Something old, somethings new...

This has been a week of the old and the new...

More fests (New!)
This weekend hosted both the hospital health fair but the next-door Medieval fest which we hit up on Saturday. Neither K nor I had ever been to a Medieval fest (the closest thing that I can recall is Medieval Times way back in the day!) and, although we didn't dress up, we had a good time.

Some girls in cute medieval costumes:


Some jousting (by a Seattle-based group):







Some goats for sale (there are goats you can rent here to graze your lawn!)



... and a petting zoo


Some life-sized Jenga:


... and a massive turkey leg (which the two of us couldn't finish!)


We also ventured to the town of Fieldbrook, supposedly our "sunny neighbor town to the east" for their art/wine fest at the Fieldbrook Winery. It wasn't all that sunny, but we enjoyed walking around and browsing the stalls, and Kelvin had some yummy oysters (Humboldt Bay supplies the vast majority of oysters consumed in California!).




Back to the OB world (Old but New)
I have taken a good share of OB call in the last week and have become far better acquainted to the hospital labor and delivery unit. I have both assisted with several c-sections (due to fortuitously being "around" at the time they needed to happen), as well as gotten to do my first two c-sections as an "attending," which felt really weird! I still have to get "proctored" for four more c-sections at the hospital (and six of any procedure I plan on doing, which includes vaginal deliveries), but I am really excited to be well on my way towards that total so that I can "fly" on my own. After spending so long being a measly resident, it is amazing to actually feel like one is in charge and control (being asked what suture I want for my setups was way cool!). While some things are done a bit differently here than at UCD (i.e. the OR is down the hospital hallway [past the cafeteria] from the L and D unit, there is no NICU or NICU team, and the hospital is still run on paper!), the OR is basically the same, making it a pretty comfortable environment.

We take call for 24-hour periods and I will be on (for HR/backup and c-sections) about 30-40% of the time, which means that it can be stressful to figure out how to juggle family medicine clinic and sleepless nights, but I love the small-town way of doing things. We squeeze in scheduled procedures during lunch hours (including a version-turned-c/s today) and things like that :) The way it works here is that you generally round on any moms/babies you deliver... so, due to the deliveries late last week, I came in daily over the weekend to check on my pairs. It was soooo wonderful to be able to discharge my own patients home without any over-conservative pediatricians holding the newborns hostage, and with knowing that the babies would have good follow-up (our prenatal clinic arranges RN home visits in the first week of life-- how cool is that?!). The work is really rewarding-- I love being back in the OB world.

Gardening (New!)
While I have never had space/time/(or much interest) in gardening, I now have all of the above. I also now live in one of the most "green" and earth-conscious spots in the country which makes me excited to take advantage of the resources that can help me get into acquiring a green thumb. I have been doing quite a bit of reading and am interested in starting a little veggie garden outside (perhaps come spring-time). I am also interested in doing some composting (perhaps with worms... if I decide that doesn't creep me out too much). And, of course, speaking of nurturing live things, I haven't forgotten about getting a dog.

But I thought I'd start with some houseplants (some bromeliads), which I purchased this weekend. I figure if I manage to keep these alive, I might be ready for some outdoor plants... and then, perhaps down the road, a pet and (maybe) kids. One step at a time, though. Composting (involving mostly dead or decaying stuff) would probably be a good first move, too. JB, if you are reading this, please send some recs my way.

Music (Old)
I picked up my old Yamaha flute this weekend. I was inspired by my clinic medical director, who brought up potentially joining a community orchestra (I'm not sure how many of you know that I was a big-time music nerd in HS and college).... and, although I haven't had the nerve to call to inquire if they needed any more flutists, I thought the first step would be dusting off the old instrument. I'm not sure how easy it will be to keep up with the weekly (weekend) rehearsal commitments due to my calls (as well as wanting to go out of town other weekends), but, after realizing that playing the flute is much like riding a bike (i.e. very doable, even after a 4-year-hiatus!), I am more motivated. We'll see.

