So I kind of feel like I should stop posting these pictures until something interesting is happening, but now that I decided to do this week-by-week thing, I am unable to half-ass it. I WANT TO USE MY WHOLE ASS. And if you're wondering, "Michelle, do you really wear the same clothes every day?" The answer is clearly: yes, yes I do. Right down to the T-shirt. (I swear these pictures were taken a week apart--I do launder my clothes occasionally.) Also see evidence of the index finger I shaved off.
17 weeks:
18 weeks:
If also you were wondering: "Michelle, you use ultrasound regularly in your anesthesia practice. Are you ever tempted, maybe late at night, on call, when nothing else is going on and all the patients are tucked up in their little beds, to take a quick peek and see what weird contortions your fetus is doing? Because you think you feel it moving around in there, but at this point it could just as well be gas or the remnants of this afternoon's beef stroganoff?" Well, the answer to that is also: yes--yes I am, and yes I have. I don't have the right kind of ultrasound probe of course (different probes have different degrees of penetration--we as anesthesiologists usually use a linear ultrasound for line placement or nerve blocks and as such usually don't need to see much deeper than two or three inches; while obstetrical ultrasound obviously goes deeper and through more tissue) but at this point, even at three inches it's enough to see a select body part or two.
(That's the feets.)
Hope your week is starting off right.
help me help you
Off the top of my head: five tips for people who might need to undergo anesthesia.
1.) Know what medications you're taking, and know what you're taking them for.
I guess this must seem easier for us, because by and large if you're reading this you are on the younger end of the spectrum, statistically more likely to be healthier and on fewer medications, and demographically at least somewhat medically inclined, but--you'd be surprised how many people have no idea what medications they're taking or for what condition they were prescribed.
Patients--please know what medications you're taking! It really makes a difference, and can affect how your body might respond to anesthesia or the various insults of surgery. And it's often not quite enough information to tell me that you take "a blood pressure medication," because there are many different types and they all work through different means. Is it a beta-blocker? An ACE inhibitor? A diuretic? An alpha-2 agonist? And guess what--even if you don't know half of what I just said, it doesn't matter. Just know the names of meds you're on, tell me, and I'll figure it out, because it's my job. If it's hard for you to remember, write your med list down or have a family member help you. Carry the list with you in your wallet if necessary.
2.) Know your own medical history.
Equally important, see above. Do you have a scar over your sternum? Do you have a device implanted under your left pectoral muscle? Sure as hell I'm going to ask you about it. I'm not being nosy, I need to know these things to make sure I can take care of you in the safest way possible. If you can't remember, or have a hard time because you have a long medical history, write it all down (list of diagnoses, surgeries, doctors with contact info) and carry it with you, maybe along with your med list. Better yet, keep it as a file on your computer, so you can update and print it out as necessary.
I know it's annoying to have to answer the same questions again and again, but it's a matter of safety as well. So bring your information. And don't just trust that, "it's in the chart," because sometimes it's not. Anyway, a good medical practitioner doesn't just trust someone else's History and Physical, they do their own.
3.) Do yourself a favor and think long and hard about your allergy list.
As an anesthesiologist (or even as a doctor in general), when I ask you about drug allergies, what I'm really asking you is, "will the benefit of me giving your a certain medication as indicated be outweighed by an adverse reaction of giving you that medication, and do I have good alternatives?" Putting lots and lots and lots of drugs on your allergy list to which you're not actually allergic does nothing but tie my hands to treat you in the safest and most efficacious way possible. Feel free to tell me if you tolerate some meds worse or better than others--if Flagyl makes you queasy or that historically you respond better to morphine than Dilaudid. I do want to know these things, so yes, tell me. But when you tell someone that you're allergic to every antibiotic on the planet because sometimes antibiotics give you the runs, it can really hamper our ability to treat you in a safe, effective, evidence-based way, because the word "allergy" means something very specific in medicine, and we take that word very seriously.
(Also: no one is allergic to epinephrine. Your adrenal glands make epinephrine. If you were allergic to epinephrine we wouldn't be standing here having this conversation right now. Sorry, pet peeve. I don't blame patients for saying it, by the way--I blame the boneheads who, knowing better, write it down anyway and thus immortalize it in the medical record.)
4.) Don't eat or drink after midnight the day of surgery, but it's OK to take most medications.
