pineapple, fried egg, and beet root? oh my!

The other day while researching the best way to season hamburger meat for our Memorial Day cookout (ended up doing 1/4 tsp garlic powder, 1/4 tsp onion powder 1/4 tsp salt and 1/4 tsp pepper for each lb of meat) I stumbled across a recipe for an Australian-style hamburger. And I was captivated. In my food-eating experience, I have noticed that sometimes things that initially sound like they would be absolutely disgusting actually end up being pretty tasty. (e.g. balsamic-vinegar-flavored ice cream... it was awesome). The Australian burger was one of those things that was simultaneously kind of repulsive but I knew that I would have to try it to find out. I also figured that it couldn't be that bad if a whole bunch of Australians have all collectively decided that this is the best way to top a burger. The ingredients:
hamburger patty
toasted Bun
slice of cheddar cheese
fried onions
pickled beet slices (from a can)
pineapple ring, grilled or fried
hard-fried egg
bacon
sliced tomato
lettuce
barbecue sauce

The resultant burger was colorful, if somewhat unwieldy.


Ethan and I both agreed that the burgers were actually very nice; the flavors combined to create a comfortably exciting taste. And Reagan appreciated being fed the scraps that we weren't able to finish because the burgers were so freaking ginormous. We won't make burgers this way every time (it's more labor intensive because of frying the onion, pineapple, bacon, and egg) but it definitely be kept in our burger-making rotation. I'm really happy that E is as adventurous an eater as I am; one of our favorite things to do is stay home with a bottle of beer or a glass of wine and and try cooking and eating new kinds of foods. Also, he doesn't make fun of me if I tear up during a tv show (watched the Grey's season finale last night online... it was a little too heavy)

Ethan and the dingo:


Now we're going to go out and sing karaoke and drink Shiner in honor of me finishing family medicine. I have succeeded in getting Ethan hooked on karaoke, which is pretty much perfect.

sit down you're rockin' the boat!

I'm getting the feeling at work that I can't win with my attending. The interns tell me I'm improving. The resident tells me I'm getting better. But the attending tells me that I need to work really hard, because I'm ALMOST at a high pass. A high pass is equivalent to an 84. It is a shitty grade. And I'm not sure how much harder I can work (I'm already pretty darn thorough).

So I called my mom and she gave me this wonderful piece of advice; "Smile and let the B*tch wonder what you're up to." It's a good piece of advice for when I'm stuck in a bad situation. The other advice that was really good came from my friend Karla; "I think we both need margaritas". And so we did go get margs this evening and vented about how awful and smelly our lives are.

so for now my plan is this:
1. call my shrink and ask for some welbutrin stat.
2. think of my boss as dissatisfied with her life and taking it out on me because I'm young and full of potential
3. continue to work hard
4. drink margaritas when not at work. other drinks may be substituted as I see fit.
5. pray to God that I don't go crazy during the next two weeks on this service.
suggestions are always welcome.

investigation- wild birds unlimited

how the hell does the store Wild Birds Unlimited stay open and thriving with multiple stores in the same city? I pass by one like five times a week and never once have I been tempted to enter it. I think they sell exclusively bird feeders and bird seed.

from the website:
"At Wild Birds Unlimited, we aren’t just a birdfood store. We are Your Backyard Birdfeeding Specialist®, here to help bring you, your family and nature together."

so really, they only do sell birdseed and bird feeders. how many bird feeders do they have to sell to be able to keep a store open on Lovers Lane in UP in what I imagine to be a very expensive area to lease? I may enter the store today to do a little investigating. My guess is that it's really a respectable-looking front for a nationwide suburban drug ring. Honestly, can you think of any store name that is more boring or wholesome sounding? I may just go in there to take a nap on a little pile of birdseed.

I'm not dumb

Today for the first time I had a patient's parent lie to me to try and save their own skin. I knew they were lying. I called several clinics where the baby was supposed to have been seen and confirmed that they were making up stories. The baby came in after almost dying, and yet the parent was more concerned with covering their own tail than with giving us correct information to allow us to provide care for the child. This is the reason why I could never go into pediatrics. It's one thing for patients to destroy themselves (the CHF patient on a low-salt diet going to McDonalds when the nurses aren't looking); I don't deal well with seeing parents practice destructive behavior around their kids. gross.

update: got my USMLE score today and am happy to see that the sacrifice of my right hand was not in vain. I did about as well as I had hoped.

stress... less? USMLE studying FINISHED!

