Thursday, March 29, 2007

March Madness

I really like the month of March. It's the month when things turn around. Sure, there's mud, the clouds roll in, and last fall's trash gets rediscovered, but March is about making the transition from potential to actual. So, yeah, thematically, I'm saying.

March is also the title of Michael Penn's first album. It's uneven as hell, and taken individually, maybe 1/3 of the tracks are skip-worthy. As a whole, though, it's awesome, and it's emblematic of that late-80s, early-90s pop that I grew up on. If you don't like "No Myth," you don't like pop music.

Fun trivia factoid: when you get married in Minnesota, you sign a document that lets you put your name prior, and your name after. In theory, you can name yourself anything you want (i.e., you get a free name change with the fee to file your marriage license).

There was a time, way back when, when I toyed with the idea of making March my last name. My real last name is not exactly hard to say, but for a pretty simple grouping of phonemes, it seems disproportionately hard for people to hear correctly, or spell. If I weren't trying to keep myself a little bit anonymous on here, I'd treat you to some amusing mis-hearings, and maybe you'd agree that it was worth thinking about becoming something else. My ex-spouse from that same late-80s, early-90s period was way into "Little Women," so there was potentially a shot at being Mr. March. Later, I was tempted to use it as a whole starting-over thing. March. One syllable. Conveys strength and directness. Almost impossible to mess up.

But ultimately, I'm glad I didn't. My Scandinavian name has character, and it forces me to slow down and look people in the eye when I say it, so they don't screw it up. Still, sometimes I wonder how different life would have been, if I'd gone through with a name change.

And anyway, at the moment March is feeling like a long-ass month. I'm ready to move on already, and have more of those 80-degree days. Out like a lazy lamb with nothing in particular to do, I tell ya...

Sunday, March 25, 2007

Blog Niblets

1. Because it Does, That's Why

As an add-on to the rant about grammar and troublesome job titles, I should have mentioned that at the end of my academic tour of duty out East last year, I arranged a visit to a PA program in one of those New Englandy states. It was a nice, if twisty and time-consuming, drive from the Farmhouse, and the town was small but cool. A minor-league baseball team plays there, which pushed my Bull Durham goodwill button and made me want to like the program.

I wound up taking it off my list of "maybe" schools, for a few different reasons. The whole school occupied one building, a squat office-type space that might have just as easily housed an insurance firm. The PA program had been added four to seven years prior, yet the signs in the parking lot still read "_____ School of Pharmacy and Nursing," which I took to be one of those small things that can signal a school's lack of attention to other, more important things. And most importantly, because in the talk about the cirriculum, the faculty member in charge had gone back and forth between the terms "Physician Assistant" and "Physician's Assistant" several times.

I just thought that was thoroughly weird.

2. Who's The Ringer?

This weekend, we attended a housewarming party. The couple hosting have a PS2, and got Guitar Hero a few weeks back. I had told Teslagrl that I would probably not play much, since I had my obsessed period and beat the game, etc., and basically I'd gone through that progression a month or so ahead of where the host was in his own GH journey. If you've had this game wreck your bedtime, you know what I mean. If not, just imagine I've read the new Harry Potter book before he's had a chance. I didn't want to be all showin' up the host or giving stuff away. I was going to let him enjoy his game, his way.

That is, until we arrived and his 16-year-old nephew was shredding it up on the Hard level. I sort of got appointed the grownups' representative.

We started out being social, and I stuck with my intentions. I took over only to assist with some kiddoes who wanted to play, despite being younger than the recommended age on the box. I think the peanut in question is about four or five, and she recruited me to push the fret buttons while she strummed the notes. I set up the two-player mode, so she and her sister could play (with me as "special rock advisor" to the younger one). The older one revealed herself to be genuinely good, which is a little eerie. I thought people under 10 were supposed to lack the hand-eye skills for that. You can't actually fail a song in that two-player mode, which made it a good choice for them.

Parents and friends watching tiny girls rocking out to the Ramones is a very amusing scene, let me tell you. There are, I trust, some good photos.

But that set up the two-player face-off paradigm. Much later, after a lot of controller-passing, did the nephew and I had our inevitable rock battle.

I crushed him.

I've liked games well enough for a long time, but never been good enough at one to beat a real live teenager. It was a big moment.

