ok, ok

I haven't updated for a while, to the point that I was starting to get performance anxiety about my next post, like after two weeks off, whatever I put up there better be good. (You can see, of course, the ultra high standards to which I have held my blog in these past few months--that is to say, I try to mostly capitalize where needed and I do not use Microsoft Paint to draw pictures of penises onto people's faces.) But then I remembered that the best way to break out of that no-writing funk was just to throw a bunch of writing up there and just apologize in advance. So!

Really I just need something to do because the chatter on the internet (in the form of the SDN forums--I find it a little embarrassing calling attention to the fact they are globally known as the Student Doctor Network as I know that a good many people who check by on the forums are actually finished with the "student" phase of their lives; I in particular only check in with it to assess when I should be freaking out about a thing and how much I should be freaking) is that the results of the Anesthesia Oral Boards are to be posted today and I need something else to do instead of ritualistically checking my e-mail every five or ten minutes. So this is good, because I am writing this blog entry on my new iPad (about which more later--I got a bluetooth keyboard to pair with it so I can actually type more than 20 words per minute) and since the iPad famously cannot multitask, I can't exit out the check my e-mail without closing this window. This is known as forced distraction.

So, the iPad! It was a present. From me. To myself. We got the next installment of my book advance recently, and though I kept telling Joe that I wasn't going to use it to get anything for myself, I would just put it in the bank and save it for bills or childcare or to send Mack to Space College (for, as you know, that is what all kids will attend in The Future--no, not Starfleet Academy, that's fictional, I'm talking about a university on the moon), I found after looking deep within my soul that actually, I really, really did want an iPad. And also, Joe just started his attending job at [Big Academic Hospital] in town, which means that we are actually a two income family now with a little more to save, so what the hell am I, Hamlet? I got the fucking iPad. And it is awesome.

The best, best thing that I love about the iPad is the fact that I can download Kindle books onto it, and I can already tell that this is going to change my freaking life. Back when the iPad was just a glimmer in Steve Job's eye, I was seriously considering getting a Kindle, though I ultimately didn't because I was trying to save my pennies. But the iPad is like a bright, color Kindle on which you can surf the internet, listen to podcasts, and play Plants vs. Zombies. If you got a boner just now, I'm pretty sure that you would like the iPad. And now I'm going to stop because who isn't already sick of hearing about this thing?


* * *


So I went to Target the other day to get some cookie mix, because Cal's class is having a "summer birthday party" celebration for all the kids who, by disadvantage of conception, celebrate their birthdays during summer vacation. Cal's birthday is July 22nd, so I'm going to send him in with some cookies for the party, because I want to pretend like I'm a real mom or something. I know that making cookies from a dry mix is not very impressive, but we're going to put M&Ms in them so who's going to tell me that's not totally fucking creative? YOU?

Anyway, so I was walking to the checkout line when I heard some lady talking what sounded very much like Cantonese, except the words didn't make any sense. For those of you who don't speak Cantonese, the sound of the language is very characteristic because it has a lot of tones and a lot of wide, flat vowel-type sounds (there was actually a great "Radiolab" episode about such so-called "tone-languages,"--but I digress), and I was looking around for the other Chinese lady when I realized that the sounds were actually being emitted by the lady at cash register, who was, in fact, a youngish African-American lady. She very pleasantly then turned to me and waved me over. "I can take you at this register." So I pushed my cart into her line and paid for my cookie mix.

"I'm sorry," she said, "I didn't see you." I told her that was OK, thinking she was still talking about ringing up my items. But then she went on. "My friend over there," she gestured to the other cashier one line over, a younger guy, "always says that I look Chinese, because my eyes are slanty." She used her fingers to push up the corners of her eyes, to illustrate what exactly she meant. "So he always calls me Chinese. So we just joke around and I pretend to talk Chinese to him." She smiled at me. "So that's what that was. I didn't see you." She handed me my bag of cookie mix. "I just didn't want you to think I was disrespecting you or anything."

She seemed so nice and so utterly without guile that I just smiled at her and told her that her Chinese language impression was actually pretty good.


* * *


I'm going to go check my email again.

