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The Stab Room September 5, 2013

Posted by therealtinlizzy in future physician.
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I mentioned in a post awhile back that I took up being a volunteer minion for a few shifts/month at HCMC in the emergency dep’t. Having been there over a year now, I was given the opportunity back in May to train as recorder/scribe for the stabilization room, to which of course I said yes please.

The stabilization room (referred to by staff as the “stab room”, pronounced stabe) is HCMC’s trauma/critical care area – a secured/closed off area of the emergency dep’t. I haven’t yet ascertained all of the minimum level of criticality factors that triggers a visit to the stab room. Certain circumstances are no-brainers for being stab cases:  a car crash victim, biker hit by a car, heart attack victim, patient found unresponsive, possible stroke victim, etc. However there are plenty of bloodied up, in-bad-straits folks who come into the ED via ambulance who don’t merit stab-room attention and are instead placed in one of the team center rooms (referred to as “cubes” by the staff, I suppose because the rooms are square-ish glass-doored rooms stacked one next to the other).

As an aside, anyone who’s ever been to a doc knows how klunky or unintelligible medical vernacular can be. Certainly medical lingo can serve a useful purpose when time is of the essence and strings of conditions, procedures and medication jargon can be whittled down to a more expeditious short-hand. To quote Danielle Ofri in What Doctors Feel on the language of medicine:

“A typical first line of hospital admission might read 82 WM w/PMH of CAD, CVA, MIx2, s/p 3V-CABG, c/o CP, SOB 2 wks PTA. BIBA s/p LOC. No F/C/N/V/D.”

I’ll spare you the verbose version of what that translates to, but suffice to say 309 chars shortened to 75 in the zippy pace of an emergency department can be a handy time saver for docs and staff across multiple patients over minutes, hours, days.

But I’ve also noticed some hospital vernacular that isn’t particularly shortened or efficient, it seems just needlessly not-how-real-humans-communicate. In HCMC, each of the separate care areas of the ED are referred to as “team centers.” As per above, obviously inside-baseball medical jargon is needful as a means for med professionals to communicate with one another. However, when it comes to the interface between medical-side folk and patients, it seems there would be some forethought to humanizing some details. Say, for example, when a name is chosen for a place where patients are cared for and where patients and families need to navigate to/from and all of the rooms & hallways look alike to those not familiar with the layout of the ED area. The designation “Team Center” might well refer to a collection of offices or conference rooms or a break area. I mean – one knows what those words mean, but nothing about “Team Center X” implies anything human-relatable in a healthcare or hospital setting. Might as well call them Sponch Zones (“Sponch” is the actual awesome name of a friend’s cat) or something equally meaningless.

Anyway, back to the stab-room. While the whole large room is an open-plan area, it’s partitioned into four areas, or “bays,” which can be curtained off from one another as needed. While each bay is equipped to treat most any cases that come in, each is geared slightly differently: one for trauma cases (accident victims, shootings, etc), one for medical cases (heart attacks, stroke, etc), one for pediatric cases, and the fourth for burn cases.

Most often there are med students on duty for any given shift who record as part of their learning/training, but when there aren’t any available or on duty, the red shirts like m’self get to record. And even if there’s a med student recording, I’m able to stay and simply observe the case.

Stab room recording entails scribing anything/everything medically relevant about a particular case from the time the patient comes through the stab room doors until they’re sent off for scans or to another dep’t (or declared deceased). When the EMS folks roll in with a patient, they rattle off all known info on the case or their encounter thereof, all of which has to be captured. This includes any/all of the following that is known (and there are times when much isn’t known): how the patient was found, who found them, all known circumstances of the incident/accident, meds or procedures administered by the EMTs, vitals, blood glucose levels, level of responsiveness, pupil reaction, etc. In the first minute or two the recorder needs to capture this flurry of info while the docs, nurses and HCAs get to work on the patient. From there on out, vitals (blood pressure, heart-rate, respiration rate, and oxygen level) are to be logged at least every 3 minutes, along with each occurrence of a procedure or admin of meds.

When there are no stab cases to record or observe (which is most of the time during any given shift), I just do the usual volunteer minion tasks and rounds. Incoming EMS interfaces with someone at the main desk in Team Center A to call in the impending arrival and a summons to the stab room occurs via overhead page, e.g.: “stab room personnel to the stab room, 6 minutes out, trauma.” This triggers all of the docs, nurses, PharmD and HCAs scattered among the 3 team centers designated as stab room staff to convene. Good on them for going with non-obfuscated verbiage for the pages. 😉

Arriving in the stab room I grab a clip board and paperwork and stand by for any further info EMS has sent ahead, find out from the stab room nurse (truly the Knower of All Things) and scribble down who’s the resident, attending doc, nurses (so many people, so many names to learn) for the case, along with any info already known.

On one particular occasion, all we knew about the case coming in was the type of trauma suffered, and that EMS was administering resuscitation attempts en route. There was a med student to record, so I just stood off out of the way to observe. When I observe, I take the opportunity to scribble notes on meds/procedures I don’t understand so I can look things up later (bless the internets). Sometimes there’s an opp to ask one of the med students or staff at the time, and sometime’s the time to just scribble notes to look up later (if I’m actually recording o’course I always ask).