I killed a beast today. Her name was USMLE step 1. I am officially on summer break! but before I get all carried away in breakiness, I wanted to share my study schedule so that everyone can be awed by my work ethic. yeah that's pretty much the only reason I would ever write this down--to self promote. but it may also help people looking for a plan in the future so there's another good reason for this post.
Books I used:
First Aid for the USMLE; cut off the binding, got it 3-hole punched and put it in a binder. During my first run through I took notes from other books and added them to my First Aid in order to create a comprehensive source for the later studying.
Rapid Review of Pathology, Rapid Review Gross and Developmental Anatomy, HY Embryology, Neuroscience, and Human Behavior, BRS Physiology, Microbiology Made Ridiculously Simple, Lippincott's illustrated Review of Biochemistry. I bought Katzung and Trevor Pharmacology but didn't use it because it was too much info.
I used USMLE World as my question bank. I thought it was good preparation for the actual exam, although the real test had more questions that were very hard or very easy. The format was identical to that of the real exam. I did all questions timed and unused. After each section I first went over incorrect answers and read the explanations for the correct and incorrect answers carefully, inserting any notable info into my FA mash-up book. After going over the incorrect answers I went over the correct answers to make sure that I didn't get any right by lucky guesses.

May 11: reviewed pictures and margin notes from Goljan RR Path.
May 12: path NBME in the morning, packed my apartment up to move in the PM
May 13: Reviewed Pharm from First Aid.
May 14: pharm NBME in the morning, listened to Goljan audio lectures while moving in the PM. May 15: Moved all day while listening to Goljan, organized study materials.
May 16: Comprehensive NBME in the morning, Mommy came in for the weekend and I did not study again until Monday.
May 19: Biochem: Read FA and transferred corresponding info from Lippincott's Biochem
May 20: Finished Biochem Read-through and transfer from Lippincott's.
May 21: Anatomy; RR in the morning, BRS Physiology. 100 questions from Qbank.
May 22: Anatomy; RR, BRS Phys (+ transfer of info to First Aid), 100 questions.
May 23: Microbiology; First Aid; referenced tables from MMRS to complete missing info from FA.
May 24 and 25: planned to study but my sister came in town for the weekend so I didn't get much done.
May 26: Finished Micro, read First Aid Immunology (supplemented by course materials),
May 27: Cardiovascular and respiratory; RR Path, BRS Physiology, 50 questions.
May 28: Renal; FA, RR Path, BRS Physiology, 75 questions.
May 29: GI; FA, RR Path, BRS Physiology, 100 questions.
May 30: Heme/Onc; FA, RR Path (nearly killed me because there are like five chapters on blood in that book!) 110 questions.
May 31: Endocrine and Reproductive; FA, RR Path, BRS Phys.
June 1: pretended to try and learn pharmacology but really watched five Alfred Hitchcock movies.
June 2: Musculoskeletal; FA, RR Path, BRS Phys. questions in the PM.
June 3: Nervous System; FA, HY Neuroanatomy, BRS Phys. Question in PM. HY Embryology when I wanted a break.
June 4: Nervous System; FA, HY Neuroanatomy, RR Pathology. Questions in PM.
June 5: Practice NBME (#3) in the morning with mediocre results. Flew to DC for my cousin's wedding in the PM; read FA psych on the plane.
June 6 & 7: Nothing. Bridal showers, Rehearsal dinner, Wedding, Race for the cure, shopping, no studying atall.
June 8: Behavioral Science on the plane ride home, practice questions in the PM.
June 9: FA; BS, Biochem, Embryology. Questions in the PM.
June 10: FA; Micro and Immuno. Questions in the PM.
June 11: Practice exam on Uworld in the AM-score encouraging but not perfect. FA; Pathology, Pharm, Cardiology.
June 12: FA Endo, GI, Heme/Onc. Questions in PM.
June 13: FA Musculoskeletal, Neurology, Psychology. Questions in PM.
June 14: FA Renal, Reproductive, Respiratory. Questions in PM.
June 15: practice questions.
June 16-19: tons of practice questions. Finished UWorld. Wrote info from explanations into FA if it seemed important.
June 20-22: re-read weak information and memorized tables from FA. These days were shorter and I spent the evenings watching movies or reading books so that I wouldn't be burnt out for the test. Also, I ate a PB&J every day for lunch in order to build a food routine. it's my favorite food.
June 23: took the test. I ate a 100ish calorie snack between each block, plus a peanut butter and jelly sandwich for lunch. I saved a Dr. Peppr for the break right before my last block as a special treat. I also brought a coozie that says "never sweat the petty things" on one side and "never pet the sweaty things" on the other. I chewed like nine pieces of gum.
I should get my score on July 16th I think. I will be posting re: my satisfaction but not with a number.
Throughout the process, I listened to Goljan audio files during my commute every day, and relaxed in the evening by running a few times a week, watching movies, reading silly books, and drinking one glass of wine or one beer with dinner every night. My daytime study breaks involved celebrity gossip websites and drudge report.
I could have taken it a few days earlier and been okay. I kind of wish I had. But now I'm free of this study monkey on my back, and maybe my hand can heal from this carpal tunnel syndrome (or something... my entire hand is spasming in neurological rebellion from studying so much) . Tonight my church friends had a wine and hors d' oeuvres party and it was lovely (I made caprese salads on a stick) and tomorrow I'm off to Austin to see my family one last time before I start Pediatrics on the 30th. I'm super excited and I'm still getting used to the idea of not having to panic when I'm not on task..l because I don't currently have a task to be on! it's great!

my spine!

