Tuesday, November 29, 2016

working insane hours with equally insane people in order to attend an even less sane Portuguese rosary

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I need to be up and at work very early because I will leave work early to attend a rosary for which I will play piano or organ. I'm already at the hospital. Probably the very last thing I should have been doing, other than shooting up heroin or something along those lines, was staying awake and blogging. I'm sure most people understand, on the other hand, what it's like to really need to get to sleep. Sleep is often a most elusive commodity under such circumstances. It's pointless to lie awake in bed trying to sleep. It only makes sleep even harder by which to come. Blogging is more productive than staring at the shadows on the ceiling.

Matthew will be with me on the travel to the rosary, and he will drive. The drive there, even though we're leaving mid-afternoon, will be a bit of a bitch because of traffic, but the drive back will be quick and painless, as we won't be dealing with traffic late at night. Matthew is probably still sleeping (he doesn't need to be at work quite so early today; he worked late last night) as though he's Michael Jackson after a dose of "warm milk," known in the medical community and by virtually everyone other than the late Michael Jackson as propofol. I should probably clarify that Matthew is sleeping as Michael Jackson did following the intravenous hits of propofol that were not his ultimate shoot-up of the drug. Matthew is still very much alive and well. I opened his door an hour or so ago to let the cat in, and could hear him breathing.  Matthew sleeps like a heavily sedated person even without the benefit of drugs. He falls asleep within five minutes of the time he first attempts to sleep, and wakes up whenever he wants, usually without benefit of an alarm clock. It's a fantastic trait for a doctor to have, and he's very fortunate that both sleeping and waking come easily to him. 

I will be on duty shortly after 5:00. I typically would not attend hospital  rounds on a Tuesday, but since I'm making up time that I will miss at the end of the day, so the most logical use of the time is for me to participate in hospital rounds for internal medicine patients. I will be the only med school students. The interns will likely pull rank and will ask me every question that is in the book and many that aren't, which is why I plan to start reviewing charts almost two hours before the scheduled start of rounds. It's a chance to look really good or really bad. I'd prefer to look good. It's also a chance to make a few interns resent me if the residents ask them questions to which they do not know the answers, and then refer the questions on to me if I happen to know the answers. Often the attending stands back and observes the drama without saying much, though occasionally he will ask questions of the residents, and God help the residents if they don't have the correct answers. I won't volunteer answers but if I happen to know and am asked questions directly, I'll either answer or apologetically admit that I don't know the answer. The very worst thing is to try to fake it when one doesn't know the answer. It's OK to be wrong once in awhile as a med student -- though not too often -- but bullshitting gets a prospective physician absolutely nowhere except in deep doo doo  during rounds. 

After rounds, I'll have time for a very brief break before office hours begin. Because I will have shown up substantially earlier than everyone else in order to review charts and talk to the patients, and for the simple reason that the lower one is on the food chain in this business, the earlier one is expected to be on the job, I won't be expected to find ways of making myself appear productive because I will have been working long before the rest of them and will be entitled to a bit of a break. That is, unless I screw up on the question/answer sessions of rounds, in which case I will be expected to make it very obvious that I am studying the material of which I demonstrated non-mastery during rounds. If I handle rounds acceptably, I'll make a few quick notes for studying later, go back and bid the patients farewell and wish them a good day, and find out if they have any immediate needs that aren't being met. I don't HAVE to do this, but it's a nice touch, and I would appreciate it if I were stuck in a hospital as a patient. I will then have a bit of time to myself.

I have protein bars, chocolate milk, and a travel toothbrush with toothpaste packed in my car for when I leave the hospital to go to the internal medicine office. I also have a five-hour energy drink in case I cannot get by without it. Those things are supposedly really toxic for one's kidneys, which is why I avoid them on normal days, but after  sleepless night (though I did have a 50-minute nap when I first arrived home from work), I cannot be yawning in patients' and physicians' faces. I may have to sacrifice a day of the life span of my kidneys in order to avoid appearing highly unprofessional.  I try hard to limit myself to no more than one of those energy drinks per month, but at those rare times they're necessary. If I yawn too much on the job, am excessively sluggish, or fall asleep, my reaction to the reprimand that I receive -- the obvious degree to which it would upset me -- would cause far more damage to my health than would the 5-hour energy drink.

The piano is still in the waiting room of the internal medicine practice at which I am now working. It will remain there until December 10, at which time it will be moved to the floor where it will be housed semi-permanently, which will allow it sufficient time to settle before being tuned on the day of the 16th in anticipation of the holiday function for physicians, administrators, board members, benefactors, and others. I still have no idea if I'm expected to play it that night. Perhaps it's presumptuous of me to think it could even be a possibility. On the other hand, it bothers me a bit that if those organizing the event are expecting me to show up to play the piano at their event, they think they can wait until the very last minute to let me know that my services are needed. The bottom line, however, is that they can.  They may very well be waiting on an R.S.V.P. from a more esteemed musician. If such is the case, they are sparing my feelings by not letting me know that I'm their second or third or fourth choice, but that I should keep the night open. I would prefer to think that it's their knowledge that they can expect me to be on call at any time without notice even though playing piano isn't really part of my scope of duties, and even if it is rude of them not to let me know further in advance, and even if it's not part of my job. My dad disagrees about the "not being part of my job" thing. He says that as a med student or intern, if one lists a skill on his or her resume,  he or she may expect to be called upon to perform that skill if it in any way benefits the program to which he or she has been accepted whether or not it has anything to do with the practice of medicine.

