lemon and saffi

posting twice in one night?! it's true. but this one's all about the pictures. we visited my sister and bro-in-law last weekend, spending lots of quality time being licked by their 6-month old golden retriever puppy and getting reacquainted with their 4-year old yorkshire terrier. here are a few shots we snuck during calm moments.

snickerdoodles

for as far back as i can remember growing up, we made snickerdoodles. i'm not sure exactly where the recipe came from, but when i got married, my mom made me a little cookbook and included the recipe.

today is my mother-in-law's birthday, and instead of going with a cake (they're so fattening, you know? wink, wink), why not cookies? time-honored, mouth-approved, pierce family tradition. plus i got to use the kitchen-aid mixer and take our new canon powershot SX120 IS for a drive. i only wish i could share the smells with you all.

(henry and i may have eaten a few of the "broken" ones)



all the ingredients: ready for action


eggs and butter: irresistible already


the dough formed into perfect little balls


one of the tricks to the taste: rolling in cinnamon sugar


another trick: the fork smush


the goods (and oh, it's good): the perfect snickerdoodle

best and worst

it had been my intention to blog much more often during my weeks in clinic. my patients were great – they taught me so much. i learned better ways to ask questions, tricks for less awkward physical examination, and even once had a 10-minute conversation about Alabama football (shout out to my husband for his help on this one). i got to know people the way you cannot in a hospital setting. i got to see repeat patients. i loved recognizing patients, meeting their family members, finding out how treatments had or had not worked. here are a few highlights i meant to tell as stories:

-removed half of a q-tip from a lady’s ear (that she waited a week to come to the doctor for)

-smoking cessation counseling: “so, ms. so-and-so, when do you plan on quitting smoking?” (without missing a beat) “when i get old, develop alzheimer’s, and forget that i do.”

-middle-aged lady, on getting her throat swabbed for strep: “i’d rather get something shoved up my vagina than down my throat if you know what i mean!” (we can only assume she was referring to a preference for a pap smear over a throat swab.)

-middle-aged gentleman, flies a lot for his job: “you know what they say about birmingham: when you die, whether you go to heaven or hell, you have to go through atlanta.”

-older lady getting her blood pressure taken, as the cuff tightened: “god bless america!!!”

-85yr old lady (with poison oak on her ankles for the 3^rd time acquired from her cat who goes outside, plays in poison oak, then flops himself all over her slippers) offering me life advice (i got a lot of life advice): “let me give you advice. don’t try to own the road. i got in a wreck last year because i’m too aggressive. stupid @#$%# GMC. my kia was totaled.”

i had an excellent teacher for most of my time at the clinic. i worked primarily with dr. l. when i signed up for the course, i had asked specifically to work with her – and i got to – but she works only tues, wed and thurs (and spends the rest of her week at home working her butt off with three young kids; her husband’s an MD, too). dr. l is great at instructing and giving feedback, but she also has a humble attitude, something incredibly hard to find in medicine. she advocated for me doing any and all procedures patients needed. i froze warts off feet, elbows, and fingers. i sent patients for x rays, urine studies, and to the lab. i did more pelvic exams/pap smears with dr. l than i did on my entire ob/gyn rotation.

on mondays and fridays when dr. l wasn’t in, i worked with some of the other doctors at the practice. most of them were great. one of them was not. dr. b was not a surgeon with a “god-complex,” nor was he a “know-it-all” resident. even so, each time i worked with him i gained a clearer picture of the type of doctor i never want to become. dr. b is an older man. he had a practice at another hospital in town that went bankrupt a few years ago, thus finding himself without a practice. instead of retiring, he took a job with this practice at UAB. it’s obvious dr. b is miserable, and that he has completely checked out. exhibit a: one morning working with him, i saw his first three patients while he meticulously placed stickers on one of those mail-in sweepstakes return envelopes to the national rifle association, complaining to his nurse that he never wins anything and makes no money compared to his colleagues in surgery and other fields.

one of the most frustrating things about dr. b is that he gives out narcotic pain medications (among other controlled substances) liberally. many of his patient encounters started something like this: “so what brought you in today?” “well, my friend/neighbor/boyfriend told me that you’re a really good doctor for controlling pain. i don’t like what my arthritis doctor put me on, and i want some lortab.” and he would give it to them. even ask the dose. and whatever other controlled substance they asked for. so much so, that the clinic created a policy that requires patients on pain meds to get them from a pain management clinic. what does dr. b do? gives the patient the note with the clinic’s policy with one hand, and the prescription for lortab with the other hand.

seeing a patient before dr. b, i talked to her about the harms of narcotic pain meds. she told me she needed them. we talked about how she could try to use less, how she could try other things long term, etc. i didn’t really think i got through to her, but maybe one day she’ll think back to the conversation we had. i was feeling ball-sy and mentioned to dr. b i had talked to her. “what difference does it make?” he laughed in my face. “that’s how people are.”

