I live in Sacramento (I was talking to Cathleen yesterday and she was like, "I told someone my college roommate just moved to California. When he asked, 'where?' I realized that I had no idea! But now that I know you live in Sacramento, I might come visit you. There is a big track meet there every year." Ah, Cathleen. :) ) Okay, so here is your geography lesson. I hope you can actually see these city names on this map. I realize that they are kind of small in the first one.
This one is better. Here you can see that Sac is about 80 miles NE of San Fran/the Bay Area and about 90 miles (south)west of Lake Tahoe.

But look at all that land north of here! Redding, with Mount Shasta (pictured below, which I could actually see in the distance when I flew into Sac), is a couple hours north of here. Yosemite (which I hear is the most beautiful park in the U.S.) is about 170 miles southeast of Sac.

Here is a topographical map showing all the (yay!) mountainous areas of the state. Where I live is in the (flat) desert valley inland, between the coastal mountains and the Sierra Nevadas, which is why the temperatures have been about 105-107 in the past week and why I (kind of a biking wimp) can handle biking around :)

Okay, enough about California for now. I'll include another map here, which is of the two-week Alaskan Cruise that my parents and godparents leave for today. Alaska is on my list of top-five-places-in-the-world (yes, the WORLD) to visit next, so all I can say (in the words of my sister) is: AhhhhhhhhhhhhhhhhhhhhI'msofreakingjealous. I can't wait to hear about their trip and see some pictures of the beautiful coastal scenery. I wonder when I'lll make it there...

