After suffering through HOURSSSSSSSSSS of GME orientation and VA orientation over the past two days, jumping through the flaming rings of paperwork/med school/repetitive PPD tests I have some schwag that says Dr. Bostonian, MD and a matching prescription pad.

EM orientation tomorrow where I get my monogrammed scrubs and free lunch, a few days off and then evenings for July 3 and 4...I'm on the med/cards side of the ED, so I won't have too many fireworks injuries but I'm willing to bet I'll get my fair share of CHF exacerbations from cookouts...too bad I have to work the first major holiday...hopefully it's not a recurring theme!


Interwebs on and a new format

I was without interwebs for around a week and it hurt my soul...but now, FINALLY I have some lovely broadband all to myself (and a new TV with some HD/DVR capabilities to allow my brain to turn to mush after my crappy shifts and so I can catch all of those shows/sporting events that I'll probably be working through).

I'm all moved into the new Upstate digs! I'm in a very nice/affordable apartment on the edge of a not-so-nice neighborhood, across from one of my city's gorgeous parks and about a mile from the hospital. Let's just say that I'm about 300 yards from Martin Luther King Jr Blvd, but I've only heard gunshots once or twice and it's actually quite pleasant during the day. So it's just me in this big quiet apartment until the fiancé gets moved up in August.

I've had a few opportunities to hang out with the new residency classmates over the past week as we collectively suffered through our ACLS and ATLS certs. In just a short time, I can already tell that they're seriously cool kids who share a scarily similar sense of humor. I think we'll get into some trouble and to enjoy some good climbing/skiing/backpacking/paddling/biking/whatever-the-hell-else-we-want-to-do on our days off....I'm psyched.

You've probably noticed the lovely new format. I saw it in the new design tab and liked it...so there it is you have to look at it. I'll continue to tweak the format so it's as pretty as I can make it and I'll probably play around with the pages settings to clearly delineate my med school posts from my residency posts, I'll toss some of my fun photos up and try to get some EM-related posts going once I start actually thinking about learning again. I've recently stumbled onto a whole wealth of online EM resources (thanks to a post from Graham Walker over on the ACEP Central Line blog) and I think having all of that posted will be a good resource for me and anyone else that might be interested (not too many EM folks read this though). It will be my fun little education project for myself. I might re-post or link to it here in an attempt to keep myself semi-anonymous so I can still gripe provide constructive criticism about whatever I want my continuing medical education, as vulgarly...er...openly...um...often as I want without the recourse of my faculty/hospital administrators/prosecutors raining down on me and potentially ruining my happy-go-lucky, laid back image and future career prospects/aspirations.


The donor

You do it hundreds of times in medical school, so much so that it becomes reflexive. Knock, open door, walk into a patient's room, introduce yourself with a smile and a handshake and then promptly tell the patient to get nekkid and toss a gown at them before invading every inch of their privacy. Then you close by saying something reassuring, and telling them they can get dressed.

I had the fortune of being on the receiving end of such a wonderful encounter today for my pre-employment physical and battery of exams. I think the highlight of the day had to have been the paperwork for the urine test...but I'll come back to that.

The low-light of the day was having to shave for my respirator fit testing. I usually keep a bit of scruff, preferring to shave every other to every 3rd day to keep my sensitive skin happy. It's usually not a problem when I don't have to look professional (it's not like anyone's around to watch me build my Ikea furniture with a beer in my hand, muttering under my breath at 1AM...I hope). The secretary shook her head and told me I'd probably have to shave for my fit test. The LPN that drew my blood wished me luck with the hospital supply closet razor and offered me my tetanus booster in the next breath. So following my physical I was lead to the dreaded bathroom with a little hospital can of "shaving cream" (worst shaving cream ever) and a flimsy-handled, single-bladed hospital razor. Now I'm somewhat particular in my shaving habits because it keeps my face from feeling like it's on fire for the rest of the day...but those OCD tendencies went out the window today. I begrudgingly scraped the scruff off with the blunt instrument, lost about half a unit of RBCs through a thousand tiny cuts on my face. Then came the fit testing where an N95 was strapped onto my face for 15 minutes and I was made to do all sorts of stupid maneuvers to try to break the seal between my face and the mask...so needless to say, my face feels like burning right now.

