August 31, 2005

August 30, 2006 at 10:57 pm | Posted in Katrina Blog Project, undergrad | Leave a comment

Wow, lots of catching up to do. Let me backtrack for a second:

August 29, 2005
I went to visit a friend of mine up on campus. She’s the administrative secretary for UT’s student government. We got to be good friends back when I was up to my eyeballs in campus politics, and have kept in touch ever since then. She’s truly an amazing person, and has managed to stay upbeat and centered through the kind of stuff that would turn most people into bitter old hags. She loves her job and does it extremely well and without any drama or fanfare. And she was a total rock for me during some really tough times in college–the kind of times where you find out who your real friends are.

So we had dinner at Trudy’s and caught each other up on our lives. She had been diagnosed with pancreatic cancer the previous summer, and had taken some time off for surgery and chemotherapy. I was taking pathology at the time, so I knew how unlikely it was for someone to survive pancreatic cancer. In my rare moments of freedom to think about other people and their problems, I’d been worried about her. But she was doing well, with no signs of recurrence thus far. She’d started swimming for exercise, and looked great. As for me, she said I looked better and happier than she’d seen me in years, and that obviously being a doctor suits me.

I got home after dinner to reports that the hurricane had passed, and New Orleans was left intact. There was some flooding on the northshore, and in the 9th ward, and Slidell was in bad shape. But the reporters were mostly in the Central Business District, which had some windows blown out but was essentially dry. I breathed a sigh of relief, and wondered how much roof damage my house had sustained. I had called Dan and Mel on my cell phone earlier that day and left a message asking if they want to get together sometime the next day. I got a text message back saying they couldn’t get through to my cell, and to call them again.

Dan and Melissa are one of those couples whom most people considered a mismatch. They got together when she was a sophomore and he was a senior in college. Mel was the former cheerleader, future trophy-wife type, and Dan was an MIS nerd who’d inherited some truly unfortunate hair genes. He was 23 and already mostly bald.

So it mystified everyone what she could possibly see in him, and people thought she must have some self-esteem issues. And supposedly it was “obvious” what he saw in her. However everyone was mistaken on both counts, and to those people who knew them well, they were very evenly matched in intelligence, and complemented each other socially. Athough it wasn’t exactly smooth sailing, since he hadn’t quite broken up with his girlfriend when they started dating. It took almost a year for Dan to untangle himself from his previous relationship, even though he’d known for a while that it wasn’t going anywhere. Frankly I don’t know how Dan and Mel, particularly Mel, got past that, but they did.

In any event, Melissa and I were roommates the year they got engaged. I was mostly good friends with Dan and had been living alone up to that point, but I couldn’t afford to anymore. So I moved in with her because I figured it would be best to live with someone whose boyfriend I already knew and liked, than risk having to deal with my roommate bringing home some drug dealer who’d turn the place into a crackhouse. Then she and I became really good friends that year, and so now I’m friends with them both.

And I just love their kids.

August 30, 2005
I spent the day with Dan and Mel and their kids. It was fun–I hadn’t seen them since summer 2003, and Ryan and Robby are at that age when even a few months makes a huge difference in their abilities and personalities.

This evening I started seeing reports of the levee breach, and rising floodwaters in the city. I stumbled across a website hosted by the second year class that’s been serving as a contact point for them, and decided to join. This evening I heard that the hospitals are flooding.

I wonder, do any of my classmates really understand what that means?

It means the people on the hurricane teams are living a nightmarish existence. And I can picture it all too clearly. The power is probably out in all the hospitals except Tulane, because that was the only one with generators above the first floor. That means Pyxis machines are down, and any electronically keyed access doors are impassable, unless there’s someone inside to open it. So drug access may be limited. Oxygen and ventilatory equipment will be non-functional, and people will have to hand-ventilate with Ambu-bags. Elevators won’t work, meaning people will have to climb however many flights of stairs to transport drugs, IVs and other necessities to patients on those floors. Not to mention that the patients are stuck on those floors, and transporting them for evacuation will be a massive undertaking. Water and wastewater systems are probably broken, so in short order the stench will be unbearable. And there’s no air movement or air conditioning, so it will also be unbearably hot.

Whether I like or dislike the people stuck there doesn’t matter–I feel for them regardless. But naturally there are some I care more about than others. And I don’t know who is on the team this time around, and I’m sick with worry over who might be there.

It’s probably better for med students not to know what it’s like to be in the middle of something like that.

I also know how long it takes to rebuild a flooded hospital, and it’s clear that we won’t be able to continue our clinical education in New Orleans.

