Friday, December 17, 2010


I love Christmas. It is by far my favorite holiday. I love the lights, the food, the music, giving presents, and the general happy spirit of the season. And although I love the holiday, I feel like I have had to work a little harder than usual to feel festive this year. And now, a week before Christmas, and because of a series of unfortunate events, I feel like all of the Christmas spirit I was trying to have has been squashed out of me.

Last Saturday, I dragged my good friend and her two kids out with me to do a 5K walk. I signed up weeks ago for a "Gingerbread Walk," a 5K where we would walk around the main street of a little town, collecting cookies along the way. It sounded fun and festive, and would have been great, had it not been December and raining. We made the best of it, but our kids were cold and wet, and they lasted through 6 (out of 35) cookie stations and about 1 mile, the last half of that being on the way back to the car after calling it quits while the two young boys screamed their poor little drenched heads off. We dried the kids off and took them to McDonald's for lunch. And then Gunner and I came home and ate our six cookies. I think that cancels out any exercise we got in that day.

Yesterday, I dropped Spiff off at the airport for his millionth interview trip of the season, and then I dragged Gunner all over the city in order to finish up my Christmas shopping. We had to wait an hour for a store to open, so as we hung out in the childrens' section of Borders, he pooped. As I went to change him, I realized that I didn't have a spare diaper with me. "There goes the rest of my shopping trip," I said to myself. But determined not to have to drag us both out of the house later in the day, I cleaned him up, pulled up his pants over his bare little bummie ("My pants fall down, Mommy!"), and carried him to the neighboring Whole Foods store to buy some organic, chemical and dye-free diapers, just praying that he wouldn't pee on both of us. He was a real trouper, and with the help of some animal cookies and dum dums, we made it through the marathon shopping trip.

Then I stayed up way too late last night finishing up some homemade Christmas presents, and wrapping and packaging gifts to send off to family members. I told myself that the sacrificed sleep was worth it because everything was ready to go, and all gifts would be to their recipients on time, as long as I could make it to the post office today. A friend even stopped by my house unexpectedly today and volunteered to watch Gunner for me while I ran to the post office! Gratefully, I took my large box and several small envelopes to the post office, where there wasn't even a long line. All good signs, right?

The lady behind the desk worked through my stack of packages quickly. And then she got to my large box, which weighed in at a whopping 6 pounds. It came up on the computer as an $18.40 package, which was more than I had hoped, but I sucked in my pride and kicked myself for procrastinating Christmas, and I swiped my debit card to pay for it. Only then did the desk lady say, as she got out a measuring tape, "Oh, gosh, wait! I don't know where that number came from! Your dimensions are all wrong. It's not $18.40. It's $32."

Excuse me?! $32?!!! To send a package that weighs six pounds?! Because my dimensions are wrong?!?!?!?!

What does that even mean, anyway?!?!

I told her that I was in no way willing to pay $32 to send this package, so I immediately grabbed some flat rate boxes and proceeded to move and repackage everything, trying desperately to get the various items to fit in a box. Two items had to be unwrapped and shoved into the box, and will have to be re-wrapped by kind family members on the receiving end of things. One item didn't fit and will not be sent for Christmas. And as much of a bummer as that was, I figured that it was okay because I would not be spending $32 to ship something that cost me only $13 to begin with.

So, I placed my newly repackaged parcel on the counter for her to work on. It was a flat-rate box that cost a blessed $10 to send. All is well.

Except that I had already swiped my debit card and already paid the USPS $18.40. And this is how the rest of our interaction went:

Desk Lady: "You have 8.40 left on your purchase. Can I sell you a book of stamps?"

Me: "No, I don't need stamps. I have plenty of stamps. Can you void that last transaction, please?"

DL: "We can't refund debit card transactions. But I can sell you a book of stamps."

Me: "I don't need stamps! I just want to pay for the package, and that's it."

DL: "Well, I can't refund the money, so you either buy a book of stamps, or pay $18.40 to send this $10 flat rate box."

And that's about when I blew a gasket, melted in to an embarrassing pregnant, hormonal puddle on the floor, gave in, bought the stupid book of stamps, and stormed out of the post office, while the desk ladies laughed as I walked away.

I'm still seething about how it was her mistake in the first place to measure the package incorrectly, how she basically forced me to buy a book of unwanted postage stamps, and how she was utterly unwilling to do what any other cashier in the country is trained to do and void the transaction.

Then when I got home, I found Gunner crying uncontrollably at the door, where he had been since I walked out of it 25 minutes earlier. My poor, generous friend was calmly making lunch and feeding her two boys in my messy kitchen while my kid screamed uncontrollably in the entryway. I walked in feeling so bad for putting her through that, and for being hoodwinked by the USPS, and she soon had two crying people on her hands.

Now besides having a new resolution to boycott the US Postal Service for the rest of time, I'm having a hard time feeling the Joy of Christmas. I'm sure that I will feel differently in a day or two. I will be happy when Spiff is finally done traveling and home for the holidays on Monday evening. I will be happy to spend Christmas with my little family and my good friends here in town. I will be happy to bake and eat yummy food, play games, and watch Gunner's excitement over Christmas presents. But at the moment, I'm just not feeling it.

