Mavericks Like Us

Just realized that it's been a year and a half since I last posted.

I'm still at the same job, working as a family physician in an outpatient practice. Things are...okay? at work. Not great, not terrible. That said, we've had 3 physicians retire in the larger organization and have not replaced them. Scuttlebutt has it that no one has even applied for the jobs in the month+ they've been posted. That means somewhere in the vicinity of 6000 patients don't have a doctor and are just getting scheduled on any available schedule, which means all of the providers are booked out for months. On Monday evening one of my patients told me she called to schedule an urgent appointment and was offered an appointment in December. That situation then trickles down to the Emergency Department, bc problems that can't wait but also probably aren't an emergency end up being directed to the urgent care or ED when there are no available outpatient same-day or next-day appointments available. It's just...not great and not contributing to a general sense of wellbeing.

On a more positive note, I got the best feedback of my career thus far in a Press-Ganey comment last week: "omigosh I can be so queer in this office, it's amazing." Me: YESSSSSS IT'S ALL BEEN WORTH IT

So that was nice.

Yesterday I got my flu shot and a covid booster. I felt mildly under the weather after my second covid shot, so wasn't expecting to feel sick. Last night was exhausted, but couldn't sleep bc I was super achy. I called out sick this morning when I had a swoop of vertigo. I was basically that grandpa simpson meme where he walks in the door, hangs up his hat, walks in a circle to put the hat on and leave again - I woke up on time, showered, dressed, got ready for work, called out, back in PJs and back in bed. Now, after 4 more hours of dozing I'm feeling tired and achy but not currently dizzy.

I presume it is because Fergus, upon (eventually) discovering I was still home and in bed, draped himself over my head and face and purred while making gentle biscuits on the nape of my neck. He's a good little bean. <3

Last Thursday people with facial hair were instructed to shave bc the N95 respirator only works if there is a seal; facial hair prevents a seal. If the N95 doesn’t fit, and therefore does not provide any protection, then you have to wear the PAPR, a hood that I call ‘darth Vader.’ The PAPR is in even shorter supply than N95, so requiring staff to be clean shaven will reduce the need for the PAPR. Religious exemptions are allowed. Notably, none of the outpatient providers or staff have been fit tested. I was last fit tested in residency, at which time none of the respirator masks fit and I needed to use the PAPR.

Apparently all of the PAPRs at our hospital are locked up in the security department.

On Friday we were trained on how to do a telemedicine visit. Our first telemed visits started today.

Friday we were sent instructions on how to don and doff PPE so we could reuse gowns & masks. Today we received instructions to reuse gloves 5 times before discarding them.

One of the nurses is out because her husband came home sick from work on Thursday. He developed respiratory symptoms on Friday. Swab came back positive for covid today.

We have been notified of medication shortages. There is a shortage of Azithromycin (the antibiotic in z-pak); only infectious disease (ID) are allowed to prescribe it now. Just received a notice from the clinical pharmacist - they anticipate a shortage of albuterol inhalers in coming weeks.

So, my cousin Tammy's granddaughter was born with an as-yet unidentified liver abnormality. Her medical costs are mounting, and some of the genetic testing that might identify how her condition can be treated is out-of-pocket. Suffice to say, their family is not in a position to pay this cost, so my cousin started a Go Fund Me page. The target is surprisingly low - only $5000 - considering the situation. Please donate if you can, and spread the word. Thank you in advance for your help!
Baby Emerson's liver fund

On Monday of match week we get an email notification that says "congratulations, you matched!" Or, alternatively, "you did not match." We won't know until Friday where we matched, but at least I don't have to participate in the scramble. Whoo!

We each have a one-month obligation in a rural setting. The month and location are largely assigned to us, and the only people getting out of it are those with child care responsibilities or some other extenuating circumstance. Housing is provided to us for the month.

When I received my assignment, I scoffed at it. How could a place :right off rt 95:, less than an hour away from Baltimore, count as rural? Well, let me tell you. The family that is hosting us lives off a dirt road in the middle of some pastures and woodland. I can hear heavy trucks driving by on the main road, but yeah. THere does not seem to be a whole lot out here. I stand corrected.

The apartment itself is cute and cozy. It is above the host family's garage. One bedrom, a small living room/kitchen combo and a little nook in one of the gables that just fits a tiny dining table. I am rooming with one of my classmates who I don't know very well. Given the variabilities in when our respective docs were in the office, we have yet to both be in the apartment at the same time so it remains to be seen how easily we get on. I think it will be a fairly good month in that respect.

In the meantime, I am sitting in the breakfast nook sipping a cup of coffee and listening to the rattling sound of rain hitting the windows. There is snow on the ground, here, and now a great deal of slush and mud as well. I completely forgot to bring boots because there was not even a speck of snow in Baltimore when I left. It completely slipped my mind. In fact, even as I type I realize that I never put the emergency back-up umbrella back in the car, either. Sigh. I will just have to be a wee bit damp today.