Anyway, I watched the nurses unpack a bag of equipment I didn’t recognize, so I looked for any brand name or lettering that I could look up later. There was a flat but curved chunky sturdy piece of plastic that I guessed would go under a patient’s torso that had the letters “LUCAS” on it. Separate was a clunky mechanical device with curved “arms” and a plunger-like protrusion. What I soon observed was that the pieces together are a device which automatically administers chest compressions to a patient:

LUCAS resuscitation device

Within a few minutes the EMS came through the doors wheeling in the unresponsive patient, who at first glance appeared to be self-administering chest compressions with the EMS’s LUCAS device. The patient’s wrists were fastened to the sides of the device (to keep the torso/body geometry in optimum position for effective compressions? Or perhaps just to keep the arms of an unresponsive patient from just hanging about?) in a manner which moves the arms along with the compressing motion of the device, creating the queer illusion that the patient is self-administering the compressions. Having not known that such a device existed, and knowing that EMS was administering resuscitation efforts en route, I guess I had no reason to expect anything other than that one of the EMTs would be atop the patient still administering chest compressions when they wheeled the patient in. Makes me wonder how long those LUCASes have been in use in the field. Bet the internets would tell me that too.

Here’s a vid that provides a demo of the LUCAS, pretty cool actually:

I’ll keep it to those generalities on what sorts of cases I have the privilege of observing/recording in the stab room, being very cautious to stay on the correct/appropriate side of privacy and propriety. But suffice to say, it’s an order of magnitude more of a learning experience being in the stab room versus just the usual volunteer duties. It’s nice actually to be able to get to do both, as I do still enjoy being a regular red-shirt in the ED: stepping briefly into folks’ varying degrees of upset or just really-bad-day to contribute a smidge of not-suck, even if just for the moment or few I interact with them. But having the opportunity to see trauma care as it happens, and a practical context for learning terminology, procedures, methods, interactions, medications in a practical = really awesome.

Can’t stop, won’t stop May 17, 2013

Posted by therealtinlizzy in Uncategorized.
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This week saw the passage of gay marriage in Minnesota, during the live-streamed Senate debate of which @snipy and I cheered and booed/hissed alternately while drinking adult beverages at Wilde Roast. Neither of us have the least inclination to get gay-married, cuz – well it just doesn’t suit us. But cheers to homos who want to for lots of compelling reasons now being ABLE to get gay married here in ye olde Minnesota, hip-hip-hooray!

This week also saw the end of the semester for me with the taking of my Microbiology final exam today (on which I think I didn’t do too dismally), and am tonight basking in twitchy punchiness after cramming, shoving, shoehorning all things pathogens and virulence into the tiny space of my head over the past few days.

Does too fit

Must pick up the personal essay-writing again this weekend, and completing other bits of my (re)application, and then back on the train of studying for a retake  of the MCAT mid-late summer (le sigh), but for tonight – it’s all curling up with Sheri Tepper’s Grass. I’m rather pleased to have made it through Robert Caro’s first Lyndon B. Johnson doorstop (an excellent doorstop, but a doorstop nonetheless) but it’s nice to dip back into some spec fiction after that slog of nonfiction.

So while my brain works on getting back to being able to string some words together other than those relating to viral & bacterial pathogens, superantigens, endo/exotoxins, and the methods of action for which antivirals/antimicrobials are used to treat which marauding pathogens, I’m going to post the essay I submitted for my extra credit assignment for my Future Physician course. The assignment was to interview a physician of our choice,  and then string some words together about it. Happily I did so rather more effectively than I’m able to at the moment.

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Unicorns, and one physician’s experience as a patient May 6, 2013

Posted by therealtinlizzy in future physician.
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My semester at the U is wrapping up this week and next with a final paper due for the Future Physician course on Thursday and final exam for Microbiology next week (in which I’m currently one of the top few students in class – no humble-brag that, am totally owning that I’m damned pleased with self!). Happily the final paper is only a 3-pager (though it’s one of the those weave-together-all-the-things-from-the-semester-into-a-cohesive-narrative-with-this-specific-focus type of papers that’s taking some noodling to compose), and the final Micro exam is just over material covered in this last section, not cumulative except insofar as the last section builds on everything from earlier sections.

While it will be nice to have the get-to-class and get-class-shit-done pressure off for the moment, May will continue to be packed through to the end of the month with getting my med school application updated and ready to submit again June 1st with a year’s worth of added work/life experience, volunteer activs and course work, as well as finishing a complete redo of my personal essay (one’s med school app needs a neon disco-ball unicorn of a personal statement in order to leap out from the pile of 4000 or so other perfectly nice unicorns) to transform it from

perfectly pleasant unicorn

into

unicorn

Yep – I just Blingeed a unicorn and dropped it here. Boom. (credit for the unbligeed unicorn)

I’ll not be sad panda to have to write an essay nearly every week, but I will miss the Future Physician course as a context for strong-arming, er motivating and providing context for me to write weekly. The FP class has actually been a really useful means for me to construct a new and more relevant (and hopefully more disco shiny) narrative for my personal statement, in addition to expanding my knowledge of different specialties and providing lots of fodder for personal reflection and understanding myself even better.