My only issue is that I need a play list, and I'd rather, if the event coordinator is not going to provide  the play list, come up with it at my leisure, as opposed to spending every spare minute on the day of the event trying to figure out what to play. Christmas music is the obvious choice unless someone in power suggests otherwise, but I'd like to know if it needs to be almost exclusively holiday music with as many non-Christmas-specific seasonal selections as possible out of respect for the many doctors who do not celebrate Christmas, or if they're looking more for light classical music, piano standards,  or easy-listening-type fare. My mom says I should have this list on hand anyway. I asked her if she had such a list on hand. She said no. Why would she think it was so important for me to be prepared in this way if she is not? 

In any event, I'm probably flattering myself to think whoever is in charge of procuring a musician for the affair  would even consider using my musical services for this event.  We're not far from one of the major cultural centers of the world.  There have to be many known artists on whom the event coordinator could call for this event, though the services of the well-known pianists in the area would not come cheaply.  I am not in a position to demand a cent.

At least I won't have to worry about what to wear if my services are requested. Male professional musicians wear black tuxes to such occasions. Women wear black clothing - usually dresses, but nice slacks and relatively elegant tops are acceptable as well. My closet is one-third filled with professional musician clothing. I could always drag out the cute little ensemble I wore for my senior piano recital. It was black, but the style was something like one of the Von Trapp girls would have worn. I thought it looked a bit silly, but my mom was in love with the dress. I considered telling her if she loved it so much she should order one for herself and wear it at her next appearance, but I know what she would have answered, which was that the dress was for a person my age and not hers. I have few opportunities to make my mom really happy, so I wore the dress she wanted me to wear.  

No one minds (or has expressed it to me, anyway) if I play the piano in the waiting room either before I'm on duty or after the work has been done prior to the start of the day and it's not yet time for patients to appear. I don't invite myself to play the piano if there's work to be done. Yesterday I could tell that the noses of three of the other four med students assigned to the practice were slightly out of joint when I played the piano. (They were already on vacation when I played in the days before thanksgiving.) Late yesterday afternoon, when one of the attendings mentioned that the doctors wanted me to play a bit more while the piano is still in the waiting room, I  voiced my concerns about it possibly causing hard feelings among my peers. He almost exploded. I was glad they had already left for the day, as he might have said something to them, which would have been awkward. He said that he is going to ask them if any of them proficiently play the piano or any other instrument that would be easy on the ears in an office setting, and to invite them to have a turn at playing if anyone answers affirmatively.  He said if he notices anyone even looking at me cross-eyed when I'm asked to play, he'll call the person in to have a chat. He said it's none of anyone's business what he does with the time of the medical students assigned to him as long as it's both legal and ethical, and he won't have med school students deciding what anyone else's duties are while they're in his office. He also said that my knowledge and skills are superior to those of the medical students assigned with me (I disagree where one of the other students is concerned, but it's not my place to argue with a doctor; I'll try to put in a good word for him later before final grades for this rotation are issued) in this rotation to the extent that none of them have any cause for complaint that I'm not carrying my share of the workload, because they need far more practical experience than I do, and  because I accomplish twice as much in half the time as most of them do when I'm on the job. That isn't not as much of a compliment as it might seem to be. With one notable exception (who is also the one who has neither complained nor given me the stink eye when I play the piano), the weakest links in our cohort are assigned with me right now to this section of the internal medicine rotation.

I suggested to the attending physician that people get tired of Christmas music if it's played too early, and that it might be good to wait until the first of December before dragging it out. He said that for now he plans to have me play for roughly an hour in both the morning and the afternoon. I can play what I want unless he or one of the other doctors thinks of something they want to hear, but if a patient requests a holiday song, I should play it. He said he happens to like the sound of Christmas music. He's Hindu, so if he's willing to listen to Christmas music , I suppose I should humor him.

Today is going to be a very long day, but then we'll be back to business as usual. I'm already at the hospital, and it's time for me to begin reviewing charts and waking patients to talk with them. They so love it when I wake them early in the morning to chat. 

P.S. Cousin Dan has arrived in the chaco, or el chaco, in Uruguay, to determine if the Mennonites there are indeed of the House of Israel, and, if so, from what tribe. I'm not sure what he'll do if he realizes once he gets there that the indigenous people are of the house of Israel, and not of the tribe of Manasseh, as interpreters of the Book of Mormon, or the Book of Morons if you prefer, would have you believe.

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Sunday, November 27, 2016

Thanksgiving, the Dallas Cowboys, my horseback-riding ineptitude, Yamaha pianos, and my brief stint as a dairywoman

This photo belongs to Judge Alex Ferrer. I didn't ask his permission to post it because he is busy. In the event that he sues me for copyright infringement (although he didn't sue Marco Rubio for lifting half of his essay and turning it into a campaign speech, so I'm not sure why he'd suddenly become vicious and come after a nobody such as me) I may need to start a Go Fund Me account for legal expenses. I shall throw myself on the mercy of his court and hope that such never comes to fruition.In any event, doesn't this lovely molded chocolate turkey make you want to give up the real thing and just eat chocolate turkey instead? I didn't think so.

Thanksgiving was Thanksgiving as the holiday always goes down with my family, whether I celebrate with my slightly-south-of-the-midline-of-the-state family or with my slightly-above-the-midline-of-the-state family. We usually alternate years, and this year we were with the northern contingent.