Then the urine drug test...my personal highlight. I hadn't had much to drink the morning prior, nevermind my normal cup of high-test coffee that allows me to tolerate tedious bullshit without wanting to strangle everyone in sight. Couple caffeine withdrawl with some Ikea-induced sleep deprivation, the medieval shaving experience and being made to wait for something that should have taken all of 35 minutes, and I was getting sort of punchy toward the end of the 2-hour extravaganza.

They stuck me in the waiting room while the folks before me finished up their tests...f-ing awesome, I love waiting rooms. With everything that had transpired that morning, I wasn't really "feeling the urge", so to speak. The nurses had attempted to orally hydrate me at every opportunity by handing me two little dixie cups of water every time one of them passed, however my GFR was clamped down pretty tightly. "Bostonian?" the nurse called...and I trotted over to get the stupidity over with. I had to then sit there and watch her fill out 4 different forms which had quadruple carbon copies (yellow, white, pink and orange!) which took exceedingly long. Finally, I was escorted to the rest room, read my list of rights (don't wash your hands!!!) and there I was, alone, staring down at the empty plastic cups. I had a stupid running dialogue:"60cc's of urine to freedom...sweet sweet freedom...try not to quote Braveheart out loud...don't laugh...valsalvaaaaaaaaa and there it is...don't pee on your hands. Wait, I can't wash my hands???"

Now for anyone that's been through this ordeal, the hospital makes you sign like 4 different forms for the urine drug screen, and everything must be done according to a stringent procedure to eliminate common sources of fraud. Usually there's a legally binding document that at refers to producer of the urine sample in a consistent terminology. Not so at my institution: one form that had 3 different terms for me, including "donor". Generally I reserve the word donor for pleasant things that confer a benefit upon the recipient...eg money, blood products, semen and the like. But there was my cup freshly voided pee...and I had to sign on the line that said "Donor Signature". Who knew!



I've realized that my brain has been completely shut off for the past 6-8 weeks. Nothing new coming in (except for experiences and beer) and nothing creative (or even remotely intelligent) coming out. So in an effort to not kill every patient that I see over the first week of internship, I have tried about a dozen times to crack open my copy of the ACLS book to get the brain rolling with some fundamentals...and then I fail miserably. I've loaded the cd to try and get something useful to fire a neuron or two...and I get through a few of the preview questions and then find something on TV like my beloved baseball team, the NBA Finals, a soccer match or really anything with moving pictures that isn't studying.

It's going to be a long intern year...
-One friend is on call Q3 in the CCU for all of July
-Another friend is in a military OB/GYN program and has to be in at "Oh dark thirty" (aka the butt crack of dawn)
-I'm working a half schedule in the ED and have class two days a week for July...not too shabby


Where I've been, where I'm going...

My 5-year college reunion was a great time (except for the 2 day hangover and some time-traveling) and it did give me a chance to catch up with a bunch of quality folks that I hadn't seen in far too long. With the newly minted MD after my name, mt friend's girlfriend altered my nametag to read Dr. Bostonian. I spent a lot of time explaining to the non-med folks why I've disappeared for the last 5 years, what I am up to and why I didn't have much control over where I'll be for the next 3. Of course the medical people gravitated toward each other to, took turns calling eachother Doctor, figured out where everyone is heading for residency. Then we drank, ate some crappy mass-produced food that wasn't worth the price of admission, drank and danced until about midnight (exact timeline is hazy) when they kicked us out because we're not in college anymore.

One of my best friends was there, despite being in the middle of studying for his Step 1 at the end of the June. I met him at his apartment to drop off some books and to pre-game the reunion. I walked in on him in his studying nest, going over a block of q-bank questions. He had that all too familiar look of despair, sleep deprivation and fraying sanity that all med students have during boards time. How I don't miss those days...at all. At least he was showered and his girlfriend had made him change his clothes unlike some other med students I know .