August 31, 2005
I spent the day in Houston looking for an apartment.

2 Snickers bars, 1 nectarine and a Diet Coke later

August 30, 2006 at 2:02 pm | Posted in medical licensing exams | Leave a comment

I’m done with Step 2. At the risk of tempting fate, I have to say it wasn’t nearly as awful an experience as Step 1. Hopefully that’s a good sign.

August 28, 2005

August 28, 2006 at 3:04 am | Posted in Hurricane Katrina, Katrina Blog Project | Leave a comment

10am
It’s been a long night of driving. All the LaQuintas are booked solid in Houston, so I drove on through to Austin. Why LaQuinta? Because I know they allow pets. But it feels so good to be off the road finally. But I can’t sleep. I’ve turned on the TV, and I see that Katrina is now a category 4 and strengthening rapidly. And it’s still headed straight for New Orleans.

6pm
Good lord, it’s a category 5. And still headed for New Orleans. Nothing to do now but watch and wait. And hang out with my friends and their kids.

Actually, it’s kind of nice to be back in Austin. I drove through here on the way to New Orleans to start medical school, and stopped for the day to see my various friends who are still in town. It feels like a lifetime ago. I’ve made plans to visit on a couple of occasions, but it always ends up that there’s a test coming up that I need to study for. I’m sure they thought I was just making up an excuse–I mean, who studies all day long, and sacrifices a social gathering for a test that’s over a week away? Certainly not me, back in my college days, or anyone in my group of friends.

Seriously, medical school has brought out a whole different side of me.

My cat votes no on neurosurgery

August 27, 2006 at 9:50 am | Posted in Uncategorized | Leave a comment

I’ve been in Houston for the last few days finishing the manuscript. And I came home last night to find that my cat had peed all over my residency application. And my Step 2 testing permit. I have no idea how she managed to pick out those two items from the massive snowdrift of papers on my desk, but she did.

Fortunately, it was my old testing permit–not the one for my rescheduled exam. Also fortunately, I can reprint my application fairly easily. I actually had already done so while I was in Houston, because I changed some of the schools to which I’m applying.

I decided just to go ahead and apply to all the big research schools, regardless of length and rumors of malignancy. Even though there’s usually some truth to any rumor you hear, it’s hard to know which part it is, and sometimes the piece of truth is so small that you might as well ignore it. But the only way to know is by taking a look for yourself.

So my list is a little longer than it was–I don’t want to sell myself short, but by the same token I don’t want to be overconfident and only apply to top tier residencies. Yes, I have a lot going for me, but so do a lot of people applying in this field, and the surest way not to match is to overestimate your chances. But I’ve been pretty selective about the places I’ve applied that aren’t top-tier research programs. They all have something that makes them a good fit for me. But as for why I would apply to one solid but middle of the road program vs. another has a lot to do with certain very specific things about that program, and often location as well.

My cat is just upset that I’ve been out of town for 2/3 of the month. She doesn’t realize that I’d be taking her with me when I go somewhere for good.

August 27. 2005

August 27, 2006 at 9:49 am | Posted in Katrina Blog Project | 1 Comment

8am
Well, it’s headed straight for us now. Jefferson parish is evacuating, and they’re putting contraflow in place at 4pm today. But Mayor Nagin hasn’t called for a mandatory evacuation yet. I still haven’t decided whether to stay or go. I’ll make up my mind after the 11am update from NOAA. But I think I’m going to end up evacuating, because the Fox guy says this is the Big One. It’s a category 3 right now, and they think it will strengthen some more.
Noon
Tulane has cancelled classes till Thursday. I’m really bummed–that’s four whole days of neurosurgery that I’m going to miss. I’m really wishing now that I was starting on my general surgery month rather than my subspecialties. Of course, my mom is happy. She was worried about me overtaxing myself with the whole one-two, medicine-surgery punch I signed up for. And the truth is, that last month of medicine really wiped me out and I could use a break. But still, why does it have be neurosurgery that I miss? Why can’t it be my ENT block? Or better yet, my trauma block? Grrrr.

I saw my neighbor coming back from the grocery store a few minutes ago. We chatted a little about the hurricane, and I said to her, “If you’re ever going to leave for a hurricane, this is the one.” She nodded, but she did so in that noncommittal way in which you know the person disagrees, but just doesn’t care to argue with you. So I think I’m leaving, but I’m not leaving yet. The freeway is turning into a parking lot, and I don’t want to be out in that mess. It always cracks me up how everyone suddenly panics and decides to leave all at the same time. And they they sit in traffic for hours to get out of town. Like a bunch of lemmings. Meanwhile I usually wait till midnight or so and hardly tap the brakes on my way out. And I don’t think they get to their destination much before me, either. So I’m going to start packing around 6pm, and leave at about midnight when the traffic subsides. And right now I’m going to sleep.

