It's all relative

This is just too good not to share. While eating hot chocolate chip cookies this morning (never too early for cookies), I asked one of the fellows if he had a good mechanic here in Nashville since my ol' buddy the Blazer is having more aches and pains than he used to.

Fellow: No, no. You know, I'm one of those guys who treats the mechanic like the doctor and the dentist. I know they're just gonna have bad news for me, so I just don't go.
Me: Ha. You're gonna be one of those little old men, huh? Who thinks he's healthy because he never goes to the doctor.
Fellow: Yup. I had this guy in residency who had Crohn's disease* who developed an enterocutaneous fistula** and had stool oozing from his anterior abdominal wall.
Me: Yick.
Fellow: I know, right? He let that go for six months before he came in! I mean, if I had stool coming out from my abdominal wall, that would make me go to the doctor like right then.
Me: Yup.
Fellow: Similarly, if there was stool coming out the front of my car, I would take it to the mechanic right then.
Me: Well, at least you have your limits.

*inflammatory bowel condition - can cause very icky things
**very icky thing in which a tract develops between your bowels and your skin

Making amends

Well guys, Izzy was a little upset about yesterday's post. Not about the crackhead comment, but about what a bad picture that is when I'm always calling her my pretty girl. So I promised her I'd make it up by posting a more flattering shot.

That's her pensive look. But you know how it goes, right? If you give a mouse a cookie... So then Dallas and Jonesy got upset to be left out of this post. Pet mommas like me can't play favorites, so here's one with all my precious furry babies.

And because I know you're wondering what could possibly be so interesting as to enthrall all three dogs that much, here's a different angle on the same scene.

Yes, that was our Christmas turkey, and yes, they all got a hefty share of leftovers.

On a completely unrelated note, I have only 88 days more of residency!

A dog story

My alternate title for this post was "If Izzy were a crackhead," but I decided that might be PG for "adult content - drug use" and get me screened by the blog police. BUT, if Izzy were a crackhead, this is what she'd look like...

Hilarious, huh? But this begs the question of why my sweet puppy looks drugged. Well, she was drugged. Conscious sedation. For a doggie dentist appointment. Both she and Jonesy got the royal treatment on their pearly whites last week in an attempt to minimize future doggie dental costs as well as curb an outbreak of dog breath. The vet said they both did well, but Izzy was apparently a light-weight in the sedation department and spent the whole day recovering in a lethargic stupor. She spent the whole ride home looking very worried, as always occurs with her in the car (she is one carsick pup); I'm guessing they gave her doggie Phenergan though because she didn't throw up, which is a first for her.

Jonesy on the other hand, was in hog dog heaven. He loves him a car ride, especially with the window down and the wind whipping through his hair fur. He wasn't as zonked as Izzy, but I did catch him falling asleep with his head propped up, enjoying the breeze.

Dallas won't be due (in our opinion) for a cleaning for another couple years, but she was very sad to be left out of the big adventure. She just kept sniffing the other two all evening, like they were foreign material. Especially their little shaved arms where their little doggie IVs had been. But she shouldn't be too sad; they'll all get to go to the kennel together for our California trip in a couple weeks.

My gift to you

So I've had enough time to do a little baking lately. And by a little, I mean a lot. Let me take you on a highlight tour of my latest culinary escapades.

Pumpkin flan:

This recipe started out as buttered rum sweet potato flan. It turned into pumpkin flan when I had no sweet potato but did have some canned pumpkin. I have purposefully provided neither a link nor a picture because it was that much of a dud. And I quote my husband, "Will you be upset if I don't finish it?" Something about the texture was just not right. Maybe it was my substitution, but overall it was too much work for the product. I won't be going there again anytime soon.

White chocolate strawberry pie:

Eh, OK. Honestly, it looks better than it tastes. Creamy and smooth, but considering the dirty dish quotient (tastiness to size of dish pile ratio), just not really worth it. And calorically devastating, too, with a whole pint of whipping cream, a bar of cream cheese, and white chocolate. Might be less off the dish and calorie Richter scale if you substituted Cool Whip for the whipped cream, which I think would keep the light, creamy texture but decrease the dirty dish burden. This will be going to Bible study for mass consumption because I'm putting on weight just thinking about it.

