Exasparagusated

Last weekend was my last weekend of freedom on the tail end of an outpatient two weeks. So nice. Who knew I would be back to be feeling stressed, down, tired, beat-up, behind, and not smart enough in just a few days? But enough of that for now.

Friday night, joined Darina and Friends for Crepeville (mmm.... pics courtesy of Darina).

Is there anything better than Nutella and vanilla ice cream?? ......well, maybe a great guy by my side like this!

Saturday night, after Shomir was unfortunately jeopardized late Friday and I was near-jeopardized (called in to cover for another resident who was sick/unable to make call), we made an evening where we headed out to Berkeley for dinner and a show (Figaro, which was really well done!) We also had amazing gelato before returning very late that night.

On Sunday, Amy , Betza, Tom, Shomir and I hit the Asparagus Festival in Stockton, about an hour south of here.
I think we all expected a few more asparagus tasting-type things, instead of just pricey food (the asparaburrito was good, although we didn' t think too much of the deep-fried asparagus specialty), but it was still interesting. They did have great frozen fruit kabobs in chocolate (yes, I realize, which had nothing to do w/ asparagus), which made it worth it on a day of this temp: !!

They also had... pole vaulting (also, the relationship w/ asparagus is unclear). Didn't see anyone make it over successfully, but it was fun to watch (can't wait for the Olympics this year!!).

.... and spirited others: here's me and Amy with asparagus-head guy:

Betza, Amy, Tom, and Shom (no, they did not prearrange the orange shirts!)

Betza was then able to sign out to me, as she was leaving and I was starting a heavy FP Wards service of 13 patients :( It's really been a rough few days so far... getting there sometime around 4:30 a.m. and leaving around 7:30. There's just so much work to be done. And I am sick and tired of being stressed and tired. I just want this year to end. I will get progressively more negative if I let myself vent here; let's just say that I hope it gets better; otherwise, it's going to be a long, rough month! Don't expect to hear from me, at this rate of work! Don't blog too much or else I'll get too behind in reading about your lives!!

In smiles: May baby Isaac John is due in 1 week! :) Additionally, congrats, Katie and Ryan, on the birth of baby Kieran! :) Thirdly, my sister (congrats, Van!) successfully finished (and quicker than I ran it!) her first half-marathon this weekend. My parents are enjoying two weeks in India. I am so thrilled that others are finding joy in their life right now. Make up for me and my currently ultranegative attitude. When you're down, though, there's nowhere to go but up, right? :)

Cheap(er) gas!!!

Not that I'm into saving money or anything (or the environment, for that matter... if you haven't, check out Rachel's hilarious post entitled "Just flush it," about Hans and toilet water conservation which made me thrilled because it seems that someone thinks like I do!!), but I thought I'd share this link Eva sent me where you can plug in your zipcode and check out the lowest, average, and highest gas prices in your area.

I'm soo glad to be driving a Prius (can you see the link at the top right where it lists it as the top fuel efficient vehicle? :)). Sac's prices are: (low) $3.79/ avg 3.89/ high 3.99 (can you remember when a gallon cost less than a dollar?!). On our drive back from Millbrae last weekend, Shomir the engineer was playing with the cruise control to find the perfect speed to absolutely optimize the gas mileage... we, being residents pressed for time, couldn't bring ourselves to go much slower than 50 mph, but I think we got up to 59 miles per gallon at that speed (just think of the savings!!)! How cool is that?!

So, if you have the time to drive around to find the cheapest gas, kudos to you.
If you can be an every-other-time flusher, I am proud of you! (sorry, Rach).
If you are into rescuing food, call me and let's have a potluck (or, if you're not a rescuer, call me and I will rescue your leftovers for you)!
Happy earth-day-week! :)

Ah, the luxury of time

with Amy and Phi

I had almost forgotten what it was like to have free time! I've been on (outpatient) cardiology for one week and feel SO great! It's amazing what rest and an additional 6 hours PER DAY to oneself can do for one's mood and outlook on everything. I almost feel like a normal person!

The learning has been great, too, though. I basically attend CCU rounds as an observer (Phi and I switched places-- now he gets to slave away on the ICU/CCU service!) and get to just follow around Dr. Pham, this legendary and wonderful cardiologist who has taught year after year of FP learners at the VA hospital. I see pts w/ him in his clinic, watch caths, practice reading ekgs, and get pointers on physical exam findings, which is so helpful and relaxing. I love having time to learn rather than running around like a crazy person on a busy inpatient service! Unfortunately, Dr. Pham is leaving in June to do interventional cards down in LA, but I am privileged to be in the last FP class getting to benefit from his expertise. He is one of the most efficient yet compassionate, brilliant but approachable people I have ever met and the week was a blast. Although Dr. Pham is off next week, I have another week (and next weekend off, too!) to just learn as much as I can about cardiology from the fellows and other attendings before it is... back to the inpatient life for two more months straight of intern year (Family Wards, then OB #4).

