sometimes it's about the journey...

left for kenya in good spirits- good travelling buds, and no mention of icelandic volcano disturbances...but somewhere on the epic 11 hour flight to amsterdam that all went to shit and we ended up in frankfurt instead, which, as far as i can figure out, is the omaha of europe...no offense, jane and doug :)...the bomb scare in the terminal didn't help much.

but....it was just this vortex of bad food, unhelpful people, forgettable scenery, and a line that we sat in or 6 hours trying to get re-routed to nairobi. which was horrible. BUT the upside of this trauma was that we got switched over to swiss air, which certainly must be the best airline in the whole world. top notch. and- important travel tip here- there's a law in europe that if your airline can't get you to where you need to go on the same day they have to put you up overnite. on their dime. and so, fortunately, one of my classmates speaks italian and gently appealed to the ticket agent our cause...and we got set up in a 4 star hotel overnite in zurich that nite. which was just short of amazing. and probably ridiculously expensive, but not to worry when the airlines pay for it. so we left the airport (finally) and headed into the swiss countryside in pristine volvo taxis...
and it made me think about what america does better than the swiss?
couldn't come up with anything.
they are completely reasonable, have a beautiful clean country, speak numerous languages, drive nice cars, eat great cheese, bake delicious bread, and have access to good wine. technologically they are way ahead of our game, at least in presentation. and everyone is polite. and well dressed. their airline gives you real wool blankets, real silverware, and fancy new planes with remote controls for your own personal TV. in economy. hmm.
it made me a little embarrassed.
and, i no longer will fly delta if i can swing it. and AND, america really is the only country so far that makes you take off your shoes before security. lame.

otherwise, have arrived no worse for the wear to nairobi. which is surprisingly modern, with delightful traffic but no honking. and people are also all decked out here. i love it. so friendly, so exhuberant. spending the next 2 days in an orientation and then heading out to bware, a village a few hours away where we'll be spending our weekends dong community health projects. monday-friday we'll be at st. joseph's community hospital in migori, a slightly larger town in western kenya.

so..looking forward to adventures ahead. encrusted in red mud, fueled by quail eggs and guinea hen dinners, nourished by sweet hot milk tea, and enmeshed with lots of laughter. a little bit more sleep would be appreciated, and although i enjoyed my european vacation, it would be nice to keep the passport stamps to a minimum from here on out.

general FYI

in case you know anyone out there who fits these profiles, please pass on my sentiments regarding the following proper patient behavior:

1a. if you are over 50 years old, 150+lbs overweight, wear glasses, don't shower, and are just weird in general, please make a mental note NOT to wear a grubby t-shirt that says in LARGE letters "get your nerd on!" to your doctor's office... or anyone's office for that matter. it's really, really distracting for the person on the other end who is trying to take you seriously.

1b. also, if you fall into the above category, don't argue with your healthcare provider when it comes to the results of your sleep study. there's no way you DON'T have sleep apnea, so just stop already with the excuses. and as much as your provider would like to believe that you can motivate and lose 100 lbs on your own, we might be a little skeptical given the t-shirt situation. take the short term solutions we are offering so that you can at least breathe and don't die. please.

2. even if you are bipolar with borderline personality disorders, it's probably safe to say that your ovaries are not in and of themselves, anxious. unless your ovaries are 2 of your other personalities. which could be true if you were the patient i saw today who talked to her ovaries (separately) quite regularly.

3a. please leave your aggressions towards past providers at the door. when you take up 10 minutes of your 15 minute visit complaining and threatening past providers who you believe have done you wrong with bad catheter complications, it makes it pretty hard to try to help you. and while you may laugh when a new provider suggests you get tested for a UTI and STD's to rule out reasons why you may have painful urination, understand that we're simply trying to solve your problem. referencing 1b, the bottom line is that we really would rather you didn't die.

3b. after 30 minutes of frequently awkward conversation with your provider about bodily functions, nether-regions, and quite unsolicited information about your sexual preferences, please don't try to give your provider a hug. it's creepy. it's doubly creepy when your handlebar mustache is over a foot long and you're wearing nothing but leather clothing.

4. if you're gay, then be gay. it's not a big deal. bottling it up is never a good choice. your healthcare provider, of all the people in the world, has no professional opinion on the matter, we just want you to be healthy. nervous breakdowns over the realization that you're gay when everyone else has known it for 20 years are sort of a waste of time and money.