In the interest of my endeavouring to keep up on the journaling kick for my own sake, I’m going to post one of my essays written for the FP class a few weeks ago where we had the opportunity to hear from a physician, Dr. Macaran Baird, who shared his story of being a patient over this past year. The essay generally (not being exactly specific so as to protect the integrity of the course coordinators’ specifics of the assignment) was to include reflection on aspects of Dr. Baird’s narrative relevant to us as future physicians. It’s prob not the most interesting of reads for a general audience, but that’s alright – it can’t always be unicorns and Iron Man. I will say Dr. Baird’s story itself was something worthwhile for any old anyone to hear, regardless of one’s interest, or lack thereof, in medicine. So, my thoughts on Dr. Baird:

One of the loveliest things about listening to Dr. Baird’s narrative (and there were many) was the humanity, humility and gentleness that flowed from him. I have not had the pleasure of meeting Dr. Baird prior to our class last week, but it seems that Dr. Baird’s experience isn’t a case of a physician whose core personality or approach to life or medical practice experienced radical transformation by gazing into the chasm of his mortality. Rather it seems Dr. Baird’s character and life experiences instead sculpted what sounded to me like a very graceful manner in which he traversed the ordeal of experiencing, being treated for and surviving [his illness]. In addition to the simple privilege it was to listen to Dr. Baird’s narrative, there were a number of notions he addressed that I found relevant to me as a future physician.

Dr. Baird described coming fairly quickly to relative peace with his [] diagnosis, the prospect of arduous and unpleasant treatment, and coping with the prospect that he may not survive either the treatment or the disease. However, he spoke of his wife having a more difficult time with all of it, that she experienced much more anger, frustration and a sense of it not being fair. He was sensitive to the fact that everyone experiences trauma and loss (or the prospect of loss) in very different ways, and that just because he had come to a sense of peace about his condition and prospects, he needed to afford his wife and others in his life the respect of each processing the situation in their own individual fashion. I believe this is a concept that physicians must learn to be mindful of and extend to their patients and patients’ families; every person comes with their own unique ways of experiencing, expressing and coping with negative health prognoses and loss. Granting patients emotional and psychological space to experience and cope with loss and health difficulties is something I intend to work hard at as a physician.

Another bit of wisdom Dr. Baird imparted that I feel is relevant to me as a future physician is being able to graciously rely on others’ skills and abilities. Dr. Baird seems to have already had a strong sense of trust and reliance on the other healthcare professionals with whom he works long before having to let other nurses, physicians and health care professionals take care of him as a patient. However, Dr. Baird spoke of having to fight his own stubbornness as a patient and to learn to take the nurses’ recommendations for his daily care, nutrition and physical fitness. So while he seems to have had a good foundation for trust in those providing daily patient care, he seems to have learned an even greater appreciation and trust for those like nurses who are so foundational to daily patient care, and the way he spoke of his experience led me to believe he was very gracious to those who took such care of him. A concept that has emerged repeatedly in these Future Physician presentations has been physicians’ trust of, reliance on and cooperation with other health care support staff. I’m certain there are many exceptions to attitude and sense of cross-disciplinary collaboration in the ranks of physicians out there, but it’s been incredibly encouraging for me given my notions of the importance of trust, collaboration and team work across a range of abilities that there are and will continue to be many similarly-minded physicians out there.

A third element of practice Dr. Baird spoke of that I feel is particularly relevant to my future as a physician is that “doctors lose a little part of themselves when patients die.” When I began pursuit of medical school, I expected to learn from and be mentored by physicians who were pros at keeping a cool, clinical detached distance from patients or about their patients’ experiences. I can’t say exactly where that expectation stemmed from, perhaps from a lack of strong personal acquaintance with any physicians in my life until more recently, as well as never having traversed any particularly fraught or traumatic medical or health concerns. However, what I found in Dr. Baird’s narrative of being a physician, as well as in the accounts of the other physicians who’ve shared their experiences with our class, is anything but clinical detachment.

These are physicians so passionate about their practice and invested in their patients that the emotion has often been palpable – running in tears down their faces, catching in their voices. That’s not to say that I’ve gotten any impression that these are physicians without emotional or professional boundaries between themselves and their patients; to the contrary, nearly every one of these physicians has spoken of having to balance the emotional attachment and investment they feel for their patients. But what I found particularly encouraging about Dr. Baird’s narrative about his experience as a physician, is the lack of fear about the emotion and care he (or any of the physicians who have presented) invests in his patients; there’s an understanding, acceptance, and embracing of the loss and pain physicians experience when patients die. What I take for my future as a physician is that while there’s a need to impose boundaries and take care of myself emotionally and psychologically, to not lose myself to patient need and loss, I can be my genuine self in truly and openly caring and emotionally investing in my patients.

I expected Dr. Baird’s narrative to be along the lines of “let me tell you how being a patient with an acute life-threatening condition transformed how I practice and how I look at my patients,” but that wasn’t at all the story he told. What so much inspired and moved me overall about Dr. Baird’s story is that while being on the receiving end of such substantial and all-encompassing medical procedures and day-to-day health care was both a new experience for him and led him to discover what he characterized as a new “syndrome” of being immensely and overwhelmingly grateful for the privilege of his life, Dr. Baird clearly got on the path long ago that led him to develop into a passionate, intuitive, deeply compassionate and empathetic human being and physician.