Midnight
Well, I’m all packed up. Good lord, that was painful! But when I decide to leave, I prepare as though I won’t be able to come back. So I’m taking my computer, and my textbooks, and a lot of my files, and all my clothes, and my cat. My car is stuffed to the brim. There are other things I would take, but they’re not critical to my existence, and I don’t have room. The roads are clearing, so it’s time to go.

August 26, 2005

August 25, 2006 at 10:49 pm | Posted in clerkships, Katrina Blog Project, professional ethics | Leave a comment

1pm
I took my medicine shelf exam today. Hooray! One rotation down, seven to go. My next rotation is surgery, and I confess, I’m a little apprehensive. Here at Tulane, only the trauma service makes the students take overnight call, and that’s the one I’ve been assigned to. I didn’t start out on that team, but it’s a funny thing how Tulane manages to push the people who can stand to be pushed, and eases up on the ones who’re struggling. Anyway, I’m with April, Jeff and Sepehr on trauma for the second half of the rotation. It should be a good group. Kristen, Ulana, Chad and Dan are on trauma the first half. I’m starting on neurosurgery for two weeks–wow, they’re just throwing me in the deep end aren’t they? Then I’m doing ENT for another two weeks, which I hear is a great rotation, and then trauma for a month. I’m also scheduled to take part in the time-honored tradition of the Surgical Bullpen, which is where they make all the people who are interested in surgery get up in front of the whole department and present a case. Then the Chairman of Surgery grills us on it, and hopefully we don’t embarrass ourselves.

But that’s all stuff to start worrying about next week. Today I’m going to enjoy being done with medicine. And the medicine shelf wasn’t too bad, actually. People say that medicine and surgery are the two hardest shelf exams all year, so hopefully that’s a good sign. Geeta and Amy and Adam all finished before me, and maybe a couple of others did too. I don’t see how though, since I pretty much went straight through and didn’t agonize much on any of the answers. But it’s a good thing I finished early, because I had a lot of feedback to give on the course and service evaluation form. Everyone was gone by the time I finished that part.

Afterward, I went over to Joe’s Bar and had a beer with my classmates, and made plans to meet up with some of them later at the block party. We throw a block party after the test every block (hence the name). Usually I don’t go, but this time I have some serious steam to blow off.
Also, for the first time I feel like a part of my class. I’ve felt like an outcast for these past two years, but that’s what happens when you fight fair against someone who doesn’t. And sadly, I knew exactly how it was likely to play out before I ever said a word. I just felt professionally obligated to do what I did, and when it’s a matter of professional ethics, you have to do the right thing and deal with whatever crap comes your way because of it. And I did make some good friends in my study group, so it wasn’t like I was friendless. But I’ll admit it sucked. The school really should have seen what was going on and done something to negate it. But it didn’t, and fortunately I’m a strong enough person to weather something like that and know that the day will come when people understand. So this rotation has been great for me. I’ve gotten to know some of my other classmates, and they’ve gotten to know me as well. It’s been really nice.

9pm
After Joe’s, I went home and took a nap. In fact, I just woke up (I hardly slept last night, so I had some sleep to catch up on), and I was planning to get ready and go to the party. But the news is on. There’s a hurricane in the Gulf, and when I went to sleep this afternoon it was headed toward the Florida panhandle. My mom had called to warn me about it just before I went to sleep, and I told her there was nothing to worry about.

Here was the projected path when I went to sleep:

But apparently in the last 8 hours, it failed to make the northward turn after passing over the Florida peninsula and its projected landfall is now moving westward toward New Orleans. Right now it’s a category 2 and expected to strengthen. This was the projection at 5pm today:
10pm
My mom called again, and wants me to evacuate immediately. But I remember Ivan, and how disruptive to my studying that evacuation was, and how the storm had veered off once we’d all left town. So I’m waiting to see what happens overnight. Instead of going to the party, I’m staying home to watch the news and see if I need to leave.

I’m flipping between channels, and they definitely seem out of sync on their projections. I’m paying the most attention to the Channel 8 guy’s predictions, because that dude has called every hurricane accurately so far. He was the guy who said that Ivan was going to veer off, even before NOAA did. And way before any of the other news channels. He actually called it before I left town, but at that point I didn’t know whether I could rely on his forecast or not, so I played it safe and left. But I stayed for Hurricane Dennis this year because he said it wouldn’t hit us, and he was right.