The surgical team may ask you to hold certain medications prior to surgery, and most of these medications make sense to stop. Since you're not going to be eating for a good couple of hours the day of surgery, it makes sense, for example not to take medications that will further lower your blood sugar (meaning oral medications for diabetes, or your full dose of injected insulin--brittle diabetics, consult your endocrinologist for specific instructions). Also, as surgeons try to keep bleeding to a minimum when they're cutting on you, so with some exceptions in specific cases (like if you've recently had a stent placed in your heart for example, of if you risk for clotting outweighs your risk for bleeding), it's usually advisable to stop taking any blood thinners or certain anti-inflammatory medications for a period of time prior to the surgery date.
But for the most part, other medications are fine to take the morning of surgery, if that's when you usually take them. In fact, I prefer it if you take most of those morning medications, particularly including any medications for your heart, your blood pressure, any breathing issues you might have, or medications for chronic pain. When you think about it, it makes sense: you want to be medically optimized for surgery, not with your blood pressure through the roof, wheezing, and with your pain out of control even before incision.
Have questions about taking or stopping a specific medication before you get to the OR? Ask to speak to an anesthesiologist prior to your surgery date. Don't just call the surgeon's office and ask--often the person fielding the call (not always a medical professional) will not have the first clue, and will instead say, just because he or she thinks it's the safest answer, "don't take any medications the day of surgery." I had a myasthenic patient come in for an afternoon surgery having skipped several doses of Mestinon because the secretary she talked to told her not to take her meds. Like I said, if you have medical questions about day of surgery medications, ask to talk to an anesthesiologist beforehand. Again: it's our job.
5.) If you have any specific fears or concerns about the anesthesia itself, let us know beforehand.
Help us help you! Are you claustrophobic and hate the idea of having a mask over your face? Do you have a needle phobia? Did you have a family member with a very bad reaction to anesthesia, or have you yourself have a traumatic anesthetic experience in the past? Do you have questions about "The Michael Jackson Drug" and want to know exactly how the same fate will not befall you? Let us know! We can help you! There are things we can do to make things easier! Better! Smoother! Less scary! We have all sorts of tricks in our bag, is all I'm saying. We just need to know when and for whom to pull them out.
Medical professionals in this or other fields: another other tips?
* * *
For people of a certain age, Whitney Houston runs throughout the soundtrack of our childhood and adolescence. So if you want to pretend that you've never been alone in the bathroom hoping that the tile acoustics would help you better belt out the chorus of "One Moment in Time," I'd think I'd have to call you a damn liar.
Thank you, Whitney. You were transcendent.
1.) Know what medications you're taking, and know what you're taking them for.
I guess this must seem easier for us, because by and large if you're reading this you are on the younger end of the spectrum, statistically more likely to be healthier and on fewer medications, and demographically at least somewhat medically inclined, but--you'd be surprised how many people have no idea what medications they're taking or for what condition they were prescribed.
Patients--please know what medications you're taking! It really makes a difference, and can affect how your body might respond to anesthesia or the various insults of surgery. And it's often not quite enough information to tell me that you take "a blood pressure medication," because there are many different types and they all work through different means. Is it a beta-blocker? An ACE inhibitor? A diuretic? An alpha-2 agonist? And guess what--even if you don't know half of what I just said, it doesn't matter. Just know the names of meds you're on, tell me, and I'll figure it out, because it's my job. If it's hard for you to remember, write your med list down or have a family member help you. Carry the list with you in your wallet if necessary.
2.) Know your own medical history.
Equally important, see above. Do you have a scar over your sternum? Do you have a device implanted under your left pectoral muscle? Sure as hell I'm going to ask you about it. I'm not being nosy, I need to know these things to make sure I can take care of you in the safest way possible. If you can't remember, or have a hard time because you have a long medical history, write it all down (list of diagnoses, surgeries, doctors with contact info) and carry it with you, maybe along with your med list. Better yet, keep it as a file on your computer, so you can update and print it out as necessary.
I know it's annoying to have to answer the same questions again and again, but it's a matter of safety as well. So bring your information. And don't just trust that, "it's in the chart," because sometimes it's not. Anyway, a good medical practitioner doesn't just trust someone else's History and Physical, they do their own.
3.) Do yourself a favor and think long and hard about your allergy list.