The Luck Dragon gets her wings April 20, 2013

Posted by therealtinlizzy in pups.
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I woke up this morning, from a night of not sleeping very well due to oh-so-smartly eating a large-ish meal (delicious though it was) and drinking both red wine and espresso late at night while at the Dakota for a really lovely Ricky Skaggs bluegrass show. It was the morning after we’d gotten clobbered by a ridiculous late-Spring 6-8″ snowfall, Lisa had already called into work to take a PTO day and I was planning on a leisurely work-from-home Friday.

I finally hauled my ass out of bed, after a few minutes of snuggling with Chloe and enduring some of her morning nibbling of the bedclothes, as she does. I noticed Shi hadn’t gotten up to wander about yet, but Shi sleeps hard sometimes, and being deaf as a post, she doesn’t wake up to ambient noise; ambient breezes, touch or shifting of whatever she’s laying on, then yeah she’s up poking her cold nose blindly in your direction, but otherwise Shiloh sleeps like a boss, case in point:

I’d just stepped over her lying on her dog bed on the floor at the end of our bed to look at the snow carnage outside, when I bent down to snuggle Shi and wake her. She was oddly still, so I felt her nose for breath and oh no oh jesus fuck Shiloh was gone. I uttered something half-coherent to Lisa, who clambered over to the end of the bed in disbelief and no-no-no-no-no while I felt, touched, confirmed that indeed – Shiloh had died in her sleep. You wouldn’t have even known, to see her laying in her usual sleep spot, in her usual sleep position, that she was anything but sleeping like usual.

Shiloh was, as of this morning, at least 16.5 years old. I say “at least” because when I and my sig-at-the-time Angie adopted her from an Aussie rescue org in October of 2000, one of the few tidbits of info about her the org possessed to give us was that she was “between 4 and 6 years old.” They didn’t know her age for certain but the guy she had come from – an older gentleman in San Diego who raised Aussies but whose own health was in rapid decline so that he could no longer care for them all – asserted she was somewhere between 4 & 6 years old.

Another thing to know about Shi is that in the 12.5 years I’ve had the privilege of knowing this fluffy white pinball of blind deaf dog, she’s had nil in the way of medical issues/conditions – the exception being the dislocation of her right hip less than a week after we adopted her, which resulted from said newly-adopted Aussie leaping out of our second-floor bedroom window (that we left open because why would you think to close a window on a nice warm Fall day??) presumably trying to find us when we left the house for less than an hour to run a few errands.

We came home that afternoon to find Shiloh standing in the yard with one leg not working, subsequently discovered the window upstairs with a busted-out screen, and put 2 + 2 together. The eventual fix for Shiloh’s dislocated hip, which wouldn’t stay re-located even after being re-set and with her leg in a sling for 3 weeks after, was for veterinary friend Dr. Jami Stromberg (one of the damnedest-fine vets around, I’ll wager) to lop off the ball of the femur and let the muscles take over holding the leg in place in lieu of a joint. Who in fuck would have thought THAT would have worked? Oh AND – Jami used a chisel bought at Home Depot (of course subsequently surgically autoclaved/sterilized) for the procedure of lopping off the ball end. I would call that baller, but for the bad pun.

How Shiloh survived a two-story fall I still can’t fathom, and how she then managed another 12+ years of walking for miles at a time and running around like a boss (and she could – you should have seen her off-leash at the big wide-open dog-park by the airport) is just a ridiculously lovely bit of fortunate happenstance. I’ve always called her the Luck Dragon as she had more than a passing resemblance to The Neverending Story’s Falcor:

Falcor the Luck Dragon

Shiloh

Other than that one Aussies-can’t-fly surgery when she first came onto our scene – Shiloh was a 16+ year old pup on no medications, with no chronic or old-age type conditions, not a speck of arthritis, not even showing signs of slowing down – hence our dubbing her recently as the Elven dog. And while we’re not nonsense people who thought that Shiloh was going to live forever (Elvish or no), both Lisa and I are acquainted with canine end-of-life scenarios that entail at least a hair more advance notice, or even downright drawn-out slogs down the path to a pup’s final breath. So while I’ve been reminding myself that Shi would eventually be moving on one of these days or years, the abruptness with which she departed was, well – heartbreakingly abrupt. Hell, it’s Dax with all her arthritis and creakiness and now diabetes, whom I expected would be the first of our canines to exit-stage-left. 

Having experienced both the scenarios of drawn-out health demise with Kaci (the pup I navigated highschool with) before she died, and knowing for days as a 12-year old that our husky Sitka was to be put to sleep (goddamn torture THAT was), I know why an abrupt and painless departure at the end of a long full life is the very the thing, short of immortality, that we all want for our four-leggeds, our people, and ourselves.  However, I can now also say that a sudden exit of one’s pup sucker punches you in its own special ways:  no last deliberate and drawn out hugs, snuggles, burying your face in warm fluffy fur, being licked, getting snuffled with a cold wet nose, holding puppy toes, rubbing a soft pink belly and velvet ears, scritching that spot that makes a leg twitch. Missing out on those last-known moments cauterizes your neural paths after your pup is suddenly gone in different ways than happens when you see it coming.

That said – having Shiloh depart so abruptly granted me the gift that all of these last moments, hours, days with her up until sometime after 5am this morning when she was still present and raised her head to snuffle in inquiry at Lisa stepping over her on the way to the bathroom, were exquisitely, beautifully perfect in their unharried, un-fraught, utter mundaneness full of love and life and normalcy and goodness, rather than days or weeks or more of pain, hurt, heartbreak and is-this-it, or that special hell of having to deliberately end suffering.