I'm an idiot. Even though I hired movers, I was too lazy to pack some of my stuff well enough for them to move it (eg kitchen, bathroom) and so I stupidly inflamed something in my spine and am now paying the price. It doesn't help that I'm spending the majority of my day sitting and studying (even though I dorkily sit on an excercise ball at my desk like Dwight from The Office).
I loved rowing, and it opened up opportunities in my life that I would not have otherwise had... but I'm kind of bummed that 3+ years after I stopped, and more than 2 years after having surgery, I'm still dealing with this thing. Also, I'm being lazy and not doing my exercises like I'm supposed to because it's annoying and I don't want to be the person who has to do PT every day in order to not be in pain. The problem is that I am that person and I'm in semi-denial about it.
I guess the back issues did lead to some good: the research I did last summer on degenerative spondylolisthesis is being presented this weekend in San Antonio. I couldn't go to the conference because I'm studying and I just moved and I don't have an extra $350 to go, but the poster is there and someone might read it. I can't give everything away, but here's a sneak preview:

FASCINATING, no? I'll wait to give all the details until I'm published. If that ever happens. Which I really hope it does.
I kind of want an MRI of my spine right now, but I think they cost a ridiculous amount of money (which my college is no longer going to pay for), I'm not sure that they could do anything about the situation if there was something inflamed, and if I did have to get surgery it would be really awkward because then I would have to choose between the different Doctors that I worked with last summer, AND people that I may want to work with/for in the next few years would see me naked (in the OR). One of my biggest fears is to be seen naked by a doctor I've worked with or by fellow students. If I'm ever in a traumatic accident, I want to be taken to a private (non-teaching) hospital so that I don't have one of my classmates cutting off all my clothes and putting in a catheter. how embarrassing would that be?

Crustacean Sensacean!

that kind of sounds like the name of a Ben and Jerry's ice cream flavor. It would probably be the worst flavor ever created. Unless they did one of their creative things where they just made chocolate bits in the shape of crustaceans...but if they made, say, vanilla ice cream with a crawfish-flavored swirl and cajun seasoning sprinkles, that would be sick.
we had an all-medschool crawfist boil on Saturday. It was a great way to end the school year and I got to meet some people and catch up with friends from the other years. I accidentally made one friend by hugging a stranger after I had mistaken him for someone in my class. he was very polite and acted as if this were a completely normal thing for me to be doing. I may do this on purpose in the future as a way to meet strangers in awkward social situations--just pretend that I already know them, give them a big hug, and enter into the middle of a conversation. Here's a picture of the banquet table.

This was my first crawfish boil, but I was told that it was ABSOLUTELY necessary to suck the juice out of the crawfish's head. tasty!

Here's a picture of the mudbugs dying. But they gave their lives for a noble cause.

My friend Jeff with a crawfish that may actually be half lobster. look at that thing! Also, please note his handlebar moustache.
It is my dream to have a party themed "Mustachio Bashio" and I will require that every man who attends grow a mustache. If they can't grow one, then they have to have one drawn on at the door with sharpie.
I am now finished with second year. I don't have much planned for the summer, mostly 10+ hour days of studying for my USMLE. Here's hoping I don't get any more insane than I currently am. wheeee!

serving the crazy

about a week after the other emails were all sent out, we got another one, which started a whole new round of drama.

From: JL
To: MS2011, MS2010, MS2009, MS2008
Subject: insanity

I know I said I would not email again, but when has my word ever been good for anything? That’s the kind of person you are dealing with. I’ve been good about not holding a grudge and ignored the names on emails sent my way. Some of you may have seen me on the wards and thought “that guy doesn’t look so tough.” The question you really should ask is if you should mess with someone who has nothing to lose. Listen, believe it or not, I actually have multiple degrees and talents and don’t need this too bad. They’ve already sent me away once. I’ve now been to the most miserable places around the world and befriended the scum of the earth, some of whom have considerable skills in technology. So I don’t want to hear about how your daddy worked hard for what you have or how you couldn’t drive a beamer like the kids crosstown. Believe me, this won’t be high school where everybody’s trying to pull us away from each other. So if you think you can take a little scrape here or there, then you should ask if it is worth it to have to go home to your big-time surgeon daddy over Christmas and tell him how they expelled you because you got into a tiff with some angry kid you didn’t even know. So you can tell me or my friends how we are such scum (its probably true). But don’t be telling nobody they can’t do this or that, be looking at us funny on the wards, in fact look the other way if you see us, don’t be breaking our mailboxes with funny computer programs, and don’t be hiding behind some stupid anonymous profile. If you don’t know who I am so you can stay away, then find out fast and find out whom my friends are too and watch out for them and find out who anybody else who might have had even just a pleasant conversation with me on rotations this year too.

