My Monday in pictures.

Work, 7:something AM. Yes, person-who-renamed-the-IE-shortcut, I understand.

For whatever reason, all the teams this MICU month have been all-female. Hence the whiteboard, now.

So I finally went to get the car washed and shampooed status-post flooding. The problem with New Orleans is that it can't decide whether it's red or blue. In favor of the blue: Advertisements for head shops in the (granted, free) paper.

In favor of the red: I'm not sure carwashes elsewhere remind their patrons not to leave firearms in their vehicles.

Shitty photo, but this is totally John Goodman. He lives in New Orleans. I know!

And then I went to Winn-Dixie. Dear America, I love you and why didn't you tell me this product existed? Love, G.

Apropos of nothing.

Incidentally, the two forms of entertainment I have enjoyed most lately -- which just goes to show you how I spend my free time on MICU, that is, sitting in front of the computer and eating, anyway -- both forms of entertainment that I have enjoyed most lately are illegal according to US copyright law.

Sita Sings the Blues

A cartoonist made it her project, status-post divorce, to turn the Ramayana into a feature-length film. Unfortunately, she didn't have the rights to the music, and said rights would have been ungodly expensive to purchase (despite the singer's having been dead for twenty years). So she gave the film away (and made some dough in the process, but still, four years of work for a single year's salary? no).

Harry Potter: The Musical

You guys. YOU GUYS. Sita Sings the Blues is beautiful and indie and all, but holy shit, the Harry Potter musical is the greatest thing ever. The Greatest Thing Ever! And I am not even young enough to have read Harry Potter when it came out or to be nostalgic for it and I haven't even seen all the movies but oh! Oh this musical is *hysterical*. And, of course, in direct violation of copyright, which... I understand, JK Rowling is alive and deserves a piece of the action, but mannnn, it sucks that because of copyright, this whole play -- I'm not calling it high art, but it's *fun*, you know? -- will only be seen by the few of us who haunt the internets, rather than, say, everyone who ever loved (a) Harry Potter and (b) musicals. Which, knowing what I know about theater kids? Helluva crossover.

MICU

Is there a nicer way of saying "potter's field"?

(He will die when we take him off the machines, and we will take him off the machines, because he is not comfortable on the machines. And no one can afford a funeral, and all she wants to know is, will he be buried or cremated?

No one on the floor has any idea.)

Six months in NOLA / 10 Things to Miss About Philadelphia / 10 Things I Do Miss About Philadelphia

Per my notes I have been in New Orleans just over six months. (The official sixmonthiversary was, apparently, the 15th.)

Huh.

I will post this now. I wrote it most of it months ago, before I had left Philly.

10 Things I Won't Miss About Philadelphia:

(Lovingly ripped off from 10 things they'll miss about Boston, linked from Inside the baby mind, linked by a college associate on facebook. Hat tip, him.)

1. The homeless people everywhere, and especially the guy begging for change outside of WaWa (going on two years now). Look, I know, I see you, I feel bad, some of you are mentally ill and there are a host of reasons why the rest of you are on the streets and probably none of you chose to be. That said, I'm a girl and you scare me.

2. The lack of viable public transportation, especially out in the suburbs. Yes, there are buses, and no, I have never taken one. Because honestly, living where I live (Fairmount)? I shouldn't be a mile and a half walk from the nearest train, and neither should my friends in Northern Liberties, or the kids down in Queen Village. Expand the subway system, have SEPTA take over the commuter rail and run the trains more than once an hour, and for fuck's sake, get rid of the trolleys. They back up traffic, and the tracks probably injure more bikers than SEPTA bus drivers do. And speaking of SEPTA bus drivers... actually, let's not.

3. The crime and the drugs and the guns. Which, ha, will be no better where I'm going, but: Philadelphia, honey, you ought to be glad I never looked at these websites too hard until now. I've been lucky, I know, but it's been entirely luck.

4. How early the city shuts down at night, especially during the week. At 10 PM, why are my only options for dinner WaWa, Tria, or a 24-hour diner? Let's pretend this place is a city, and give me more than one option (and let's make it a well-lit, outlet-besotted, cleanish option) for late-night coffee and studying.

5. Parking. It is worse than Chicago (y'all, I could find street parking off the Loop if I tried hard enough), worse than Atlanta (where at least there are decks), hell, no joke, it is worse than Manhattan (where I have, despite my worries, always found a place to leave the car, except in Midtown and around Union Square).

6. Driving. One, this city isn't designed for cars: From the narrow streets to the giant joke that is 76 (two lanes! the major artery between Philadelphia and its suburbs! WHAT THE FUCK?) And two, the drivers here are alternately idiots and/or assholes. Idiots, because they slow down and rubberneck at pretty much anything (See: 76, the Conshohocken curve, OH LOOK IT IS A STALLED VEHICLE ON THE SHOULDER WHY ARE WE GOING 25?) And assholes? Just... assholes. People speed down one-way, narrow, lined-by-cars residential streets, only to slam on their brakes and California-roll through the stop sign at the end of the block, only to gun it again through the intersection. And let's not even talk about the Philadelphia classic, when a driver just... stops, parks, and leaves his car in what is very often the *only* lane, letting traffic build up behind him as he saunters towards whatever errand he needs to complete, and very often through an open parking space he has deigned not to use. Never mind us, asshole; we're just trying to go about our lives.

(It is both very good and very bad that I don't own a paint ball gun. Actually, I wonder whether or not that'd be legal: A paint ball gun of some kind, loaded with non-toxic, non-permanent paint that'd temporarily brand another driver as a giant douchebag. HEY NERDS STEAL THIS IDEA.)

7. The insane liquor laws. Down in NOLA I happened to be in Whole Foods with Adam's hot cousin (... yes) and I just launched into a tirade against the Crazy Rules In My Quaker State and How Great It Is To Be Able To Buy At Least Beer And Wine In Supermarkets. And he said, oh, some supermarkets sell liquor, too. They just had to apply for a permit.

8. The accent. I still can't imitate, I can't even describe it -- something about the vowels, of course; Philadelphians leave their Rs alone, at least -- but I know it when I hear it, and oh, youze, it grates. The "ou" in "out" is a dipthong, which means the word has one syllable. One.

(I may, though, keep saying "wudder ice" after I go. More PC than Italian ice, and who the hell has ever heard of a snowball?)