This is my first loss of a pup as a grown-up – that is, a pup who’s lived with me, been part of my own pack and household and daily routine, whose ticks and fidgets and bumping into my shins and pacing to find me and ambling through the room like SNL-David-Patterson and click-click-clicking of her nails on the hardwood and Helen-Keller-style nosings/pawings/demands-to-be-petted and backing all the way up the stairs and snuffling my hair/head like a crazy person have all so thoroughly and indelibly been woven into my daily-life muscle-memory over twelve years.

One would think given such a week fraught with national and collective angst and bad news (Boston Marathon bombings, Congress/Americans devolving into some nasty awfulness over guns and gun laws, the explosion of a fertilizer plant in Texas, and manhunt/shootouts to find what may turn out to be the Boston Marathon bombers – even the Onion called it with “Jesus, This Week”) that waking up to find that my little Shiloh, my Luck Dragon had passed away during the night in her sleep, would perhaps be the grimest of cherries on an already grim cake.

However, I’ve found that more grim on top of grim isn’t how today has been at all. Having my attention jolted from the frenzied cacophony of the world’s current madness-du-jour by a gut punch of the sudden and unexpected exit of this sweet kitten of a canine of ours, to be undone by grief and weeping and memories and loss…is wrenching, is jagged, is devastating. But it perhaps is no bad thing to tell rest of the jacked world to just fuck off for a time, to weep and grieve and rejoice in and remember the life of one of my little daemons.

Shiloh was a double-merle Australian shepherd – mostly bright white in color, but for a couple of small Holstein-like dark patches. However in the winter, somehow the snow still beat her in pale brightness by comparison. It seems fitting that the White Dog took leave on a ridiculous late spring day when the surrounding world was utterly buried in snow.

100_0231

Enjoy the bellow snippet of Shiloh doing something she was awesome at: digging the shit out of things – floors, dog beds, occasionally dirt, but mostly impenetrable things:

It hurts so very badly only because we love them so very much. Goodbye my sweet kitten, my Luck Dragon, my daemon, my Elven dog – you, originally named Avalon from San Diego, who will forever be Shiloh: you are my sunshine, my only sunshine, you make me happy when skies are gray, you’ll never know dear how much I love you.

John Turnipseed April 16, 2013

Posted by therealtinlizzy in future physician, North Minneapolis.
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There’s a new-ish U of M-associated building on the North Side called UROC – the Urban Research and Outreach-Engagement Center (I suppose UROC rolls off the tongue better than UROEC :)) housing “a dozen University programs committed to research and problem-solving in authentic and engaged partnership with individuals and organizations in Northside communities.” I know there was not a small amount of controversy with the U of M acquiring the building – which while somewhat haggard and run-down, used to house some neighborhood shops and a restaurant.

I think it’s understandable and even good for folks residing in a troubled and complicated community like North Minneapolis to turn a critical/suspicious eye to those in ivory towers coming in to “engage” them; I also think that connections can’t start to be made, underlying issues can’t begin to be intelligently and meaningfully addressed, without some deliberate meeting of the minds between those residing in North and those with the sorts of resources and initiative that an institution that the U of M is able to bring to the table. Sometimes those attempts at “engagement” and meaningful connecting occur in fits and starts, sometimes with some fair bit of socio-cultural clunkiness and lack of understanding, but I believe the important thing is that they get started and persevere despite the fits/starts/clunkiness.

Encouragingly, the two instances of “community engagement” initiatives at the UROC  in which I’ve participated have been spearheaded by folks from the Broadway Family Clinic, which has been a part of the North Side community since the 1970’s in addition to being part of the U of M medical system. So, rather than being a case of academics with no direct connection to the North Side community coming in to try and fix the North Side’s problems, the engagement initiatives to which I’ve been privy are being lead by those who live in, work in, and serve the North Side. (Also too, I sort of hate that term “engagement” and “initiative” in this context – it’s such a corporate-speak kind of verbiage thing, but – well, sometimes spinning language to make a thing seem more accessible and cozy is how we humans do.)

In addition to the Ladder, which seeks to mentor and connect North Side kids to the health care professions and sciences, another initiative the Broadway Family Medicine folks do at UROC is a monthly event called CHAT – Community Health and Advocacy Talks (because acronyms is also how we do!) – an opportunity for the community to hear and participate in discussion on some topic where individual and/or public health intersects with socio/cultural/economic issues.

Last week’s CHAT event presenter was John Turnipseed, director of the Fathering Center in Minneapolis.  Mr. Turnipseed’s presentation centered both on his experiences from childhood until he was 40 years old with gangs, drugs, sexual exploitation, and violence here in Minneapolis, as well as the transformation which has led him to now use his connections and experiences to provide opportunities, understanding, education, and a sense of accountability to others caught up in the same cycles of harm in which he had been trapped. Mr. Turnipseed’s presentation included the screening of a portion of a biographical film based on his life, a verbal narrative about his life experiences and subsequent work here in Minneapolis, and a question-and-answer session.

johTurnipseed

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Med school for medicine? Nah dude – wind-sailing! April 8, 2013

Posted by therealtinlizzy in Uncategorized.
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Not actual advertisement for the U of MN medical school

(not the actual advertisement in question for the U of M medical school)

Last Thursday’s Future Physician featured a doc/topic to whom/which I was very much looking forward: Dr.  Carrie Terrell – an Ob/Gyn at the University of Minnesota Women’s Specialties Clinic.