Anyway, back to the FUN I've been having.

Here are some snaps from hanging out at R15 in downtown Sac and shooting some pool:

Shomir and Arash

Alvin and Sonia

Tuesday, we did our Rubio's fish tacos + Idol. I think the right girl was kicked off!

On Wednesday evening, I checked out the Farmer's Market in Davis with Amy and Joth. Davis also has a great Saturday a.m. market, which I remember checking out one of my first months here, but I'd never been on Wednesdays. It was a great day-- 75 and beautiful, and everyone was out on the lawn picnicking with their children and dogs, enjoying the weather and the bluegrass band playing. I got some great fruit (amazing clementines) and veggies (sugar snap peas are my favorite!!) to take home (and of course got to try some great samples). I didn't take many pictures, unfortunately.

One pic I did take, however, was one of these little "towel dresses" that (I thought obviously) were intended to be hung over oven racks and such other kitchen knobs as a decorative way to have a hand towel around. Amy cracked me up with her comment (along the lines of), "so these are so that little girls who play and get dirty can just wipe off because their dress is, in fact, a towel?" Maybe you had to be there but this totally had me holding my sides in laughter. Can you picture little girls tottering around in these? :)

This weekend, it was back to Millbrae to see Marie, Shomir's sister, and fam before they move to Boston in a couple of weeks (sniff, sniff :().

I also cracked up when we saw the following license plate in front of us at the drive-thru. It is just so bizarrely random. How many of such plates do you think they make? Do you think it was a gift of some sort?? Are you supposed to honk when you see it??

We just played some games Friday before sleeping soundly (Shom is glad to be done w/ night float, as am I (glad that he's done, that is. I like not being on opposite schedules!). Saturday afternoon, we headed out to bayside Seal Point Park, where the girls had a great time frolicking in the sandbox and exploring the water "inlet" while the adults supervised (/napped in the sun)and tried not to die from the pollen in the air.

Lily (buried in sand), Emma (face down in pink) and Anne

Adam with Lily-bud Anne and Emma with "Uncle Shom"
Anne did a great job taking our picture (I know it seems funny to wear a headband in April in California, but it was quite windy and pretty cold by the bay!!)

We had a great dinner at El Torito, a Mexican place right on the water, before snagging some Baskin Robbins on the way home (yes, even if it is cold, ice cream is still the best dessert ever).

Will Lily ever look at the camera and will Shomir ever show some teeth?

with Anne

Do you think Emma enjoyed her chocolate ice cream? (I'm wondering if any of it even made it into her mouth!)

the group

Today (Sunday), Shomir was blessed by going into the hospital at 6:30 a.m. only to find out that he mistakenly thought he was on call when, in fact, he was not! He then had a whole day free to spend with me! :) We went to church (this month has been awesome-- 3 weeks in a row! ) and then joined some residents in the FP and psych depts (Michelle the liason) for some fun outdoors on a beautiful sunny day @ McKinley Park! There was soccer, then frisbee, and then.... Bocce Ball!

Action shot w/ Diane

Betza lets it fly

Michelle, all business

(notice that my technique is a bit different! :) I just tried this, "the shotput" b/c us reds were losing so badly!)

Mary officiates

Eric measures, to be official. Can you tell we are a bunch of doctors?? :)

Weekends off are such a beautiful thing! We had some dinner and I'm going to do some reading while Shomir works on building an airplane! I think I start at 10 a.m. tomorrow... aaaaaaaaaaaaah.

Hand of Hope?

From a fwd Amy sent me:

"A picture began circulating in November. It should be 'The Picture of the Year,' or perhaps, 'Picture of the Decade.' It won't be. Infact, unless you obtained a copy of the US paper which published it, you probably would never have seen it. The picture is that of a 21-week-old unborn baby named Samuel Alexander Armas, who is being operated on [1999] by surgeon named Joseph Bruner [Vanderbilt].

The baby was diagnosed with spina bifida and would not survive if removed from his mother's womb. Little Samuel's mother, Julie Armas, is an obstetrics nurse in Atlanta She knew of Dr. Bruner'sremarkable surgical procedure. Practicing at Vanderbilt University Medical Center in Nashville, he performs these special operations while the baby is still in the womb.