The northern Thanksgiving celebration is a hugely attended affair. I didn't bother counting, but my aunt thought eighty two people ate at one time or another during the afternoon. Most people other than I ate too much. A whole lot of people probably drank more than they should have. No one of whom I was aware became angry with anyone else, however. I wouldn't say the event was peaceful with all the yelling at the TV during the football games, but it was congenial yelling. I think everyone was even for the same teams, which was slightly odd -- especially that everyone there hated the Cowboys, especially since many of the men present are literal cowboys, either who ride and rope competitively on weekends or who ride horses while herding cattle for a living. Usually there's at least one @$$hole in any crowd who has to cheer for the Dallas Cowboys. We were blissfully spared the token pendejo this year.

I did my usual ban on Black Friday. I don't believe in Black Friday. it's like the Kardshians to me. If everyone ignored the Kardashians to the extent that I do, there would be no fincail incentive for any network to keep televising a show based on them, and they would fade into oblivion. i fell that the same is true of Black Friday.I plan for the rest of my life to budget my income carefully enough that I don't have to join the throngs of shoppers willing to stampede atop toddlers and elderly people in order to save a few dollars, to get their hands on the year's impossible-to-acquire toy, or to save a few dollars. If I ever can't afford to purchase gifts, I'll learn to sew and make quilts for people, or do something similarly ingenious to avoid participating in Black Friday.  Not everyone is in as comfortable financial position as I am; I'm far from wealthy, but my needs are met easily enough that I can put away enough money to buy gifts for those on my list without leaving the house or whatever house in which I'm sleeping on Thanksgiving night at 2:00 a.m. or earlier on the morning of Black Friday.

I've begun to treat black Friday almost the way Orthodox Jews observe the sabbath, except maybe not quite as extreme. I don't demand that my aunt put her lights on timers so that no one has to "work" by turning on and off light switches. If anyone feels like cooking something and it's something that's palatable to me, I'll eat it. Usually it's just leftovers from Thanksgiving, anyway.
I do not, however, shop under any circumstances, though I suppose a vending machine would be acceptable if I were desperate for something.  If someone needed medication and didn't have it, I would purchase it for them. It is sort of as Jesus explained to either the Saducees or the Pharisees or both when he said that if an ox falls into the mire on the Sabbath, it wouldn't be right to leave the poor animal there until Sabbath was over. Common sense should apply.

I do not, however, get into a car on Black Friday unless it's the equivalent to a medical emergency on someone's part or perhaps to flee to higher ground because of an oncoming tsunami. (We have a whole lot of tsunamis in the San Joaquin Valley. [sarcasm font])  My Aunt Victoria wanted me to go with her to Aunt Debbie's house to see Aunt Debbie's new piano. (Note: Aunt Debbie is not really my aunt. She is married to my Aunt Victoria's [my mom's sister's] husband's brother. It's just simpler to call everyone "aunt" and "uncle." ) When I was little I was confused about who my actual aunts and uncles were, but I sorted it out by the time I was about four. I'm not sure if Matthew has yet figured out who our real relatives are and who are the relatives-of-relatives or extremely close family friends. He usually just asks me. I made a chart for him once, but he lost it. Anyway, Aunt Debbie lives about three miles away, and it was raining, but my Aunt Victoria was determined that I see and play Aunt Debbie's piano.  

I was willing to put on rain gear and walk the three-mile distance to Aunt Debbie's house. There's an off-road route that will cut the distance roughly in half, but it involves walking  in areas I'm not comfortable traversing. I'm not afraid to walk on the roads around here. If a person goes hiking on trails or across any territory beyond the pastures, he or she is taking chances. There are wild boars, coyotes, bobcats, and even occasionally mountain lions that venture down this far.  I refuse to hike around here unless someone carrying a gun who actually shoots proficiently is with me. That would not be my Aunt Victoria. My mother was going, too, but she would almost certainly be a worse shot than Aunt Victoria is. 

So then Aunt Victoria got the bright idea that we should put on rain gear and ride horses there.  There is exactly one horse (Georgia) on this property that I trust enough to ride by myself. Georgia currently has a sore hoof. I need a horse that I ride to be approximately as predictable as a merry-go-round horse, which Georgia is. My Uncle Ralph said I could ride Georgia if I really wanted to, but it would be uncomfortable for her. I am unwilling to intentionally cause pain to an animal if it's not a rodent, and even rodents I would prefer to kill painlessly. If I found rodents inside, I would transplant them to appropriate outdoor locations, but I'm too afraid of them to do that. Actually I'm too afraid of them to kill them, either. I just climb atop high surfaces and scream for help. If I were alone and saw a mouse or rat inside my dwelling, I would probably dial 9-1-1 if I did not have a heart attack first.

Anyway, my cousin Philip offered a solution. He said that he would ride his horse along with my mom (who can ride basically any horse that's broken) and Aunt Victoria (who can ride a horse whether or not it's broken) and would tote a gun in case we came across a predatory animal that challenged any of the horses. He said unless it's a mountain lion, you usually just have to fire a shot in the animal's general direction to make it retreat. With a mountain lion, one must shoot to kill if the animal is approaching or stalking. And he agreed not to go directly under any trees where a mountain lion might be poised to pounce on unsuspecting riders (the horses often sense their presence, but they rear back and try to throw riders of if the riders try to force them to go forward in such a case.) Anyway, I trusted my cousin Philip to be strong enough to control the horse and shoot at the same time. He's big enough that I would just need to hold onto him to avoid falling.

My mother thought the whole thing was ridiculous and used it as one more opportunity to voice her opinion that I am too strange to have been sired by anyone other than my father. She went along with us, though. She probably didn't want to seem like a wimp driving her car there while the rest of us rode horses in the rain. In the end, after we were wiping down and brushing the horses, she agreed that the ride in the rain was far more fun than simply driving there in a car would have been.