I was initially acquainted with with Dr. Terrell as one of the “visiting” physicians who provided abortion services at Midwest Health Center for Women (acquired over a year ago by Whole Woman’s Health) where I volunteered as a patient escort for over 5 years. While I didn’t have much opportunity to interact with Dr. Terrell directly during my years at the clinic due to my volunteer duties being on the sidewalk in front of the clinic, my experiences at MHCW provided the foundation for my inspiration to become a physician (inclusive of being able to provide abortion care for women), and Dr. Terrell was my initial point of contact for reaching out to a real-live physician to discuss my intent, plans and really to just get a first clue about where to start.

In addition to being incredibly gracious to meet with me and share her experiences in getting into med school and her journey leading to becoming an Ob/Gyn, Dr. Terrell was the one who opened doors for me to observe a number of surgeries and her clinical work at the U of M. She has generously provided me connections to other physicians, including to those through whom I’ve been given many learning and experience opportunities, such as with the Ladder and the Broadway Family Clinic.

Ok – enough prelude gushing, except to say that I hold Dr. Terrell in extremely high regard for my own personal reasons, in addition to my knowledge of the incredible work she does for women individually and for women’s rights and health on a more broad level. Now back to the part about being excited to have her present for my Future Physician class last week.

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The Very Drunken Caterpillar March 21, 2013

Posted by therealtinlizzy in so that happened.
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So yesterday brought an unexpected bit of excitement to the day, and not of the good kind, but then again – perhaps it played out for the best in a bigger-picture sort of sense, and happily with no harm having come to anyone. I detail it here because writing is a good way for me to process/chew things over, even though I’ve already well-chewed things over with my sig, but also feeling free to do so as I can nearly guarantee that the individual involved will remain unknown/anonymous to anyone reading this. Also – any real or perceived sassy/lightheartedness about any of the ensuing events is because it turned out all right, and well – viewing some things in life thru the glasses of humor is one way I process things.

So we have someone come clean our house every two weeks. Why? Because we would rather forego most all other special nice time things in life short of food or the actual roof over our heads than spare the time required to keep at bay the ever encroaching entropy resultant from three Very Furry Caterpillars, one Very Chaotic Caterpillar, and one Not At All Messy But Who Doesn’t Want To Clean Up After The Rest of the Menagerie Caterpillar. So yeah – we unabashedly pay moneys for someone to clean our house every two weeks.

The Very Chaotic Caterpillar (me)

credit: Eric Carle

As a side note – the org we go through to acquire cleaning folks is beyond super duper wuper awesome, we’ve had a number of rockstar wonderful folks from there cleaning up after us and I would mention them by name here if I weren’t poised to detail a “so that happened” involving one of their (now former) employees. Just know that they made everything right on my end with the sitch, as well as showed extreme sensitivity and kindness to the individual involved. So if at some point you’re all “day-um – wish MY house could have special cleaning nice time once in awhile a la magic faerie pixies” give me a holler directly and I’ll tell you to look these folks up. See how you’re all resentful panda now at the dust monsters and dog/cat-hair tumbleweeds choking your house?

So the woman who’s been cleaning our house took over in February for an adorable and sweet but total-stoner of a hipster who, while very nice was – well, a total stoner. And if by some sliver of extreme improbability she was not in fact a total stoner, she could certainly play one on the teevee and she should look into that as a career move.

Anyway, after a couple months of stoner-girl who couldn’t find her way out of a weed haze long enough to make sure all 3 dogs were let back in the house before she left without locking the door – let alone manage to clean a few things, the woman who replaced her was a dream come true. See – the thing is, we know we are utter nonsense people to clean for. There are dogs, there are dog stuff, there are papers and books and bike and bike gear and winter gear and piles of study stuff and just stuff (mostly my stuff). Now – do not mistake us (me – really) for hoarders or clutterers – I’m not a holder-onto-things, I’m an overlooker-of-things, and – well a scurrier – so much scurrying around and it’s easy to forget to put stuff away. But I digress, this isn’t about my chronic battle with Chaos.

So everything has been dreamy for a couple months; when I come home after (I’ll call her Lindsey Lohan; and not Lindsey Lohan gone all epic train wreck, but Lindsey Lohan when she was still just a nice kid) Lindsey Lohan has been there, I want to weep tears of joy for how nice she’s been to wrangle the chaos and let the pups out and we can exist for at least a day or two in a peaceful bliss of Clean House Zen that’s totally special nice time.

Yesterday I came home, almost a couple hours after Lindsey would have left, saw the pups in the backyard and thought “huh – Lindsey must have come late today” which isn’t unusual.  I walked in, heard the radio on, and was just going to holler a hello when I looked over and saw Lindsey lying unconscious in the dining room.  I went into action mode and first checked that she was breathing and warm (which she was) and quick tried to rouse her carefully without moving her. She appeared to have fallen into/against the one table, which was knocked askance, and was laid out between both tables with her head almost in the corner, so I needed to move chairs and tables out of the way just to get at her.