Edited to add: I passed! U-S-A! U-S-A!

a supposedly fun thing i'll (hopefully) never do again

You know I've taken five Board exams in my life now? Five! That's a lot of exams! There were the three "Steps" of the USMLE (the U.S. Medical Licensing Exam) in 2001, 2002 and 2004, my written Anesthesia boards last August, and now this one. This was my only oral board exam though, and the key difference between a written and an oral exam is the difference between feeling publicly stupid instead of privately stupid. On a written exam, you just guess at the answer, put a star next to it, and move on; whereas on a written exam, you have to say something out loud, even if it's not right, and then you have to just have to try and keep going on as the echos of your wrongness reverberate throughout the room until you are crushed in an avalanche of shame boulders. Or at least so it seems inside your head.

But anyway--the oral boards! End of the story: they went fine. Compared to some of the more brutal practice sessions I'd been through, it was pretty straightforward, though that isn't to say that there were a few things here or there that didn't quite jump from the fountain of universal knowledge to the tip of my tongue. But it went fine, I think, and at the very least, it's over. I get the results in about a month.

But on to the more important issues...this is what I wore:




Excuse the blurriness of the photo, as well as the fact that there is stuff all over the floor (including a lampshade) which makes us look like we live like meth addicts. To our credit, the lamp was Ikea (read: readily broken) and, having outlived its usefulness as a light source, Mack has been wearing the shade as a hat. Because he's a party animal in a Rodney Dangerfield movie. Oh, yes, the blurriness. When we moved into this house, one of the first things we did was try and clean all the mirrors, because it looked like they were super dusty. But what we found was that the dust and grime is not on the surface of the mirror, rather on the inside of the mirror, presumably where the reflective surface meets the glass backing. It's an old house, and they are old mirrors. So we've just gotten used to looking at ourselves through a glaze of mid-century dust motes. However, large-scale information is transmitted.

As several other people who have seen this dress in the flesh warned me, the V-neck was a little bit low, even for a flat-chested lady, but I wore a camisole underneath it, and also the green scarf you see. Ain't no one going to be looking at my funbags. As you can see, the dress ended up being a little long as expected, but nothing that needed to be altered. Also: the shoes I love, and they were from Target, their cuteness only enhanced by their cheapness. It was a little cold this morning, so I also put on a yellow cardigan, which also looked sprightly and preppy, but possibly made me stand out a bit, in that everyone else taking the exam that session (and I mean everyone--men and ladies) was wearing a full suit in either navy, black, or charcoal. Compared to them, I looked like the eccentric Psychology professor who swans in at the beginning of lecture in some Pucci caftan wearing those half-profile reading glasses made of blocky rainbow plastic. But I do hate wearing a suit.

Oh, I don't want to push this "I'm so wacky!" thing too far--because whatever, I'm so not wacky--but I didn't have a watch to wear to my exam (in the interest of keeping my hands and wrists as clean as possible at work, I stopped wearing a watch a few years ago, and though I use my cell phone as a clock I obviously couldn't bring that into the testing room) so I borrowed Cal's:




I am not going to tell you anything about the questions that they asked on the exam, of course, because that's illegal, but I can tell you about the exam process, because I think the mechanics are fairly widely known. The oral board exam administered by the American Board of Anesthesiology are conducted in a hotel, which they say is done to keep the costs down of renting a freestanding facility to administer an exam to 1300 applicants over the period of a week. The Spring 2010 session is being administered at the Buckhead Ritz-Carlton in Atlanta, which I've never been in, but looks like a pretty nice hotel. It also looks like a pretty expensive hotel, which makes me doubly glad that I live in Atlanta already (there's no rule that you have to stay at the hotel that the test is at, but a lot of people from out of town don't want to have to rent a car and have to figure out how to get to the test site, especially if they're only flying in for 24 hours).

The day started with a brief registration and orientation session, where they checked our IDs and a very nice avuncular anesthesiologist from Durham, NC (no doubt he teaches at the Big University Hospital there that also starts with a D) told us what to expect. He also tried to calm us all down by being super-encouraging and telling us that we had all already passed the exam, because we had gotten this far and had the right stuff, baby! "This is a great day!" he told us. "You've already done the work! Have fun in there!" He was adorable, I loved him. (He also reminded us not to get mad if Bad Stuff happened to our patients despite our best efforts, because that was the point of the exam, to see how we deal with Bad Stuff. Also, THE PATIENTS AREN'T REAL.)

