action packed

sadly, this rotation is now officially a wash- i just can't seem to convince anyone that i can see patients. on my own. so, it's more of a shared affair, a threesome where generally at least one of the particpants is totally unwilliing. sometimes more, and then it gets weird. but mostly it's just bump on a log boring. at this point though, i figure i've got nothing left to lose, so i can be as pushy as i want. i like everyone there, i just can't understand why they've chosen dermatology as their career.

oh wait.

because they live in a mountain town mecca and have stupid amounts of time to spend enjoying it.

surely that must be it, since i cannot for the life of me figure out any other reason. so i'm gonna go with that...in which case i better ramp up the enjoyment part for the remaining 2 weeks. last weeks enjoyment menu ran something like this:

thursday nite: one last family munch 'n music fest, complete with elephant ears and reggae.

friday: went to check out the cascade classic up at mt. bachelor, a pro bike race in town with some big names to go watch...floyd landis, levi leipheimer (out with a fx wrist, i heard) and the winner of the stage we watched, oscar sevilla. ben rode up from town and got to cross his own finish line and then ride back down with the pros. then there was some packing up the boys for their journey back east and doing some riding around town on bikes to find mexican food and cold beer. success.

saturday: drove up to portland to be a taplister ambassador at the oregon brewer's fest. ben lined it up since it involved of his 2 favorite things- beer and iphone gadgetry. free admission and free beer as long as you twittered like mad and went around chit chatting it up with people. i bailed at the last minute, which ended up being the right decision based on the heat and crazy drunk people factor. i spent the afternoon playing with the boys, which was delightful. lego mania. good times.

then we went to this INSANE crawdad fest in NE portland with our friend bryce- which was pretty much the best.party.EVER. live cuban music, heaps and heaps of crawdads (toasted my n'owleans peeps- fred, amy and shay- of course- with ice cold PBR you can pretty much toast every last person you know and still stand upright) vats of cold beer and large quantities of watermelon....and the quintessential peach and berry cobblers rounded out the smorgaasbord. it's a house/garden party this guy throws every year, just for fun. i will now aspire to hold such a party. it was amazing. and his garden was unbelievable. total sight to behold on all fronts.

then (sniff) dropped the boys off at the airport for their red eye back to boston (smelling pleasantly of spicy crustaceans)...very sad. (for me, not the other passengers). 7 weeks of familylessness. on one hand, i'm sort of excited to be completely spoiled in do-whatever-i-want time, but coming back to bend without them really sucked. walking into our room and seeing their stuff there without them hit me hard. no one to cuddle with, no giggling, no little boy bodies running around like crazy...
digression done.

to cheer up, i went to stay with erica and phillip for the nite, which was super fun. met them at a friends post wedding gathering and chatted with some fun people. got to taste test the deschutes new gluten free beer- good news abby, it's DELICIOUS!

sunday- decided to tag along with erica and phillip and friends up to frenchman's dome to go climbing. it's been a loooong time, which was immediately and quite pathetically felt. i thought it would all come flooding back, i mean, shit... i used to climb for a living. turns out, it's gonna take some more poking and prodding before i feel the way i used to about it. but i had a super fun time despite the fact i think i was brooding the whole morning about the boys being gone. the view of mt. hood from the top of the crag was pretty stunning. and it was shady with a nice breeze, not something to be taken lightly on a 95 degree day. the company was super fun- a few folks from the previous nite, AND i got to meet boone speed, a famous climber whom i've read about for years and years...so maybe now i can give up looking for lynn hill in bend's nooks and crannies. one climbing celebrity just might do it.
then i drove back down to bend in some sort of weird daze and when it cooled off a bit at 6:3opm, i went for a 2 hour bike ride out mt. washington road and all around, just sort of riding...cathartic healing. and it was goooooood. have i mentioned i love this town??

and that's my plan pretty much. wake up, eat, work, bike, eat, sleep for the next 7 weeks. maybe try to find a decent swimming hole every once in a while. cause i've got nothing else to do or anyone else to take care of. just me. and if i think about it for too long i'll get bored, lonely, or sad....and chocolate only cures one of those afflictions. so...yeah. it's just me. huh. weird.