9. The sports fanaticism. Yes, occasionally it's charming when a convent puts an Eagles poster in the window. But when every guy I meet feels the need to tell me of his love for the Phillies? Eh.

10. The public dirt. Yes, Philadelphia, I know you're poor, but goddamn, could you at least sweep the streets once every blue moon? Or maybe let the shame of the newspaper-cigarette wrapper-plastic bag tornadoes goat you into action once in a while?

(So I'm reaching. It's a good thing.)

10 Things I Will Miss About Philadelphia

1. Kelly Drive / West River Drive / the Kelly loop and the path all the way to Fitler Square. Sure, there aren't enough water fountains or bathrooms or lights when it's dark, but on a spring day when the cherry trees are blooming and there's a regatta going on and it feels like the whole city is outside?

(Okay, I hate it when the whole city is outside. Fucking weekend warriors don't know how to keep to their side of the path. But anyway.)

2. The beer and the bars (and quizzo!). Oh, Philadelphia. You are a beery, beery town. Without you I would never have found Fin Du Monde, or Aventinus, or dear, cheap, perfectly good Yuengling. Lager, I mean. Give me a lager.

3. The relaxed attitude. Per Revi, people in DC do a lot of the day-to-evening wear at bars (men in suits or dress shirts, women in dresses and skirts who add a cardigan when they need to show less skin), and per Bo and Dean and personal experience, I mean, Manhattan is just insane when it comes to women's playing dress-up. But aside from that one stretch of Walnut Street in Rittenhouse where people like to pretend they're in New York -- hint: you're not -- Philadelphia just... doesn't care. People go to bars in jeans here, and really dressing up means adding heels or a hoochie top. Yeah, the men irritate me when they show up in Phillies gear (there is *nothing* like a man in a suit, y'all), but overall I'd rather live in a city where I don't feel any pressure to try that hard.

Philadelphia: We're lazy, get over it.

4. The food. Despite the shortage of good Mexican food, which, eh, you know, my thighs don't need good Mexican food, this is a pretty foodie town. The cheese (DiBruno, Downtown Cheese, Salumeria, Fair Food Farmstand, even Whole Foods), the apple butter (Kauffman's, Halteman), the coffee (La Columbe, I will miss you most of all). Scrapple. Reading Terminal Market, the Italian Market. Perhaps someday I'll develop a serious intestinal complication from over-consumption of grapes (Italian Market, Sunday, 4/26: bought 12 pounds of grapes for $8.50. Wednesday, 4/29: grapes gone.), but it will have been so, so worth it.

5. The people in this city, or at least my chunklet of it. There's enough colleges here to keep the city young, and while I bitch about the Erin Express every year -- YOU ARE IDIOTS AND IT'S NOT EVEN ST. PATTY'S YET -- it's nice, also, that this place is small enough that I always bump into someone I know. Yeah, I wish I weren't slow-jogging, jiggly and red and sweaty, when it happens, but my ego will survive. Ish.

6. For a tiny city, we've got more than our fair share of museums and theaters. Half-price student rush tickets to the opera? Done and done.

7. wXPN. God, it is so good.

8. Biking. So we're not bike-friendly like Portland, maybe; we don't have bike lanes (I mean, we *do*, but they have cars and buses in them), and the drivers, as I mentioned, are douchebags, and lord knows, as I also mentioned, that trolley tracks and I do not get along. And my left knee, I think, will never actually recover from that spill on the ice back in December. But Philadelphia is the city that taught me that a bicycle can, in fact, be a viable method of transportation, and I'll be grateful for it. At least, until I get hit by a bus. Or a streetcar.

9. The occasional shining weirdness of this city: The Mummers on New Year's Day. Eastern State Penitentiary on Bastille Day. The hustlers down at the Italian Market. Isaiah Zagar's mosaics all over South Philadelphia, and the murals -- good, bad, ill-advised -- in general. The partiers on General Meade's birthday at Laurel Hill (no, I've never been; it's enough to know it happens). Laurel Hill itself. The shot tower down in Queen Village. The weird hometown pride in TastyKakes. The urban cowboys. The kids swimming in the fountain when the weather turns warm.

10. My neighborhood: Walking on a narrow, row-house-lined street in Fairmount on a warm, shimmery, summer afternoon, the light just right so it looks a little like an impressionist painting over there where the road crests. That corner at 24th and Aspen where the veterans sit and gossip and smile at me when I jog past. The Flying Saucer for conversations with strangers. Belgian Cafe for mussels and Fin du Monde. Bishop's Collar for meeting dissatisfying boys. Urban Saloon for hook-ups and stories. London Grill for happy hour. Bridgid's for whatever hefeweizen they've got on tap. Trio that I only just found. MugShots for hipsters and sometimes friends. Eastern State Penitentiary, looming and crumbling and beautiful and just a part of my landscape. The RiteAid I hate. Two used bookstores in walking distance. The glorious library I never visit. If anyone reading this blog is moving to Philadelphia, move here. I'm not kidding.

(Sigh.)

And now: 10 Things I Do Miss About Philadelphia

1. WaWa. Oh, WaWa, you across the street from me, shining like a beacon through the night, selling me shit I don't need at ass o'clock in the morning. WaWa, let me sing you a song from seven hundred miles away. WaWa, I miss you. Even if there's a 24-hour Walgreen's just down the street.

2. Reading Terminal Market, the Italian Market, various little shops in Chinatown: Why oh why can't I get cheap produce in New Orleans? Is it because all of you Yankees are taking it instead? At any rate, it sucks.

3. La Colombe. Look, NOLA is a coffee town, and I appreciate that, and I even like chicory coffee (sometimes), but La Colombe is just *better*.

4. Cool nights and a sea breeze. Despite being about as far from the ocean as Philly is (if not closer; my geography is a little weak), NOLA gets neither.

5. Chinatown in general. Ethnic food, in general, though it's entirely possible that I just haven't looked hard enough yet. Cheap produce, for sure: Yes, I can get a po-boy with enough calories to feed me for two nights for $5.99, but my lettuce is $5. What?

6. wXPN. We've got a serious NPR station, and I'm glad to have WWOZ and WTUL and, hell, public radio for the blind (what?), but still, I miss wXPN.

7. Theater. I'm not sure it happens here. Oh, and public art. People in NOLA are trying, with their homemade signs and stickers and inspirational gutters, but it's not the same as the murals.