The piano at Aunt Debbie's house was a glossy ebony baby grand Yamaha. I'm not a huge Yamaha fan, but they produce a nice enough product, especially considering that no one in Aunt Debbie's immediate family actually plays the piano yet. I wish someone had asked me. I could have steered her toward a nicer Kawai for a comparable price, but I was not going to tell her that. She is proud of her new piano, and I would say or do nothing to make her less pleased with it or to make her think I didn't like it. Actually, I do like it. I just wouldn't have chosen it for myself. Elton John seems to be very fond of Yamaha pianos, and he's a skilled musician, though part of his affinity for Yamahas is that the corporation will make the pianos in any style or color he desires. He's quite the showman and likes flashy instruments.

My mom and I each played a song on Aunt Debbie's new piano. Then she asked if either of us knew how to play "Music Box Dancer." If there's a song that my mom and I despise hearing or playing equally, it's probably "Music Box Dancer."
Aunt Debbie is such a sweet person, though, that we couldn't deny her the pleasure of hearing a song she really wanted to hear played on her own brand-new piano. My mom and I did a quick rock/paper/scissors game with our backs turned to the group, and I lost. I'm not sure who the real loser was, however, as I'm not sure which is worse when you really hate a song: playing it or listening to someone else play it. Aunt Debbie liked it, which was the important thing. She had tears in her eyes. At least I assume the tears in her eyes were because she liked hearing the song. She may have been crying because she hated the way I played it, as though I was defiling her prized piano. One never knows for certain about such things.

Today, I studied nearly all day to the extent that I was almost anti-social.  I have grand rounds on Monday morning and need to know everything I can learn about the patients, their diagnoses, their proposed treatments, and any other information I can glean. Even though I will be tired, I will make it to the hospital about ninety minutes before grand rounds are scheduled so that I can speak to each of the patients and find out if there is any pertinent information missing from their charts. It sounds as though I'm doing this out of a competitive streak, and such is not entirely untrue, but my primary motivation is that I want to help the patients to get well. I don't have any particular in with young and middle-aged adults -- they tend not to trust me because of my age -- but I'm reasonably good at communicating with the elderly patients. It's like I remind them of their grandchildren, and they will sometimes speak more openly with me than with some of my peers or superiors.  I have an inside track with children as well, but we won't be seeing children on the internal medicine rotation.

Today (or yesterday, technically) I did venture out to watch a cow give birth to her first calf. It looked for a moment like she might have difficulty, but the new little calf (a heifer; heifers are what the dairymen want) got herself turned around and out with relative ease. It took her just minutes to stand and nurse. They only need so many bulls, so the bull calves are of limited value. Unless there's reason, usually due to lineage, that they have potential to be prime bulls themselves eventually, they're sold to ranchers who raise them for beef, but dairy cattle do not provide the prime beef. They don't have terribly long lives.  The little girls have a much better shot at long, happy lives. (Happy cows are California cows, you know.) The dairy at which the calf was born is an organic dairy, which means that the cows get mandatory pasture time, as opposed to the more factory-like operations of non-organic dairies. Organic calves also get a little more time (how much I'm not certain; with non-organic dairies, it's within a day that separation occurs) with their mothers before they're shipped off to calf-raising operations. The calves are bottle-fed a mixture of milk and other nutrients, and their mothers produce milk for consumers. 

The dairy here is a Holstein dairy. Holsteins are the black-and-white spotted milk cows, although red Holsteins pop up on occasion just as black labrador retrievers mate with other black retrievers yet produce chocolate lab babies. Holsteins are desired for the quantity of milk they produce. Their milk isn't especially rich in fat, although there is some fat in their milk. Jersey cows, who are usually a soft brown color, produce the milk richest in fat. Jersey cows are more valued for the fat in their milk than for the milk itself. If you are a fan of cream, butter, or ice cream, you probably have a Jersey cow to thank for it. There are breeds whose milk is in between that of a Holstein and that of a Jersey - more milk than a Jersey, but milk of a higher fat content than a Holstein. Guernseys are probably the most populous of such cattle in the U.S. and Canada.

An incident I had forgotten about but mentioned to a friend briefly was that when I was seven years old, I helped to deliver a cow. The mother was a small heifer, and it was her first calk (hence the term heifer; a heifer is a female calf until she births her own first calf). After that, she is a cow. Cows are females. Males of the breed are bulls are bull calves until they are castrated, at which point they become steers. Anyway, the poor young heifer was having an awful time getting this calf out, and had labored long enough that my uncle and his brother were concerned about her. All three vets they used were unavailable. It was a busy tie for calving. 

My uncle put on the arm-length gloves and tried to reach in and turn the calf, but his hands and arms were too large to go far. Then his brother noticed me. My Uncle was at first a bit skeptical. but decided they had nothing to lose in giving me a shot at pulling the calf out. They put a pair of long gloves on me. My entire hand fit in each thumb slot. Then they took a garbage bag, poked holes for my head and arms, and slipped it over me. I pushed my arms through the holes and was ready to go to work. My uncle's brother showed me with a nearby calf the ideal position the calf should be to come out of the heifer. It needed to be head-first with its front paws extended. I gamely stuck my hands inside the calf, felt for the head, but the head wasn't quite in the direction my uncle's brother had shown me. I told him that, and he said to try to gently rotate its head. I did. Then he said to feel for the front legs and to gently pull them forward, which I did. Then he said to put my right hand over the cow's neck, and my left hand (I'm a lefty) on the cow's chest just below where the legs connected to the body. He said to pull gently. I pulled gently, but gently for me was not enough force to get the calf out. He said to pull a bit harder, but to try to keep the front legs in position. I did and got the calf out all the way to its midsection, with both legs out. The heifer gave another push, and the calf was all the way out.