As an anesthesiologist (or even as a doctor in general), when I ask you about drug allergies, what I'm really asking you is, "will the benefit of me giving your a certain medication as indicated be outweighed by an adverse reaction of giving you that medication, and do I have good alternatives?" Putting lots and lots and lots of drugs on your allergy list to which you're not actually allergic does nothing but tie my hands to treat you in the safest and most efficacious way possible. Feel free to tell me if you tolerate some meds worse or better than others--if Flagyl makes you queasy or that historically you respond better to morphine than Dilaudid. I do want to know these things, so yes, tell me. But when you tell someone that you're allergic to every antibiotic on the planet because sometimes antibiotics give you the runs, it can really hamper our ability to treat you in a safe, effective, evidence-based way, because the word "allergy" means something very specific in medicine, and we take that word very seriously.
(Also: no one is allergic to epinephrine. Your adrenal glands make epinephrine. If you were allergic to epinephrine we wouldn't be standing here having this conversation right now. Sorry, pet peeve. I don't blame patients for saying it, by the way--I blame the boneheads who, knowing better, write it down anyway and thus immortalize it in the medical record.)
4.) Don't eat or drink after midnight the day of surgery, but it's OK to take most medications.
The surgical team may ask you to hold certain medications prior to surgery, and most of these medications make sense to stop. Since you're not going to be eating for a good couple of hours the day of surgery, it makes sense, for example not to take medications that will further lower your blood sugar (meaning oral medications for diabetes, or your full dose of injected insulin--brittle diabetics, consult your endocrinologist for specific instructions). Also, as surgeons try to keep bleeding to a minimum when they're cutting on you, so with some exceptions in specific cases (like if you've recently had a stent placed in your heart for example, of if you risk for clotting outweighs your risk for bleeding), it's usually advisable to stop taking any blood thinners or certain anti-inflammatory medications for a period of time prior to the surgery date.
But for the most part, other medications are fine to take the morning of surgery, if that's when you usually take them. In fact, I prefer it if you take most of those morning medications, particularly including any medications for your heart, your blood pressure, any breathing issues you might have, or medications for chronic pain. When you think about it, it makes sense: you want to be medically optimized for surgery, not with your blood pressure through the roof, wheezing, and with your pain out of control even before incision.
Have questions about taking or stopping a specific medication before you get to the OR? Ask to speak to an anesthesiologist prior to your surgery date. Don't just call the surgeon's office and ask--often the person fielding the call (not always a medical professional) will not have the first clue, and will instead say, just because he or she thinks it's the safest answer, "don't take any medications the day of surgery." I had a myasthenic patient come in for an afternoon surgery having skipped several doses of Mestinon because the secretary she talked to told her not to take her meds. Like I said, if you have medical questions about day of surgery medications, ask to talk to an anesthesiologist beforehand. Again: it's our job.
5.) If you have any specific fears or concerns about the anesthesia itself, let us know beforehand.
Help us help you! Are you claustrophobic and hate the idea of having a mask over your face? Do you have a needle phobia? Did you have a family member with a very bad reaction to anesthesia, or have you yourself have a traumatic anesthetic experience in the past? Do you have questions about "The Michael Jackson Drug" and want to know exactly how the same fate will not befall you? Let us know! We can help you! There are things we can do to make things easier! Better! Smoother! Less scary! We have all sorts of tricks in our bag, is all I'm saying. We just need to know when and for whom to pull them out.
Medical professionals in this or other fields: another other tips?
* * *
For people of a certain age, Whitney Houston runs throughout the soundtrack of our childhood and adolescence. So if you want to pretend that you've never been alone in the bathroom hoping that the tile acoustics would help you better belt out the chorus of "One Moment in Time," I'd think I'd have to call you a damn liar.
Thank you, Whitney. You were transcendent.
more on hand wounds
Thanks for the input, guys, though I wish now that I had solicited your advice on how to more easily peel ginger (with a spoon? Really? And it doesn't just turn it into a mush?) BEFORE slicing a sliver of my damn finger off, not from the arguably more bloody world of the retrospective. This is why I can't have nice things. Like, you know, fingernails.
Also, one commenter noted: "Wasn't there some big debate over bagel slicers at one point and now this? Is that irony I smell?" (Click on the link to read the debate itself, but for the lazies, briefly: Joe had this bad habit of holding his bagels in his palm while cutting them in lengthwise directly into his hand, and I had a problem with that, especially given that he's in a profession where hand tendon injury could be catastrophic. For instance, a minor to moderate hand injury would not necessarily end my career as I know it, but it could almost certainly end his. However, you will be gratified to know that after that last discussion more than a year ago, Joe doesn't cut his bagels employing the "hand taco" method anymore--or at least he doesn't do it in front of me.)