Kelvin cooking (definitely New!)
Kelvin gets home earlier than I do on Mondays. Although he is pretty self-sufficient in making fried rice (which I don't like anyway), I'm not sure he's ever cooked a meal for us. So when he offered to make us carne asada for tortillas, I was really excited (and not at all nervous :)).

Here was our spread for tonight: (tortillas, spanish rice [in the rice-cooker-- love it!], onions, tomatoes, basil, cilantro, jalapenos, grilled beef, salsa, and (how could we forget) tapatio sauce!).
I wish we had a dining table (still waiting on our new furniture!), but we ate happily watching the Redskins-Cowboys game on TV.



It was delicious, and I'm thinking he should "volunteer" to cook more often. I still can't get him to willingly use the dishwasher, but meal preparation is a start.... :)

North Country Fall Festivities

Kelvin and I are loving life on the "North Coast." We are really appreciating life in a small town, which is absolutely devoid of traffic and which comes with the convenience of us being able to run virtually any errand by driving no more than 10 minutes. We generally work from 8:15 or so to 5 on weekdays (with a 1.5 hour lunch break!), except I have Tuesday free from clinic duties. We are usually out of clinic with notes done by about 5:10 or so (oh, what a change from residency!), due to our fabulous medical assistants and the awesome efficiency of the clinic as a whole.

I just got added to the OB backup call schedule, which means that I am on call (from home) about 30-40% of the time for our group's patients who are higher risk or who may require an operative delivery (or VBAC). The hospital privileging process has been quite drawn-out and frustrating, and I still need to get "proctored" for deliveries as well as surgical procedures, but I think we are getting there. I got oriented a bit more this past weekend but haven't had to do any actual patient care yet in our tiny community hospital (labor and delivery has just 3 laboring beds and 2 triage meds, quite different than UCD's large unit!).

Kelvin and I continue to be amazed by the sheer number of activities that go on every weekend, which seems and is far out of proportion to the population here. On Friday, we saw a Sondheim musical, "Into the Woods," based on Grimm Fairy Tales, at Eureka's Repertory Theater. On Saturday evening at the Arcata Playhouse, we caught a clown performance by the Pi Clowns, a San Francisco Physical Comedy Troupe, whose comedic acts and juggling routines had us and all the other audience members rolling with laughter and ooh-ing and aah-ing with respect.

This weekend was also the North Country Fair & Harvest Festival, an annual fair in Humboldt County held on the Arcata Plaza that boasts over 200 craft, food, and information booths, as well as live music and parades. We stopped by on Saturday, and were really impressed by the various artisans' goods and activities. We were blessed by fabulous sunny and warm weather which made it a joy to be outside! Apparently over 10,000 people were expected to attend!

Here are hula hoopers on the green:


I was really excited to make a wax flower (you could also do a wax hand) when I saw that booth, which had a long line of children. This reminded me both of summer camp at Camp Lake Hubert in MN, when making wax "sundae" candles was one of my favorite activities, as well as a bit of a past Minnesota state fair, when I lined up with a bunch of five-year-olds to milk a cow, as that was a new activity for me :)





Here is me with my wax sunflower, which, like a piece of elementary school art, is now displayed proudly on one of our living room shelves :)


While we were ambling around the various booths, a man in a jousting costume came up to Kelvin and asked if he was interested in information on the Medieval Festival that is scheduled for next weekend. We were interested in checking it out, but both of us envisioned walking around and feeling weird with everyone else wearing medieval garb... Kelvin clarified that we don't, in fact, have to dress in period dress which is good because neither of own anything that would remotely pass; however, we might still go to sample the huge turkey legs (and because watching jousting is always fun, right?!). We are not bored here yet!