Sometimes when a birth is difficult, a calf has more difficulty standing than it otherwise would. A cow must stand or it will not survive, but it can receive a bit of assistance. My uncle had a bottle of colostrum ready for the cow. He gave it to me and allowed me to feed the newborn calf.  Within forty-five minutes, the cow was trying to stand, and in less than ninety minutes flowing her birth, she was on her feet, nursing from her mother. The placenta was hanging out, and dropped shortly thereafter. 

I was allowed to name the calf. I named her Christianne. For some reason I wanted her to have a French name. Christianne lived to be almost nine years old. Dairy cows are slaughtered when they can no longer produce milk. With conventional dairy farming, a dairy cow may last only five years, but cows raised in organic environment are given more time between pregnancies, and they spend more time in pastures and less time on concrete, which reduces hoof infections and is less stressful. Still, almost nine years is a long life for a dairy cow. (A cow left to its own devices in a pasture setting, particularly in a mild climate [remember, California cows are happier than Wisconsin cows] allowed to get pregnant when ever she got around to it, and to nurse her own babies to maturity, might live to be twenty or more years old.) It seems sad but dairy farming -- even organic dairy farming -- is a business, and profit is the bottom line.

I don't pretend to know everything there is about the dairy business, but if tomorrow someone gave me one hundred healthy dairy cows and either a quality bull or contact information for of a good artificial breeder, the facility and equipment needed for a dairy, the phone number of a good large animal vet, a tutorial on the business end of dairying, a few experienced milkers, and contact information for a few experienced dairymen to answer inevitable questions,  I'd have a fighting chance at making a go of it. If medical school ends up not working out, I do at least have another career option.

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This photo does not belong to me.  I didn't take my cell phone with me when I wandered out to the shed. It is essentially what I saw today.

Thursday, November 24, 2016

Happy Thanksgiving, and along with my greeting, I offer a gift of the world's ugliest baby until my mom makes me take the picture down.

Unless we are or someone close to us is dying, or our lives are falling apart around us for some reason,  we all know what we should be thankful for. I don't have to blather on and on about it for your benefit or for mine. 

For those who have lost someone recently or are perhaps marking the first Thanksgiving without a beloved friend or family member, I offer my heartfelt condolences. (Note the total absence of the sarcasm font here. I say this with sincerity.) 

Meanwhile, I'm trying to find a picture of the world's fattest baby. She's not truly the world's fattest, but she's in the top 5th percentile for her age I'm pretty sure. I've shared her before, so you may remember her. I'll probably have to take her photo down soon, as she's a relative of a relative, and my mom is nervous about my starting off a mega-extended-family feud.

I FOUND her! I thought I was going to have to add the loss of this picture to the list of things for which I am not thankful. My Black Friday tradition is to dwell on things for which I am not thankful, at least for an hour or so. By then, I am sufficiently fortified to be over it and to move on to the merry and bright Christmas spirit stuff. P.S. Wouldn't you think clothing would be a nice addition to this baby?

Tuesday, November 22, 2016

Pianos in doctors' offices? It's probably OK as long as they're GOOD pianos.

I should have snapped a picture of the actual piano in the lobby yesterday. I'll try to remember to do so this morning.

Yesterday when I walked into the office where I'm assigned for the remainder of my internal medicine rotation, there was an ebony black baby grand piano sitting in the lobby. It had been delivered after I left work on Friday. The lobby of the office where I'm temporarily stationed is only a temporary home for the piano. The doctors in the internal medicine practice housed in the office donated it to the hospital foundation. The piano's permanent home will be on the fifth floor of the building. The entire floor is an open space for entertaining, fundraising, and so forth.

Since the doctors of this practice paid for the piano, they feel that they may do whatever they damn well please with it.  The piano will be needed for a major function to be held on December 16, which is, I think, on a Friday. I would not be surprised in the least to learn that I'm expected to play this new piano at the function on December 16, but of course no one has bothered to mention this to me, much less to ask if I'm available on that night. I could be wrong, anyway. Perhaps John Tesh is showing up that night to play the ubiquitous background muzak-style cocktail party sonic equivalent to gibberish. I may be crazy to think the people in charge would want my services as this supposedly important event.

I'm doing very well if I can accurately come up with the day of the week for December 16.  (There are autistic savants who, upon being given an arbitrary date such as, for the sake of argument, July19, 1969, and can instantaneously come up with the corresponding day of the week. It so happens that I can tell you in that particular case that it would have been a Saturday because it was sandwiched between two other notable  dates in history, which were the Chappaquiddick incident, which happened on Friday, July 18 of that year, and Apollo 11's landing on the moon, which happened on Sunday, July 20 of the same year. As far as having any savant-like calendar skills, though,  I don't.) Right now I'm  living sort of a day-to-day, hand-to-mouth existence. I know that today is Tuesday, November 22 [53rd anniversary of the assassination of President John F. Kennedy] only because my computer right in front of me says so. I can't tell you what day of the week Christmas falls on this year. I don't know what day of the week my birthday, which will happen relatively soon, falls on, either. I would have to count to tell you how many days it is until my birthday. OK. I'll count it. It's ten days until my 22nd birthday. I do at least know which birthday it is. So if we extrapolate the data, one week after my Birthday, which ten days from now would have to be on a Friday, the next Friday would be the 9th, and the one following that would be the 16th.