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Tip of the database March 19, 2013

Posted by therealtinlizzy in day-job, navel-gazing.
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My day job (some fair bits of which occur not during the day at all) includes the planning/execution/orchestration of technical procedures (server builds, code deploys, OS/app upgrades), as well as responding to, triaging, and “stopping the bleeding” when one of our servers or applications crashes and burns.

Toast

This past weekend entailed the former – a planned system outage for the purpose of executing a scheduled upgrade to one of our environments. Simply put – we had to migrate the databases from 2 old servers to 2 new servers. Not a terribly complex implementation, as these things go, but nonetheless requiring a not insubstantial bit of planning, deliberation, collaborating, scheduling, assembling of needful technical folks (other than myself), and documenting a roadmap/checklist for all of the tasks involved.

I know – you probably just nodded off there, but stay with me – tech nerd circle-jerking isn’t the point of this post. But don’t worry, there will be plenty of time to nod off again later on.

After signing off at 6am Sunday morning (having begun at about 11pm the night before), with nary a glitch in the whole thing start to finish, I was pondering the aspects about the whole affair that made me so pleased and satisfied specifically, and about what makes me most enthused about my job generally and other projects/extracirriculars on and in which I’ve been immersed.

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Reflections on Neurosurgeons March 15, 2013

Posted by therealtinlizzy in Uncategorized.
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One of the good things about the Future Physician course I’m taking is the compulsory small bits of writing we’re sometimes required to do for the quizzes each week following the physicians’ presentations. Some of the quizzes are simply multiple choice, but some or parts of them are essay/reflection type questions. Oh, and on a timer – which, for this noodly meandering writer who finds concision difficult and excels in tangents and rabbit-holing, is a good thing.

alice-falling-down-rabbit-hole1

Case in point, last week’s quiz included a request for reflections on some specific elements of the presentation/talk given by a pair of neurosurgeons. It was actually one of two presentations that particularly lit up my neural net like a Lite-Brite (each of them have been brushfire-inducing in various ways, but these two even more so), so I appreciated the added prompting of an assignment to prod me to write a bit about it. Also, I had only one hour to write it – so great practice on that whole “better get my mental shit together FAST.” Too bad the MCAT is doing away with the essay-writing portion. Actually no – it’s not too bad, I felt more harried over the essay bit than I did agonizing over some obscure physics passage on harmonics and composite waveforms that I crashed and burned on. Then again, I fared better on the essay portion than I did the physics portion…

harmonicsWaveforms

Anyway, decided I’d post my hastily-thrown-together thoughts on the neurosurgeons from last week, Dr. Andrew Grande and Dr. Bharathidasan Jagadeesan, who were both brilliant and engaging. I particularly resonated with Dr. Grande, whose enthusiasm and love for what he does, and the genuine emotion with which he talks about his life and his patients, just gushes from him.

Note – I’m just leaving the sentence frags and misspells, because it’s how I wrote it in an hour where I ran out of time to proof (gah – frags and misspells! Am mortified that I had to submit it before cleaning those up):

One of the valuable notions I gleaned from Thurday’s session included Dr. Grande’s assertion of how every single individual on the team invovled in a patient’s care is significant and necessary – from nurses to health care assistants to techs to physicians to specialists. Early on in my pursuit of medical school I grew concerned at the hierarchy I perceived within the health care professions, that it rubbed wrong my egalitarian sense of respect for everyone’s differing skills and abilities, even when those skills and abilities are quantitatively or qualitatively diverse. However, Dr. Grande’s assertion and attitude reinforced for me what a number of physician mentors and medical learning opportunities have shown me: that there are many, many physicians who, rather than perceiving non-physician health care staff as inferior or to be condescended towards, they perceive teamwork and trust of each other to be of utmost importance.

The speakers also reinforced for me that medicine isn’t a profession that you just “lock up in your desk” at the end of the day – at least the sort of medicine Drs. Grande and Jagadeesan practice certainly isn’t. Dr. Grande’s description of a particularly harried week where he progressed from a 24+ surgery, to a follow-up on another patient (or few), to an engagement to which he had committed illustrated that being a physician, or certainly a neurosurgeon is a lifestyle, not a “job.”

In addition to the many meaningful and inspiring notions I took away from Thursday’s session, one piece of advice I found particularly relevant in assisting in preparation for a life in medicine was the reinforcement of the expectation I had already settled into that the “becoming” a physician isn’t some 7-10 year grim sentence to be endured, after which one can emerge into the light of finally “being a doctor.” Rather, 7-10 years spanning classwork slogging, rotations, residency and fellowship (and everything in between) is all part of the “practice” of medicine. As a prospective medical student already in my late 30’s, one of the first notions with which I had to come to terms as I considered pursuing medicine was that I wouldn’t be a full-fledged physician until at the earliest my mid-fourties. Almost immediately in my consideration of that, it occurred to me that it made no difference to me – because clearly the entire process of becoming a doctor – all of the schooling and apprenticeship – are exactly that: part of the process. The pursuit as well as the actual “becoming” a physician are what I’m passionate to pursue. Drs. Grande and Jagadeesan assert similiar notions – that the entire process of medical school, residency and fellowship (at least after the initial classroom work) is all apprenticeship and “doing,” and that was very encouraging to me.