Thursday, July 5, 2007
Patient Care
On Monday, I saw a woman who was in 10/10 pain from an IUD that was "missing" as far as the strings go. She wasn't febrile or infected as far as we could tell, but she wanted that thing out ASAP. It took a little maneuvering to squeeze her into the (next) Monday gyn ambulatory surgery clinic and I was worrying over the past couple of days how she was doing at home (we gave her pain meds but couldn't do much more for her; additionally, she was Spanish-speaking, so I feared she might get lost amidst the system without someone advocating for her). Once we got an appointment time for her, I kept calling and finally got a hold of her tonight, but felt kind of weird calling a patient at 8 p.m., while I was supposed to be "off" relaxing. I wondered how common this is going to be for me. I think I tend to get to involved/attached/wrapped up in people (patients now included) and want to be a dedicated and good physician, but when do I have to draw the line as far as (theoretical) personal life goes?
I've been sort of phone-stalking another patient, a woman trying to get pregnant who finally had an appropriately-rising hcg after some conflicting urine test results (I called her each time to tell her the latest news). I was planning on keeping her in my continuity OB clinic and doing her delivery, but she told me that she had set up an appointment to try to see a NP in the OB clinic (recommended by her sis-in-law) for "continuity" as far as OB return visits go. I felt bad about calling her back to try to "beg" her back into my clinic, but my advisor (who I LOVE, by the way-- she's a former FP/OB grad) said that I ought to do just that. The NPs aren't going to go to the delivery, whereas (if she gets followed by me), I will do everything in my power to be there and do it myself (she would be due around first week of March, when I would be here on Block Time or actually on L&D itself for the month). I also do have at least a 1/2 day of clinic per week that she should theoretically schedule all of her OB checks into. It was a weird feeling to try to "convince" a patient that she would want to see me as her provider-- like I was trying to win her over or something. But, after the conversation, she said that she would be interested in coming to me, so her new OB visit is set up for a couple of weeks from now.
In other patient care news: we have quite a lot of no shows (also known as "DNKAs") in clinic (I kept hearing these residents referring to patients that "dinkad" and I had no idea what "to dinka" was. Turns out it is an acronym for "Did Not Keep Appointment". I'm not sure why they don't just say "no showed," but maybe it's a California thing). The upper-level residents tell me that it's quite nice to have some "dinkas," because it gives you a chance to catch up when you are behind, especially with notes. But I kind of take it personally (although I do recognize that I probably handle rejection worse than anyone else on the planet). I only had 2 out of my four patients scheduled this afternoon actually show. They were here to "establish care," but didn't. The residents tell me that patients tend to "no show" (Oops! I mean "Dnka") less when they know you, as their provider, better and have that continuity (one of the main draws of Family Medicine; it's hard to provide that continuity as a resident, though, when you're being pulled in so many different directions!). I'm actually looking forward to patients' considering me their doctor, whether it happens during residency or has to wait until afterwards (I may then have some added incentive to stay put in some town or other!).
Anyway, so more details.... there are the patients I stalk, and then there are the lab results to keep up with. We have electronic "inboxes" where new results, messages, refill requests, etc., pop up, and we always have to stay ontop of that. If we plan on being away or going out of town for the weekend, we are supposed to get someone to cover our inbox so that things don't just sit there. I suppose it's similar to the "Clam" system people at Mayo were always grumbling about, but I'm not positive.
Another thing I have to get used to (well, not so much used to as BETTER AT) is my clinic notes. I'm kind of anal when it comes to those things and really like to be extremely accurate and thorough. I think that this, too, will get better with time as I remember what all sections I draw things from. You can also create personal "smart phrases" where typing in things like ".me" adds your signature or ".PENL" inserts a pre-typed (from your created "favorites") "normal physical exam." I might sit down one day and make such a long list of phrases that I never again have to type anything more than a few letters! :) At least I'm a fast typer-- writing notes could get really old and take forever if I weren't. And I think I prefer it to dictation. I haven't gotten into trying to start/type the note while in the room with the patients-- since the nurses, when obtaining vitals, "start" the encounter, this is possible. Theoretically, it could save time, b/c you could enter things like HPI and ROS right in there, but I don't know. It seems a bit impersonal to be looking at the computer (which in some cases is in a strange location in the room) and/or typing, but could be a time-saver. We'll see if I change my practice as time goes on.
Well, that was a pretty long and boring post of some of the things I do every day. Tomorrow I'm back in FP clinic in the morning and in REI in the afternoon. If you're not already asleep, good night! :)
Wednesday, July 4, 2007
Folsom and the Fourth
I had a wonderful first Fourth of July in California. I decided that it was not acceptable to sit at home on this day off and so I ventured out to Folsom, CA (eastern suburb of Sac) to see some sights. I thought about calling someone to go with me, but figured people would either be "busy" or have better plans, so I went solo.
First, I went to the Folsom State Prison. This is the penitentiary made famous by Johnny Cash's performances live here in the 50s and 60s, particularly with the song "Folsom Prison Blues." While you couldn't go in the prison itself (it is still active-- with thousands of inmates), just being on the grounds did kind of give me the heebie-jeebies. But the little prison museum was kind of neat to visit, and the old man who volunteered there told us interesting stories about some various escapes that had happened and how it had changed since his time as an employee there. Here is some history for you in an excerpt about the prison from the California Department of Corrections and Rehabilitation site:
The California Legislature authorized the construction of Folsom State Prison in 1858. Twenty years later, in 1878, construction began on one of the nations first maximum-security prisons. On July 26, 1880, Folsom received its first 44 inmates. The inmates were transferred by boat from San Quentin State Prison to Sacramento and then by train from Sacramento to the prison.
Folsom State Prison's location was selected due to an unlimited amount of native granite stone for building the prison. Also, the American River offered ample water and formed a natural boundary. Inmate laborers built the first dam and canal on the American River, which led to the first hydroelectric power generation for the Sacramento area.
Originally designed to hold inmates serving long sentences, habitual criminals, and incorrigibles, Folsom State Prison quickly gained the reputation of being the end of the line. Prior to the completion of the granite wall in the 1920's, the prison witnessed numerous escape attempts; the first one occurring shortly after the first inmates arrived in 1880. Throughout Folsom's violent and bloody history, numerous riots and escape attempts have resulted in both inmate and staff deaths. Here are some photos:

Visiting regulations
Cell (with fake guy:))

I thought these bumper stickers were funny....
I found my way to the Recreation area of Folsom Lake and did some biking on the trails there. I was a bit directionally confused, but think I found Folsom Lake proper (there is also a Natomas Lake and other nearby waterways)-- there were a lot of people sunbathing and swimming on the lakeshore, as well as boating in the waters. I'm glad I went. But it was HOT-- i.e. 107-degree hot (and tomorrow is supposed to be 105!) and I definitely had to thoroughly hydrate myself when I got home. Since I couldn't take a picture of myself biking, here is my bike on the trail with the lake in the background :)

Us by a pretty rose-surrounded fountain (from left: Anika, Adeel, Phi, and me)