saying of the week

it's been said elsewhere, but bears repeating, as it was truly a phenomenon of words in action.
after suturing up a patient yesterday, he checks out his wound and looks at me and says "well, gag a maggot, girl! you sure can stitch!"

cowboys. they're the best. how will i live without them?

wind up toy

i feel like a wind up toy. every week i get a new preceptor. it's like starting from scratch every. single. week. and mondays are generally really really boring since i have to shadow my new preceptor and try to prove to them i've seen (most) of it all before. that i'm competent. that i know how to talk to and examine a patient. add to that mix that the MA's here do all the chart notes themselves and are pretty territorial about it, and my work load dwindles quite a bit.
i'm a little unsure about what to do about it...do i just take the nice relaxing, no stress rotation and go with it or do i try to put up a stink at this point in the game and figure out a better strategy? add to that the clientele who mostly don't want a student (that's why they're paying out of pocket, dammit!) and 2 new providers who are scrambling to add as many new patients as possible to their rosters...fighting over patients now that business is a little slower in town...and it makes their time for me pretty low on the priority list. it's a bit of a problem. by the end of the week, everyone is happy, things are getting cranked out, i've finally found a groove...and then monday it all comes back to a screeching halt again.

on the other end of the ranting...another good weekend was had exploring out and about. more mountains, lakes, cowboy towns, rivers, and waterfalls. it never ends here. on a funny note, ran into a classmate's bf coming down off of mt. washington, the peak in the picture. random. it was totally one of those "hey! what are YOU doing here?" moments.

favorite moments in clinic from last week include chatting it up with the 1960 olympic gold medal winner of the breastroke (not a whole lot of effort involved, he has found a second calling as a motivational speaker) who is trying to gain support to get rid of the medals and move to more of a super bowl ring award...because what DO you do with a medal for the rest of your life besides put it in a safety deposit box somewhere? interesting dilemma. that i will never have. that most people will never have. but i did like that he referenced bend in a way that made me want to move here even more....he said that there are tons of other former professional athletes and olympians that call bend home, that i would be in good company if i lived here. i love it, as if by a mere change of address, i too could be a virtual athletic rockstar. which is so appealing to my former self. tis true, lots more badassness here than obesity. ir's appealing, no doubt.

also, had a handful of ranchers come in. i love them as much as i love the vets. they have such a simplistic richness to their lives. talked to one couple for a long time about cures for "post suckers", ie horses that like to eat the fenceposts. a good soaking of creosote usually does the trick. alternately, a good dousing in goose shit will probably work too. whatever is more readily available. i bet that would work for nail biters too. and probably a great host of other maladies. i love when they tell stories about life on the ranch, like you know just what they're talking about. "i ain't ever seen such a thing before as a bull suckling a cow, have you? i mean, he's almost 2 years old. that ain't right, don't you think?" ummmm....probably not?

also had a fair share of vets...those WW II vets looove their stories. a good one popped up today from one of the local band of brothers (he had the weekly luncheon that he had to go to, otherwise he would have stayed to tell me more, i'm sure). This patient was in a trench at the battle of the bulge (which i had to google to get my facts straight, but to tone it down to the point of idiocy, it was the bloodiest battle of WWII) and happened to be next to another soldier who is also now involved in the local band of brothers luncheon extravaganza- when a german grenade came flying in. they tried to throw it out, but there was a cover on top of the trench that they couldn't get through so the soldier threw a blanket on it and dove over it. to save the lives of everyone else in that trench by using his body as a shield. it exploded, everyone retreated, and they left the soldier for dead. but he wasn't dead, as someone found out after going back later for important paperwork they'd left behind. there's a happy ending here...the wounded soldier recovers from his wounds, receives medals up the wazoo, and comes home to find one of his trenchmates here in bend, OR. and so now the big joke between these two goes something like this...

