Almost done

I'm exhausted, and counting down the final 16 hours before I hand off the pager. I'm nearing the end of my 7-day call.

Admittedly, I'm still sometimes unprepared for this. True, I worked a lot harder as an intern. But, then I knew there was a light at the end of the tunnel, that at the end of the wretched year, things get better. Now I'm still sometimes unnerved that as a non-surgical attending, like today, I started rounds at 6.30 am, and got home at 6.00 pm. This, on top of the 12.15 am, then 2.00 am, then 3.03 am pages. And somehow, they always know how to catch you at the worst of times: pager is quiet for a coupe of hours. You decide to take a shit, or take a bath. Wham, beeper goes crazy.

I do catch myself wondering, if this kind of lifestyle sustainable for the next 20-30 years of a professional career?

Perhaps too heavy of a question, after all in these times one should be lucky to even have a job, especially one with excellent colleagues, support system and reasonable salary, even if the hours are heavier.

I just can't wait to break out my bottle of rum and take a few swigs of hard liquor when I'm done with call.

While leading my entourage of medstudents on rounds today (had an unusually bigger group this week) we came upon man and his son in the hospital lobby.

Their interactions made me pause, and really does show one father's simple act of love for his son.

The son was a 40+ years old, also fairly obese (medically, it's a BMI of >50). He had obvious issues walking, and was fairly out of breath. His shoelaces were also undone, but as he was, his tummy was too protuberant to allow him to even bend down. His father, probably in 70's, was a dearly old bespectacled man, who walked with a bit of a shoulder stoop.

"Son, let me do up your shoelaces for you."

And so, he did. There, in the busy lobby of the hospital, the father nonchalantly bends down to tie the shoelaces of his adult son (who was probably somewhat embarassed).

It wasn't something we were expecting to see, waiting for the elevators to start rounds. And true, one could have been judgmental about how the son had let himself get into that shape. But no, I'd much rather see that moment for what it really was, a moment when a father was simply being a father to his son, and the rest of the world didn't matter.

I'm glad they shared that heartwarming moment with the rest of us, though.

It's Over

It's in the air. The coldness. The relative darkness of the morning that greets my wife and I as we drive to work. The yellowing leaves on the trees. In fact some are already beginning to fall.

^%$%$!!!

Today is the official first day of autumm. What on earth happened to summer? Did it already end? While I do like what fall brings (apple cider, the sound of crackling leaves under your feet, campfires, the fiery red color of fall leaves) it's what follows I dread: the white stuff that comes next, winter. It was a topic of half-hearted humor at clinic today when I saw my patients, for we knew when we next met for their 3-monthly hemoglobin A1c checks we'd see the dreaded white stuff on the ground.

And childishly, fearfully, this will be the first winter in, oh, 4 year, where I won't get to spend with my family (well, aside from my wife)- mom and dad usually like to spend a month here during winter but I talked them into coming during spring 2010. So much for my big fat mouth. Oh well.

Home!

Ok, after a week-long trip, we're back. I have to admit, we were beginning to miss the dogs, and work was starting to creep up on the back of our minds and we were getting ansy. In a weird way, it's great to be back to our smaller city, and away from the relative craziness of California. One day to recuperate before we start work.

San Francisco

We biked the Golden Gate Bridge!

In San Francisco now, will be here till Saturday. Napa Valley was interesting though we visited only four wineries for the lack of time (and liver tolerance!). One additional treat was a stopover at one of Guy Fiore's (of the Food Network) restaurant, Johnny Garlic's. The food was good, but the treat was that he was there, filming a shoot for one of his shows! So we actually got to watch all that.
Will be making a trip to Alcatraz tomorrow, and probably Chinatown. Will need to stuff up on our dim sum!

So we made it to Napa Valley! Yosemite was swell, and we even got to see a bear in the flesh, not more than 200 feet away (though there were some jokers who actually ran after the mother bear and cub to snap more pictures- definitely not smart people). Will spend a night in wine country, then we'll be headed to San Francisco. That is, IF we're sober enough.

KNNCCB!

It costs more to fill half the tank of our rental Yaris with regular, than to fill up the tank of the Porsche with premium gasoline. Another sore reminder of the cost of living in California.