So at this shindig [I absolutely abhor the word shindig, by the way, and am using it with the most sarcasm my fingers can muster in this font]  I may or may not be expected to provide background piano music. There is another undergrad piano major in my cohort but, at the risk of sounding unkind, and I really don't like to be critical or catty in regard to the skills of another musician as I believe we as musicians should generally stick together and to be more complimentary and less competitive toward each other, the other piano major plays piano as though he is using a sledgehammer instead of his fingers to strike the keys and as though his wrists are weighted down with lead. There's nothing subtle in his style, and the usual chit-chat that takes places at cocktail parties will leave the attendees hoarse by the ed of the evening. That, however , is not my problem.

In any event, a piano, after being moved, needs to be tuned, but ot immediately thereafter. It needs a small amount of time to settle before any tuning job attempted can be expected to hold. The bigger the piano, the more time needed, but the higher the quality of the piano, the less time needed. This piano -- a baby grand -- is large as baby grands go. It's an Essex, which is a Chinese-manufactured Steinway, which, in the grand scheme of piano rankings, would have it as a much better-than-average piano. Those two factors of size and quality somewhat cancel each other out.  A tuner came in after hours last night to tune the piano. A slightly longer wait would have been optimal, but for the intents and purposes of the piano at its present location, three days is probably a perfectly acceptable interval between moving. If Martha Arkerich, Vladimar Ashkenazy, or anyone of their calibre were to play it, the piano alone wouldn't be sufficient, much less the tuning job possible three days after it had been move to a location.

No one of their calibre will be playing it today. The piano will, instead, be played by yours truly. I've been told to bring enough music to play ll morning. I will not bring music because my style of fulfilling such an assignment doesn't involve reading notes off a page. i often use printed music when I accompany out of request for the person i'm accompanying, but if I'm soloing for something formal, I have the music memorized. If I'm playing for something less formal, I play by ear. Books or sheets of music would be more trouble than they would be worth to play elevator music for four hours.

I asked the receptionist to print up a sign inviting patients to make requests if they so desired. Most requests I can probably accommodate. If i know what a song sounds like all the way through, I can play it. If someone asks for "Melancholy Baby," "As Time goes By," "Come Sail Away," "A Thousand Years," "Bohemian Rhapsody," or "Pachelbel Canon," I should be able to play those songs. If someone asks for "Coal Miner's Daughter," I cannot accommodate the request. It's not merely Alexis being a high-brow snob who refuses to tarnish her fingers with the likes of the music of Tammy Wynette, Conway Twitty, or Loretta Lynn. It's just that I haven't heard enough of the country standards to play them. If I had a book of country standards, I would bring it. i do not, however, own such a volume, and I didn't find out until yesterday that I would be expected to play the piano all morning today. By the time I escaped the office, local music stores would have been closed for business. I'm counting on our clientele to be too sophisticated to make such requests.

I've been told to pack so that as soon as the office closes for lunch break, I may be on my merry way to hitch a ride on a charter plane with my friend Tim back to the city in which our parents reside.

I could be resentful that I am being deprived of the opportunity to learn more of the ins and outs of internal medicine, or I could be grateful that the doctors who assigned me to this task are essentially giving me the morning off, and are, additionally, allowing me to leave for vacation earlier than they had to let me leave. I choose to be grateful.

The piano will remain in the internal medicine office lobby for a week following the Thanksgiving break. I'll probably be asked to play Christmas music at least once during the remaining time that the piano sits in the lobby. It will then be moved to the fifth floor and given adequate time to settle before its official tuning, so that it will sound nice for whomever plays it for the shindig on December 16.

I'm glad the fourth-year medical students are off on vacation already and will not be present to wander by and make sarcastic comments just loudly enough to be heard by me about how nice it is that someone can play the piano so that she doesn't have to do any actual work. I'm capable of ignoring them, but it's even better not to have to listen to their comments, period.

Monday, November 21, 2016

Vicodin or Booze: That is the Question

It's more than an hour before I need to be at work. I've eaten breakfast and am dressed and ready to go. One of the advantages of my sleep cycle being off i that I don't wake up to the sound of an alarm at 5:45 on days like today. I fell asleep shortly after getting home from a beach trip with friends, just after showering but before eating. ihe missing a technical dinner was OK since we ate plenty in the afternoon. Then I woke up just before 3:00 a.m. ready to jump out of bed and to begin my day. I should have done more of a workout, but I got 45 minutes of treadmill use. 

We have a workout facility in our condo complex. It has someone on duty 24 hours daily except for Friday and Saturday nights, when it closes form midnight until 7:00 a.m., and a few major holidays as well. Security has complained if I run by myself within our gated complex, so I use the treadmill.  A treadmill run isn't the equivalent to a real run, but when i'.mm 55, my hips and knees may thank me for using a treadmill as opposed to running n a had surface. one a week or so I try to make it to the university's track when the hurdles are set up. The track coaches are so impressed that a tiny white girl can hurdle that they let me use the hurdles during practice as long as I'm not interfering with what the team is doing.

In terms of exercise or anything else and the stone, i'm having to ply it by ear now. Some days are exercise days, while other days are Vicodin days. This stone isn't moving along as briskly as my doctors and I would have it move. I really do not want lithotripsy, and the stone needs to move out of its current kidney-ureter junction for that, anyway, as the shock waves can be damaging to that specific part of the anatomy.  I'm probably going to have to double up on anti-emetic (snit-nausea) meds so that I can increase fluids, and then, o top of evrything else, take flo-max which is a medication typically given to men with prostate problems in order to increase their urinary flo and pressure and make it easier for them to urinate. what it does for a kidney stone patient is to increase the pressure of urinary flow, thereby moving the stone along a bit faster. i know that its just what everyone wanted to hear. I apologize for the excess of information.