So, please tell me something to cheer me up. Share a Christmas story, or a successful shipping story! Or just something to help me bring the Christmas spirit back into my hardened little heart. I do want to love Christmas this year.

Thursday, December 09, 2010

Loving My Boy

We put our Christmas tree up on Sunday. Gunner was so excited about decorating the tree, and it was so much fun to watch him hang the "guys" (little Scandinavian people) and "tubas" (bells) on the tree. He loves his tree so much, and he calls it his "Christmas". He even made Spiff and me sit down on the floor with him in front of the tree and "Watch Christmas". Who knew that a Christmas tree could be such an exciting show?

Gunner and I made a batch of Jiffy blueberry muffins today, and then he licked the batter bowl. Seriously, Jiffy Muffin mix is really that good!
And just as a side note, notice the box of Wheat Thins on the table. Gunner refers to them (and Chex Mix) as "chicken". They are the only meat products he's willing to eat.

Tonight, my baby had the hiccups. I put Gunner's little hand on my belly so that he could feel it, not really expecting him to feel anything or get it at all. But he felt it! I explained that the baby had the hiccups, and he smiled and pressed his little hand in closer so he could feel them better. Then he kept asking for more hiccups as I put him to bed. Pretty awesome.

The best part of my day these days is bedtime. I love reading books and cuddling with my little boy before his nap or bed. It gets better every day as he gets better at talking. He remember phrases from his favorite books and quotes them throughout the day. And he almost always asks for more books, which is almost always irresistible for me, and I almost always cave and read him just one more. Especially when he asks for them by content, like tonight when he asked for the peanut butter ("beanut buttet") book, which turns out to be a library book where a dog eats some butter off the kitchen counter on one of the pages. I think the only thing I love more than reading him stories is singing his bedtime song while he cuddles on my shoulder. He's old enough to pick his song these days, and it melts my heart to hear him ask for "the daddy song again." Like I said, it's the best part of my day.

Sunday, December 05, 2010

The interview trail and duty hours

So the interview trail has been a busy one for me. I have been trotting all over the midwest, and I'll share a few thoughts on the strengths of the various programs that I've been to:
Mayo: Amazing physical facilities. Dozens of different kinds of marble in the waiting rooms alone. Also, the truly bizarre cases come to Mayo
Michigan: A lot like Mayo from a pedagogical standpoint, Ann Arbor has a little more going on than Rochester
Case Western Reserve: Sweet moonlighting possibilities where you can make $65/hr doing anesthesia after hours. Level 1 for children's trauma.
Cleveland Clinic: Very strong in hearts, lots of pump cases and congenital cases. Very strong ICU
University of Wisconsin: national leader in transplant, very livable town.
Medical College of Wisconsin: Strong peds rotation
Washington University: Has everything, knife and gun club.
SLU: lots of penetrating and blunt trauma.

I have two more anesthesia interviews and three more prelim or transitional year interviews before I'm all done in January.

So, now my rant about duty hours. Residents are currently able to work no more than 80 hours a week, averaged over a month, with no shift lasting longer than 30 hours. They must also have 8 hours off between shifts. I think this is reasonable and allows for sufficient exposure to ensure a balanced and adequate post-graduate education. The Institute of Medicine, a think-tank (if they in fact think there) which makes recommendations to the ACGME, which is the accreditation body for residencies, recommended that interns not be allowed to work more than 16 hours at a time. This recommendation becomes codified into regulation next summer, when I become an intern. Great! I hear you cry. Interns won't be as tired and will be alert and less prone to make errors. Right? Wrong.

Here are the problems with that line of reasoning. Yes, there will probably be fewer fatigue related errors. The flip side of having shorter shifts is that there will now be more hand-offs of patient care between residents. Would you rather have your ailing father be cared for by someone who had seen and monitored his care continuously for the first day he was admitted? Or would you rather have 3 different hand-offs?
Remember playing Telephone as a kid? the same problems with garbled messages and discontinuity will now exist in medicine. In essence we're trading fatigue for the problems engendered by frequent pass-offs of care. I think it will also turn the newest generation of physicians into clock-punchers who will be ill-prepared for the real world where doctors don't have duty hour restrictions. I would rather work hard as a resident and emerge a well trained physician who is competent and has seen and cared for a wide variety of illnesses than emerge a well-rested but half-trained doctor.

There are also changes for upper level residents, who will only be able to work for 24 hours straight. This will not be any change for anesthesia residents who only work 24 hours at a stretch when on call anyway, but will be devastating to surgical residents. If you shorten the amount of time a resident can be at work, you limit the number of procedures he does. Would you like to have your knee replaced by new surgeon who has done it 350 times in training? 200 times? 100? 50? 10? It is a mathematical necessity that in order to be competent in a procedure, you have to have a baseline minimum number of repetitions to be good at it. Surgical residents are going to be doing fewer cases and emerging from training with less experience than their predecessors.

Bravo, institute of medicine. That's some strong work.