"remember that time in the trenches when we were next to eachother and that german grenade went off?"
" remember it!?! shit, not only were you next to me, parts of you went flying over me, around me, and on me!" (big laughter here)

oh, army humor.

heard a great one liner from the wife of a patient today complaining about his seborrheic keratoses, which we frequently refer to as "barnacles"

"so what you're saying doc, is that if he were a ship, we'd need to scrape his hull?".

precisely that. and i'm using it from here on out. specially with the vets.

fun with unpronounce-able diagnoses

another week, another profoundly good time spent here in bend...i could seriously get used to being here non-stop, although sometimes i worry that since we're packing it all in now, what would be left to do if we actually moved here?? explore the many hundreds more hiking and biking trails, lakes, and secret spots i guess. or maybe have the cash to actually go and experiment the culinary wonders of central oregon, etc etc.
employment still seems a world away, so now is the time to savor whatever relative freedom i have. so far, it's delicious. as it turns out, living life the way it should be lived doesn't take all that much effort at all. (minus the lack of cash, that part sucks)

spent this past weekend exploring the newberry volcano national monument, paulina peak and waterfall, and the east lake areas. lava flows just continue to amaze me. obsidion chunks the size of minivans are not meant to be taken lightly. so i don't. went to summerfest downtown on sunday...a bit of a people watching excursion, really. still trying to piece together who lives here and how and why, and who's just stealing clean air for the summer. there is the same aversion to people of the so-cal persuasion here as we had to new yorkers in new england, which cracks me up. except that new yorkers at least have the decency to take themselves seriously. southern californians....who knows. here is my summerfest food analogy of what i observed this weekend:

if new yorkers- actually forget new yorkers- there really aren't any here, no fair to poke fun if there's no reaction, plus people here on the left coast don't get it anyway. start over...

if oregonians are the pulled pork sliders and sensational pint of locally brewed hoppy beverage then the southern californians are the cotton candy (in a bag no less) and diet coke.

* nothing against diet coke, it's a great weakness of mine. but it's just chemicals and coloring with some fizz marketed to make you think you're somehow being healthy by drinking it...no one knows why it's supposed to be good, and we (i) know i should move on, but for some reason we (i) just can't get enough of it. and the cotton candy...well...yeah, i mean, like duh.

anyways

back to the real reason i'm here...dermatology, lest i forget...and sometimes i do....
last week was actually quite a turn around in terms of clinical fun. one morning we saw 4 patients with really obscure crazy diagnoses, which made me momentarily reconsider the seriousness of this specialty...

the 2 most interesting i'll discuss just cause i'll probably never see anything like that again, and, well....they were super cool, maybe a tad gross. anything weird is bound to be cool, and these were off the weird-dar scale.

osteoma cutis. bone chunks that grow in your skin. (collective eeew) little fibronous or cystic irritations that become calcified and grow, not unlike a pearl...in subcutaneous tissue. how's that for a biopsy finding...glad i didn't have to do the 'splaining to that patient. don't worry ma'am, you're not an alien/part dinosaur/freak of nature, although we can't entirely rule it out....
the best part was watching the entire staff scramble to figure out how to order a facial x-ray. they gave up and had to call a radiologist. now, i know i'm just a student and all, but how hard is it really?

cicatricial pemphigoid. not only is it super fun to say (if you dare), but it's super fun to see. unless you're the patient, in which case it's terrifying. you get bullous blisters that erupt and scar over, causing crazy adhesions. this pt had ocular and nasal involvement. she could barely breath out of her left nostril anymore. her left eye had big old skin bridges that only allowed her to move her eyeball in very limited directions. left untreated, it can certainly cause blindness and all kinds of strictures in places that are never good, like all your airways. treatment is mostly a half ass prevention thing, but ultimately surgery is where you're headed, which leads to more scarring....what a downward spiral that becomes. plus i'm still not ok with eyeball surgery. i might never be. it is the one thing that still makes me squirm.

my icing on the cake for last week was getting in on a bunch of decent surgeries...which i loooove.
my favorite was a shy little old gentleman in his 90's who wanted me to hold his hand while he was getting numbed up. "you could hold my hand if you wanted to, miss".... how do you say no to that? he took a nap while i was suturing him up. so cute.

and on tap for this week is getting to work with a PA who graduated from my program, so it's fun to compare notes. plus she's giving me free reign, which i feel entitled to at this point.
and, and...
wednesday is laser day... a whole day devoted to zapping people! wed afternoon is solely dedicated to tatoo removals. i can't wait. cause for one, there's the point and shoot aspect, which is thrilling if you've never done it, probably boring if you have...but then there's also the whole anticipation of seeing just how awful these tatoos are that people are willing to go along with being zapped for minutes on end to get them removed....will have to make a top 3 list for sure, so stay tuned!