5. lying about narcotic and illicit drug use will eventually come back to kick you in the ass. while it's sometimes difficult for your healthcare provider to believe that you can function in society on the amount of prescription pain killers you're legally on, it's frequently a little bit easier for us to see through the BS when you add more drugs to the cocktail and then come in for an appointment slurring your words, and with fresh track marks in plain sight, denying that you ever had any pain to begin with. seriously people? hope your withdrawal doesn't suck too bad. (sorry to turf to the poor ER providers here....but yeeaah)

looking forward to celebrating some march birthdays this weekend! carrot cake! brownies! sparklers! and maybe if i'm lucky it will warm up just a bit. just. a. bit.

ski day!

my first attempt at shooting video and editing....not exactly great, but a super fun day on mt. hood with weather to match. (sorry shannon and t, i would've gotten more footage of you guys if you didn't go so damn fast....)

cast of ladies:

harsono- riding a bamboo board

shannon- a blur in most shots

t- AT rockstar

me (there are no words)

settling in

week 7, things are feeling quite homey. i've never had this much time to settle into a rotation, and some slightly medically complicated patients i'm now seeing for the 3rd time- and for the more neurotic ones, 5th and 6th times. sometimes we talk on a weekly basis...one pt on an almost daily basis for constant reassurance and for notes to her work allowing for all of her weird nuances. at first it was sort of a drag, but now it's getting really interesting to see what more we can come up with...and i wonder how long her employer will continue to smile and nod. it's also quite interesting to track how her new medications seem to be taking effect. it's far more fascinating than i ever thought it could be.

also, when you see 30+ patients a day, something interesting is bound to pop up beyond the sinus and ear infections. like patients who get botox injections for overactive bladders but it backfires and instead they end up with chronic UTI's due to their inability to really void...or the pt who ends up in renal failure because her naturopath family member put her on medications without checking her kidney function first....

it's good stuff.

also...more overheards, since they are kinda fun...

pt: "thank you for looking, but when is the real visit going to start, the one with the real doctor?"

pt: "i feel like you have really been listening, and i appreciate your concentration, trying to figure out what's wrong with me today."

me: "oh sure, no problem. has anyone ever told you that you have the same voice as owen wilson? i feel like i'm talking to lightning mcqueen. ha ha ha"

pt: "who?"

me: "ahem. nevermind"

preceptor: "wait a minute...is that why you spent so much time with that pt?"

me "yeah, maybe. on an unprofessional scale of 1-10, how would you rate that?"

preceptor: "6."

i feel like i have more stored somewhere in my brain, but it's late and there are olympic level distractions and spring! is currently going off outside. i'll get back to these soon enough.

overheard

It's been an exciting week in the wide and wonderful world of psychology, i mean, family medicine. here are some of my favorite things i've heard this week:

pt: "are you the doctor?"

me: "no, i'm...."

pt: "well if you're not the doctor then the least you can do is get me some coffee. black."

pt: "i keep gaining weight. i don't know why i keep gaining wt."

me: "ok, let's try to sort through this and come up with some ideas and strategies so you can lose that weight.....(long interview inserted here, blah blah blah) ...so tell me about your caffeine use..."

pt: "i drink 2-3 liters a day"

me: "of what?"

pt: "soda."

me: "of regular soda??"

pt: "yes, well i read on the internet that diet soda is bad for you."

and my personal favorite...

pt: "i have sort of a weird question for you, please don't take it the wrong way..."

me: "nothing is sacred. shoot."

pt: "um...do you guys have any body bags you could loan me?"

A quick pic from the new hood- the park this was taken from is 3 blocks from our place. have i mentioned that we love it here?? today i wore heels to work with my fancy new haircut...damn i feel all growed up. for like the first time ever. it's almost exciting. painful, but exciting.

back by popular demand!

For those who have requested a new post: here it is, the past month in summary:

1. finished up in newport, WA- a great rotation. amazing people, which is like 90% of any experience...even though i was forced to sing karaoke at the ER christmas party. and the remaining 10% was all fun and guts encompassing good times in the ER, surgery, inpatient, long term care, and labor and delivery. 4 baby girls came into the world with my (limited) assistance. i hinted to ben that maybe it was a sign...and he says yes....that the world is clearly overcrowded with them. nice try.

2. back to NH for the holidays to see friends and family, which was super fun despite the fact that it was FREEZING cold the whole time we were there. or maybe i've just become a wuss. to be honest, i've been a wuss for some time now, just able to hide it well. call a NW winter whatever you want, but you don't have to shovel rain and i have yet to wear a hat or gloves here. in a nutshell, it was a whirlwind of sledding, gingerbread, champagne, cousins, lobster, vegan gluten free carrot cake, captain underpants, more champagne, and a few parties involving christmas cookies and more champagne. it was good to be back, good to see old friends, good to see how things have changed in our absence. good to be in sunapee harbor, fun to be in a beautiful rural locale in new england, totally normal rockwell'ed out.