One of the most meaningful moments for me from Thurday’s session was Dr. Grande’s story of an older woman who collapsed while on a riverboat casino with her husband. The woman came under Dr. Grande’s care and was discovered to have aneurism which caused the collapse. After being informed of the state of her condition, the family decided to withdraw treatment or life saving measures and to instead let her body go when it would. Dr. Grande spoke of happening to walk past her room when doing rounds as her heart monitor flat-lined and she passed, and of looking in on her to find her husband curled up next to her in the bed. Dr. Grande’s compassion, caring and empathy for his patient, and her husband, was evinced not simply in the telling of the story, but by the emotion evinced in his voice and on his face. Not only this story, but other descriptions of his interactions with patients and their families, and his assertion that physicians are present in the inner circles of patients and families, the most vulnerable and fraught of places – where the most patience and compassion from a phycian is possible and needed.

Another point about compassion that Dr. Grande made which struck home for me was his assertion that true compassion isn’t about being kind and caring during the breezy times when everything works out smoothly, or even just being caring, empathetic and respectful to the patient. Compassion is about being able to care for patients and their families, to be able to be frank and honest, during the most difficult of times – when circumstances are the most fraught and traumatic, when patients and families are frazzled, anxious or even short-fused, and particularly when circumstances are going entirely “off the rails.” The ability to remain actively, heartfeltedly caring, honest, gentle and empathetic towards patients and their families under these sorts of circumstances is what true compassion is, and what’s required of any good physician.

Etch-A-Sketchin’ March 15, 2013

Posted by therealtinlizzy in Uncategorized.
6 comments

These past couple months have been the usual blur of rarely stopping long enough to even fit in a delectable episode of Doctor Who (I’m still on the 10th Doctor you guys, and will be utterly heartbroken when he morphs into his next incarnation).

doctorwho

In addition to the ol’ day job (which has actually been hella enjoyable,  ridiculously challenging and surprisingly rewarding since the exit of two former co-workers whose workloads I took on), the minion/volunteer shifts at HCMC (which I <3), and MCAT (re)studying there have been some additions to my cookie dough mix.

I’ve started participating in something called the Ladder, a gathering/org that seeks to mentor North Minneapolis kids towards pursuing health science careers. Obvs I’m not a North Mpls underprivileged kid, but rather my participation is about trying to make myself useful as a mentor to the particularly-disadvantaged-at-having-any-shot-at-becoming-a-physician demographic of North Minneapolis youth. Or rather more so, because I’m a grown up white kid wanna-be-doc who had/has all the privilege and who doesn’t on the surface have a lot for a dicked-over-by-society kid-from-the-North-Side to resonate with, to at least just be a useful minion to those (like the residents & docs from the Broadway Family Physicians clinic who started/run the program) who are in the bestest position to be meaningful mentors to such kids. I’ve found a happy niche as website-update-minion for them, in addition having the privilege of getting to know a crew of physicians, residents, students, and North Side folks to whom I can look as mentors as well.

Then in addition to recently dealing with hospitalization-level healthcare matters with both my dad and @snipy’s (both cases of which were excellent learning opportunities, and happily all has worked out and is nearly resolved in both their cases), and getting a crash course in management of type I diabetes (for this one, whose pancreas in early December apparently gave up insulin-production as a bad job)…

100_0051

…I’ve picked up a couple of Spring term classes at the U of M. I’m only taking 4 credits (one 3 credit course and one 1-credit), which seems on the surface rather wussie – who couldn’t breeze through 1.5 classes?  However, taken in the mix of All The Things – I’ve got zero reports of lacking challenge at the moment.

One of my classes is Microbiology, which this Bio major somehow missed out on taking in undergrad. I know right? Actually – I had very good reason for missing out on it: St Kate’s only offered Micro one semester (maybe only every other year?), and it happened that the one time I could have taken it – I would have had to forgo Neurobiology, which I was seriously jonesin for at the time (and which did end up one of my very favorite classes in undergrad).  Anyway – it’s sort of a boon to have not taken it back then, because I could not have been nearly as enthused over little creeping/flagellating/sex-pilus’ing microbes then as I’ve grown to be over the past couple years.

Caulobacter crescentus

(That’s one of my favorite microbes of the moment, Caulobacter crescentus, part way through dividing to produce a stalk cell and a swarm cell. Summon swarm!)

The other class is called The Future Physician – where every week’s lecture is a presentation and Q&A opp from a different type of physician or surgeon (with a 5-point quiz or writing assignment as follow-up). Guest speakers have been without exception utterly compelling and engaging, and not surprisingly I leave each week wanting to go into whatever specialty was discussed that day. Except for sports medicine – I have next to zero interest in sports med, despite having been the recipient multiple times of sports medicine (looking at both of you, ACLs). Presenters so far have included: a cardiothoracic surgeon, an emergency pediatric physician, endovascular neurosurgeons, sports medicine doc, a policy-wonk/rural-medicine doc, an orthopedic surgeon, and a panel of med students.

etchasketch

Aside from the information and inspiration deluge that all of them have been for me, one of the presentation (by Dr. Marilyn Mellor, the pediatric emergency doc) was in particular on the art and usefulness of journaling. Her prescription was to journal, privately and for one’s own eyes only. And not just (for her) on the big things, but on the seemingly small things too, to take the time to commit to words the moments, the details that will eventually be Etch-A-Sketched ™ at least somewhat, if not completely, by time. I’m working on taking her advice, although a good bit of that  may end up here rather than the private pages of a notebook. Not many other than me sees this anyway, so it’s all good. 😀