8. Well-paved streets, oh my holy Jesus, the reason I don't like biking as much here as I should is because it rattles my ass, um, wow.

9. The accents. I really, really, really don't miss the accent in Philadelphia, even a little bit.

10. ... I'm not sure yet. Looking over the lists that I wrote earlier this year, it's just... well, it's different. New Orleans is different. I'm not a bus ride from New York anymore, and I will miss it, but not yet (and anyway what does missing New York have to do with missing Philadelphia?). There's no one here practicing Yiddish, but it's not like I've done that in a while, anyway. I do miss specific restaurants and bars, but I'm almost certain I can find substitutions down here.

Driving here is annoying (crappy streets, moving slowly) but it's *less* annoying (I'm almost never going very far, and there's almost always a parking spot when I get there).

The streets are dirty, but *less* dirty (there are fewer people, and it rains more).

The sports fanatics here are just as fanatic, but *less* irritating (maybe... fewer Jersey boys? less E-A-G-L-E-S, more Saints spirit?).

I don't know. Philly... I did try to find photos of the snow falling there (go figure, the link on the Inquirer's page was broken, so I checked out my usual blogs), out of some weird nostalgia, but... Eh. Mostly it doesn't feel like I've been away that long. Which, either my memory is failing, or the things I thought would be ultra-important aren't anymore, or I've been working so much that I haven't noticed the world go by. It's medicine, mostly: The parts of me that used to be important -- the languages, the lib arts -- have fallen away; I don't have time for them anymore. But the angst is gone too.

So anyway. Yeah, six months down south. Who'd'a thunk?

I wish I had more than a single day off this whole month.

Because the thing is, when I have only one day off a week, I'm not exactly *inspired* to use it well. Mostly, I sit inside and stare at the computer, dicking around and snacking and dreading the next day.

Like now. When I just realized that I still haven't dried out my car all the way, and now it is too late.

(Problems I hope money can solve: This one. Whatever a good, solid shampoo-and-dry of a car's interior costs, I will pay it happily.)

On the other hand, I did just watch The Princess and the Frog online. (Yes, that is illegal. Hooray!) It was *adorable*. And! Vaguely feminist, or at least not blatantly sexist. Hooray for Disney! Hard work and sacrifice! Your man should support *you*! Bring on the twenty-first century!

Though: Wait, did Tiana build her restaurant on the Wank? Really?

(You know how the camera pans out and up, and it's clearly St. Louis Cathedral in the background, and the restaurant is in the front, with the river behind? So it's got to be the West Bank, right? But then the river is too narrow to really be the Mississippi, and I *know* it's a cartoon, dammit, and also you're not from New Orleans so *shut up*, you don't really care, but it's annoying me, since all the newspaper articles have been, "Oooh, Disney really cared to get the details right." Yeah, Disney really cared, except for putting the river in the wrong damn place, *or* for exiling the heroine to Gretna. What?)

Also, that was not a spoiler, because, let's be honest here: Duh, the movie has a happy ending.

Annnnnnnd finally, let's talk, for a minute, about the sweet Cajun firefly with the messed-up teeth, who just... fixes things that needs fixing, all intuitive and shit. You guys! You guys, it is so right. I mean, for me. Who spent two-and-a-half months in Houma. So obviously I'm an expert.

-----

Breaking news! That is only somewhat breaking. So my classmate Mack recently received a diagnosis of thyroid cancer, the rare kind that usually affects sixty-year-old women. Which: Sucks. Suuuuucks. Seriously, he sent out an email a few days ago, and I happened to be down in the ER at the time, admitting a patient, and CatherineTate happened to be on, and I said, Hey, did you check your email? Adn then I handed over my phone and we sat for a while. And then she emailed Mack, and I did, too, though my email consisted of three words, of which two were "fuck."

"Fuck" is just my way of saying "I care." Obviously.

Luckily Mack's PET scan was clean, except for a spot on the lung that we're all hoping is actually a granuloma. At any rate, he's scheduled for some pretty heavy neck surgery (thyroidectomy + lymph nodes) in January. And then probably not chemo, but maybe radiation? It's all up in the air.

The point being! The point being, obviously, cancer sucks, but also: Schedule rearrangement ahoy, which involves my going to Houma for floor medicine in January, instead of March as previously scheduled. Which, ugh to having both my call months in a row, but yay to getting them both over with. They will both be over with! And then I won't have to deal with Houma EVER AGAIN.

Because Cajun fireflies aside, I really have no desire to live down on the bayou.

-----

Last night was another classwide get-together, even closer to my house than the last one; this time, we met upstairs at The Avenue, where there was beer on tap and beer in the fridge. I hadn't showered since before my call (so... Wednesday morning, and actually I still haven't showered and it's getting ripe) and I have a ridiculous sty on my left eye that has just been looking worse and worse (you guys! you guys, what the fuuuuuuck?), but at least I got to see people. LukeSkywalker is engaged, everyone hates Dr. Squawk -- Shel is down in Houma now -- and also, no one is particularly fond of my MICU upper-year, which... I haven't written about it much, because she's not cruel, she's not a bitch, she has moments where we get along... but we're just not going to be friends, ever. You know? And she's wayyyy OCD, which you need for the unit, but also... condescending, said someone last night, and I said, Omygod yes. Because that is *it*. "I'm not a retarded child," I have said to her (once), and she kind of laughed it off but I meant it. I need help with a lot of things on the MICU, a *lot* of things, but sometimes? Sometimes I'm okay.

After the Avenue CatherineTate and this PGY2 named... oh, god, what should I call her? I could use her real name, which is fairly common, but I've already set the precedent of *not* using anyone's real name on this site, you know? (And I didn't previously care about the first name thing, obviously, but then I had that unusually-named resident one time in MS3, and after I bitched about her, I googled her first name, and damn if my blog wasn't one of the first hits, because: Right, she has an unusual name.) Anyway, this PGY2 is friendly and funny and also single, so basically exactly the right sort of girl to go drinking with at a bar. We'd gone to the Bridge Lounge -- CatherineTate drove, since I'd walked to The Avenue and also had two beers there -- and were sitting at the stools by the counter badmouthing Dr. Squawk. Loudly.

And here, because New Orleans is a small town, is exactly the moment when she walked in.

Y'all. Y'all.