Cousin Dan has purchased his ticket to the chaco (I don't actually know if it should be capitalized or not; I must find out) in Ururguay. actually, i have no clue as to where in South america he will land. The chaco probably doesn't have airports or runways. I've been given, by email, one last plea to increase my own blessings by contributing to this all-important endeavor.  No one is stating the obvious, which is that what I would really be doing by contributing to this folly would be to increase Cousin Dan's blessings. nothing about giving ay my money to this wild goose chase would increase my owI blessings. Sorry, Mormons, but it's the gospel truth.

The impromptu beach trip, hurriedly thrown together when I learned that I wouldn't need to work the overnight shift last night, was a blast.  I had to lay off the booze because at this point of my delightful trip through the Disneyland-like state of kidney stone travel, I never know when I'll need Vitamin V.  Vicodin and alcohol do not mix well. It's been done before certainly -- even on purpose -- but the practice wreaks havoc on a person's liver. I personally, value the function of my liver, as I know that transplant livers aren't easy to obtain. Beyond that, I don't wish to be on anti-organ-rejection drugs for the rest of my life. 

Thus, on a given day, I choose between Vicodin and booze. Actually, on most given days, I choose neither of the two. It's just that the kidney stone sometimes necessitates Vicodin in my current situation, and social outings with my peers offer the option of booze. I suppose the option of booze is always there, but I don't even consider it except for social situations, and even then do not always choose to partake. (It would be different if I liked either wine or beer. I can see how a person who likes either might choose to have it with a meal.) I'm not a lover of all things related to alcohol. A nice buzz can be pleasant on occasion, but my suspicion is that it would become increasingly hard to achieve -- that Nirvana-like state between sobriety and inebriation -- the more heavily one consumed alcohol on a regular basis.

I know I work today, but I'm not certain on which day I will be told to take a hike from the rotation and begin my Thanksgiving break. Furthermore, it would be unwise for me to alert any potential stalkers as to what date or time I will be making my way south on one of the major freeways that travels the length of California. It's a bit disconcerting not to know how many days I will be working this week, but I'll survive regardless. I enjoy working, and I enjoy my time off as well. With such being the case, I win either way.

Happy Thanksgiving if I do not communicate with anyone with whom I am in most frequent contact at this site at some time before the big day.

Image result for house md vicodin

Sunday, November 20, 2016

Drunken Cinderellas and the Ups and Downs of School, Work, and Life

When I appeared at the hospital before 11:00 as directed to do so by the 4th-year medical student who is in theory my job superior, the intern in charge of my block wanted to know why I was at the hospital. I told her I was ordered to be there by the fourth-year student who is technically my superior. She was not happy. She sent me home. She told me to contact my supervisory attending physician to determine whether he would prefer that I work the night shift tomorrow or to work the day shift in the office the following day, but that I would not be doing both. I didn't text the attending yet because I don't know what his phone settings are. Perhaps he keeps his notifications audible at night and counts on us not to text him during night hours unless something is a true emergency, which this is not. I'll text in the morning.

I won't say a great deal about the specifics just to avoid making anyone unhappy who happens to be my job superior if such a person has found my blog, but my preceptor was unhappy with technicalities related to my evaluation. She says it will be redone. I was almost OK with taking the maximum scores on the scorable items minus the comments, and , when all is said and done, I may regret having it redone, but the total absence of comments was scary to me, and furthermore, it is now out of my hands. In terms of the test I had to literally run at full speed to take, she offered me the opportunity to retake it. i appreciated the offer, but I'm not concerned about my score.

I'll hopefully find out tomorrow whether I work the night shift tomorrow night or the day shift Monday. I'd prefer to know now, but I do not, and those are the breaks.

I had another xray. The kidney stone is still lodged firmly in the kidney-ureter junction. It is allowing some fluid to pass, so my kidney will not rupture in the immediate future. As long as I'm supplied with the drugs I need in order to be functional, I can work without excessive complaining. 

I dragged myself to the bank and came up with money to feed the missionaries, but sent voice messages and texts to the bishop and to the person in charge of the schedule for arranging meals for the missionaries that on rare occasions I'm willing to help with meals, but I need to be asked in advance, and that any change in the schedule that I have agreed upon must be requested a minimum of 24 hours in advance. (It's a bit funny: the bishop's wife has a kidney stone, so the ward is taking meals to the family; I have a kidney stone, and I'm expected to come up with a meal for the missionaries. It's all about rank in the LDS church.) The coordinator of meals tried to say that she had called, emailed, and texted me, but she has my numbers, but there is no indication that any of the previous ever took place. In today's world with caller iD and all, you can't just say that you called a person when you didn't and expect to be taken seriously. The same goes with texting unless you can prove that you sent it to a wrong number. I didn't come right out and say that she was lying; I merely presented the facts as I observed them to be and allowed her to reach her own conclusion about how I see her actions. If the glass slipper fits, she is most likely Cinderella.

P.S. My DNA kit arrived. I shall try on Monday before work to muster enough saliva to fill the vial, which will not be easy in my current state of constantly fighting dehydration. Since my parents have both had their DNA done, I will learn once and for all whether or not there is a strong possibility that the Maytag repairman had anything to do with my conception. We know it's not an issue of the wrong baby being sent home from the hospital, as there's no way anyone but the actual mother would have taken home a baby as ugly as I was.