Red wine chocolate cake:

Sigh, the happy kind. I find myself the frequent victim of the following predicament: I buy a bottle of red wine for cooking but only need a teensy-weensy bit. I then spend the next week scouring my cookbooks for recipes to use up the rest of the bottle since I paid good money for it. A Food Network show recently gave me the idea to try it in cake, and this recipe gave me a final common pathway for all that leftover wine.

A hefty 1 1/4 c. wine keeps it moist with a tender crumb, but the flavor isn't overt. Just gives a little depth to the chocolate in my opinion without tasting like wine. People at work noticed the change, but no one guessed red wine until I told them. And these went fast - lots of seconds, which people are usually too polite to do. This cake doesn't really need much on top; I tried buttercream on one and felt it just covered up that delicious, unique flavor. Chocolate ganache complimented the flavor better than buttercream, but honestly my favorite for this was just a light dusting of powdered sugar for presentation and eating the thing dry. And I am an icing fiend - the one who always secretly positions herself to be in line for the corner piece. 

On a practical note, doesn't store well past 2 days. I baked as cupcakes, which required 16-17 minutes in my oven. My only caveat is that the result surely will vary greatly depending on which wine you use; something dry was recommended (whatever that means). That being said, I used cabernet sauvignon. You are welcome.

Happy baking!

Anxiety provocation test

It doesn't take much to stress me out. I just don't know what to do with my type A self unless I'm worrying about something. This is a problem I've been working on for a long time now - like my whole life. And I've finally started making some progress these last few years. Well, that's all out the window because fellowship is on its way. Interviewing and matching were stressful, but I've been basking contentedly in the joy of returning to Houston come July 1.
Then came (dum dum DUM!) the e-mail in which I was informed that July 1 really means June 27. First, I was excited that they're still planning on me being a fellow there. Then I went straight to worry mode. My last day here is June 23. So I have 72 hours in which to move the 800 miles from Nashville to Houston. No easy task, eh? But then I kept reading about all the required paperwork and orientations and badges and on and on and on, which catapaulted me from worry into all-out panic. This was certainly not helped by the format of the e-mail: red type, all caps, bolded, with yellow highlighting. It's like they want me to have a heart attack!
Don't they know that we all need these jobs? I have no other marketable skill set, so I'm already planning to do whatever it takes to keep my future employer happy. No need to utilize scare tactics. But it surely worked. I promptly printed off the 41 (yes, forty one) page document and went straight to work. If I'm lucky, I'll have it completed by my start date. Let's just hope June 27 doesn't actually mean something else, like June 15.

Breakfast, updated

It's funny how time warps itself when you're up all night on call. When the sun rises, things that happened only a few hours ago seem so very long ago. Like dinner. Six a.m. rolls around, and my tummy begs for food in a very loud and obnoxious manner. But there's often no time to hunt down an emesis basin (remember this?), let alone haul it all the way downstairs to the cafeteria. So you just gotta make do with what you can scrounge up. Kinda like MacGuyver. The nurse station is always prime hunting ground. Just don't tell them I told you so; that food is for patients only, young lady!

Yum, chocolate milk!

Class effect

I followed a Subaru out of the parking garage today, which got me thinking about things for which I have an irrational aversion. Things that just plain irritate me when I encounter them. Like SSRIs cause hyponatremia, the following never fail to get under my skin...

PS Please take no offense. This is all in fun. And I'm sure something about me annoys you. :)


10. golf
Stemmed by memories from my childhood of my father saying he doesn't play golf because that's for doctors who don't love their families. Not categorically true, I know, but neither categorically untrue.

9. hiking sandals
See example here. Unjustifiably ugly. And honestly, how is a sandal ever a good idea for hiking?

8. puffy and fleecy vests
Especially when worn indoors over a shirt and tie. Like you weren't sure if you were going hiking or to the office, so you just thought you'd dress for both. Not OK. Ever.

7. fake blond hair
I think this requires no explanation from yours truly.

6. yellow
Blame this one on my childhood bedroom and the horribly mistaken concept of my parents that "yellow is good for a boy or a girl." I'm overcoming this one little by little, but it's taken a decade. Or maybe it's related to #7 above?

5. too many people who all look alike
I'm not talking about uniforms. I'm talking people (usually family) who are the spitting image of each other. Now a dad or mom with a single kid is cute, but something about seeing parents with 8 kids who all look like mini-me makes me wanna scream, "Get your own genes, for crying out loud!"