Not-so-proud iPhone owner

I am one of those people who didn't learn to text (and did so against my will) until about a year ago. When I got my cute Samsung flip cell phone 2 years ago from Verizon, I was so excited I was moving ahead technologically. When my Dell laptop died about a year and a half ago (although it has since been partially revived), I got a Macbook, which is fine for internet surfing and word processing, but drives me nuts in most other functions (check out this article on CNN which reports a good use of a MacBook Air-- as a kitchen knife). When Ted the IT guy dropped off my iPhone yesterday at my desk at work, it hit me... I now have two Apple devices that I don't know how to use.

With so many friends being happy iPhone owners, I know I should be ecstatic that my new employer has generously given me an iPhone for both work and personal use, as a perk for being part of the OB call group. They pay the (group) plan, which includes minutes which I will never use as well as an unlimited data plan. However, this new iPhone is rather intimidating for simple ol' me (I still use a paper planner for keeping track of appointments and meetings and I don't even talk on the phone much!). Before I even had possession of the phone, I had voicemails I didn't know how to check. The first time I tried to answer a call, I think I simultaneously took a photo and hung up on the caller. I have people from American Express calling me and asking for "Tim Louis," which is also extremely confusing. I have gotten some simultaneous calls on my old phone as well as this new one which leaves me perplexed. It is all a bit awkward, to say the least. I swore I would never get an iPhone because I would never need all the bells and whistles with which it comes, and now here I am. I am now ONE OF THOSE people.

I have, painstakingly, transferred my phone numbers from the old phone to the iPhone. I hope they transferred accurately, as I fear that my fingers are not dainty enough to accurately text on the touch-screen (although I must say, it sure beats texting on my old flip phone). My old verizon account/phone number is set to be disconnected on 9/21, so you should be hearing from me re: my new number. Please e-mail me or leave a comment if you want it and don't have it. I have acquired a screen protector and a hard case. I hear there are a lot of tutorials I can do in order to figure out how to use this alien device but I have yet to read the little manual Ted gave me. Sigh.

I don't know which is scarier-- being on OB call for the first time this weekend or this iPhone....
All tips (for "how tos," apps, etc.) from you iPhone-savvy people are very welcome!!

Staying local (tennis obsession with a few veggies on top)

Staying local is what we did this weekend! Neither Kelvin nor I have had the luxury of cable TV for the past several years... but, this weekend, boy did we realize that we love it! We are both sports lovers and watched tens of hours of great sporting events on TV, venturing out of the house minimally! I have been particularly obsessed with U.S. Open Tennis and watching all of the new, young stars make names for themselves (the last time I watched a lot of tennis was at least 5 years ago; my, how the times change and my, how depressing to hear the commentators discuss how "old" [i.e. 30] some players are!).

I was happy that Serena Williams went down in the women's final against Aussie Sam Stosur (Sam played brilliantly and Serena, definitely acting like a twit, was fully deserving of the fine she got) and, while I really like Roger Federer, seeing Djokovic come back and win the semi in five sets and then go on to beat formidable Nadal in the men's final was extraordinary. Parts of the women's doubles final was also thrilling!!! I really believe I have a bit of the post-U.S. open blues, when I can't look forward to being planted in front of the T.V. set, living vicariously through these amazing athletes (until the Australian Open, that is... ):) Kelvin and I had a bit of a "discussion" over what was more important to watch-- college and opening season NFL football (which I do enjoy watching) vs. the latter rounds of the U.S. Open, but I did watch some great football (Michigan vs Notre Dame, anyone?!) in between my mad attention to tennis, above. And I guess, for just this reason, it's okay (and probably good) that we have two functioning TVs.

We did check out a couple of "local" events (now, we have only 95 more things to do in Humboldt County!) :) On Friday, Arcata had its "Arts Alive" evening (which rotates among local towns-- Eureka has one on the first Saturday, McKinleyville on the third Friday or something), which is similar to Sacramento's Second Saturday festivals. Some local shops and galleries and many eateries on and around the downtown Arcata Plaza stay open late, promoting local artisans' crafts and local musicians' talent (with lots of great live music!). We checked out a sushi place (Tomo, a great one!) and somehow walked away from a garden store with a too few many "cute" gifts...

