One of the rules of surgery

"Eat when you can, sleep when you can, never fuck with the pancreas."
~ Dr. Rudolph

In other news, I have eczema and one of the patients on our service has diagnosed themselves based upon the hit television series "House, M.D." I wish that was a joke.

(M. Jagger/K. Richards)

I saw her today at the reception
A glass of wine in her hand
I knew she would meet her connection
At her feet was her footloose man

No, you can't always get what you want
You can't always get what you want
You can't always get what you want
But if you try sometime you find
You get what you need

We went down to the demonstration
To get your fair share of abuse
Singing, "We're gonna vent our frustration
If we don't we're gonna blow a 50-amp fuse"

You can't always get what you want
You can't always get what you want
You can't always get what you want
But if you try sometimes well you just might find
You get what you need

I went down to the Chelsea drugstore
To get your prescription filled
I was standing in line with Mr. Jimmy
And man, did he look pretty ill
We decided that we would have a soda
My favorite flavor, cherry red
I sung my song to Mr. Jimmy
Yeah, and he said one word to me, and that was "dead"
I said to him

You can't always get what you want
You can't always get what you want
You can't always get what you want
But if you try sometimes you just might find
You get what you need

You get what you need--yeah, oh baby

I saw her today at the reception
In her glass was a bleeding man
She was practiced at the art of deception
Well I could tell by her blood-stained hands

You can't always get what you want
You can't always get what you want
You can't always get what you want
But if you try sometimes you just might find
You just might find
You get what you need

You can't always get what you want
You can't always get what you want
You can't always get what you want
But if you try sometimes you just might find
You just might find
You get what you need

Bunny

Also, Tina's bunny is hopping around on the floor and may have just pooed on the floor. He likes to be free.

oy vey

So can I just say outright that I have the up most respect for people who do research. Y'know, the people who really enjoy mulling through their hypotheses and figuring out how best to test them, people who like to mess with statistics to figure out relationships and the proper way to interpret data. These people are great and necessary for the future of pretty much every scientific discipline out there.

That said, screw it. I'm good at the idea part. I can even formulate a hypothesis. I get hung up, however, when I try to figure out how best to test my hypothesis. There is something hypnotic and enjoyable about data entry; it's meditative. Writing I can do; words are pliable. I don't even mind the revision process, because I still feel like I'm doing something. Similarly, data collection is good, if it involves talking to people. People fascinate me. Basically, what I need is a research project where I can either share ideas, do the literature review and writing (did I mention that I like doing searches for things? I should have been a research librarian), or enter data. Don't make me design the protocol for the study; I'll manage to confound it somehow. I could probably analyze data a little bit if someone gave me a crash course in statistics. Unfortunately, this program I'm in seems to want me to do all of these things. This doesn't seem realistic; a simple search on PubMed for anything will show that most journal articles have multiple authors. Certainly all of the authors didn't design the study, do the data analysis, enter the data, collect the data, or come up with the idea. That would be highly inefficient.

I think what I was hoping for from this program was to be a part of a research TEAM. Instead, it's just me. And my mentor, who is good and available, but is confusing. I think he teaches by giving me cryptic hints and then watching me flail for a few days and then dropping more cryptic hints. If I do research in the future, I want to do it as part of a team. I don't need to be first author. It doesn't need to be solely my idea. I certainly don't need to design the damn thing. Just let me write it and be obsessive compulsive about grammar, spelling and split infinitives.

On a somewhat unrelated note, if you're ever in Boston, you should go to the Countway Medical Library. They have a skeleton of conjoined twins on the fifth floor, in addition to other sundry and macabre items.

I had one of those weeks where everything I did seemed to go wrong, except when I was working with the PM&R resident on a patient's chart and got her pimping questions right. I like her, I've decided. Other than that, though, everything seemed to go wrong. My mentor didn't realize that I was actually enrolled in the MSTAR program, and thus didn't realize that I actually had to do some kind of research project. This would, I guess, explain why he was so confused when I kept mentioning figuring out how we would collect data. I think it's better now, as we've had a brainstorming session, Maybe. Either that or I'll somehow manage to get kicked out of the MSTAR program, which would suck. I just have to keep reminding myself that the goals of this program are to:

1. learn about how to do research.
2. do a research project, obviously a small one, as program is just during summer.
3. learn about the research process, e.g. hypothesis forming (got it), literature review (totally got it), methods (um...workin' on it), data collection (um...yeah workin' on it), results (so not there yet), and discussion (I'm pretty verbose so this should be easy).

Also, I'm writing this on the train to Maine (yes, that's actually Amtrak's slogan; cheesy ain't it). The future is NOW!.

