Stamping this on my brain...

I am putting this here mainly to remind myself later down the road. Mom, remind me! I overheard some attending physicians discussing residents today, and what they said needs to be stamped on my brain. Here's what they expect:

#1- A resident needs a get-it-done modus operandi. YOU are responsible for the patient, and you need to follow through all the way every day. A resident cannot be passive. If your patient has a problem, get up and go see them. If you order an intervention for your patient (transfusion, for instance), watch them during, after, and check them periodically YOURSELF. In general, do stuff YOURSELF. Don't ask the nurse to do it. Don't tell another resident to do it. DO IT.

#2 - Really an extension of #1 - Get your skills under your belt (checkoffs done EARLY) and use them whenever you need them. This means: blood draws, lumbar punctures, rectals, pelvics, paracenteses, and the rest. If your patient needs it, JUST DO IT. No getting someone else to help you/ sort of do it for you and then saying "can I check it off?" Do it yourself.

#3 - Have your clinical reasoning down pat. We follow algorithms sometimes, but we think it through...that's our ROLE. Thinking, reasoning, knowing why we do A not B. Knowing why A didn't work and when to switch to B. If you can't reason it out, read until you can. Again, take responsibility for your ability to think it through.

#4 - If you think you are 4's and 5's out of 5's on any self-assessment, you may want to re-think that. Look for areas to improve rather than thinking you've arrived at a "5". Ask those senior to you: How could I have done _________ better?

#5 - (This was my own observation): Communicate about expectations very clearly with examples and concrete terms. Do this for your interns' and students' sake.

Family pics

In random order, these are:
a) Richie at the Varsity (downtown burger joint for non-Atlantans). We were a one-car family for a bit, which gave Richie a chance to bike halfway to and all the way from work.
b) Mazie holding a doll quilt she made, materials supplied by Nana. Vivian is thinking.
c) Daisy Campout: Happy Vivian and me
d) Mazie (yellow shirt) on the hayless hayride (therefore a "Hey!" ride) at the Daisy campout.

Happy Days

Just some happy days!

Video from Talbot Taylor's Intro to Linguistics 1999

Here is a video clip from American Tongues, a documentary that my linguistics professor thought was important enough to spend class time on. I loved this film because there's not much editorializing by the narrator. The subjects say their piece, share their attitude, then the film moves on. So the medium is the message. Also, this is a subject particularly well-suited for video. You couldn't do the same thing with a book. Maybe a radio piece, but it would be missing something.

This is just a bit of it, but as the film goes on, people reveal more and more of their attitudes about others' accents - regionally speaking. This, together with research about the way people differentiate themselves linguistically...perhaps not consciously, but nonetheless actively, is food for reflection.

I wonder what this documentary would look like re-made in 2011 instead of 1988. The old-timers are dead now - I suspect we'd be missing a lot of old-timey richness because today's old-timers are thirty years farther from a pre-radio or pre-TV era. I think about Pop-pop and his sturdy Oklahoma drawl. My mom, the accent chameleon. My midwestern stepdad, who got made fun of for talkin' funny when he moved to The Deep South as a six-year-old (or thereabouts). And, of course, my husband, whose accent is so Southern that it seemed exotic when we first met. He truly is a rare bird, but in a houseful of Forest Park natives, I can't tell him apart from the rest if there's a closed door between us.

Poor Kitty.

There is a meme in my family of origin called: "Poor kitty. Pooooor, poor kitty." We usually had a cat around the house. The cat was well-loved but also known to exist in a state of mutual tolerance. Cats invariably take themselves too seriously, and in so doing, set themselves up for good-natured taunting. This is how "Poor kitty" works: the cat pines away for some small luxury ("Meowwwwww!"). We reply: "Pooooor kitty. Pooor, poor kitty" with tragic expressions on our faces. It's fun! The fun comes from the fact that we feed this animal, give it the best spot in the house to sleep, let it in and out pretty much whenever it wants, and take it to the vet periodically, adore it liberally - and it has NO idea how good its life is. We know it has limited perspective because it's irritated about being in when it wants to be out or vice versa.

I can't help adding that the reason this is satisfying is that I, myself, AM a Poor Kitty. What's the matter, kitty? You can't fit in a jog? You're having car trouble? You don't get to vegetate tonight? Poor kitty. Poooor, poor kitty.