Those two glimpses back on where I've been made me think all the more about where I'm heading. I start up this week with some health clearance awesomeness (yay for being stabbed with needles and having strangers touch my genitals and watch me pee!). Then I have a weekend off to get settled and help my former roomate move into his new digs (for a nominal fee of beer/dinner). And then shit gets real with some ACLS training and ATLS and formal orientation activities where I get my ID, long white coats and monogrammed scrubs.

Luckily my program is big on residents having a life outside of the hospital, and EM residents are limited to 65 hours nationally now so life will be awesome! My program also dedicates the first month an orientation month with lots of didactics/labs, reduced clinical hours and several gatherings/outings.

For now I'm just trying to get the ever-expanding list of home-improvement stuff done at my parents' house (STILL PAINTING!!! just a little bit of trim and a second coat on one bedroom left). I'm definitely looking forward to completing my move and building all of my fancy new Ikea furniture (that store is the DEVIL!), adopting a pup and getting my frigging life on its way already. I'm especially looking forward to playing with my little graduation presents to myself (plasma tv and a 4 season tent).

Until then, I'll be huffing paint fumes (too bad we buy the low volatility latex stuff) and talking to myself while lying on the floor to paint the baseboards...not a pretty picture.


I feel panicky...I feel old

I have two more glorious weeks off before my orientation starts up and I've been hanging out at my parents house in MA. They're relocating to the west coast because of my dad's employment situation (now employed, but on the west coast). So by hanging out I mean I've been cleaning out all of the relics of my childhood and being forced into unpaid labor to get the house ready for the market (painting, cleaning, repairing, etc). I'm a frigging Doctor! I shouldn't be painting the woodwork...I should be out living or hiking or paying someone to do this for me!!! ButI guess I do owe it to them for draining their finances, crushing their social lives and causing 33.3% of their graying hair for the past 26 years.

Anyway...all of this manual labor led to alot of thinking.
I was going through the ample piles of my stuff in my bedroom and stumbled across my Middle School and High School yearbooks...and I felt suddenly as if I was ancient. I don't even recognize the chubby little, pre-pubertal runt I was back in 8th grade or the know-it-all, post-pubertal asshole I was in 12th grade.

Then I remembered that my 5 year college reunion is this weekend where I get to suit-up and talk with my classmates to hear about their families/jobs/houses/cars/positive net-worths (oh wait, I haven't seen a paycheck since 2006 and can't even afford the cash bar).

Then I remembered that I'm going to be in charge of people's medical care. People are going to page me in the middle of the night and ask "Doctor, what should we do?". My loans will be coming due and I have to start saving for retirement and the college funds of my unborn children.

And then I looked into the mirror and noticed the grey hairs starting to multiply and spread into my beard, the crows feet starting to form at the corners of my eyes, the careworn creases in my brow, the incredibly awesome sunglass tan I have from Utah (Ok, so I photoshopped those crows feet out of my ERAS application photo...I am not immune from vanity).

And I felt dizzy and hyperventilated a bit as the realization washed over me that...I am officially old. Or maybe it was the paint fumes.

As I regained my composure I realized, I'm still 26 going on 27. I've spent the last 10 or so years of my life in the singular pursuit of this stupid degree...but I'm not even middle aged yet. I've put off a lot of living in the process of getting here and a lot of my former life goals have been tossed to the wayside along the way.

One of my college friends was lamenting that he hadn't been on a vacation with his wife in over 2 years...I haven't gone away on vacation with my girlfriend since July 2005 (sorry sweetie)! This trip to Utah was the closest thing to a vacation I'd done since March of 2007. I keep telling her...just 3-4 years and life gets soooo much better when we have a real income that can cover our collective loan payments, and I can move my schedule around enough to accommodate a real vacation.

I guess that one of my goals for this residency thing is to to make sure that I do remember to squeeze in some time to live in the midst of the chaos of a flip-floppy schedule, my academic aspirations (and the work that goes along with them) and the parents living 3ooo miles away in the Pacific North West. And it doesn't help that I'm still missing being places like this:

Anyway, I should get back to my chores...that woodwork wont paint itself.