I'm not sure what it is about the east coast, namely New York City and Boston, but the majority of the people I interact with seem to be quite image conscious. This is probably confounded by the fact that I interact with a lot of well-paid nurses, nurse practioners, and doctors, but it's definitely there. Some of the ladies on our service have positively massive diamond engagement rings, only one of which I could potentially see myself liking even remotely. People carry handbags as a statement, not as a means to cart around stuff. Here I was, foolishly assuming that handbags were to cart around books for the subway, chapstick for the lips, the wallet, the keys, and various other sundry items. This is not the case; in fact, one of my co-workers has a large Coach bag in which she keeps a smaller bag. The smaller bag is for all of her things; the Coach bag is for...something. I have a really nice purse that I like. It's a decent size, it's black, classic looking, practical. And it was on sale at Macy's. Compared to my coworker's bags, it's a non-event. I'm fine with this, although recently I've started carting around my purple backpack from undergrad just to see the looks on their faces.

The handbags aren't the only sign of this image consciousness. I am not used to seeing people look so well put together all of the time. I don't necessarily mean within the hospital; there's a professional aspect to that mode of dress. I mean when I'm wandering around Boston in a daze. Precisely ripped jeans paired with an Abercrombie t shirt and a little jacket slung just so. Women who have their hair perfectly styled to go to the grocery store. People who refuse to wear things that aren't some name brand. Everyone has an image in mind that they're trying to project.

This extends beyond the realm of clothing and accessories. On Tuesdays, I meet with a group of medical students from around the country, all of whom are participating in this "learning research while doing research" thing. The first day, the lecturer told us that simply by being in this room, we were setting ourselves apart from our classmates, making ourselves more competitive for residencies. This is probably true but it still struck me as odd. He seemed to focus on the program as a method to boost our CVs as opposed to an opportunity to learn some cool things while visiting a strange place. He spent a decent amount of time sharing with us that he thinks he got where he is today solely because way back when, he participated in this program and got an awesome letter of recommendation. While that might be true, I hate that he insinuated that our classmates who chose to travel, life guard, or sleep on the beach were dumb.

I am enjoying my time on the east coast, but I would be lying if I said that I wanted to stay here.

Research

What have I gotten myself into? I have until the end of the summer to create some sort of original research project.

Oh god. How am I going to pull this off?
Starting tomorrow, I'm kicking my work ethic up to 11. I will pull this off. I figure if I can get around on the Boston public transit system, I can survive this.

Sometimes you can't go home again...

Literally. We have a patient on our service who will probably never go home again. It's complicated, but it is in large part due to the fact that his daughters and long term partner don't want him at home because they don't think that they can give him the kind of care he needs. Now, his insurance has a hospice benefit, so it would be plausible to send him home with hospice and have visiting nurses. The patient doesn't know this though, and I'm under the impression that we're not supposed to tell him. Really, I think his family just doesn't want him at home because he stresses them out.

I wonder what his last days will be like, where he will spend them.

bah-ston

We had a patient the other day who suffered a stroke and then abruptly began to hemorrhage, creating a subdural hemorrhage. Those are bad and will generally kill you unless it is caught in time. This patient's case was complicated, though, and they quickly took a turn for the worst. The family was called in, the patient given a morphine drip to keep pain at bay, and spiritual counselors called in. Her surname was stereotypically eastern European, perhaps Jewish, perhaps not. We all thought she was Jewish. Anyway, we're standing at the nurse's station talking over her pain regimen when two rabbis and a priest walk onto the floor looking for our patient. It was really all we could do to keep ourselves from laughing hysterically. I said to a nurse, "two rabbis and a priest walk onto the neuro-oncology floor and here I am without a punchline."

It was a good day.

(By the way, 2/3 of the time spent at hospitals is spent at the nurse's station. True story. 1/6 of the time is spent walking and 1/6 of the time is spent in patient rooms.)

It's strange to be excited about learning about death. I mean, I obviously don't want patients to die, don't want families to have to learn to cope with loss. However, something about helping the process go smoothly for everyone involved is fascinating for me. Helping to keep the patients comfortable and the families feeling supported, informed, and free to grieve appropriately is really fun. Not like going on a roller coaster fun, mind you. More of a peaceful fun. The reading I did today was different than any I'd done recently. It wasn't science really (thank goodness). No kinases, no interleukins, no prostaglandins.

I am damn sick of that hand sanitizer though. I swear it just makes my hands more of a breeding ground for little bacteria.

We actually had an incident the other day where two rabbis and a priest walked onto the neurology/oncology floor looking for a patient. There I was without a damn punchline.

"Just a small town girl, livin' in a lonely world..."

Oy. Yesterday was my first day in Boston and at MGH. Ugh. I'll have to write about it later as I need to brush my teeth and such so I can achieve my goals for today, which are quite a bit LESS lofty than yesterday's.

goals for today - don't wind up at the naval shipyard and think it's MGH; don't fall and skin knee (again); get to work in time to get a cup of coffee; get to work on time today, not nearly an hour late; don't be intimidated by the harvard medical students as i was accepted to this program and am allowed to be here too; don't lose my badge (again).