Rainy Day Women #9

These ladies love to cavort in the rain. In rural locales, they have been known to run out in the rain in their unmentionables (if there's no thunder). I let them do it because I love to run around in the rain, too!

Motherhood and med school

I think when I started this blog I had in mind to document a path of what it's like to be a parent (of the female sort) and be in medical school. As I actually go through the days, clarity is elusive and nothing feels done. I don't really feel on top of anything, only thankful to have completed another step or to be in the middle of a step I'm completing. I enjoy the time...but it doesn't feel clean. A good friend of mine said to me a long time ago that I don't really talk about things I haven't figured out. I think a little of that is showing as I go day by day not writing about the things that really come up that are difficult. Number one, usually they're mundane. Number two, if they're not, I've become too private to really say much in a public forum, although I'd gladly have an open face-to-face conversation with the readers I know of. I guess that's the nature of the blog format.

The pervasive theme has been that I can't micromanage. That sounds very zen, until not-micromanaging causes some sort of large responsibility to slip through the cracks (because none of us is perfect). Richie doesn't really get adequate backup from me. I mean, we throw out leftovers when they go bad and we still flush the toilet, but less immediate things are more difficult to wrangle. Gymnastics? Hasn't happened. Birthday party RSVP's and gift-buying? Almost un-doable - between figuring out whether it's me or Richie who's available, convincing Richie (bless his heart) of the worthwhileness of attending said celebration, then getting a gift that fits into a budget that has no allocation for gifts...very tricky.

So, we sort of hobble along, smiling mostly, and mostly patient with our shortcomings. I'm sure we've blacklisted ourselves as poor respondents and giftgivers, and probably a few other bad things, but honestly? I have to not worry about it and do the best I can. I guess the complicated stuff that I could write about in this forum is a mixture of boring and embarrassing. Life is good, better when we concentrate on controlling our irritation levels, working hard when we're working, being fully present when we're physically present, taking small failures in stride, etc.

There are some great joys (besides stuffing face with cookies, which is usually the urge I'm fighting) that don't take long. Planting things is surprisingly quick to accomplish, then yields joy and a feeling of connectedness. Doing hair in the morning is pretty fast, then the girls are properly coiffed and a joy to behold. Jogging need only take 15 minutes - once upon a time, I'd pish posh on such a quick jog, but now I recognize how vital it is to get moving if only for a quarter hour. Dancing through some songs is always fun. And there's dinner every night and every night (lately) I've read a chapter from the Chronicles of Narnia to the girlies. We're finishing The Magician's Nephew. I look forward to that time all day long.

Nightswimming moons are here.

It's that time of year when summer wanes but fall isn't quiiiite here yet. We've been making the most of it...not actually nightswimming per se (except Richie, who always jumps in the neighborhood pool after he runs or bikes) but definitely making the most of the end of summer.

These pictures are a series from visiting a spot at Lake Lanier 10 minutes from Richie's folks' house and 5 min from the church where we got married (that's us in front of the church as a fam...10 years later). We swim across the lake about 1/4 mile - really don't know the distance - to an unpopulated island. The girls paddle across in inner tubes and Richie tugs a big truck inner tube behind him as he swims. The island gives us a very Robinson Crusoe sort of feeling. There's a ton of mica on the shore, so we imagine we've found a deserted island with gold on it. We admire the heron nest. The girls play on "Stingray Point," which has some real sand that must have been imported at some point. We walk all the way around the island, then swim back. Next, we eat snacks and some of us read while others play in the "sand." That's our day. We've been lucky to have this handy stay-cation practically in our back yard.

I love ambulatory (outpatient clinic) medicine. I like hearing about peoples' lives. My family medicine preceptor is a really wonderful person to learn from. He does a lot of small procedures and tests in-house, so we get hands-on experience doing really simple low-hanging fruit medical stuff that lots of people outsource, like drawing blood, giving vaccines, interpreting x-rays, ekg's, doing small procedures. I am a master ear irrigator. That's a satisfying job. It doesn't hurt the patient and you see/hear immediate results. Small office procedures are really interesting middle ground between thinking and doing. My preceptor's attitude about referring to specialists is: not if we can do it here. It's a fun practice model to see in action.

Of note, I lost my International Year of Chemistry 2011 pen today at my afternoon clinic. I'm pretty sure it got folded into a fat chart and will not see the light of day until that patient comes back.