3. fast forward a few weeks to the insanity of coming home new year's eve, making into town and into the warmth of our friends home just in time to ring in the new year. the new-improved-don't-look-back-this-one-is-gonna-ROCK! year. since i have nothing nice to say about 2009, i won't. but i am super hopeful about what's coming down the line, and it was nice to have a solid delineation. i'm not really much for new year's celebrations, but i had a little celebration at every single time zone we crossed on our flight back.

and now we're settled into our new (slightly longer term) place in sellwood, the neighborhood we've sort of been coveting for a year now. it's like a dream come true. walkable, bikeable, eatable, drinkable, playgroundable...pretty much hits all the major checkpoints for a place we want to live in, PLUS a sock emporium. what's not to love?

take the photo tour:

http://www.portlandneighborhood.com/sellwood-moreland.html

my current rotation, the biggest of the year, a 3 month family practice gig, is a short commute away and so far seems to be a gem of a spot. most of the pts are intel/yahoo/nike employees...and totally normal, nice people. a good international mix, lots of interesting life stories. i see it all, at a high volume. so it's nice to get a little bit of everything. from thyroid disorders to hypertension to diabetes to toenail removals to depression to rashes and the dreaded well child checks...it's good stuff. i get it. it's a comfy spot to be in. the light is getting brighter at the end of the tunnel and the track is smooth at the moment, so i'm chugging along quite nicely.

after this rotation, things may or may not get a little more roller coastery, but that remains to be seen as i have at least one unfilled rotation, and the other could be iffy depending on how things shake out in eastern africa over the next few months. but my passport is all renewed, ready to go just in case.

life is good. i feel like i haven't been able to say that for a while. i'm rolling with it. cause i finally can. phew.

northern exposure

so....

3 weeks here and i've finally found some wireless internet....at the hospital. where i work. all day. every day. and now, on my day off, here i am.
it's not so bad when you can show up and not have to think.

otherwise, it's a struggle. for a rural town in northeastern WA/northwestern ID, there sure are a lot of interesting cases. mostly cause people up here do what they want and only get medical care when they really really really need it. which is great for me, bad for them. huge cans of worms lurking around every corner. and people my age who look 50. 50 year olds who look 70. very few 70 year olds....

other than that, it's kinda fun. no surprise here, i love rural medicine. i love that providers choose to be here and are compassionate and not assholes about it. and that they laugh about things that 90% of the population really would not find funny. i love that they love teaching me cool stuff. i love that it's a small community that you could easily integrate right into. i love that i see pts in the ER, follow them to inpatients, through the OR and back out on the other side. i love visiting the folks in long term care and delivering babies in the same day. and i can't beleieve that i haven't seen the same pt twice in the 3 weeks here.

and truth be told, i love assisted living. there would be a gold mine to be made for anyone who wanted to create some sort of post-college age assisted living sitaution i think. it's just so easy. amazing how much time you can spend doing things you like when you're not worried about keeping things neat and clean, or cooking for yourself. for single people, it's pretty much the holy grail of living, i'd say.

i like this town. granted, there's not a whole lot here, and i haven't seen the sun in 3 weeks. but there is a nice safeway. i don't get out much cause i don't have a car, but the surrounding area looks nice. lots of mts, lots of trees, lots of snow. the assisted living place i'm staying is right across from 3 churches and a funeral home. one stop shopping. everytime i venture outside the town smells of pine trees and woodsmoke, not a bad combo. other than that, not much going on. i feel like it may as well be alaska, minus the grizzlies. they've got everything else here...i run into deer around town all the time. fortunatly, none of them have run into me.

i work, i eat, i sleep a little bit inbetween so i can go home a week early. i was adopted for thanksgiving and it was nice. lots of babies to squeeze. my own babies have been busy running amok in seattle and being city kids through and through. i think about bringing them to a place like this and wondering how it would all shake out. would they be outfitted in camo and bringing me home some elk by first grade? would we live on a ranch? have horses and tractors? would they ever be clean again ever?

my slightly humorous note of the day involves a little scenario that went down last wednesday, the day before thanksgiving...we're sort of sandwiched between 2 reservations here, and i had a native american patient who came in that day who wasn't exactly the easiest to talk to but we muddled through the encounter and came to the end and not really thinking about it, i said goodbye. and wished her a happy thanksgiving. and then walked away and tried not to cringe. can you do that? was it bad form? politically incorrect? it was sort of funny in retrospect, though...

gearing up for the big ER x-mas party next weekend. will try not to make an idiot of myself, but can make no promises. in the meantime, i plan to relax for the rest of the day, turn on the TV and pretend like sitting on the couch for the rest of the day uninterrupted with my bag of lucky charms is somehow a luxurious endeavor. and then right back at it tomorrow.

home in a week and a half. i can't wait, even though i'm dreading another move during the holidays....to who knows where....