It's fine, she didn't hear anything, and we smiled at one another and she gave me a side hug (because she is great at *acting* friendly, Dr. Squawk), and I introduced her to CatherineTate, and then she and her boyfriend headed to the back of the bar, and we stayed where we were at and breathed again (at least until I got shooo druunk (beer before liquor, self) I had to go home).

New Orleans is very, very small. Very small.

Which is also why, incidentally, it was a bad idea to pretty much tell everyone at the Avenue that I got drunk and made out with the bike guy. Dear Self: Shut Your Fucking Face, You Don't Need A Reputation (You Really Didn't Earn). On the other hand: Hee, BikeGuy.

-----

I really don't want to go to work tomorrow. We have traded attendings, which, whatever; the new guy teaches, but rounds? Rounds last *forever*. We round until 5 PM. The *only* benefit of MICU, the single thing that kept this service from wanting me to shoot myself in the face every single fucking day, was that on non-call days, we could go home by 2 PM. Guaranteed.

And now? Now I think we will be lucky to finish by 6.

Eleven more days, I think.

(By the way, the last call? Wednesday to Thursday? We didn't sleep, either. And I kept falling asleep during radiology rounds, when we all crowd into this room the size of a closet to review x-rays, and tradition dictates that, you know, the post-call kids get dibs on the few available chairs. And of course you want a chair when you're post-call, because you're exhausted, but it's also the worst idea ever to sit down, because you're exhausted, and it's dark. Oh! Oh, and I have already mentioned that piece-of-shit sty on my eye, but picture this as the saddest thing ever: 3:30 AM, tired as shit, on call, and whenever I can I'm heating my warm/cold pack in the microwave in the nurses' break room and walking around with it applied to my eye. Classy.)


Ugh.

Happy last night of Chanukah, I have lit candles not once.

Synonyms for "Jewish" utilized by my facebook friends:

Jewy Jew Jew
Chosen
Jewish?
Hardcore Insane Jew
Oh, just guess
M.O.T.
J-Tribe
crafty jew
jewified
Oh No, I'm A Jew! The Musical

Special mention:
Zoroastrian - its making a comeback, really
Can A Guy Worship Food?
Zubrowka
Josh Groban
[not included: 8,000 variations on "Jewish/agnostic/atheist/Buddhist," just saying, we are not a particularly devout people, most of us]

And:
Religious Views: Yes, I have them

Later I told Karen about the whole thing, and of course she was much amused.

"That's great, BikeGuy," I say, for the not-first and not-last time during our conversation when he hits on me in front of his friends. "But this will make it really awkward when I have to come in next with a flat."

He laughs, and I laugh, and the conversation flows on, and his friend Brian from the computer store joins us, and then Steven the odd-jobber from the bike shop comes in, and then someone wakes up the guy at the next table who's been sleeping with a sign on his back, "Please do not. wake. me up," scribbled on a napkin. His name, he tells us, is Hausbock. "What?" I say. "Hausbock," he says again. "But you can call me Jason, babe." "So your last name is Hausbock," I say. "No," he says, "but it's what everyone calls me."

Have you ever felt completely and totally out of your social element? And I mean *completely*. Because before the hour and a half is over, Brian has told Hausbock off for mentioning Jessica, what the hell, he doesn't even like her and anyway they're not dating anymore. And Hausbock has gone on a drunken rant about how he's made two boys already, but they were adopted, one by a stranger and one by the babymomma and her new husband, and he has nothing to do with them. But when he has a daughter he will name her Luciana. Unless his wife disagrees. But to her, she is Luciana. And BikeGuy is talking about how his brother has three kids by three different women, and also, isn't it true that a woman can't get pregnant at the start of her period? Because the egg is pushing out the sperm.

For the record, BikeGuy is 37.

Also for the record, I have never been so glad to be a woman, because (1) any babies *I* make, I will know about, and ahead of time, and (2) barring significant changes to US law (DONATE), I am in charge of that scenario.

What happened this afternoon is this: After work I went to the gym, and then I left the gym, and I came home and showered and threw the bike in the trunk to rush over to the bike shop before it closed, because, like I said, the bike basket that Shane and BikeGuy installed last time had collapsed onto the rear tire and popped it after I went grocery-shopping.

Luckily, Shane and BikeGuy were both working this afternoon, and neither one gave me any shit, or, um, asked for a receipt. And lo, my bicycle now has a new bracket on it, the one that probably the boys should have installed in the first place. BikeGuy walked my bike to the car -- it was around the corner this time -- and helped me shove it into the trunk, which was kind but unnecessary, I told him. And then he offered me a drink.

"Really?" I said.
"Sure, c'mon," he said.
"Um... sure. I've got shit-all to do this afternoon anyway."

So that's how I spent an hour and a half in a dive bar on Napoleon, mixing with the townies and wondering how the hell I got here. In the universal sense.

(Wondering how the hell to explain how this doesn't happen to my people, to my family, how we *don't* have children out of wedlock, sorry, we just don't. Other things that don't happen to my people: Jail time, associate degrees, alcoholism.)

Later when he walked me back to my car he offered a hug goodnight, and I took it, and then of course he kissed me in the dark off Magazine Street. Which, it was a good kiss, a long one, and in my mind I thought, This can never happen again, because I'll have to start driving my bike to Jefferson Parish for flat tires.

"Well," he said afterwards, "you know where I am."

And I do.

Boys and girls are *different*.

"Wait, how old are you?"
"34."
"Really? Huh."
"Yeah, the beard hides it. But I'm old."
"Oh, yes, so ooooold. Tell me what your wisdom, Old Man. Because you are oooold."

Here is a conversation I would never have with a girl. And not because she could not grow a beard.

Unpleasant discoveries to make after call.

(1) Friday, I walk out of the hospital into the sunshine... to find that my bicycle has a flat tire. Unable to hail any cab that is not driven by man with a single functional eye (the other one was smaller and laterally deviated with a drooping lid) who, incidentally, is only looking for Darlene, I wheel the bike the forty minutes home.

(2) Monday, I walk out of the hospital and get into the car and finally, finally look at the floorboards on the passenger side... to find the source of the sloshy noise my car has made since Sunday morning, the Sunday after the Friday and Saturday when it rained like hell, and I wondered, the one time I went outside, why all the neighbors had crammed their cars onto our driveway when there was plenty of parking in the street: Oh, right, because *the street flooded*. And the water crested just high enough to flow in under the passenger-side doors. I just used up all the towels in my house and still failed to dry out the carpets. Oh, dear friends. WHAT WILL THE NEXT CALL BRING?