3. Nice of Me to Notice

I'm writing up my notice letter for work. I like to say it's my retirement from the nursing assistant/ medical assistant world. There might be a party, or at least a happy hour. Potentially AARP-themed.

Does anybody need any scrubs? I have a couple sets I'll keep for anatomy lab, but I have several and can't imagine I'll have a lot of use for maroon ones. Maybe I'll sell them to my co-workers, or outfit some of my new classmates.

4. Bio-Synthesis

Last week I did the biochemistry chapter on the TCA cycle, aka the Krebs Cycle. This is the core of it, everyone's least favorite part of their least favorite class. It's reassuring, and kind of fun, do ask working doctors what they remember about it, which is what I was doing a week ago. Now that I've finished it, I'm finally starting to feel like I'm going to be okay at this. Chemistry plays fair, after all; stuff that's true stays true, and once you get something, you can use it to make sense of other things. And I'm lucky in that this class is geared toward people who will practice medicine, and stuff that's chemically interesting but clinically irrelevant is skipped over.

Most crucially, biochemistry answers the implicit question that has historically stood in the way of my love of this kind of class: why should I care about this crap?

Because, my dears, if these processes don't work, you effin' die. It really puts oxidative phosphorylation in a different sort of a light.

Monday, March 19, 2007

Points for Grammar

I'll continue my budding rant about excellence vs. mediocrity, which is designed to turn into one about politics, soon. For now, I'm just going to whine about this idea of my career path being "Physician's Assistant."

The focus of my white-hot burning rage isn't the people who innocently use the wrong term. It's not really even the lack of careful thought that would reveal to any sane and intelligent person that if you go to school for eight years to be a doctor, you don't go to school for six years to be some doctor's "assistant." No, the problem I have is with the general fatigue we all seem to have suffered, which makes it all the easier to shrug our shoulders and be wrong about stuff without caring.

Oh, look, I guess this is the rant about mediocrity. Cool.

I'm going to keep politely correcting people. Accent on politely. I won't be deeply and personally offended, I won't hold it against you if you do it, and I'm not going to go out of my way to interrupt the flow of conversation to back up and fix the mistake. But I'm also not going to let it slide, if it can be helped.

Not for reasons of ego; if my ego were really that sensitive, I'd probably think it was worth it to do the time and get an MD. More because Judas Priest, people, the profession has been around since the 1970's, and the AAPA has somehow done such a horrible job of publicizing it that it falls to those of us who will actually be, you know, doing it to explain what it even is.

My job right now, the one where I work in the Emergency Department and get paid less than I did in 1998 as an office temp, that's an "assistant" job. I'm a nursing assistant, I'm a medical assistant, whatever you want to call it. In Ye Olde Days, I would have been called an "orderly." Which is kind of a cool title, because it reflects my function well. The ER gets disorderly in a hurry, and I help fight back the forces of entropy. Yes, I wipe some butts (although thank god I don't work in a nursing home). I push stretchers around to xray and up to the inpatient floors. I fetch stuff, I clean stuff, I stock things so they are there when clinical people need them. I generally make other people's jobs easier. And yeah, I get to do some cool stuff as well.

So I am the assistant to the nurses and to the physicians. Gramatically, I am right now a "Nurse's Assistant," and I am a "Physician's Assistant." (Okay, really I'm a "physicians' assistant," but go with me here.) I would never call myself that, because it would just make the confusion worse, but the point is the butt-wiping stretcher-pusher is the apostrophe-S assistant. The PA is somebody that sees patients and practices medicine.

The word "Assistant" is built right in to "Physician Assistant," so it's a logical and reasonable thing, if you're encountering the phrase for the first time, to assume there's a fair bit of assisting going on. "So do you pass instruments to the surgeon, and close up at the end of the surgery?" "That's like a resident, right?" Arrrrgh! But as I say, I can't get too wound up about it. It makes sense to think that.

After all, executive assistants are there to assist executives. Production assistants run around film sets, assisting people with random stuff that has to do with production. And physician assitants... practice medicine. Great. Thanks. Awesome.

In a nutshell, we "assist" physicians in kinda-sorta the same way a law firm's junior associates "assist" the senior partners. We do essentially the same job; true, the major cases and the really uber-high-stakes stuff will tend to go to the higher-ups, but that's fine because more training and more experience means you should handle more pressure. By handling a chunk of the cases ourselves, including mostly the stuff that comes in every day, with a little fun stuff mixed in, we reduce the workload. That's a mighty fine way to assist.