Well, here's the difference as I see it. I slice a lot of vegetables with a vegetable peeler. This most recent event I would classify as an accident. Accidents happen. For example, I try to be cautious at work, but sometimes accidents still happen, like, say, needle sticks in the OR. But accidents happening despite best precautions is different than habitually unsafe practice--like recapping non-blunt needles by hand, or sloppy sterile technique. (This is no one in specific, by the way, just a few easy everyday examples I can think of). Or, to bring it out of the hospital setting and back into the kitchen where it started, let's say slicing bagels using your palm as the cutting board, or rubbing raw chicken all over your countertops. My point being, I would say it's the difference between cutting yourself in the kitchen (it happens to everyone) versus setting up a situation where cutting yourself is much, much more likely to happen.
So no, that's not irony you smell. Just the smell of human flesh and ginger cooking in a delectable mélange.
Oh, and by the way, not that I wish you pain, but if you happen to have cut your hand and if you also happen to work in some kind of germ zone (or at least in a job where you have to wash your hands a lot), here's a great and truly occlusive bandage that will hold up for, I kid you not, a good couple of days.
Also, one commenter noted: "Wasn't there some big debate over bagel slicers at one point and now this? Is that irony I smell?" (Click on the link to read the debate itself, but for the lazies, briefly: Joe had this bad habit of holding his bagels in his palm while cutting them in lengthwise directly into his hand, and I had a problem with that, especially given that he's in a profession where hand tendon injury could be catastrophic. For instance, a minor to moderate hand injury would not necessarily end my career as I know it, but it could almost certainly end his. However, you will be gratified to know that after that last discussion more than a year ago, Joe doesn't cut his bagels employing the "hand taco" method anymore--or at least he doesn't do it in front of me.)
Well, here's the difference as I see it. I slice a lot of vegetables with a vegetable peeler. This most recent event I would classify as an accident. Accidents happen. For example, I try to be cautious at work, but sometimes accidents still happen, like, say, needle sticks in the OR. But accidents happening despite best precautions is different than habitually unsafe practice--like recapping non-blunt needles by hand, or sloppy sterile technique. (This is no one in specific, by the way, just a few easy everyday examples I can think of). Or, to bring it out of the hospital setting and back into the kitchen where it started, let's say slicing bagels using your palm as the cutting board, or rubbing raw chicken all over your countertops. My point being, I would say it's the difference between cutting yourself in the kitchen (it happens to everyone) versus setting up a situation where cutting yourself is much, much more likely to happen.
So no, that's not irony you smell. Just the smell of human flesh and ginger cooking in a delectable mélange.
* * *
Oh, and by the way, not that I wish you pain, but if you happen to have cut your hand and if you also happen to work in some kind of germ zone (or at least in a job where you have to wash your hands a lot), here's a great and truly occlusive bandage that will hold up for, I kid you not, a good couple of days.
I got a six pack of these for the winter season (A.K.A. the "I'm washing my hands so much and the weather is so dry that my hands be cracking everywhere" season) and between me and Mack (Mack is a great believer in the curative power of Band-Aids, even without any actual visible injury--he prefers to prophylactically laminate himself) we are putting them to good use. They're a little more expensive but seriously, they are worth it for high-mobility areas--as mentioned before, they are truly occlusive, they really stick well, and don't tend to get all sodden and ooze off like the more traditional model.
Now everyone go get injured!
the view from below
What I didn't tell you before because it seemed premature (poor word choice) was that during my 12 week ultrasound to measure nuchal lucency, my OB told me that he was "90% sure" that the fetus was a boy.
"Can you really tell that early?" I asked, trying to see the screen better. I saw what he was looking at, but from my (admittedly imperfect) memory of embryology from medial school, I thought that at 12 weeks gestation the unmentionables were simply classified generically as a "genital tubercle," with no real differentiation between male and female, blah blah blah something Wolffian and Mullerian ducts, blah blah. (I never said I didn't remember the words, I just don't remember what they mean or are.) Anyway, the OB said that was basically right, but sometimes one can get an indication one way or the other from the angle of the genital tubercle, uh, protuberance--and in his own, anecdotal, completely not scientifically rigid experience, he has a track record of being able to call the gender from the 12 week ultrasound about 90% of the time.
At the 16 week ultrasound this last week, he looked around a bit, looked at my chart, and asked, "What did I say it was going to be the last time?"