(Yes, I was drying out the car at midnight. On a dark and lonely street. Yes, I have to be at the hospital by 7 and probably more like 6:30 tomorrow. I just kept waiting for it to stop raining, y'all, and it never, ever did. Also, I suck?)


Ugh.

Dean said it first.

"You know," Dean says "it's amazing how many of the problems I had during high school could be solved by *washing more*."

Crossovers that have not happened yet.

Wal-Mart does not sell The New Yorker.

Wal-Mart does, however, sell a magazine entitled GUNS, and another magazine entitled PREGNANCY.

The possibilities are endless.

Iiiiiiii don't want to go to work tomorrow.

Since my last post -- actually, since call -- I have not left the house at all. I showered, once, because I thought maybe I'd go out to this Latke/Vodka thing over in the warehouse district, but it is *pouring* and I didn't want to drive, because the warehouse district has no fucking parking and also it is pouring and also-also I would've arrived, at that point, forty minutes before the event was over.

Sorry, Mom, I am never going to meet a nice Jewish boy.

Also, I haven't gone running in days, and since apparently I need to be in the hospital at 5 AM tomorrow, it seems unlikely that I ever will go running again.

So there's that.

MICU sucks. And I am tired.

More or less cross-posted from OldMDGirl's comments, sorry.

Last night was the first call night I had as an intern where I got no sleep whatsoever. Literally. The relieving team showed up this morning and said, "... Oh. The beds are still made." Yes, yes they are. And I was in the hospital from 7 AM yesterday to 1 PM today, and I was so tired on rounds this morning that I almost fell over. Repeatedly. Was I paying attention? Not at all. Did it negatively affect patient care? Yes, probably; certainly I had to rely on the listening skills of others just to get the attending's orders straight. (Eventually I just left and went to the caf and bought myself a cup of coffee. Unprofessional? Yes, especially on the ICU. But what were my options, really?)

Also, this morning before I left the hospital, I was the most rude I have ever been to people who didn't deserve it. Not bitchy, I hope, just... I stopped being so friendly answering pages. I'd say "What?" in a dead, low voice to the nurse lurking behind me instead of a happy, perky, "Yeah?" I told a patient's daughter I wasn't her doctor because it was after 1 PM and I just didn't want to deal with her anymore, and anyway she was being transferred to the floor and let them handle it.

So: Yeah, sleep deprivation. Woo.

I am going back to bed soon.

-----

Oh! I almost forgot the best part. The best part is, I walked out of the hospital, and my bicycle? Had a flat tire.

Y'all. Y'all.

And I just looked at it, and put my bag down, and unlocked it, and walked up to the one cab that was waiting on the circle, and asked the cross-eyed driver, "Hey, what are the odds I could get this bike-with-a-flat-tire in your trunk, if I take the wheel off?" And he said, "Are you Darlene?" And in my mind I laughed, because: Darlene! But I said, "No," and he said, "I'm waiting for Darlene. But the odds are good."

I guess he found Darlene, because I wheeled that bike 2.3 miles, all the way home.

And that is the only exercise I am getting today.

(I'm mad, too, because clearly this flat is the result of the basket that the bike guys put on last week, and on... Wednesday night after the coffee shop I went to Whole Foods and Winn-Dixie, see, and the baskets were full, and the way the rear... thingy is attached to the bike, it just... collapsed, until the last few blocks the baskets were basically resting on the wheel. So now I have to go to the bike shop and argue. But I didn't go today, because I am exhausted, and that means I have to go tomorrow... Ugh.)

Thought, MICU call, 3 AM.

So my patient is dying and my classmate has cancer.

Awesome.

God, I feel like a pretentious fuck right now.

Dear internet, Hello! I am not dead. I had not even considered that you might think me dead until Rachel, in the course of our conversation yesterday -- in one of the universe's great signs of impending collapse, she called me -- said, Hey, that text message this morning? Way to be alive.

Because that is how I am right now, the part where I am not alive a lot of the time. As I have explained (in entries that I have not published), MICU is q3 call, which means that I am on call for thirty hours at a stretch (7 AM to 12 PM the next day, officially), and then I am post-call (beginning at 12 PM), and then I have one normal day, and then I am on call again.

It both sucks *and* blows.

"Aren't you learning a lot, though?" say the upper-years, occasionally, when I bitch about MICU. I try not to bitch about MICU, because so far it hasn't been that bad; we haven't had *that many* patients on my service, and the attending is fine (... literally), and the fellow has walked me through some procedures, and my upper-year is OCD in a way that works to my benefit.

But.

Am I *learning*? No, I do not think that I am learning, exactly. I think I am learning that I do not do well when I am exhausted all the time, or else not motivated because I have finally stopped being exhausted (like right now), but I know that tomorrow I am expected to be awake for thirty hours at a stretch again.

Basically, I do not really have the time to look up what I'd like to look up (DKA! It is important!) (Lactate versus LDH: Oh fuck they are different?) (PML in AIDS patients: Wait what is that again?) when my brain is in any way functional.

And on top of that I've got so much shit I'm just supposed to be thinking about outside of this rotation:

• The EM (practice) boards in February (I am *finally* trying to do a few PEER VII questions every time I'm on call, because I finally printed out the text (... five months into residency), but a few questions -- that I inevitably get wrong -- does not a passing score make.).
• Registering for Step 3 (Which is important! says my OCD resident, YOU NEED TO DO IT RIGHT NOW.)
• And the so many other things I need to do RIGHT NOW -- go food shopping cook for call pack for call unpack from call take a nap go running figure out how to make it to the post office during normal business hours try to keep that guy with AIDS from dying attempt to control my humorous interaction with the dudes in the program such that it is clear that I am just a friend, just a friend, just a friend -- that it's taking a back seat.

And, you know, then there's the shit I want to do: call the people I love (it was my grandmother's birthday on Sunday, and I called and left a message, and the grandparents called and left *me* a message, and to return their call on Monday, when I was on call, I had to sneak into the copier room on the floor), see my people now and then, finally attend a Krewe du Jieux events (they inevitably fall on call nights), etc etc.