ok, the subject wasn't really insanity, but I lost the actual email so I don't know what the subject was. however, the text did deal mostly with insanity and scariness so I think the subject heading was appropriate. later on that day we received several updates from the administration that an "email action team" had been formed (on a Sunday afternoon!) to address the situation of the crazy patient. I actually just wrote "patient" on accident, as J is a student, but as he may soon be a patient of the psych ward I'm going to leave it in because it's kind of funny that my fingers automatically typed it.
The following is an analysis of the crazy.

when has my word ever been good for anything? That’s the kind of person you are dealing with. By this Mr. L wants us to know that he is ape-shit crazy and you can't trust anything he says. He imagines this image of himself to be intimidating, and picturing himself as an intimidating force is soothing to Mr. L.
Some of you may have seen me on the wards and thought “that guy doesn’t look so tough.” Infers that he really is so tough.
The question you really should ask is if you should mess with someone who has nothing to lose. The words "nothing to lose" suggest that Mr. L sees himself as an outlaw, a rogue agent, a man who is willing to do ANYTHING to work toward his ultimate goal (of...?) and will not allow anyone to stand in his way. Kind of like Harrison Ford in "The Fugitive". Also, it denotes poor situation analysis skills, as Mr. L is currently in medical school and has (on paper) a lot going for him.
I actually have multiple degrees and talents and don’t need this too bad. Mr. L isn't doing medicine because he has to, he does it because he chooses to. His other talents include playing the clarinet and being able to type 80 wpm. He can also tie shoelaces with his toes, which would be more useful if you weren't actually covering your toes with shoes before you tie them.
They’ve already sent me away once. to the psych ward.
I’ve now been to the most miserable places around the world and befriended the scum of the earth, some of whom have considerable skills in technology. He knows this other guy in the psych ward who knew how to beat super mario brothers in 3.5 minutes by using a secret key code that only he knew about. Also, one of his friends from junior high once opened his sister's locked diary using a paper clip.
So I don’t want to hear about how your daddy worked hard for what you have or how you couldn’t drive a beamer like the kids crosstown. He's too important for your problems. And he can't spell "beemer".
you should ask if it is worth it to have to go home to your big-time surgeon daddy over Christmas and tell him how they expelled you because you got into a tiff with some angry kid you didn’t even know. He is bad at surgery and therefore jealous of surgeons. He also has delusions of power (ie that the administration will expel a student if Mr. L asks them to).
If you don’t know who I am so you can stay away, then find out fast Because he's an unpredictable outlaw and he knows people with lock-picking skills.
and find out whom my friends are too and watch out for them He has friends. His friends are also crazy and may stab you with a hemostat. It's like a med school gang. They're called the HoSpiTaLiZers, and their color is death.

I'm not sure what the powers at our school have done with this kid, but three strikes seems kind of overly lenient when someone is that unstable. The idea that this person could one day be in charge of other people's lives is absolutely frightening. Also frightening: the week before this email was sent out, there was a bomb threat on North campus. I suspect that the timing was not a coincidence.

Parkland is hilarious.

This week I am on my phlebotomy training rotation. For those of you not medically inclined, phlebotomy means "I take your blood with a needle and a tube". How does one begin to take blood? good question. We watched a 30 minute video, practiced on a classmate (I made sure to choose a skinny girl with good veins...) and then they release us into the hospital to work on patients. Scary, isn't it? I had a patient ask me yesterday "have you ever done this before?" my prompt answer was a very firm "yes!" followed mentally but not verbally by the word "twice".
Yesterday I went with my instructor to the room of a middle-aged guy to get some of his blood. As soon as he saw us, he started insisting that my instructor was a student, that she probably didn' t have any experience, that they always send students in, that he knows better than anyone how to get blood; he never went to school for it, but he gives his wife medicine and takes her blood every day! I refrained from asking him what he did with the blood after he took it out of his wife.
My instructor ignores him or humors him and tries to get into his veins, but they're hard and rolling all over the place. The man insists that his nurse come in to get the blood, and the same thing happens again, all while the man is complaining that no one knows what they are doing in the hospital and they all must be students.
Finally, he says "give me that peice of rubber you got there!" then takes the torniquet, applies it to his own arm using his TEETH to hold one end, and says, "okay, now go on and get you some blood!" At this point only do I finally notice a big circular scar over one of his more prominent veins and it all comes together. I may be naive, but I'm pretty sure I know EXACTLY what kind of "medicine" he was injecting into his wife (and himself)