"You said it looked like a boy."
"Huh." He angled the probe this way, then that. (Thing 3 was angled weirdly, legs all criss-cross applesauce). "Well, I think I may have...hmmm. It looks like...huh. I think I was wrong. I think it looks like a girl. See that mound here?"
(I did not see the mound.)
"Usually this mound here means...oh wait. Here's a better picture. I think...I think I was right the first time. I think it's a boy. Usually I can get a better picture than this, though, at 16 weeks...Usually it's like, KABOOM, you know?"
"Kaboom," I echoed, obligingly.
"Huh. I wish I could see better. But I think it's a boy. Let's say 99% sure it's a boy. But I'll save that last 1% for next time, when we do the anatomy scan." And then I forced him to look at the head and heart and the diaphragm and the guts to make sure they were all properly septated and in their proper areas (it's a little early to do the full anatomy scan, but major anatomical badness we could probably see, though thankfully nothing ominous presented itself at this point).
So, we are left with several possibilities.
1.) It's a boy, a fact that will become KABOOM, in your face (ew) obvious once the testes actually descend from their Spring Training Camp in the peritoneum. (Yes, now is an appropriate time to scream the word "GUBERNACULUM,"--I for one have been waiting for years to use that word in its correct context, as opposed to just, you know, saying it randomly just because it sounds awesome.)
2.) It's a girl (unlikely, I think, which is probably good, because we were already expecting a boy and when Target had a huge sale a few weeks ago I got a bunch of boy-flavored onesies, for like, a dollar. When Cal was first born I was determined to find only gender neutral clothing, because, like, gender role stereotyping is bad! See also: votes for women, step in time! But soon I realized that outside of a very limited selection of green-or-yellow newborn items, no one makes gender neutral kids clothing; everything is either, like, a screaming pink onesie with scalloped neckline and rhinestones spelling out "DADDY'S LITTLE PRINCESS" or a hyper-blue onesie reading "MOMMY'S FAVORITE QUARTERBACK," embroidered with, like, a football and a rifle or something. Anyway, my point being, it's probably not a girl--a fact that might disappoint some but for me and Joe, at least, was admittedly something of a relief.)
3.) The final option, which crossed my mind, and which I will sum up with the following story. Back when I was a Peds resident, we used to write notes or call consults in this little glass-walled closet known as the Resident Work Room (the term "room" was generous--for those who similarly trained at Babies Hospital, as we were known at the time, this was back when we were still working primarily out of the old hospital building, which looked like a sanatorium and still reeked faintly of cholera and The Black Humours). Anyway, sometimes we would stick things on the walls of the resident work room--mostly they were boring things, like schedules and reminders, but sometimes there were funny things, like notes or dictations gone awry. One such dictation was from an abdominal and pelvic CT of an infant (maybe it was a plain film), and either the radiologist had a very heavy accent or the transcriptionist was tired that day. The final line of the dictation was highlighted in yellow, and read, "DIAGNOSIS: UMBIGUNOUS GENITARIA."
Anyway, Thing 3 looks good. And it's looking with increasing certainty like we're going to be living in a live-action version of Alvin and the Chipmunks. (To be clear: Cal is Simon, Mack is Alvin. Joe and I, of course, play the role of Dave Seville on alternating nights, please check your programs for last-minute substitutions.)
Usually it wouldn't have taken me that long to write the above entry, but this morning I was peeling some ginger (I am attempting an experimental new recipe for Asian-esque short ribs--if it turns out well I will post the recipe here, otherwise let's never speak of it again) when the vegetable peeler slipped and instead of taking the skin off the ginger, took the skin and 1/4th of the nail off my left index finger. Look, usually I'm more careful in the kitchen, but ginger! It's so bumpy!
Anyway, the good news is that it didn't ever hurt that much (strange how little it hurt, actually, juxtaposed against how disgusting it looked) and it's on my non-dominant hand. However, the bad news is that my left hand is also my laryngoscopy hand, so I guess I'll be intubating next week with one finger sticking out, like I'm a dainty madame or something.
"Can you really tell that early?" I asked, trying to see the screen better. I saw what he was looking at, but from my (admittedly imperfect) memory of embryology from medial school, I thought that at 12 weeks gestation the unmentionables were simply classified generically as a "genital tubercle," with no real differentiation between male and female, blah blah blah something Wolffian and Mullerian ducts, blah blah. (I never said I didn't remember the words, I just don't remember what they mean or are.) Anyway, the OB said that was basically right, but sometimes one can get an indication one way or the other from the angle of the genital tubercle, uh, protuberance--and in his own, anecdotal, completely not scientifically rigid experience, he has a track record of being able to call the gender from the 12 week ultrasound about 90% of the time.