And blog. I miss writing.

-----

Blah. This post feels very disorganized to me. I think it's the hyper-navel-gazing effect of blogging in a public space. I'm at the CC's on Jefferson; after at least two attempts, I finally made it into Retroactive, which is apparently run by, like, one dude whose hours have nothing to do with the hours posted on the door.

($41.42, a sterling marcasite pin with a small garnet stone, very retro-looking, pre-art-deco, said the man who sold it to me, and who is going to Trinidad and Tobago for Carnival in February, and has been to Carnival in Brazil, and whatever the equivalent is in Italy, and also Germany, but he likes New Orleans best.) (I only feel a little guilty. I don't wear pins, but I think it'd make a lovely necklace if I can find a jeweler to solder some additional rings to the back.)

(Solder! It is a word that means very little else.)

(Words! A dude on OkCupid, whom I should message but won't, posed the question in his profile: What are the three words in the English language that begin with "dw"? It took me a minute, I confess. Also: There must be more than three.)

(The man at Retroactive had WWOZ New Orleans on, and I started paying attention when a recording of Charmaine Neville said hello. Y'all: Holy shit. Jacqui Naylor, "Once in a Lifetime," and Eartha Kitt, "Lilac Wine." And I don't even *like* jazz.) (I'm streaming it in the coffee shop now, because the coffee shop is playing Christmas music.) (And no, Jess'ka, *not* CHRISTMAS BELLS THOSE CHRISTMAS BELLS. I promise.)

-----

(Incidentally, I *know* that blogging in public in New Orleans, a very small city where I run into people I know *all the fucking time*, is a very bad idea. I also know that if I go home, I will (a) eat all the food in my house, again, and since my loosest jeans are now tight I need not to do that, and (b) *not blog*, and I really want to catch up and talk to y'all again.)

But: See? How can I say I have no time? On my q3 normal days -- which actually end at 12 PM; basically, we go in, round on our patients, write orders, sign out to the on-call team, and let them handle the shit for the rest of the day -- I clearly have time for long lunches and afternoon naps and thrift shops and coffee shops, and then I will go food-shopping! HOW CAN I BE SO SELFISH OH GOD oh wait I was at the hospital for thirty hours Monday-Tuesday and then slept most of yesterday.

Oh! And then this woman from the Jewish something-something came by to deliver a Chanukah basket. Her husband used to be a pathologist at my hospital! Her cousin is a resident in Atlanta! She was at the brunch a few weeks ago! She lives right around the corner! Call her for anything!

(Seriously, she was very sweet, a teensy sixty-something-year-old woman with very nifty glasses, and her husband was driving her around in their expensive German car so she could deliver these baskets that contained, like, a mini-challah, and candles, and chocolate, and a promotional cleaning sponge, but I had woken up from a nap, and taken her phone call, and I could not have been more confused.)

-----

Basically what concerns me about this rotation -- to turn back to that for a moment -- is this: I don't know any of the patients well enough, even my own, and I really don't give a shit.

Which is awful. Inexcusably awful.

These patients are sick; they're the sickest in the hospital. The average MICU patient has something-and syndrome: Not just cancer, but metastatic cancer with brain mets, and also maybe hepatic congestion and the beginnings of liver failure. I have seen a blood pH of 6.9 now, which... should be impossible (and, incidentally, that person will probably die). I have seen a CD4 count of 7 (normal is above 700, say several websites, and below 200 is AIDS, not just HIV, but AIDS). I have seen sugars in the 1000s, and bicarbs in the single digits. And I am impressed by all of it, but I do not *care*.

I cannot make myself pay attention on rounds.

I cannot make myself show up at 7 AM. (We don't round 'til 8, and if I can get my shit done before 8, why do I have to be there at 7? Why not 7:15?)

I cannot make myself remember everything that needs to be remembered for a simple set of admit orders (service diagnosis condition vitals i+o (foley? fluids? accuchecks?) diet activity (restraints?) allergies medications and I know I'm forgetting something).

I just cannot remember the simplest shit: who is in what bed and why. If I lose my list -- and I lose my list multiple times per day, usually in one pocket or another -- I am lost.

Oh, medicine.

-----

Speaking of that post office package, though, Mom -- probably also in an effort to confirm that I am alive -- bought me several items off of my Amazon list, which makes me think that, incidentally, I need to look at that list and make sure it's not just crap I bookmarked for future reference. (Like everyone else's in the universe, my Amazon list isn't just a "to buy" list, but also a "to read... if someone lends it to me" list, and a "music to steal" list, and a "ohhhh, I remember that book!" list. It's several years old, and has crap on it that I don't even remember putting there. Basically, it's exactly like yours.)

(And I found the "we need your signature" note in my mailbox on Saturday, after attempted delivery on Friday, and the post office was closed all weekend, and I was on call Monday-Tuesday, so I finally got to pick up the box yesterday. You see? You see how MICU works? MICU is *stressful*. For my *life*.)

So I read thirty-something pages of The Wordy Shipmates, is what I am saying. And I will try to keep reading it. Because I don't give a fuck.

-----

I don't want to go back to work tomorrow.

I spoke to Revi Sunday night. Sunday night, I was pre-call, and I'd gone to this applicants' drinking event at the Bulldog on Magazine, and had two beers, and biked home in the dark with my new hat on instead of a helmet, and Revi and I had been trying to schedule this phone call since I texted her on Friday morning and she called to say, How did you just do that? Because I was just about to call you, except I was on call and couldn't talk. And so I sent Revi a text on Sunday night, Hi, I'm awake, and she called, because she's on nights. And we were talking and talking, and then she said, Holy shit, you're on call tomorrow? GO TO BED. And I said, You know how it is, Revi. You know how you force yourself to stay up too late, because as soon as you go to bed it's time to get up and go to work again. And she said, yeah.

Yeah.

And cue that music.

When you hear, "WOOOOOOOOOOOOOO! YES! YES!" through your walls on a Sunday afternoon, it might be afternoon delight...

or the Saints might have just come back to defeat the Redskins, 33-30.

Wow, that's creepy as fuck.

So for reasons unrelated -- I'm setting up my high school reunion profile -- I googled myself today (and also several ex-boys, because why not?). The usual links appeared: my current employer, my sorority, my undergrad, my grandparents' obituaries. And then, MyLife.com, which -- as far as I can go without paying or giving it additional private data -- knows not only where I have lived, but who my parents are and who my brother is, and where they live.