This really has little to nothing to do with the price of tea in China. It's a video I googled from a movie based loosely on the story of Cinderella. I obviously don't own it. And I DON'T sing unless the voice of a mediocre-yet-on-key ten-year-old is in demand but the mediocre-yet-on-key ten-year-old is nowhere to be found.

Saturday, November 19, 2016

The Lost Tribes Can Lose Themselves in a Black Hole as Far as i'm Concerned

I worked from 11:00 p.m. Thursday to 8:00 a.m. Friday then went for a meeting for my semi- review. I was given approximately 45 minutes' notice prior to my review. I was under the assumption that these meetings were to be scheduled so that the subjects of the reviews could be adequately prepared as opposed to literally running down the block from whatever hospital at which we had worked overnight shifts wearing bled-on scrubs and barfed-on white coats with uncombed hair. One review panel member, whom I had never met or even seen in my life,  had the gall to comment on my disheveled appearance. The dean of my program was the only person present with whom I was acquainted. She, it would seem, did not do much of a job in advocating for me to the rest of the panel.

The questioners weren't especially cordial or reassuring. I would be very afraid of the results of the review had I not been given a copy of the review form as I was leaving from work this morning. I received maximum scores on all scored items. In the "comments" sections, absolutely nothing was written. I cannot help feeling that this absence of verbiage will be interpreted as  writing between the lines by potential internship and residency programs. I am afraid of the results, just not very afraid.

Following my interview, I was asked to wait outside the interview room while the panel talked about me in the event that they had additional questions. They apparently forgot that they told me to wait, so I sat there patiently for seventy minutes. I could have slept after working all night but was afraid they might have considered me unprofessional had someone come in to summon me and found me asleep. Instead, I poured water from the water cooler into a cup and splashed it onto my face in order to refresh myself. i sent  text to someone and brushed up on material I though might be covered on the test i was to take shortly. After seventy minutes. it was five minutes before my exam was to begin in another building. It was difficult for me to do this, but I approached the door to the conference room. I knocked softly. No one responded. I knocked harder, and still no one responded. i opened the door to find the room empty. The entire panel apparently left out a door at the other end of the room without bothering to tell me that I was excused.

Following my interview. I had to literally sprint from one building to another down the road to take the exam for internal medicine. I'm dealing with kidney stone issues, and the run combined with the kidney stone caused me to have to throw up in the bushes beside the building I was entering to take the test. An exam follows each clerkship. The problem is that the exam is supposed to follow the clerkship. My schedule,  because of complications of my potential HIV exposure and the treatment that followed it, have me three weeks behind the others in this rotation. Those in power decided that, because they did not want to risk anyone giving me the answers or the questions to the exam, and they did not want to go to the trouble of making a new exam for me (each rotation gets a new exam to minimize the possibility of sharing information) it would be my problem that I was three weeks shy of completion of the rotation. i took the exam along with those who were finishing the rotation. I'm sure I did fine. That's not really the point. Had it been may students other than I, they would not have done fine. I suppose that is not my problem.

I stayed awake to speak with a friend, but our wires crossed and we never made contact. I eventually fell asleep at five, and was up, dressed, and at work at 10:50, which was five minutes lates than I would have liked to have been there, but te minutes beofre i was required to be. The shift went without incident. no one did any field sobriety checks in me last night. i wonder why they were so painstaking about it the nght before without even asking a single question about it the last night, but in the end, it's up to me to ensure that i'm fit to deal with patients on a given night. i don't have enough authority to do anything to harm a patient, but still, it's up to me to be in an unimpaired state. I don't know what would happen if I showed up and told them i'd needed to take too many drugs or was too sick to work. Depending upon who was my direct supervisor for the evening, I would either be sent home or told to drink coffee to sober up and to barf in a trash can and to pass out in low-traffic areas. with last night's crew, the latter would have been the more likely scenario.

Most med students were off as of yesterday morning following any shelf exams. Because i missed time due to the HIV exposure thing, I'm expected to work at least through Tuesday and possibly Wednesday as well.  I was scheduled to have this weekend off.

as I was leaving this morning, the fourth year med school student who has no real clout but just enough authority to make my life miserable on occasion, told me that I would be expected to work 11 p.m. to 7:30 a.m. shifts Saturday and Sunday nights. She's going to be gone. ll the med school students ae going to be gone. she did this just to be mean to me. On monday morning, I'm expected to make it to work in the office at 7:45 and work the full day after getting off  at 7:30. There's no time for breakfast or to shower or to change clothing. I like to wear nice clothes and look decent when I work in the office, but it's out of the question on Monday morning. I'm pretty sure this is against state regulations, but I've called and texted my preceptor. she's not taking my calls or returning my texts.

I'm not liking medical school very much right now. Those who have the authority to pull rank do so just because they can. Those who should be high enough on the food chain that they should no longer get their jollies from pulling rank are still doing so, perhaps out of habit or perhaps out of sheer meanness. People in the profession who should advocate for defenseless students are not stepping up to the plate and doing so. I  could take a few classes and be a fully credentialed math and science teacher. Then again, I'd be dealing with obnoxious adolescents, and i don't know that I'm sufficiently masochistic to dothat to myself.  Perhaps I'll just go to work for my father. I could complete a PhD in pathology. It would take me approximately three semesters -- three far easier semesters than the ones I'm currently facing. That is starting to look better and better.

Please excuse me while I barf. I'm having a tough time keeping anything down. That will make it easier to barf all over the E.R. when I show up for my shift tonight.