At the 16 week ultrasound this last week, he looked around a bit, looked at my chart, and asked, "What did I say it was going to be the last time?"
"You said it looked like a boy."
"Huh." He angled the probe this way, then that. (Thing 3 was angled weirdly, legs all criss-cross applesauce). "Well, I think I may have...hmmm. It looks like...huh. I think I was wrong. I think it looks like a girl. See that mound here?"
(I did not see the mound.)
"Usually this mound here means...oh wait. Here's a better picture. I think...I think I was right the first time. I think it's a boy. Usually I can get a better picture than this, though, at 16 weeks...Usually it's like, KABOOM, you know?"
"Kaboom," I echoed, obligingly.
"Huh. I wish I could see better. But I think it's a boy. Let's say 99% sure it's a boy. But I'll save that last 1% for next time, when we do the anatomy scan." And then I forced him to look at the head and heart and the diaphragm and the guts to make sure they were all properly septated and in their proper areas (it's a little early to do the full anatomy scan, but major anatomical badness we could probably see, though thankfully nothing ominous presented itself at this point).
So, we are left with several possibilities.
1.) It's a boy, a fact that will become KABOOM, in your face (ew) obvious once the testes actually descend from their Spring Training Camp in the peritoneum. (Yes, now is an appropriate time to scream the word "GUBERNACULUM,"--I for one have been waiting for years to use that word in its correct context, as opposed to just, you know, saying it randomly just because it sounds awesome.)
2.) It's a girl (unlikely, I think, which is probably good, because we were already expecting a boy and when Target had a huge sale a few weeks ago I got a bunch of boy-flavored onesies, for like, a dollar. When Cal was first born I was determined to find only gender neutral clothing, because, like, gender role stereotyping is bad! See also: votes for women, step in time! But soon I realized that outside of a very limited selection of green-or-yellow newborn items, no one makes gender neutral kids clothing; everything is either, like, a screaming pink onesie with scalloped neckline and rhinestones spelling out "DADDY'S LITTLE PRINCESS" or a hyper-blue onesie reading "MOMMY'S FAVORITE QUARTERBACK," embroidered with, like, a football and a rifle or something. Anyway, my point being, it's probably not a girl--a fact that might disappoint some but for me and Joe, at least, was admittedly something of a relief.)
3.) The final option, which crossed my mind, and which I will sum up with the following story. Back when I was a Peds resident, we used to write notes or call consults in this little glass-walled closet known as the Resident Work Room (the term "room" was generous--for those who similarly trained at Babies Hospital, as we were known at the time, this was back when we were still working primarily out of the old hospital building, which looked like a sanatorium and still reeked faintly of cholera and The Black Humours). Anyway, sometimes we would stick things on the walls of the resident work room--mostly they were boring things, like schedules and reminders, but sometimes there were funny things, like notes or dictations gone awry. One such dictation was from an abdominal and pelvic CT of an infant (maybe it was a plain film), and either the radiologist had a very heavy accent or the transcriptionist was tired that day. The final line of the dictation was highlighted in yellow, and read, "DIAGNOSIS: UMBIGUNOUS GENITARIA."
Anyway, Thing 3 looks good. And it's looking with increasing certainty like we're going to be living in a live-action version of Alvin and the Chipmunks. (To be clear: Cal is Simon, Mack is Alvin. Joe and I, of course, play the role of Dave Seville on alternating nights, please check your programs for last-minute substitutions.)
* * *
Usually it wouldn't have taken me that long to write the above entry, but this morning I was peeling some ginger (I am attempting an experimental new recipe for Asian-esque short ribs--if it turns out well I will post the recipe here, otherwise let's never speak of it again) when the vegetable peeler slipped and instead of taking the skin off the ginger, took the skin and 1/4th of the nail off my left index finger. Look, usually I'm more careful in the kitchen, but ginger! It's so bumpy!
Anyway, the good news is that it didn't ever hurt that much (strange how little it hurt, actually, juxtaposed against how disgusting it looked) and it's on my non-dominant hand. However, the bad news is that my left hand is also my laryngoscopy hand, so I guess I'll be intubating next week with one finger sticking out, like I'm a dainty madame or something.
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