4. store-bought pie
OK, here's the low-down. That pie will always taste store bought, no matter how many times you say how you can't even tell the difference between that and homemade. Yes, you can. And I will always, always bring something homemade to which people will flock like seagulls, leaving your store bought yickiness alone and lonely at the end of the table.

3. those roundey-bottom shoes that claim to whip you into shape
Eg, Skechers Shape Ups or Reebok Easy Tone. For so many reasons, the foremost of which are ugliness and ineffectiveness. And the fact that almost every nurse at the VA wears them. Enough said.

2. mayonnaise
It's the goopiness. I almost can't handle making Nick a sandwich.

1. Subarus
I know, it doesn't make sense. But I have a visceral reaction, especially to the station wagons. I think it's the whole idea of function over form to which I am categorically opposed.

Survey says...

I've mentioned how I volunteered to give some med student lectures, which makes for great teaching opportunities for me and more practical, on-their-level teaching for the students. But I have two problems in this situation.
1) I can't not volunteer myself for things.
It isn't even that I can't say no; I just sign up before I'm even asked! Like 4 of the 10 med student lectures. And the ACP poster. And moonlighting. And the fibromyalgia paper. Wait, make that two fibromyalgia papers. Get the picture? Nick tells me I have no one to blame but myself.
2) I love the sound of my own voice.
Just ask Nick. Or anyone who's ever lived with me for that matter.
So when the resident heading up this little project kept e-mailing out week after week asking for volunteers because she couldn't fill the spots, I just kept signing up. It was fun, but I admit that I was a little afraid of the heckling that was sure to come on the students' course evaluations. I mean, I know they have no bearing on my graduation or matching or really anything frankly, but I couldn't help being anxious to know what they'd say about me since I really invested myself in this. And you know what...They liked me! They really liked me! I averaged 4.66/5, which is 0.2 above the average average. Big deal, right? And med students can be brutal - I mean, they sit in a lot of lectures and take out their bored frustration on those dumb evals. I know, I've been there. Here's my favorite comment: "Beth Scholz and [other resident] in particular were great teachers."
No, I take that back. My favorite was the comment about all these lectures they have to go to are a bit excessive. I won't quote to protect anonymity (as if anyone cares), but that is nearly verbatim. Um, I'm sorry. Did you not understand the title "med student"? It's kinda what you do. Go to lectures. And read. And then go to more lecture. And write notes. And do a rectal exam before you go back to lecture.
Whew, I can't even tell you how glad no one can ever make me do that again. Be a med student, that is. I've already signed up for the next round of teaching. :)

Gullible me

Earlier this week the pulmonary attending told me he was taking the current fellows and resident (that's me) to breakfast at Pancake Pantry before work. He said to all meet there around  6:30am. Later that day, I asked the fellow about it.

Me: Hey, about breakfast tomorrow. Is that for real?
Fellow: Huh?
Me: I mean, everyone's really gonna be there, right? Or is it a joke on me by the fellows? Like, hey, let's all tell Beth to be at Pancake Pantry super early, and then no else shows up!
Fellow: Ha, ha, ha. No, it's real. He does this every month.

I showed up promptly at 6:29am, and everyone was indeed there. Breakfast was delicious.

I told you that story to tell you this one. Clinic was a real doozie today - payback for the >40% no-show rate over the last few weeks. So I texted my fellow just after 5:00pm.

Me (text): Clinic crazy. Just finished w/ last pt. Writing notes, but call if I need to come back.
Ring, ring.
Me: Hello?
Fellow: Hey, Beth. I'm glad you called. We had a pretty quiet afternoon, but we actually just got called about this guy with big lung nodules.
Me: Oh, ok.
Fellow: He's got RA [rheumatoid arthritis], so we think it's probably just rheumatoid lung.
Me: Hmm. Wow.
Fellow: I was gonna see him, but we thought you might want to instead since it's a rheum thing. So how about you run back from clinic and see him real quick. Then maybe present to Dr. E in an hour or so? I mean, since you got out of clinic so early.
Me: Uhh, ok. (pause in which I gather the strength to put fake perkiness in my voice) I can head back over right now.
Fellow: I am so messing with you.
Me: Oh thank goodness because I would NOT have been able to feign interest for another hour!
Fellow: Ha! You did a good job of faking interested just now. Ha! No, we had a really light afternoon. I just wanted to mess with you.
Me: So Pancake Pantry was real, but this was not.
Fellow: You got it. Have a good weekend. See you Monday.