How awesome would it be if you had someone at your job who did the same thing you do (at a level a little under yours), and all you had to do was answer the occasional question or give some advice? This person does, let's say, 40% of your total work, and they do it as well as you do. Would you call that person your assistant?

Yeah, it's confusing, and yeah, it's vaguely insulting that the wrong idea persists. I saw a PA recently at the Target Clinic, for removal of some stitches, and as we were talking, I remarked that the poster outside in the little waiting area had an apostrohpe-S. She said "yeah, you kind of have to get used to constant little insults." Ohh, yay.

So if I've explained this to you already, sorry to be repetitive. I'd love to stop having to be.

Friday, March 16, 2007


I'm not sure I like my last couple of posts. But hang in there with me; I'm attempting to build to a larger point, one that needs a little stumbling room, to get where it's supposed to go. And that point is not meant to be cheese-sandwich-y and self-absorbed, nor grandiose and mighty. It's the gremlin of blogging, is the thing. It seems like the choices often come down to talking about the world in general and sounding like a crank, or talking about your own tiny corner of it and sounding like a short-sighted schmoe. Either way, there are times when dude, you're taking yourself very seriously.

But hey, this thing is meant to be about progress, so give it a couple weeks. When I have time to write more, the progression should start to become more clear. Besides, there's a word for people who wait to express a single thought, until after their message is thoughtfully considered and completely crafted: politicians.


Thursday, March 15, 2007

Be Excellent to Each Other (pt. 1)

I just got back from the laundry room in my building, where I moved two loads of wash into the two dryers. There's a sign on the wall there, reading "Be Prompt and Courteous," and then some language about getting your crap out of other people's way and not making them wait for the machines to be free. I don't know exactly what it says because the phrase "Prompt and Courteous" reminds me of a grade-school report card, and makes me smile.

But I have to admit to something that might be insufferable; in the back of my mind, there's the feeling that the sign really isn't meant for me, you see, but rather for the others who don't already feel an intrinsic motivation to move the laundry along.

I know self-congratulation is a pretty toolish quality, so I hope I can talk about this without appearing to go too far to the dark side. I spent a fair chunk of my younger life being deathly afraid of being a screw-up, and this led to an overcompensating smugness when it came to the few things I felt I had under control. I like to think I'm past that.

And then I think, hell, it's time to relax about that historical noise. It's going to be my job to take care of people who literally can't take care of themselves. Of course I should care about being excellent at... well, really, anything. I should notice the stuff I'm good at, as well as the stuff I'm not. I should work to get as much on the "good" list as I possibly can. It's basic, and ought to be obvious, and everybody should be doing it. Right?

I'm damn good at laundry. No over-filling, none of the thumpity-thumpity noise of an unbalanced tub. No clumps of detergent on the wet clothes, or lint on the dry ones. The wash cycle takes 26 minutes, according to the machine. I bet it was 28 when I happened to get up and go back there. I have an awesome internal clock.

I do the same thing with microwave food. I get up and cross the room in time for the beeeep, without having looked at the display. Obviously this is handy in those situations where someone asks, for example, "how long until the ambulance gets here?"

I really believe in my heart of hearts that I fold t-shirts the best possible way that human hands can fold them.

I think that other people must surely notice and admire that I take care to tweeze the stupid little hairs that sometimes grow around the outsides of my ears.

I wrecked the clutch in the car I drove when I was a teenager, because I misunderstood the fundamentals. Having learned my lesson, I believe that my current car has lasted to 102,000 miles because of my effective and talented application of the manual transmission. Which is, it should be said, far superior to an automatic transmission in every way.

I have a slight stutter that comes out when I'm tired or stressed, but in general I have excellent diction. My written grammar and spelling are nearly flawless.

This is not to say that I look down on people who turn their underpants pink by forgetting about a red sock, or people who kill their engines at a stoplight. Looking down on others is a horrible quality, and only the worst sort of people engage in such things.

And it's not like I don't have plenty of things I let slide. I should floss, but I don't, usually. I eat way too much frozen food. I procrastinate, and work on things in order of interest instead of order of importance. Like anybody, I can forget what really matters and get all caught up in my own ideas about what's happening around me. I think too damn much (...but you're reading my blog, so we both get a giant "duhh" on that one).