----

so if ever someone says to you
"life isn't fair, get used to it"
then you should say:
"well it might be
if folks like you would let it be"

-the avett brothers, the lowering

----

clinic

something unique about me among many of my colleagues: i love clinic. and this is great because i started my outpatient acting internship in family medicine this week.

and it's awesome. i knew it would be. here's why:
1. laid-back doctors who let me do a lot ("did you write the prescription? order the labs? can you just run my clinic?")
2. steady flow of adult patients (no babies! or kids!)
3. 8a-5p, baby
4. and - dum, dum, dum - i did my family medicine clerkship here! so i have intimate knowledge of the whereabouts of important things like the bathrooms, vending machines, staff microwave, younameit

in medical school where you sometimes switch to a different ward/service/specialty as often as every week, it was such a delight to be starting something where it didn't feel like my first day was my first day.

and my cheap jab above about not seeing kids in the clinic? nah, don't sweat it. they say kids say the darnedest things, but i'd be willing to fight 'em for it. here's an example from today from a delightful little woman in her late 60s. my patients say plenty to keep me rolling all day long.

"hi, ms. so-and-so, what brings you in today?"
"this awful cough" ::coughs:: "i've had it for a month. last time i had a cough like this it turned into pneumonia. i hadn't planned to go to the doctor that time, but my husband told me he wouldn't have SEX with me anymore if i didn't get myself fixed up, so i guess i just HAD to!"
"i see. well we wouldn't want that to happen. tell me more about your cough..."

age

when i was 16, i went to the beach with a friend and her family. one night we decided to hit up a little amusement park, and my friend and i rode pretty much every ride that didn't make me barf. most of the park workers were local teenagers, and as teenage boys are wont to do, they flirted with us. except - they flirted with my friend, telling us they thought she was 17-18 and i was her 13yr old kid sister.

when i was 21, i was in my senior year of college. i went to a local restaurant in the city with some friends for a champagne brunch. we were carded, of course. but when the waiter looked at my license and looked at me, he frowned and said he needed to take my card to his manager. mind you, my friends had out-of-state licenses, in-state licenses, you-name-it. here i was with my in-state as-legitimate-as-you-get-license, getting the twice-over from some waiter likely because of my age.

i could go on and on. apparently i look younger than i am.

but - over the past year, something changed. around january, i stopped getting carded at restaurants. it was mysterious really. i would order my drink, look down to my purse to fumble for my license, and the waitress would have already disappeared. i have been chalking it up to the chronic state of sleep deprivation and stress of third year, especially since just prior to january i had my surgery rotation.

and then it happened. we got our pictures taken for our residency application, and i picked them up yesterday. i looked nice, i thought, and then, out of nowhere: "hey, who is that grown-up?!" apparently somewhere along the way it is the goal of medical school to attempt to make you look like you are old enough to take care of so-and-so's dying mom. hey medical school? goal accomplished. ...or maybe medical school has just flown by so fast the last time i looked in the mirror was my early twenties? in any case, here's the evidence.

yours truly, all grown-up:

coping

how is the language we're speaking the same?
shape shifter have you discovered a change?

why does the soul hallucinate?
i've got control, i shift my shape

your eyes, they swell like a riot, deranged
tomorrow you're laughing like a child again

why does the soul hallucinate?
i've got control, i shift my shape
if flesh and bone do not contain
the mirrors don't reflect my face

psycho, you killer, you cancer, my friend
why don't you give me an answer for when
when you'll let it go
when you'll let it go
when you'll let it go

shape shifter, local natives

bye bye, babies!

so i survived OB/GYN. !!! this is big, people. all-in-all i was pleased with my performance, although henry will tell you i whined my way through the entire 8-week rotation.

i actually ended up enjoying OB more than i thought. it's definitely one of those specialties (like trauma surgery) where you acquire awesome stories to tell at dinner parties (y'know, one day when you have time to go to dinner parties and friends who throw them). in retrospect, i am actually thankful for my newfound ability to wield a speculum, acquire and interpret a wet prep of vaginal discharge, and manage every aspect of a pregnancy. and i will say that when i got to deliver my first baby, it was - without a doubt - one of the most rewarding and beautiful things i have done in my short medical career.

and now i am one week into my four-week block of studying for 2nd round of boards and preparing my residency application. that's right, my RESIDENCY APPLICATION. after a lot of strife this past week, my application is mostly complete and ready to be sent to 20 (yes, twenty) residency programs on sept 1 when they start accepting them. it is completely befuddling to me that in less than 8 months, i will actually be an MD. simultaneously exciting and terrifying. sort of like a roller coaster, although maybe that's a bad analogy considering that i vomit every time i get on one.

after i take the USMLE step 2 CK exam on september 17, i fully plan to venture back into the world of pleasure reading. i have a stack of books i've been acquiring over the past few years in medical school (which in their own right have been acquiring about a 1/4" of dust). a few among them: inside the outbreaks, by mark pendergrast - a historical/ investigative report about the epidemology intelligence service at the CDC, aka my dream job; every patient tells a story, by lisa sanders - the writer who helped inspire the series House, MD; a few titles by my favorite author ian mcewan, saturday (from my dear from amanda) and the innocent; and my stroke of insight, by jill bolte taylor - a neuroscientist who had a stroke and wrote her story.

ahhhhh, 4th year. hurry up and be awesome! for now, though, i'm happy to bask in the glory of OB/GYN being over -- and the fact that i won't have to look at another vagina for a very long time.