It is really lovely, though. There are lines of icicles hanging from every branch of the trees, and the snow in the fields is largely untouched.

I am unsure what to expect from this rotation. Some of my classmates have really enjoyed their AHEC months while others have complained that they did nothing but shadow. While shadowing can serve a purpose, I really hope that that is not all that I do. It gets really, really boring watching other people work all day and as learning tools go, shadowing falls far behind hands-on experiences. My plan is to state outright some clinical goals and my desire to get hands on experience in some areas where I feel I am fairly weak (orthopedic exam & diagnosis, for example).

Last month I was on an ambulatory family medicine rotation, which had me working with a doc in the community. He was a year younger than me (although has been in practice for a decade), also has ADHD, and generally was irreverant in all the ways I love. I really enjoyed working with him and feel I learned a lot about the job of being a family doc. He commonly treated multiple patients for the price of one, for example. One patient would be on the schedule, but they would bring family members with them. When the scheduled appointment was drawing to a close, someone would say something like, 'I also wanted to talk to you about my depression - is there something I could take for that?" and he would write a script or counsel or whathaveyou. That wasn't something he could bill for since the person wasn't on the schedule, but it was a service to the patient and a way of keeping the whole family healthy.

Although this AHEC experience will also be in a primary care outpatient setting, I am not looking forward to it. It will be fun once I am there, I think, but I am kind of a homebody and feel a bit uncomfortable with the unknown. I am working on improving my attitude - by all rights, this should be a good month for me and more-or-less in my wheelhouse.

Last Friday I took the second part of the board exam. This involved a day of standardized patients in a simulated clinic. We had 25 minutes allotted to each patient; 15 minutes in the room and 10 minutes to write a note. If you left the room earlier, that time could be used on the note. Ultimately, I don't feel good about my performance. There was something unnatural enough about the setting/test situation that I kept forgetting to do anything outside the interview/exam. Essentially, I forgot to counsel anyone about anything. Smoking? Not gonna talk to you about quitting! Having sex without barrier protection or any form of birth control? A-okay, don't need to change a thing! I exaggerate, but only barely. I think I remembered to counsel one woman about quitting smoking, but that was it. More than once I made a mental note to counsel about something, but completely forgot by the end of the exam. Likewise, I one put a reflex hammer into my white coat pocket as a reminder to do reflexes. Not only did I NOT remember to do reflexes, I walked out of the room with the hammer still in my pocket. Whoops!

98% of US med school students pass the Step 2 Clinical Skills (CS) on the first try. My roommate just received word that she failed hers, though, so I have zero faith in the outcome of my own test day. If I fail, it should not affect the outcome of the match, but it would entail another $1200 to retake the test. Plus, stress! Do not want.

On the up side, I fully expected to fail the Step 2 Clinical Knowledge (CK) portion of the boards. I walked out of there feeling craptastic about it. Imagine my surprise when I passed! Thank god. \0/

And now is the time on sprockets where I eat breakfast and get dressed so I am not late on my first day.

Tell me, how is your day going, Flist?

My medical school has a 'big and little' program, where first year students are paired up with second year students each year, with the hope that second years will provide advice, a friendly face in the hall, whatever. The day my little moved to Baltimore last year was the day her mom was diagnosed with pancreatic cancer.

This summer, my little (and hopefully her mom) will be participating in a walk-a-thon to raise funds for pancreatic cancer research. I'll c&p their story below:

I am writing to ask that you join me in support of the Pancreatic Cancer Action Network's effort to advance research, support patients and create hope. In honor of my amazing mom who is battling pancreatic cancer, I will be participating in an event with this organization called Purple Stride. Keep reading to see why it's a cause you'd like to support, and MAKE A DONATION ON MY FUNDRAISING PAGE!!

Here's mom's story:

My mother was diagnosed in late July 2011 with pancreatic cancer, 2 months after she began complaining of abdominal pain and went to her doctor. She had a successful surgery to remove the tumor in her pancreas and then began radiation therapy as well as chemotherapy. Things were looking good and we were very optimistic. Most people discover this cancer after it's too late and surgery is not an option, so catching the cancer at stage IB made us feel quite lucky. A few months later, still undergoing chemotherapy treatment, her routine CT scan showed metastases in her liver- the cancer had spread, the drugs were not working, and suddenly my mom had metastatic stage IV pancreatic cancer. The news was devastating. She immediately began a much more toxic chemotherapy treatment. Now we hope that the new treatment is working and will find out soon...

This is an aggressive cancer, and so many people lose their lives to this terrible disease because we still don't have a good way to diagnose pancreatic cancer early, or even a treatment that prolongs life by very much in most patients.

Since Celia sent me this email, it's become clear that no standard chemo regimen is going to work for her mom. They're now looking for clinical trials that she might be eligible to enroll in.