I'm a long way from perfect, and I'm not even excellent at all the things I want to be excellent about. It's just that I try, and I keep trying, and things continue to matter to me. I really think the world in general would be a much better place, if only a greater number of people gave a crap about actually doing well. What we do most of the time is to struggle just to get to "good enough." We stop before we get to "good." ...And then we collapse in a heap, only to complain about it ten minutes later.

My life happens to have diverted me to several points where "good enough" just wasn't good enough anymore. And when you've had that lesson bonked into your head repeatedly, it changes your point of view.

There's a line in Tallageda Nights, a generally un-excellent movie, where Ricky Bobby declaims his opinion on this very subject by telling an interviewer that he gets up in the morning, and pisses excellence.

I just checked on the dictionary definition of "declaim" and the spelling of "Talladega." See, I care about stuff.

Which is a part of why I proposed to Teslagrl. I'll tell you all about that in the next few days...

Wednesday, March 14, 2007

Now Hear This

The other day, I was working in the critical care/ trauma room -- the part of the department where the TV-like stuff happens. I did some more CPR this week, actually (and I'd like to thank another patient for not dying in our care). This time was trickier, because this person started out with Pulseless Electrical Activity (Paramedics say PEA stands for "push Epi, Asshole!") which turned to atrial fibrillation and back again more than once. The patient did indeed get a bucket of atropine, and enough shocks to drive George Clooney's car to Vegas, by the time all was said and done. I couldn't tell what tempo I was compressing at, because this person's heart went from 82 beats to 145, and then ran itself at 140-some for the next hour. I think I was doing about 100 beats, but who knows?

One of the first-years claims that Queen's "Another One Bites the Dust" has a tempo of 100 beats per minute. I like the idea of humming that as you're compressing somebody's ribs; it's morbid, but snappy, and if it's true, it's useful. But I'm not convinced; I thought 100 was a nice Sousa march tempo. Anybody out there know? I was in junior high band, but if I scour my neurons for that info, I'm afraid something more recent, which might show up on a test, could fall out.

EDIT: A quick Google search tells me that it's about 110 bpm. Sweet! Still morbid, so maybe another song would be better. Or learning to not hum it out loud.

Another fun moment in that room was having a pit boss* borrow my stethoscope twice. Hey, I've been the Human IV Stand, holding a bag of fluid up like the Statue of Liberty. I've been the Human Retractor in the OR, doing work that can otherwise only be done by a little metal contraption with screws and clamps. Why not be an equipment-carrier for somebody I actually like, right?

So I was in the critical room, doing my tech stuff; we get patients exposed, hook them up to monitoring, and make sure blood gets drawn and sent to the lab. We activate the pagers for consulting teams (and try to be polite but firm when some dork from Pediatrics or Medicine calls back rather than seeing the number on the pager and just coming down, the way everybody is supposed to. No, I can't have a conversation about this now. First, I'm not a doc, and second if I don't have time, you can bet they don't, either). The doc needed to listen to the patient's lungs, and swiveled his head around until he saw me. "Hey, can I borrow this...?" he said, lifting my scope while I maneuvered a syringe full of blood into tubes. "Sure," I said. "That's basically why it's there."

And what's weird is, that's true.

None of the stuff I do on a daily basis really requires me to carry a stethoscope. Once out of every 50 or so blood pressure readings, my little computerized machine on a wheeled stand can't get a good reading, so I do it the old-fashioned way, with the hand-pumped cuff and the stetho-thingy. But really, I could keep it in my locker, or just borrow one of the nurses'. Slinging it around my neck is pretty much just a costuming move. It makes me look "medical" to non-English speakers, little old ladies, and irrationally anxious people of all ages and ethnic backgrounds.

Sometimes I'll get tired of it, and leave the thing at home. At the end of the day, I'll wonder if I needed it, and the answer is "nope." This goes on for about a week, max, and then there will be a day when it really would have been useful to have the damn thing. If I were scope-less last week, the pit boss would have found one on somebody else in the room. But hey, one of the best things about mine is that I probably won't need it. Oddly enough, it would seem that's a good reason to carry it.

Another will, I suspect, reveal itself in school, when we get to the class where they show you how to interview and examine patients. I still see students get a little flustered and nervous when they take their stethoscope out of a pocket and tentatively step toward a patient. If I'm to the point where I'm sick of carrying an item around, surely that means I'm way past that point of view, right?

The trauma shears still rule, though. I'm constantly cutting stuff.