Saturday morning was Arcata's longstanding Farmers' Market, which was outstanding! I was blown away with the scope and variety of the market, from take-home and house plants to wonderful heirloom tomatoes, to every variety of pepper you can imagine (did you know there are purple peppers?!). We, like most of the other farmers' market-goers, brought our recyclable bags (I saw many people with baskets! [this place is very green]) and came away with some wonderful, tasty goods.

Enjoy the market pics:

Peppers!!



(succulents)


more peppers...


This farmers' market is going to probably be a regular event for us! Arcata, a town of independent thinkers and businesspeople (chain stores and eateries are almost banned here!), really encourages buying local. I think we will be "staying local" for quite some time!

Fleas be gone

We discovered, soon after moving in, that we had a problem with some kind of biting insects. Without furniture for two nights in our new house, we slept on an air-mattress on our floor and I soon noticed that my feet and ankles were covered in horrendously-itchy raised bumps (Kelvin was luckily affected less).

It wasn't until we started spending considerable amounts of time crouched on our floors, assembling furniture, that we noticed the culprits-- tiny jumping bugs which I immediately recognized as fleas (did you know that they can jump up to 7 inches vertically and 13 inches horizontally!). I remember having a few flea problems when we lived overseas and had a dog (may Toccata rest in peace), but we don't even have pets (yet), so this was obviously a preexisting problem of the house. The family that lived here before us did have a dog.

Flea bites are maddening. I've probably gotten thousands of mosquito and other insect bites in my lifetime, but none even come close to approximating the discomfort that flea bites cause. They are, by far, the itchiest bites you could ever imagine. The itch is hydrocortisone-resistant. It is hydrocortisone- & antihistamine-resistant. The itching wakes you up from sleep. The most effective treatment I have found is the "After Bite Itch Eraser" (ammonia) in conjunction with copious calamine lotion, which I had to go out and purchase when the other treatments were not working. I was putting "Off" on my ankles routinely when I was inside.

Those topical remedies just treat the symptoms, however. In order to truly get rid of a flea problem, you have to do a number of things to target all four (!) stages of a flea's life cycle (21 days). Fleas can live up to like 7 months without a meal, and the larvae can lie dormant for even longer than that, pupae just waiting for the human step and vibration to awaken them from their slumber into the active, biting stage... which is why many people find that they are preyed upon upon entering an empty house (as we were). So, "flea control" requires a number of different steps/approaches:

- treat your pets (hosts), which we don't have-- this includes flea collars, and treatments like "Frontline," which you can obtain at your local pet store
- vacuum regularly (i.e. daily), which can kill more than 90% of adult fleas and also suck up larvae to break the cycle
- use chemical sprays which have both an adulticide, and an insect growth regulator (inhibitor) to kills the larval stages or, alternatively, carpet powder with borax
- fog your place

We used the spray around our whole living room (the main problem area that we could identify) and bedrooms upstairs with Siphotrol, which includes both an insect growth regulator and permethrin, an adulticide, but still caught a few buggers. So we decided to proceed with the fogger.

Flea fogging (bombing your place with a high-density insecticide) requires pre-vacuuming, clearing all food-preparation spaces, and setting off a spray canister to mist your open space (treating up to 700 sq feet). You (and any potential pets, children, etc.) have to leave your home for at least 2 hours; you then have to return to open all doors and windows and not return "for good" until at least another hour after that. Kelvin's office is close enough that he was able to set off the fogger before his afternoon clinic so that when we returned from work, we only had to open windows (which took about 10 minutes, I must say! This house has a LOT of windows!), and wait one more hour before we were safely allowed to return to house.

We really hope this worked. We have seen one flea that seemed to have survived "the bombing," but I personally feel much more comfortable exposing my feet and ankles at home (I have been walking around in tall socks, slippers, and sometimes boots both because hardwood floors are cold, and to prevent bites) and sitting on our downstairs couch. We still feel itchy from time to time; however, I think it is largely paranoia from feeling like we are going to get bitten. We hope we solved the problem for good... but I am thinking it will be longer than previously planned before we get a dog of our own...