Yosemite

Giving this mobile blogging thing a try. Yosemite was simply magnificent; the giant sequiaos against the granite mountain backdrop- just breathtaking. However... If you have a thing with heights, try driving a wobbly rental Yaris on a narrow road along the cliffs and you will discover that your cremasteric muscles possess strengths you never knew they had.

Staying in this decent hotel, but we found this mom & pop bed and breakfast by accident, and we really wished we knew about this sooner as we would have stayed here in a heartbeat. The locale was excellent, the rates were better than our hotel, buffet breakfast was included. And, we were kinda miffed to find out that our hotel was trying to buy out this mom and pop property (but they wouldn't sell) so they decided to literally build around it. Anyway, this was a very charming property with new rooms, magnificent views of the Merced river. So, if anyone's ever thinking about looking for a place to stay at Yosemite, this is just a mile away from the west entrance of the park: The Yosemite Blue Butterly Inn

Tel: (209) 379-2100, email yosbbinn@att.net

Anyway, we're off to the wine country for some indiscretions before heading to San Francisco. Updates soon.

Vacation!

We're off for a vacation to California. A much needed break.

Back in a week (if the bears or the sea lions don't get us first) (if those aren't clues to the two destinations we're going to).

Have a good week, folks!

Informing Patients

As doctors we were trained to always discuss the risks and benefits of any treatment with the patients. You always discuss the side effects, perhaps not all the gazillion listed in the PI, but at least the common ones. Gone are the days of the paternalistic 'doctors-know-best-just-tell-me-what-to-take-dammit' (though I still have a few patients who are like that).
Anyways. My recent experience has made me wonder if we really should caution patients about side effects:
I get migraines. Fairly classical migraines. Have had them all my life. But probably because of work (or perhaps marriage-related ) stress I've been getting them a lot more now. So, I recently saw a neurologist to start prophylactic migraine therapy with topiramate. And, naturally, he went over some of the side effects to look out for. Including muscle fatigue, word finding difficulties, brain fog, altered taste sensation especially to diet soda, concentration problems. Heck, the muscle tiredness was so bad I couldn't even keep up with a single game of Wii Sports last weekend.

Now, I'm a firm believer in the placebo effect and the power of the mind. And I'm pretty sure that I'm at least 75% nuts here with the perceived symptoms, since from the migraine standpoint things are definitely better. But this gets me thinking too though; if I start my diabetic-hypercholesterolemic patients who are clearly at high cardiovascular risk on simvastatin and tell them to watch out for muscle pains, the power of suggestion alone would cause quite a few of them to experience those symptoms.

So, maybe a much better (but probably highly litiginous!) way of doing this is how the researchers have been doing this all along: to 'blind' the patients. So, I should start telling my patients:

Trust me, you really need this medication for your diabetes. I'm not going to tell you the name of this medication, or it's side effects to not influence you. But list down any problems you may experience, and come see me in a month!

Now that might be a more objective way of doing it!

Letter of Reference

Things are certainly beginning to turn full circle. My medical student asked me to write him a letter of reference the other day. For residency application, that is. Programs begin accepting applications this month, I believe, and most programs require 3 or more letters. I was in his position, oh, 9 (gawd was it that long??) years ago.

Not the best medstudent I've worked with, but still, a good kid. Sure, I told him. I could write him a letter (if I didn't think I could at least say something nice in a letter I would have told him to ask someone else). I did sit him down to ask him to tell me about anything else he might have done during his month-long stint in endo that I might not have been aware off. And talked to my other colleagues for feedback too. And had him give me a copy of his CV.

And so the other night I did something I had never done before. I wrote a student a letter of recommendation:

"Dear Program Director,

It is with pleasure that I write this letter of recommendation for Mr. B....

Yours truly,

Assistant Professor Vagus "

I'm thinking this will be the first of many. I hope it gets him where he wants to go.

My Favourite BMW

We checked out the latest BMW Z4 the other day. Though the Mercedes SLK was always my 'other woman' to the Boxster, I have to say this probably now replaces it Merc's place. The new Z4 is now a hardtop convertible, and unlike the somewhat controversial SLK with its hate-it-or-love-it F1 nose, this is much more conventional yet svelte, and pleasing to the eyes. And so, I thought this would be my favorite BMW if (in another life) I ever got one.

Until I saw this:

Farking brilliant!!! What he needs now is a chrome-plated tail-pipe! (taken from failblog.org- a hilarious site if you don't already know of it. I check it out daily for laughs)