The boys with their coffee
It was a very fun day, filled with lots of activity, sun, and good times. These guys made me laugh a ton! :) I think we're going to try to have some more "regular" get-togethers, but people's schedules (except for mine, really) are tough right now. We'll see.
Oh... since the blog is a new thing for me as of last November, I rounded up a couple of pictures for "history's sake." Here is a group shot of some of us at Ronnie and Ebby's house last fourth of July.Christo, David, (Karuna), Les, me, and Brandon
Wendi's first experience with a sparkler. I love the expression on her face! (Don't kill me for posting this!) :). This is at Silver Lake, July 4, 2006.
What a fun Wednesday. I wish I didn't have to go back to work tomorrow! I think Wed. is a perfect day to have off! At least the weekend isn't too far away! Onto the fifth...
Tuesday, July 3, 2007
Likes and dislikes
- I like cold-brewed coffee! I tried what that article recommended and it turned out well--I'm not sure it is "better" than hot-brewed, though (coming from someone with fewer functional taste buds than the average person, mind you).
- I don't like cooking for myself. I've gotten very lazy and just end up eating "whatever" once I get home--recent dinners have included soup, peanuts and raisins mix, turkey and cheese wraps, a hodge-podge of corn on the cob/mangoes/oatmeal, etc. I should gear up and do some "real" cooking one of these days. And this is an easy month, so "being busy" is not a legitimate excuse. Blah. I miss being invited over to others' houses to eat...
- I like Crystal Light "on the go" packets, which I add to my water bottles while at work.
- I really like the people in the OB department! Saturday night was the "OB roast," where we did a lot of "roast'n and toast'n" to honor the outgoing chiefs and enjoyed lots of great food (sushi, the most delicious-looking cakes I had ever seen in my life [from the local place Rick's Dessert Diner, which I have yet to try!], etc.) and fellowship at the house of one of the attendings.
- I really like the Arcade Church that I attended this past Sunday morning and think that I might have found a church to call "home." I enjoyed the contemporary aspects, such as the mellow guitar music and worship songs (loved the lead singer's voice), but also the traditional feel (we sang "How great thou art" to a more contemporary accompaniment at the end).
- I didn't like the Flood church service I attended later that day just to try out another group. It was too casual and new-agey-feeling.
- I like my short hair, but I hate how I can't really put it up. It's so warm here that I've been trying to get it off my face with things other than headbands... but I end up with a small poky pony-tail with the short "bangs" parts being held off my face with various clips... I think I'm going to try to grow it out for a while.
- I don't like my current AT&T bill-- it included lots of one-time charges and taxes that I was unprepared for. I'm thinking of trying the measured service plan, where you pay less for the landline but pay per local call (3c for the first minute, 1c/minute for time thereafter). I haven't quite gotten a feel for how much I will use the landline for local calls vs. how close I am to going over my daytime minutes on my cell, but this switch may be in my future...
- I like running more than I ever used to. Yesterday, I signed up for the Fleet Feet fall training program, which could technically whip me into shape for an October half-marathon. We'll see how that goes.
- I don't like my closet size. My clothes are too smushed and yesterday, I was looking everywhere for a pair of pants I wanted to wear (which I didn't find in the morning) that I later remembered live in my dresser because they didn't make the "closet cut."
- I like wearing "normal" clothes to work every day. I can actually choose the pants or skirt and top that I want to wear and make an "outfit" out of them (and accessories, of course), instead of having my suit supply dictate what I wear. I wore my purple and green "Nigeria" skirt today and got a ton of compliments!
- I don't like Lotus notes, the UC Davis e-mail program. I haven't figured out the millions of icons, and when you reply to an e-mail, it doesn't show the text of the original e-mail directly below it. It takes forever to load and log in. You also can't access it (without going through slow webmail) if someone other than yourself is logged onto windows on the computer you're working at. And my domain name is so long that I haven't given it to anyone to use as a real "contact" for me.
- I like gmail instant messaging! I briefly talked to Jesse yesterday while I was catching up on e-mails, which was fun!