During the procedure, the doctor removes the uterus via C-section and makes a small incision to operate on the baby. As Dr. Bruner completed the surgery on Samuel, the little guy reached his tiny,but fully developed hand through the incision and firmly grasped the surgeon's finger. Dr.Bruner was reported as saying that when his finger was grasped, it was the most emotional moment of his life, and that for an instant during the procedure he was just frozen, totally immobile.

The photograph captures this amazing event with perfect clarity. The editors titled the picture, 'Hand of Hope.' The text explaining the picture begins, 'The tiny hand of 21-week- old fetus Samuel Alexander Armas emerges from the mother's uterus to grasp the finger of Dr. Joseph Bruner as if thanking the doctor for the giftof life.

'Little Samuel's mother said they 'wept for days' when they saw the picture. She said, 'The photo reminds us pregnancy isn't about disability or an illness, it's about a little person.' Samuel was born in perfect health, the operation 100 percent successful. Now see the actual picture, and it is awesome...incredible....and hey, pass it on. The world needs to see this one!""

Now, I was a bit incredulous and did a bit of research on the reputable research interface, google. Some say that the pic is indeed real, but that the baby (also anesthetized) didn't really reach out and grasp/squeeze but that it just "flopped" out of the uterus and the surgeon grasped it and returned it to the uterus.

But a little magic, and a cute picture like that, can sometimes brighten one's day regardless! :)

At last...

Updates since last miserable post:

• Schedule has gotten way better. The service has calmed down, and we are actually discharging people to i.e. San Francisco VA for procedures, to the floor, home, etc... the hours are more manageable. I can't WAIT to start my 2 outpatient cardiology weeks on Monday... we so rarely get outpatient time!
• I got to try my first fish taco (mmm) on Tues. when Phi, Jeremy, Noelle, Brenden and I got together to eat @ Rubio's and then watch Idol. I have to say that I have not been faithfully following Idol this season secondary (mostly) to schedule, but there are some really talented singers on there (matching Sanjaya's prowess from last season :)). I haven't seen the results from today, but I'm hoping that Kristy Lee Cook or whatever her name is gets kicked off. I love the 17-year-old guy, David Archuleta :)
• Tara working 14 hour days @ the VA hospital while Shomir working 14 hour nights on night float @ UCD = not very much hanging out :( But, at last, we did cross paths today for the first time since Sun. when I was able to stop by this afternoon. If I get out at a reasonable time Saturday, we may go to a cello concert!
• I finally got my car washed (+oil change/ tire rotation) today. If you have ever seen my car, you will know that this (generally a low priority of mine) was much needed.
• Sprummer (California spring --> summer) is here! I was lamenting the pseudospring (it got warm/sunny at the end of Feb. but has just sort of stayed the same temps-- even only in 60s-70 last week). It is supposed to be 80 (and sunny, of course!) tomorrow and this weekend!
• To put things in perspective: see Randy Pausch give a very inspirational "last lecture..." Thanks to my cousin Amy for forwarding this incredibly moving message. Wow.

Trying to take things less seriously

(pics in this post courtesy of a fwd from my Mom).

Sometimes I feel like I have the worst job in the world. I started in the ICU/CCU (intensive care/coronary care unit) at the VA on Monday, and it's been a rough week. I had a long day Monday, there until 8:30 p.m. (ok b/c L and T weren't back from the beach yet). I ended up missing a continuity delivery b/c I didn't escape fast enough from the VA to drive to UCD (even though my awesome senior res, Zach, allowed me to leave), but then returned to do another admission. I think I got out at a reasonable hour Tues-Thursday but then Friday, got slammed with admissions on our senior's day off and was there until like 9:45 p.m. (definitely breaking one of those RRC rules, b/c I was back at 5:15 a.m. the following morning)! Yesterday night (today was my day off this week-- the only reason I'm able to sit down and write.... I apologize for not calling people back!) I left at 8:30 p.m. Yes, I kid you not! (Amusingly, yesterday, when I tried to d/c a patient around 2:30 p.m. after he decided he wanted to go home rather than wait in the hospital for a BKA [below the knee amputation], the pharmacist (who may have had his Rxs to fill) told me, "You really shouldn't be discharging people this late in the day. I've already been here for 8 hours and was headed home." I was smiling inside but think I even said something along the lines of, "How'd you like to be here for 16 hours in a day?!?!( and then 15 hours the next day??!)".