Humboldt Intro

We are officially "residents" of Humboldt County. Depending on where you are from, you may have heard of Humboldt County, CA because (unbeknownst to me until about my third time visiting the redwoods) it is apparently the marijuana (smoking & growing) hotspot of the U.S. However, we are learning that this area is well known and well worth visiting (/living in) for more than its weed!

Here are some of the ins-and-outs of our new stomping ground:

Humboldt County is named for the German naturalist and baron Alexander von Humboldt; the area was formerly inhabited by a number of different Indian tribes but currently, the demographic distribution is approximately 81% white, 10% Hispanic, 5% black, and 2% Asian. Arcata, our city, has a population of around 17,000 (plus the students who come from all over to attend Humboldt State University, which is just down the street from our house). Eureka, the "big city" eight miles to the south, where the closest Target and mall are located, has about 27,000 residents. The county is very rural, with thousands of acres of protected redwood forests, and also many farms. Fishing (halibut, perch, oysters) is also a large industry, as we are right on the Pacific ocean (i.e. tsunami zone). It takes about 5 hours to drive to SF, and probably about 2-3 hours to get to the Oregon border, but we are still about 7.5 hours from Portland.



It is really gorgeous in this area. I must say that I'm a but apprehensive of the weather, which, in contrast to the "desert" climate of Sacramento (100+ degrees on our wedding day), is rather cool and foggy (highs of the 60s in the summer!). I am also worried about how much we'll get to see friends and family given that the closest major airport (San Francisco) is about 5 hours away by car (there is a dinky airport in McKinleyville which has a few, overpriced flights per day to other CA cities). However, I am so excited to explore the outdoors and all of the natural beauty in this area and really feel that we are fortunate to get a chance to live here.

We have obtained a publication called "101 things to do in Humboldt County," and started tackling items this past Labor Day weekend.

On Saturday, we drove north about 15 miles to outside the fishing town of Trinidad to hike in Patrick's Point State Park, which is popular for its old seastacks, including "Wedding Rock" where some couples tie the knot, and 6 miles of hiking trails. While the route was not overly strenuous, we enjoyed walking the Rim Trail, which circled along the Pacific bluffs and then back through the forest. We also hiked down to Agate Beach, which is popular with surfers (way too cold for me to want to venture in!) and gem-finders. We heard the sea lions on the rocks but couldn't see them, due to fog, which eventually lifted to reveal a very beautiful, sunny day! There are great whale-watching opportunities here, particularly when the whales are migrating (Nov-Jan, April- June); however, humpbacks apparently can be spotted at any time of the year. Open year-round, Patrick's Point SP is also a great place to go camping (we can go if you come visit :))






On Sunday, we got quite sucked into watching U.S. Open tennis (we are LOVING having cable!), but did venture to try out a community church in McKinleyville and hiked in the Arcata Community Forest, a large area (2100+ acres) of public land no more than 1 mile from our house, which permits hiking, mountain biking, and even horseback riding! (we passed a few horses and their riders on our trip). Kelvin, my dear city boy, was amazed to see a "real, wild" deer within the city limits...





On Labor Day, we checked out an Arcata block party benefiting a town in Nicaragua (Arcata's sister city), and then went kayaking on Humboldt Bay, which was a wonderful way to spend an afternoon! Humboldt Bay (along with the Bay Wildlife Refuge and Woodley and Indian Islands) houses over 250 species of birds, along with tons of fish (unfortunately, we didn't see any leopard sharks!), as well as mammals like foxes, deer, racoons, and seals which we saw surfacing at several different points of our trip!