- I don't like how gmail labels things as "conversations" so that, even if you've responded to one person on a group e-mail chain, if someone else on the list writes you back, it comes back as the same whole conversation. Or if multiple people in the group reply at different times, it shows up as one e-mail "conversation" even though there might be more than two unread messages in the "trail." I'm not sure I'm explaining this well, but this aspect of gmail is kind of irritating. I feel like I can never clean out my inbox (and yes, I'm compulsive like that)! :)
- I love speaking Spanish with patients. Yesterday, I was basically running the OB/GYN Spanish-speakers-only clinic. I even surprised myself with how comfortable I felt being the sole provider with no interpreters present-- I did a whole new OB visit with genetic and other history, talked to a woman about her IUD and having it out, and did a few OB checks.
- I don't like being slow and staying at work late. I had two new OB visits this afternoon (one Spanish-speaking only), and the paperwork took forever... since FP is "online" but still has OB paper forms, it seemed like I had to do double the work... and I was there till well past 6:30. I left the building and then forgot that I was still wearing a fitted skirt and would need to change back into my shorts... except that the building was closed. So I tried to change quickly and discretely behind a bench :)
- I love riding home in the sunshine. The good part about it being late was that it was cooler and there was little traffic.
- I don't like being heckled by drivers while I'm biking. I know the helmet is sexy and all, but honestly. I don't need any more distractions that might cause me, the klutziest girl alive, to turn my head to give an evil look and then crash. I almost wiped out yesterday waving to my intern classmate, Adeel, when I saw him walking on the sidewalk as I rode home.
- I like having access to the EMR while at home (can check daily schedules, finish up notes you didn't get a chance to do in clinic, etc.). But this is also slightly dangerous, because it may lead to "bringing work home" with you.
- I like the book Freakonomics, which I recently started and which argues some controversial points such as: teachers and sumo wrestlers have a lot of incentives to cheat, crime rates in the 80s and 90s dropped due to the legalization of abortion with Roe v. Wade, real estate agents are like the Klu Klux Klan, and more. I'm not that far into it yet, nor do I generally read much nonfiction, but I think this one has sucked me in.
- I love holidays!!!!! Meanie Mayo never gave us "normal" holidays off... I think this is my first real "July 4th" holiday in years! :)
Sunday, July 1, 2007
Cold beverages are good, too! :)
I will let you know that I have not drunk hot water ONCE since moving to California. I have had tea and coffee occasionally, but it is so warm here that I prefer refrigerated and cold drinks. I even have put ICE in drinks while here (gasp). I have a nice coffee maker and have enjoyed starting my days with drinking (while reading Wendi's blog!) a cup of iced coffee from a pitcher I'd made the day or so before (brewed the coffee, added cream and equal and all that, and chilled).
Interestingly, my dad just sent me an article on iced coffee mentioning that the best way to make it is to not make it hot and then refrigerate it, but to actually brew it cold (entails just mixing water and coffee, leaving it out overnight, then straining out the grounds and diluting it). You can even make coffee ice cubes from the concentrated stuff. I'm definitely going to try this sometime soon!
Melissa asked me a while ago how to make the (green) Alligator drinks we had at my godmother's house before I left VA, so I will share this other recipe (green stuff has to be healthy!):
1 can (6 oz.) frozen limeade concentrate (not thawed)
1/2 c. water
1/2 c. rum, vodka, or apple juice
2 teaspoons lemon juice
1 large avocado, peeled and cubed
8 ice cubes (if you are using a normal blender, best crushed beforehand)
Measure all ingredients into blender and blend for about 15 seconds. Can garnish with mint springs or lemon twists.
I also think that, for anyone who hasn't had a mojito (Laura and Wendi-- it has alcohol, but is good), you should try one. I think it is my favorite cocktail. I haven't made them myself before at home (my sis said she had good success with a recipe), but definitely have to start doing so (now that I have rum I bought on sale at Rite Aid :)). Just as long as I'm not doing it and drinking alone, right? :) I watched a video of making one at a Bacardi site online with music and drumbeats and all that-- very inspiring :).
12 mint leaves
1.5 oz rum
1/2 lime
7 oz club soda
4 tsp sugar
In a tall thin glass, crush part of the mint with a fork to coat the inside. Add the sugar and lime juice and stir thoroughly. Top with ice. Add rum and mix. Top off with chilled club soda (or seltzer). Add a lime slice and the remaining mint, and serve.
Enjoy! :) If anyone has a special summer drink, please comment and share! I always love new things to try. And I'm loving this summer!