Midnight:
As the night goes on, the projections are becoming more and more concerning. I wonder if my classmates have any idea what’s headed our way, or if they’re all drunk and oblivious right now. I’d bet on the latter.

Here’s the projected path now:
But who really knows what Hurricane Katrina is going to do at this point? I’ll just have to keep watching. It’s such a pretty name though–what a shame that they have to name hurricanes. If it happens to turn into a really bad one, then anyone who happens to have that name is cursed with stirring up bad memories anytime they meet someone from the area it hit.

Katrina Blog Project

August 21, 2006 at 12:30 am | Posted in Hurricane Katrina, Katrina Blog Project | Leave a comment

A fabulous idea from Dr. Hebert. I’ll participate as long as I can, but starting on September 4, I’ll probably be too busy. And I’m not sure I’ll have computer access.

Wake me up when september ends

August 20, 2006 at 10:18 pm | Posted in Hurricane Katrina, New Orleans, personal favorites, professional ethics | Leave a comment

It’s been almost a year since Hurricane Katrina, and the storm still looms large in the collective consciousness of New Orleans. As I drive through Uptown, everything looks almost back to normal, with a few changes here and there. The Winn-Dixie still isn’t open 24/7 like it used to be, and the Wendy’s on Tchop is still closed. Thimbelina’s has moved to bigger quarters (which it should have done long before the storm). And Whole Foods probably still isn’t serving breakfast on the weekends (I don’t know though–I haven’t managed to get up early enough to check). Starbucks is still closed (and still no one misses it). But all the stoplights are fixed, and the buses are running down Magazine, and nearly all of the storm debris is gone.

The area around Charity Hospital is still eerily deserted, and when I walk into the medical school building, I’m disoriented by the changes and the emptiness. I don’t even know where the computer lab is now. And Lord only knows where my mailbox is, or if I even have one. I feel like an alumna already, I have so little to do with the day to day life there.

I’ve been thinking today about what I would do if it were my turn to be on the hurricane team and I got caught in the aftermath of a storm like Katrina. I’d do my duty, I’m pretty certain. But what kind of toll would it take on me? I might be as bad off as any patient, and the last thing anyone needs is another person to take care of in such a circumstance.

The bottom line is, I evacuated because I had the option to do so, and when you have the option to do so, you should. It’s bad enough to have to stay at the hospital in a storm like that, but to have the added burden of worrying about people you care about who didn’t evacuate is unpleasant, as well as unnecessary. I didn’t know who was stuck at the hospital until several days afterward, and let me tell you, I was nauseated with worry that whole time. To make someone else worry like that when you have the option to get out is just crappy.

It’s true that I had a feeling beforehand that Katrina was the Big One, and that I had flashbacks of the days at Methodist immediately following Allison, and knew that Charity wouldn’t be the safe haven that hospitals are supposed to be in a storm. And I was scared, as anyone in their right mind should have been. But I’ve never been one to make decisions out of fear, and although I say I did, the truth is I didn’t in this instance either. I left because instinctively I knew that the fewer people there were to worry about, the better. And I didn’t want anyone worrying about me.

There are people who say that it wasn’t a courageous act for those on the hurricane team to stay, because that was their job. Well, I beg to differ. Courage is doing your duty despite your fear, and despite the danger. Even if it’s your job, it’s still your choice to do it or not. And even if you crack under the strain, it’s still courageous to make the attempt. So I have a lot of respect for the people who stayed out of duty, no matter what they had to do to make it through.

But it is not courageous to risk life and limb when it’s not called for, and you are not serving any higher purpose by doing so. That’s foolish at best, and narcissistic at worst.

Whiskey Tango Foxtrot

August 20, 2006 at 1:44 pm | Posted in medical licensing exams | Leave a comment

I’ve been trying to study for step 2, which is now 10 days away. Qbook is pissing me off. You know it’s bad when you have to choose between the standard cookie cutter answer, and the answer that you know is more correct in the specific situation outlined in the question. Or when there’s really no answer that fits, although one of them might if it weren’t for some nitpicky detail that’s either present or missing in the case.

I mean, I am still missing questions due to knowledge deficits, and there are actually some diseases covered in there that I’ve never even heard mentioned in 3+ years of medical school (polyendocrine deficiency syndrome? WTF, did they just make that up?). But mostly I find the questions to be of the “guess what I’m thinking” type, where there’s a sweet spot of knowledge required to answer correctly, and either too much or too little will lead you astray. And they say stuff in the answers that clearly indicates that the question writer didn’t even consider the issue that led me to another answer. Or the answer’s flat-out wrong, or based on presumptive results from a trial that’s still underway, or wouldn’t present like that, or any number of other issues.