The VA system is really bad in that we admit every day of the week. It is a day float/night float system so that you don't take o/n call; however, this means that, every morning, you come in with new admissions to your team overnight that you then have to learn and present (along with rounding on all the other patients). This really drives me crazy-- I get so anxious every morning wondering how many new people I will have to learn while scrambling around in the morning. And then, since you didn't admit them youself, I always feel like I don't know them well enough. I don't think there's a "cap" (i.e. max # of pts you can carry) because we are the only ICU/CCU there.

We admit until about 7 p.m.- and then there's always orders, the H and P notes to write, etc (while trying not to get behind on d/c summaries). It's pretty brutal. It's not so bad when you have a service of 3. But with a service of 17-- which I think is what our census swelled to at one point last week-- it's almost unmanageable.

Also how I feel:
The pulm fellow asked me the other day if I was doing okay, because he obviously picked up on the fact that I constantly look (and feel) stressed. I am frustrated because, at this point in the year, I want to think that I am efficient and confident and know how to do most things. But these cards and ICU patients are complicated, sick, and just make me nervous!! Get me back to L and D where I feel like I know what I'm doing (most of the time)!!!

This is kind of how I feel:
I wonder if next year will be better. There is just so much to learn and know and I hate not feeling ontop of things. Hard to believe that only 2 1/2 months remain of intern year! I do have to do some "intern" FP rotations (newborn, peds wards) as a 2nd year but the responsibility and expectations will surely be stepped up. I hope I can handle it!


Here are just some other amusing pics in that e-mail my mom sent:

In honor of my patient yesterday who took somewhere around 66 oxycodone pills and had to be on a narcan drip....

On feeling lost and like I was swallowed whole...On infidelity? ...

Scrubby!!

In honor of May baby XY (coming soon!!!!!!!!!!!)- JB, don't feed him too much Thai food!
On still loving California...

Today was great. I SLEPT, Shomir and I went to church, and I've just been catching up on some things around the house. One more week of CCU/ICU madness before I'm on cards consults (nice schedule! Can't wait!). Happy Sunday!

Yosemite in spring!!! (Laura and Tony visit CA!!)

So I hope there are enough pics in this post to make up from the lack-o-words on the blog lately. It's mainly because I was so busy spending time with my awesome friends who came to visit from NC for 5 1/2 WHOLE DAYS!!! :) Thanks to Laura for sharing these pics from her camera, as she was the designated photographer on the trip.



Laura and Tony arrived Thursday night and, as I still had to work an OB night shift, Shomir shuttled them back from the airport. Friday, they had fun exploring midtown and Capitol Park while I slept for a couple of hours and then we enjoyed some catch-up time at Tower Cafe, Old Town Sac, and back at my place, where Alvin, his friend Tony, and Amy joined us four for Time's Up!

Look who's armless!Old Sac

Saturday, it was onwards to the great park Yosemite, which is breathless in the springtime, too (last time I was there was back in July hiking Half-Dome). It was Tony's very first time there!

Hiking to Upper Yosemite Falls

(that's Half-Dome in the distance)

We didn't plan the red, really!

Being pensive

Crazy Tony being goofy



real snow on the ground!

Near Bridalveil

hard-core rock climbers It was chilly!!!
Comfy tree for sitting

We stayed overnight at a cheap inn in Oakhurst, outside the park's south entrance, and had some good bbq (even better ice cream pictured below-- can you believe that this whole dish cost only $2?!?!) :)

Sunday, we headed back in for some more hiking and snow-frolicking, as you can see!

Check out the snowy forests!
Vista point

Hiking in Tuolumne Grove

(had to show them the giant sequoias!)

Tony, making not a snow-angel but a snow-chicken

On our way out of the park, we stopped to visit in Groveland with Laura's great Aunt and uncle, Wanda and Jean, who treated us to yummy Cobb salad and said we could stay there anytime we wanted to come to Yosemite! Tony will probably kill me if he reads this blog, but this is how he was entertained in the backseat during our drive back on Sun.!!
Sunday night: Kite Runner at the Arness theater made from a sheet and Shomir's projector. I managed to stay awake! Have to say that I wasn't that impressed with the movie.

I was impressed, however, with Laura's famous rum cake and the yummy pasta dish she made for us for dinner (wish she lived here to cook for me!!!)

While I had to start back at the Cardiac/ICU at the VA on Monday (blech), Laura and Tony visited with some relatives in Monterey and then, on Tues., hit San Fran. We hung out for some Idol at Phi's last night and then, this morning before going to the VA spa, I dropped L and T at the airport b/c they had to return to NC :( It was so great to have them here. Who will be the next visitor??! :)