This monument on Woodley Island recognizes the many fishermen who have died at sea (the waves during the winter, which is the best Dungeness crab-catching season, lures several people to their deaths each year):






Today (my day off [nice to work two days, be off for four, then return for three!), I did a lot of errands both in Arcata and Eureka (including a trip to Costco [hoping to get a discount] for gas, which is running $4.09/gallon, only to realize I couldn't pay for it because I don't have an American Express Card; aargh! ). However, I was able to go for a run on the Hammond Trail, a five-mile trail from Arcata to McKinleyville voted the "best place to walk, jog, or bike in Humboldt County" (horseback riding is also permitted :)). The route parallels the ocean and you can sea many glimpses of the impressive sand dunes from the paved trail.

This is just the start of what I believe will be many great years of exploring. After this weekend, there are only 97 new things left for us to do in Humboldt County :)

New Kids on the Block

After a glorious two months off, Kelvin and I officially started our new jobs on September first (yesterday). The evening before we started was, for me, filled with quite a bit of dread and anxiety (sadness that our nice "break" had come to an end and nervousness about starting over at a new, unfamiliar place); K, on the other hand, was super excited to "get back into it," and probably to escape the responsibilities of full-time home maintenance and my rantings about dishwasher use... :)

Our first day was filled with orientation-type activities-- watching safety videos and completing HR paperwork and then getting acquainted with our workspaces at our respective clinics. It was an odd day at my site-- I walked into a potluck at my clinic to learn that a pediatrician from next door had been hit by a car and taken to the hospital with a broken arm. Subsequently, one of the MAs (ironically, the one who was the guest of honor at the goodbye potluck) had a anaphylactic reaction with shock to something in the food that was served, and had to be given epinephrine and taken by ambulance to the ER... which left me wondering, "Do I really want to be on staff here?"! It was a very freaky day.

In any case, I had my first real patients today (which was calmer, in some respects). They started me at about half-speed... and it wasn't too bad! I thankfully and luckily have the advantage of being familiar with the electronic medical system (Epic) that they use here (we used the same one in residency), although there are some system differences and all my saved "smartphrases" don't work exactly the same. All the staff at my small clinic, including the providers (3 other docs, who alternate weekdays off, and one NP), site administrator, and all of the medical assistants, have been incredibly helpful at orienting me and showing me the ropes. Nevertheless, it is naturally still incredibly painful to learn how to "get things done" in a new practicing environment and it is frustrating to feel "slow" again; it will definitely take some time to get up to full speed. What is nice this time around (in contrast to starting med school rotations or residency), however, is that the medical knowledge is there and solid-- the easiest part of starting this new job (my first "real" job!) is that I know what I am doing when it comes to the "medicine" part and (most of) the treatment plans, which makes me feel a tad more confident.

A few more blessings to count:
- the patients seem really nice; all the patients I had today seemed very excited to meet their "new doc" (my clinic site has been closed to new patients for quite some time) and were very respectful and encouraging
- the clinic uses Microsoft Outlook, and not the horrible Lotus Notes e-mail that we had at UCD which I was more than thrilled to abandon
- a "plan" is firming up for my OB responsibilities, which should include sharing back-up (c-section) call with one FP/OB veteran, along with high risk OB duties in the outpatient and inpatient settings, although this may not start till later this month or October
- our "benefits" with our employment became effective immediately on 9/1 (and not 10/1 as we thought would be our health insurance start date), which means that we each effectively get a refund of the $90 we were paying for monthly interim/temporary health insurance through Blue Shield which we didn't use anyway...
- WE PASSED THE FAMILY MEDICINE BOARDS... which means that, after plodding through the MCAT in college, steps 1,2, and 3 of the US Medical Licensing Exam, various national medical examiner tests, and this recent Family Medicine Board Exam, we are board-certified family physicians and don't have to take another obnoxious standardized test for about 10 years (yeah!!!!!)
- we fortuitously (well, incidentally-- I don't think we had looked at a calendar) started work on the Thursday before a three-day weekend... and I have Tuesdays off, which means... yes, four more days off (for me, but only three for K)!!

We hope to do some exploring of Humboldt County, including some hiking... we are excited!