Whaaaaaaaaaaaaaaaaat?

Let's file this under "The internet is *disturbing."

This MICU team is nowhere near as fun at my medical school MICU team.

You guys might remember my medical school MICU rotation, towards the end of my fourth year. (Not! Even! A year! Ago!) We joshed and jousted, we did, the fellow and the PGY3 and the intern and the attending and I. Like a British quiz show, I said at the time.

This year is not quite the same, sadly. While I'm glad not to be at Healthyman for many reasons -- the presence of a site-rite on the floor, for example, or the fellow's willingness to let me try, say, intubating a patient (YAY) or to walk me through putting in a femoral a-line (YAY AGAIN) -- I am sort of missing the... I dunno, humor of that rotation. I mean, yes, the patients are sick as shit, but... really? No joking, just halfhearted laughter at our attending's occasional cracks?

(Oh, medicine. You are such a cliche!)

(Incidentally, the young attending: He's mid-thirties, probably, with a face I want to call Irish, all squinting blue eyes and a scruffy beard that's just going gray at the chin. He wears tiny silver earrings -- two on the left, one on the right -- and a variety of chunky necklaces and coordinated bracelets. There is at least half a chance he's gay. I try not to stare at him.) (Incidentally, medicine: Not only are you forbidden to crush on your boss, which, doy, but you are forbidden to crush on *anyone's* boss; that is, it would be very awkward for me to date any kind of attending or upper-year-resident, medicine or surgery or what-have-you. Not that the opportunity has presented itself, but: Hierarchy! It exists.) (Says the girl who flirts unceasingly with that Ed Norton-ish med student I met at CC's that one time, and who then showed up last month in the ER. New Orleans: It is *very very* small.)

(Also: It is amazing how a wedding ring makes me stop looking, and the absence of one... It is one argument in favor of the archaic institution of marriage, is what I am saying. Or at least in favor of rings. Rings! They tell you important things! Like THIS PERSON IS OFF THE MARKET SO STOP ACTING LIKE A GODDAMNED SCHOOLGIRL.)

(Anyway. If he were funny he'd be a dreamboat, is what I am saying about this attending. As it is I try to stare at other things, but other things that are not (1) alternate team members, and (2) the television that is inevitably blaring in the patient's room, because (1) makes me look equally creepy and (2) makes me look disinterested. Which I am! Because I fucking hate medicine rounds, even ICU rounds, which are, as rounds go, 80% more painless than general medicine rounds. And this attending tries to teach, even! But OH GOD I HAVE TO PEE and WHY ARE WE STILL ROUNDING? WE STARTED THREE HOURS AGO LET'S BE DONE.)

(Did I ever tell y'all about the 80/20 rule in medicine? When you are pimped on rounds, and the question demands a percentage answer -- "How often are sputum cultures positive in the setting of community-acquired pneumonia?" for example -- go with 80 or 20. I'm not sure why it works, but someone -- gah, an attending, I think -- passed that rule on to me, and so far it's held up pretty well, particularly in questions (like the above) where the attending is pretty clearly trying to make a point about, say, the idiocy of that JCAHO quality measurement that requires all ICU patients to have blood cultures drawn, and therefore implies that pretty much everyone gets blood cultures done in the ER, even those patients who are destined for the floor instead, because what if they get stepped up? What if OH GOD JCAHO WILL DING US ON QUALITY MEASUREMENTS AND THE HOSPITAL RATINGS WILL DROP AND WE WILL ALL LOSE OUR JOBS.)

(Note: But I'm pretty sure that blood cultures are only positive in far less than 20% of pneumonias. Just FYI.)

BACK TO THE ANECDOTE I INITIALLY MENTIONED

"Right, so we need to replete this patient's phosphorous," the young attending says.
"She's on the electrolyte protocol," the resident says helpfully. "I think it's 2 packets of neutra-phos QID."
The young attending gets a wry look on his face. "Fellow!" he says. I will credit the young attending with this one thing: He may get pissy when other people talk when he is talking, and he may be so new at this that he keeps citing his own attendings in conversation to the point of absurdity, but at least he directs his pimptation to the appropriate target. "I shouldn't even be asking this; it's a total mind-reading question. What's a good way of repleting phosphorus non-pharmaceutically? A good food source."
The fellow's eyes bug out slightly more than usual. And then PrincessPeach, my resident, jumps in. "Coke!" she says.
"You... snort it?" I say wryly.
"No, Coca-Cola," she says.
"Even Diet Coke works," says the attending.
"No, seriously." PrincessPeach turns to me, her blue eyes wide. "It's the greatest hangover cure ever. You ever wake up feeling like heck, you drink a real-sugar coke, it works like magic."
We're all laughing now, a sort of quiet harumphing in the corner outside the patient's room. And then:
"You know," the patient calls out from her bed, "I shouldn't say this, but she's right."
And then? Then we actually laughed.

And this poster made me think of blowjobs.

Who dat, etc.

I'm just saying, you haven't lived until you've seen a grown-ass man get his groove on to "Who Dat" / "When the Saints Go Marching In."

At 9 PM on a work night.

At Walgreen's.

(OH MY GOD Y'ALL IT IS LIKE A SAINTS THEME SONG MARATHON. THE STORE IS PLAYING ANOTHER ONE. WHO KNEW THERE WAS MORE THAN ONE VERSION?)

(Incidentally, did I ever tell y'all that the trauma team's pagers play "When the Saints Go Marching In" whenever we activate? You guys. You guys. I cannot tell whether it is irony or not! WHAT THE HELL IS HAPPENING TO ME.)

Bike shop and $98 later.

Went to the bike shop today because I discovered that I had a flat on Monday, and on Tuesday-Wednesday I was on call and not dealing, which brings us to today, sportsfans, and my not-altogether-triumphant return to Mike the Bike Guy. (Not-altogether-triumphant because I could not figure out how to get the fucking front wheel off the bike, which is embarassing; I mean, my bike has fucking quick-release wheels with goddamn lawyer tabs, and still, no dice. So eventually I got mad and threw the thing in the trunk with the front wheel hanging out and the trunk thump-thump-thumping along, and scratched up the paint job on the bike *and* the bumper. But only a little.)