Bumblebee

Why Tennessee is not for me...
Reason #2: I have a low tolerance for bumbling.

We took Izzy to the vet for a skin thing. The vet gave her a prescription, which also happens to be a people medicine. We therefore took it to a people pharmacy to be filled on the cheap rather than pay through the nose at the vet office. I approach the window. Italics indicate inside-my-head thoughts. :)

Me: I have a prescription. For my dog.
Pharmacist (heretofore known as "Bumbler"): OK. Birthday?
Me: Uhhhhh, January of... Hmmm, 2005.
Bumbler: January the what?
Me: I don't know. It's a dog. I don't know what day she was born. Like it matters. Um, January 1.
Bumbler (with look of incredulity): January 1, 2005?
Me: Yeah, sure.
Bumbler: Been here before?
Me: No.
Bumbler: Oh. Fill this out.
I complete the form, including the section under "Is this prescription for an animal?", and hand it back to him.
Bumbler: Izzy, huh? That's an unusual name. Where'd you get that?
Me: What's it to you? Short for Isabelle.
Bumbler: Whoa. Is this prescription for an animal?
Me: Yes. What clued you in? The part where I said "for my dog"? Or maybe it was the prescription with the big picture of the dog on top and the words "Veterinary Hospital"?
Bumbler: OK. So I need your birthday and name.
Me: February 13, 1982. Beth Scholz.
Bumbler: Are you two at the same address?
Me: Yeeessss. No, she has a condo on the other side of town.
Bumbler: OK. I'll need 25 minutes.

I do some grocery shopping and then head back to the window.

Bumbler: Oh, hi. I need to know if it's a male or female.
Me: So apparently us discussing how my dog has a girl name and me circling "female" on your little form wasn't clear enough. Female. O. M. G. Please don't tell me he's been standing here this whole time, not filling my prescription, just because he didn't know if she's a boy or a girl. Like it matters - it's a DOG!!
Bumbler: OK, just let me print her sheet off, and I'll fill it.
Me: OK. Aaaaaahhhh!! Aaaaaahhhh!! Aaaaaahhhh!!

I'll spare you the details of our conversation about how I plan to feed these pills to my dog, but suffice it to say that I walked away with the impression he'd never heard of giving pills to a dog before. So there you have it, one more reason not to like Tennessee.

Serendipity

This post could be about that fact that I've had my LAST in-house call forever and ever and ever. But it's not. It's about a chance encounter in the MICU. I sauntered down there the other day to bounce some ideas off the fellow and resident, seeing as I'd hit a mental dead end with one of my new admissions. So I'm leaning on the counter, telling the other resident my story, when her eyes get big as she sees something through the doorway into the patient room behind where we're standing.

Resident: NO NO NO NO NO NO NO!!!! Mr. Smith, don't pull on that! NO NO NO NO!!!!
Me: WHAT?!?!
Resident: He's got his Dobhoff!*
Me: Aaah! (Dive into the room and grab the Dobhoff and his hand.) He won't let go!
Resident: Aaah!!
Nurse: Aaah!!
Resident and Nurse rush into the room, and all three of us wrench his vice-grip of Dobhoff-pulling-death open.
Resident: Why are you doing that?! If that one comes out, you just have to go through getting it put back in all over again! (Translation: I do NOT wanna wrestle with you over another one of those!)
Patient: (I am so not making this up. It's the truth, the whole truth, and nothing but the truth.) But no one told me I couldn't take it out.
Resident, Nurse, and Me: Sigh.
Resident: Well, now you know. Don't take it out.

*A Dobhoff is a type of nasogastric tube used for feeding. It's a very thin caliber, so it can stay in for weeks. It also has a metal tip to help weight the bottom, which in theory helps keep it in place. This also makes it a dangerous weapon of gastric perforating proportions. Therefore, nurses can't (ie won't) place them. This means each Dobhoff tube represents a very personal, hard-earned battle on behalf of the resident. This emotional investment is reflected in the overuse of !!! in this post.