what i DO know...

still suffering a bit on the derm front, although thus far this week, things are going way better clinically speaking. some juicy rare rashes that came in today cheered me up, as well as discovering a massive 2 volume dermatology picture bible in the clinic...just what i needed!

in as far as what i DO know so far, or at least after my first full week in this town is...it rocks and i would live here in a second.

a brief run down of what we packed in over the holiday weekend:

*a short float down the deschutes river, to harass the canadian geese but NOT the swans...
*a long float down the deschutes river, to allow for even more yelling at the canadian geese "watch out, eh! ya hosers!"
*the pet parade (complete with a flying chihuahua- seriously)
*waterfront festival- where liam totally rocked the dizzy bat race and the climbing wall
*hiking, sledding! and a swim at todd lake
*beer tasting at bend brewing company and cascade lakes brewing company
*exploring lava lands- one of the coolest national monuments i've ever been to, including:
~a cinder cone caldera rim hike
~a well intentioned but unfulfilled trek to benham falls due to the family members with really short legs that got tired out before we got halfway there and who we refused to carry the rest of the way
~spelunking at lava river cave, much to camper's terrified horror...(he was afraid of the bears, bats, and dragons that live in there)
*scenic auto tour of the cascade lakes highway (lots of mental notes made for later hiking and swimming- devil's lake...are you for real??)
*fireworks at pilot butte with liam
*many, many trips to the playground for apres dinner playtime and family frisbee time
*lots of riding bikes around town, although for future reference we should decorate them far more exhuberantly

so yes....things are going well here on the non-clinical side of things. the weather has been delightful. acquaintances keep proving to be unreasonably nice. we dig it here. we could stay a loooong time. will get off my arse and put some new pics up here in the near future.

the only bummer so far was that liam and i spent last nite and today puking all over the place...we are now ginger ale and saltined out, happily convalescing in bed...me with this distraction, him with a scooby doo distraction....relaxing after our ordeals which have yet to have a cause that we can determine. it happens.

i plan on going to bed momentarily and having the luxury of sleeping in until 6:30 am tomorrow to rejuvenate. oh derm, how i love thy office hours...let me count thy ways....

good, bad and ugly

the least looked forward to event of the year has now come and gone...the packing up and the storing of all accumulated junk and good stuff alike....in a marathon 3 day session of swearing, frustration, and a half way decent blamefest. a big shout out to bryce who helped hugely and who we owe more than a lot to.

and then we packed up the gyspy car for reals and headed out, an A & W treat looming on the near horizon to start things off proper.

rolled into Bend at 11pm the nite before starting my next rotation...found the new house that we're renting a room in, unpacked, slept for a few hours, and then attempted to hit the ground running.

and so far, the main point in education here seems to be know your golf courses and fine wines, cause that's your clientele. The more BS the better. I think we spend 10 min of every visit just chit chatting and then 5 min of actual down to business slicing and dicing. one one hand, i love it- there sure are some great characters here. it is gentrified wild west territory with a few hanger's on. On the other hand, BS is not my strongest suit. so...verdict is still out. that, and i haven't been able to touch a patient yet, and I'll be passed around to different preceptors the entire time i'm here, so i'm wondering how that will really work out since no one seems to trust me doing it the right way (their way). Hmm.

on the bright side, the place is super cush, the hours are super cush, and the people are ridiculously nice. every last one of them. even the kids. especially the older crowd. throw in a few cowboys and celebrities, and it keeps things really interesting. not in terms of medicine so much, cause there's only so many warts and acne you can see without getting totally bored, but the stories sure are fun.

top few fun facts i've learned so far this week:

1. Spider bites ususally come in 3's
2. Aspirin would most probably not be legal if it had come out in this day and age
3. (personal favorite serenade from a 93 yr old firecracker today) "if you go forth on the 4th with a fifth, you shall not go forth on the 5th."
4. Penny candy shoppes still exist
5. If you irrigate the desert, ANYTHING will grow there. also, i might have forgotten that scorpions live in the desert. won't be making that mistake again.

am looking forward to having the next few days off to recoup, figure out where i am, find a good swimming hole, and enjoy the biggest beer holiday of the year in a town that reveres the stuff.(even though the head brewer at deschutes has reportedly jumped ship). gotta love small town gossip!