Anyway. Because I felt guilty for admitting, last time, that my light set came from Wal-Mart (... which, what?), and also because I have been contemplating such a move for a while now, I ponied up an additional ridiculous sum of money this time (the flat would have been, oh, $15? maybe? for the new tube and the work) for a rig on the back of the bike that includes, um, the bar that sits on top of the wheel, and then a folding basket on either side. On the other hand: Folding baskets! Now I can bike to the grocery store and *not* hang my groceries from the handlebars! It is exciting.

More to the point: So the guys had the movie Honeymoon in Vegas on in the store, and I am desperate for non-medical human interaction, especially with people who are sort-of hipsters (me = loser), and we were joking, and then the guy who's renovating the restaurant across the street came over to ask Mike whether he wanted to grab a beer down the road, and Mike said sure, and asked Shane (?), but Shane said nah, and I was kind of *right there*. Which is how I ended up with a Dos Equis, and, later, climbing *into my car* with *the open container*, because I live in New Orleans now, and that shit is *totally legal*.

You guys. You guys.

I just remember this one high school party -- and by "one," I literally mean, "the one I attended, ever, or maybe one of two" -- watching Chris the sweet Republican from Latin class, balancing his to-go cup on the top of his car before getting in, and yelling at him, "Don't drink and drive!" Semi-ironically, but I also think I meant it back then.

And now I'm climbing into my car with an open beer in my hand.

How the hell did this *happen*?

(One answer is "New Orleans." Also, "time," but I prefer "New Orleans.")

Elegant Greek solution also a lie.

MICU has begun, etc etc. I came on yesterday morning at 6:45 AM after working from 7 PM to 11 PM on Monday night and then not going to bed early enough, and I didn't leave again until a little after 11 AM today. Luckily, I got a good amount of sleep (interrupted sleep, but still) for the MICU, an hour or two between maybe 9 PM and 11 PM and another two hours or so between 3 AM and 6 AM. Hooray sleep on call nights! It is a rare blessing.

The unit here contains... eighteen beds, I think, run by three teams, each composed of a PGY3 and an intern. The teams are split according to both specialty and medical facility, and the patients just go to whichever team is on that night.

IMPORTANT DIGRESSION IN WHICH I REALIZE I HAVE NOT YET CLARIFIED THE WAY NOLA WORKS, HOSPITAL-WISE

There are two medical schools in New Orleans, one of which, mine, is public and has quite a few residency programs; the other is private, has only slightly fewer residency programs, and its own hospital nearby. Prior to Katrina, both residency programs *also* staffed a large, Huey P. Long-built hospital that sits between our institutions, and which closed in the mess after the hurricane through suspicious circumstances. The staff at my hospital still reminisces about the old place. At any rate, after Katrina, the big hospital shut its doors, and my current hospital became the city's level 1 trauma center and center for care of the urban poor.

To complicate matters further, there are also a few residency programs -- surgery (a few kids I met in Houma), ob-gyn (ditto), psychiatry? -- based at two additional private hospital systems in the city.

Also, and as an additional complication, since my hospital is public and connected to the public university system in Louisiana, we -- the EM residents -- rotate at a few other public hospitals around the state, eg the one down in Houma. *And* we also rotate -- again, the EM residents in my program -- at several of the private hospitals in New Orleans, either to get more experience with pediatrics (we don't go to the pediatric hospital in the city, but to a general hospital with a peds ER) or with patients who can read.

(You think I'm kidding, but I'm not. Also, you think I am comfortable with patients whose literacy is equal to my own, but I'm not.)

(This would all be very much easier if I could just name the institutions in question, but I can't, obviously, and even though none of my attendings seems to know what a blog is.)

What you need to know is this:
1) There are two medical schools in New Orleans, which have residency programs at their hospitals, and also there are some non-academic residency programs in the city as well.
2) Most of the residency programs send their residents to various hospitals in the city and suburbs, for the experience. This means that residents rotate at a variety of settings with residents/staff from other institutions.

Where this all ties in is, there are three teams in the MICU. One team is an IM resident and intern from the state medical school/residency program (mine), one team is an IM resident an intern from the *other* medical school/residency program in town, and one team which is an EM resident and intern (us, obviously).

BACK TO THE MUCH SHORTER ANECDOTE

Alright, so. There's this word that has been explained to me a couple of times by different docs:

(The reason I'm pasting rather than just *using the damned word* is because it shows up on google, um, twice? Which means it probably is wrong, and perhaps all the attendings who have ever explained it to me have been wrong, too.)

As the docs have explained it, the phenomenon occurs when a person, due to a present (medical, I think) illness, presents with the symptoms of his old stroke. Eg, Uncle Pat thought he could get away with not taking his metformin for a couple of days, because he needed to spend that $4 on a pack of smokes or maybe a very small crack-rock, and now his right side is all slumped like when he had the stroke last year, but actually he's not having a new neurological event; he's hyperosmolar hyperglycemic nonketotic blah-blah-blah, and his brain just decided to recapitulate its previous deficits.

(Oh, look! Once again, it is really hard to talk about science without attributing will to organs, theories, or processes utterly without consciousness! Oh, well!)

(Also: Ontogeny recapitulates phylogeny! It is a quote I always forget.)

Or so I understand it. Again, this is one of those terms that has only been explained to me on rounds, and while I could google further, I'd prefer not to at the moment, because heyyy, I have a boring story to tell here.

Anyway. After rounds today, when said word came up, I was trying to get shit done -- what the hell is a transfer note, why the hell isn't this extensive H&P I actually wrote only seven hours ago good enough, or maybe the SOAP note I wrote only two hours ago when we were already talking about step-down, the fuck -- and I was talking to the med student, and I said, Oh, hey, I bet it's the same as eureka!, you know, eureka, it comes from skein, the verb "to see" plus this prefix. Which would make sense, you know, seeing again.

Except *none* of that is true, if it's diaschisis. And here we can blame Greek's having two not-really-accurate ways to translate two-not-really-equivalent sounds into English. In this case, it looks like the chi became a k, whereas the kappa became a c.

And so, my derivation is total bullshit.

BOOOOOOOOOOO.

Oh god people it is a *Monday* night.

I have never before lived anywhere I had to calculate my life around football.

Goddamn.

(Incidentally, they let me out of the ER early to get some sleep before MICU call, and what am I doing? Blogging. The end.)