* The pit boss is the third-year resident, which is to say a doc in their final year of residency training, and therefore someone who will soon be out in the world, working as a staff physician in emergency medicine. Maybe they'll work in a teaching center like the one where I work (kind of a "Top Gun" kind of a thing), or maybe they'll kick back in some small-town ER where they're the only person in a 200-mile radius who can stabilize and package patients for a helicopter ride, after they've tussled with a nasty piece of farm equipment, or just had too much eggs benedict for the past 30 years. Probably something in between.

The pit is the area where the docs keep their computers and books, their Xray reading screens, and it's where they hold their discussions about what to do next. So the pit boss is the nominal person in charge. There's a staff doc overseeing the area, too, but part of completing training is getting to the point where the staff start giving you opinions and advice instead of instructions.

Saturday, March 03, 2007

Blog Niblets

1. A Tip o' the Hat

A couple of visits ago, I left my Team Ortho baseball cap behind at the M. Giant household. I got it a little less than two years ago, when I shadowed an ortho surgeon friend of mine. Before the scrubbing-in part of the day was the setting-down-my-stuff part of the day, so we started in the doctors' tiny offices. One of my friend's office-mates is the guy who is in charge of recruiting for the "team," which is a combination fundraising and public outreach entity. Every Ironman event and triathlon within a few hundred miles usually has a Team Ortho contingent, in snazzy blue and white bullseye jerseys. The recruiter guy introduced himself, and pretty much right after "hello" was "you look like a Medium." This confused me, until I was thrown a free shirt and the aforementioned ball cap -- all I had to in return do was promise to check my calendar for good times for me to swim, run, or bike a great distance longer than I otherwise would, or realistically could. I checked. I checked twice, in fact. There were none.

Last time I was down at the Giant homestead, I inquired about the hat, and MG said, "oh... that was yours?" It seems M. Small has adopted it into his compendium of random cool stuff. This is a kid who can derive hours of enjoyment from the plastic spindle-thingy that outdoor Xmas lights are strung on, and so it's a pretty good compliment. Besides, maybe he'll be a triathlete someday, and at the very least he can spread the public awareness. People notice stuff on adorable moppets in a way they don't, on surly Nordic ER techs. So, seeing as how my hat is in a better place now, I switched to the ball cap I had stashed in the closet: the NASA one.

This one I got at the Kennedy Space Center, in Florida, when Teslagrl and I went down there later that same year. I am something of a space freak. The rocket garden, with its recreated shells of Atlases and Saturns, command modules, and a LEM you can crawl around in was like holy ground to me. I got a little choked up at the recreation of the Apollo 11 launch. Ron Howard can make crappy movies the rest of his life and Apollo 13 will still be on my top 10 all-time list.

And today, at work, I discovered the NASA hat has ironic hipster cache now, too. A co-worker asked me, "where's your diaper?" Heh heh. Thanks, love-crazy astronaut! You've made space cool again... kind of.

2. Guitar Anti-Hero

I hate this kid. Eight years old, and he pwns a song on Expert I can barely handle on 'Hard.' I got to see the original Star Wars in the theater 13 times, though, so nyaaah. I'd love to say the video is somehow faked, but that would be sour grapes on my part.

3. This is why they invented the Internet

Speaking of YouTube, I guess last year's most fun video is this year's most kickass meme. I guess I really am growing up, if high school kids actually look somewhat cool for even a minute.

4. This week's medical mystery

So, the kid with the five-week case of hiccups finally got relief? Awesome. And although there was no story as such, Friday's Strib had a little blurb that said the 15-year-old was crediting a chiropractor, an acupuncturist, and a hypnotist (more about that, in the link above). Sure, fine, cool. No love for the medical establishment. We're used to it; we don't need outpourings of gratitude. Besides, it's not like the establishment has weird ideas about curing intractable hiccups... like, say... digital rectal massage.

Yessir, nothing balances the q'ui, aligns the shakras, or increases the flow of your positive energymeridians like the old fashioned gloved digit up the ol' pooper. It's peer-reviewed Western medical journals, baby. Read it and weep. Some days, the Q-ray bracelet has nothing on our side. Those are fun days.

And if I ever have hiccups lasting that long, and it turns out the "intern year salute" is what brings them to an end, I'll probably credit something else, my own damn self. That, or just smirk mischeviously at Katie Couric when she asks me about it...