All in all, it’s very frustrating.

Nothing ventured, nothing gained

August 14, 2006 at 8:42 pm | Posted in medical licensing exams, neurosurgery | 2 Comments

Well, I was just about to shell out a hundred bucks for a question bank covering Step 2 topics, when I remembered that Tulane had bought us access to ExamMaster this past year. Now, I have no idea whether ExamMaster is any good or not, because there’s almost zero word of mouth out there about it. But since my score on Step 2 doesn’t matter a whole lot, I might as well use whatever free resources I have on hand. I did OK on my shelf exams, so with a reasonable amount of studying, and some focused effort to learn OB/GYN stuff, I should be fine.

I doubt I would have used it for Step 1, though. The stakes were just too high to be using an untested resource.

So I think I’ve figured out where to apply. My ideal program would be 6 years total in length (including intern year), with a full year of research, good breadth and depth of research mentoring, especially in neuro-oncology, be known for producing technically excellent surgeons, have a 6 month peds component at a hospital with a strong peds program, be rigorous but not malignant, and be someplace with good weather most of the year.

I did not restrict myself to any particular region. Why should I?

I mean, really, tell me why. It’s not a rhetorical question.

Of course, no program has it all. So I compromised on something with every program. A lot of things if both the peds and the neuro-onc were there, not as much if one of those two were missing, and not much else if both were lacking. The only two programs that didn’t have to meet my criteria were Tulane and LSU, because they’re my home programs.

As my research mentor says, it’s like dating. Dating indiscriminately is a sign of desperation, and so is applying to a bunch of programs without screening them based on your own goals. She also said that programs know where else you’re applying, even if you don’t tell them, and you want to be able to explain clearly why you applied to their program in particular.

Now, I’m not entirely sure I’m competitive for all the programs to which I’m applying. But you never know if you don’t try.

Which brings me to one last thing. There will be no more talk of the guy on here. I had a point to make about how inappropriate it is to talk about things in a public forum that should first be shared privately. (Edit: why is that a problem when it’s all things I’d want to hear? Because when no name is mentioned and I haven’t been told privately, I have to assume it’s not directed at me. My other choice is crazy by definition. So I lose either way, and THAT’s what pisses me off.) Well, the mile is up and I’m well aware that women’s shoes aren’t made for walking. So no more of that from me.

A Proposal for Radical Changes in the Drug Approval Process (NEJM)

August 10, 2006 at 1:57 am | Posted in Uncategorized | 2 Comments

No, no, no, that just makes too much sense.

Someone else who will be single for a long time

August 8, 2006 at 6:20 am | Posted in Uncategorized | Leave a comment

Nice to know I have company.

This is not Beth Israel

August 7, 2006 at 5:47 pm | Posted in Uncategorized | Leave a comment

Alright, now I’m worried. Lately when I talk to my mom, I get the sense that she’s not entirely with it. Her capacity for handling anything complex has decreased substantially from a year ago. It seems like some sort of frontotemporal dementia, because everything I notice is related to behavior and executive function rather than memory, but her MRI looks like that of a 20 year old.

It could just be an inordinate amount of stress that she’s under, because pretty much everybody gets like this when they’re under too much stress. But again, the level of stress at which she becomes dysfunctional is markedly less than it used to be. So I don’t know.

This is part of medicine that I hate: the part where we say, “we don’t know what it is, so let’s just wait and watch until it declares itself.” Often by the time it does, there’s nothing to be done, whereas if it had been identified earlier, there might have been options. I’m just not comfortable doing nothing when it’s MY mother we’re talking about.

Which is probably why I tend to be a pretty aggressive clinician. I always think, “What if this were my mom? Or my dad? Would I let this bit of poor care slide? Would I be content to let days go by while we try halfheartedly to figure out the problem? Would we be so ready to accept a poor outcome and not question whether there was anything we could have done better?” The answer is always no. And yet, here at the bottom of the chain, I get poo-pooed for feeling any sense of urgency about the situation. As though it’s the mark of the uninitiated.

Well, unlike most medical students, I actually do have enough experience to be as jaded as the rest of you. And it offends me to be patronized for still caring.

Area Man Calls for Immediate Release of his Endorphins

August 6, 2006 at 4:09 pm | Posted in Uncategorized | 1 Comment

Ahh, I love the Onion.

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