I'm not in a position to do much to help, but I made a small donation and figured I'd make a post, in the event any of you felt like contributing, too. (No pressure, either way!)

Thanks!

Amazing! A politician - during an election year, no less - didn't throw Teh Gays under the bus! I assumed that when Biden and pretty much all of the cabinet members came out in support of same-sex marriage, that Obama was going to do the same at some point. I just...cynically assumed it would be after the election.

But no, he came out in support of gay marriage today!

Watch a star-packed reading of Dustin Lance Black's play, 8. The dialogue is entirely taken from transcripts from the Prop 8 trial, and it is incredibly well-done. Go here to watch it on youtube. The play starts at apx the 30 minute mark, so you may want to hit the 'skip ahead' button.

Then, check out this website to find a staged reading near you. There is a Baltimore performance coming up on March 19th. (It's going to the theater festival at the Mother Ship, for example.)

I thought it was spectacularly well done and have already rewatched several times. Highly recommended!

Sinead wrote an inception story for the Canadian Shack anniversary and it is fantastic! When I idly suggested it yesterday, I never imagined anyone would write it, but she DID and it is fantastically sly meta that works rather well within the Inception universe.

Go and read and tell her how awesome she is! \0/

If I'd known simply posting to DW/LJ would be like some magical self-fulfilling wishlist situation, well. :ahem:

Downton Abbey Canadian Shack - Lucy and Anna somehow end up in North America. (drunktuesdays, I'm looking at you!)

The NSYNC Behind the Music special, Canadian Shack edition. (I want this like whoa, mostly as homage to the fandom I was so deeply invested in a decade ago.)

Bandom - PATD rents a cabin in the Northwest Areas to write their next album. Or, you know, MCR wants to rent the Least Haunted Place They Can Think Of, and this one had a really wholesome, happy-looking Mountie on the website.

The Eagle - come on, there's totally evidence of viking settlements on North America!

Firefly - they had to set her down somewhere to make repairs, and who would think to look for them in a Canadian Shack?

Just think of the implausible characters you could stick in a Canadian Shack:
Jim Kirk, forced to take leave on Earth, decides to sulk in the wilds of Canada!

Veronica Mars! For reasons I can't actually think of at this moment, but who cares! Shack!

Bliss Cavendar (from Whip It) escapes from Texas!

Kenzie and Bo - the travel agent sends them to a shack. For some totally important reason, I'm sure. And then they're...in a shack! \0/ (My imagination is totes The Best)

Bret McKenzie & Jemaine Clement (of Flight of the Conchords), on their super-awesome World Tour. (2 dates in, I don't know. Moose Jaw or something, does it matter? Shack!)

Cheeks and Brady are forced by their PR people to honeymoon in a Canadian shack, far from the paparazzi.

Shawn & Gus, Danny & Steve, Michael Weston & crew, basically everyone ever should spend quality time in a Canadian shack. (And then Fraser can complain about the 'urban sprawl' that is starting to encroach upon his pristine wilderness.)

Or, dude, a silly meta romp where characters from an implausible mix of fandoms are simultaneously stuck in tiny, adjacent Canadian Shacks, like sometimes happens, and have to deal with their neighbors.
(Which actually kind of reminds me of that awesome Popslash story, where characters from WIPs are forced to live in the Abandoned Characters Hotel until their story is finished. Like Hotel California, but even more tragic. Then two characters from completely different years fell in love and tried to trick an author into writing them together so they could escape the hotel and live Happily Ever After? Who wrote that? Is that still up on the net? I'm pretty sure it was someone on my flist. Whatev, it was awesome!)

Anyway, the point is, shacks! It isn't even about the fandoms, it's about the challenge. Its like yuletide, except shorter! And faster! And silly! Really, the shacks challenge is just one of those things that makes me love fans' creativity, humor, and intelligence. I love this stuff! Go and write (she selfishly demanded) so I can read all of the ficlets! \0/

...and now back to my regularly scheduled studying.

Once upon a time, a group of fans were joking about the post-Call-of-The-Wild Due South trope that had Ray and Fraser living in a Canadian Shack (literally or figuratively). And then they started joking that, really, the Canadian Shack should be the universal fandom trope and ALL pairings should end up in a canadian shack. And then, it became a thing. An awesome, awesome thing.

And now, ten years later, everyone gets a chance to play!

Aerye proposed a Sherlock Holmes shack story, which I want to read like whoa.

Then I started giggling to myself at the idea of an Inception shack story, where Eames and Arthur are hired to go into the mind of a fanwriter with a very popular yet tragically abandoned WIP, in order to find out how the story ends.** Naturally, the secret is hidden somewhere in a Canadian shack in the writer's subconscious, because where else would it be?

So many hilarious and awesome possibilities! Go! Write! And, uh, if I ever catch up on my studies (oh, stop laughing, that's just rude), I might try my hand, too.

**Hypothetically, of course, because I'm not wringing my hands about such things right now or anything. Kof.