There are two exam "sessions," each lasting exactly 35 minutes and primarily made up of a large "stem question" (usually a patient presentation in the setting of an operative plan). The first session has a big stem with a fairly extensive patient history and preoperative workup--the main focus of this session is in intra- and postoperative management of the patient--and the second session has a shorter stem, with the questions focusing on pre- and intraoperative care. Also to round out each session is a handful of what they call "grab bag" questions, which is to say that they are shorter, freestanding questions that they can ask about, well, anything. You have time to look over each "stem" before you go into the room (there is a series of exam rooms down one whole hallway on several different floors of the hotel--just regular hotel rooms that I believe the board examiners are actually sleeping in after hours) and at the end of each session, someone knocks on the door with a wooden spoon, indicating that your time is up.

This was my favorite part, by the way, the knocking on the door with a wooden spoon. It's a cross between formalized and ridiculous, like something they would do in Skull and Bones. (The other reason it was my favorite part was because that meant the session was over.)

There were no big surprises on the exam. The examiners were poker-faced, as they were supposed to be, and sometimes they would try to push you or tangle you up, "Why not this?" "Someone suggests XYZ might be a better solution--what do you tell them?" But on the whole that was expected and it was fair and before I knew it, the second wooden spoon was rapping on my door and it was over.

So now what do I do? For as long as I remember, I've always had something hanging over my head--either the next set of revisions for my book, or some kind of exam that I had to study for. And now I don't have either of those things. I still will have to take Boards for the rest of my professional life, of course, but if I pass the orals, I don't think I'll have to recertify for something like ten years from now. Even I can't start studying for an exam that's ten years away. So now what do I do? Pick up bocce? Start watching more TV? The possibilities are endless.




Now if you'll excuse me, there's a celebratory hummus quartet with my name on it.

this is what is known as a multi-pronged approach to preparation

One other consistent piece of advice that I received about taking my oral boards (yes, I'm talking about the fucking boards again, but just bear with me, they're on Wednesday, and then hopefully never again) is that I should be sure to take some beta blockers before showing up. This under no less authority than my partner at work, the oral boards examiner himself. As he explained it (and not like I don't know this to be true, but he's actually seen it happen year after year) is that when you show up to take the boards, you are very NERVOUS and you get a HUGE CATECHOLAMINE SURGE and meanwhile you're WAITING AND WAITING for your exam to begin and your SYMPATHETIC NERVOUS SYSTEM is all revving OUT OF CONTROL, so by the time you actually get into your first test room you're all WRUNG OUT and EXHAUSTED and SHAKING, which just makes you feel like hell before they even ask you your first question. Also: flop sweat. So, I agreed that if he thought it was best, then beta blockade I would.

(Now before the non-medicals accuse me of taking the PERFORMANCE ENHANCING DRUGS, let me assure you that this is not the same as blood doping or taking, I don't know, Ritalin or whatever. Beta blockers are a non-narcotic medication usually prescribed for hypertension and/or ischemic heart disease that work on bringing down your blood pressure and heart rate, thereby reducing the stress on your heart. They have no psychotropic effects, and lots of people--actors and public speakers in particular--will take them for stage fright and whatnot to block the physical effects of anxiety. So don't worry, I'm not juicing like Drago in "Rocky IV.")

Anyway, beta blockade seemed like a good enough idea, and conveniently enough, I actually have some metoprolol at home, which Joe has been taking for a few months after his run-in with myocarditis. (He mainly takes his to suppress ectopy--that is to say, he gets palpitations and the metoprolol smooths them out.) However, given that I don't usually take any medications to reduce my blood pressure, and it's not like my baseline blood pressure is super high to begin with, I wanted to do a trial run with the metoprolol. You know, so I wouldn't take it for the first time and keel over in front of my first two examiners in some ungainly display of orthostatic hypotension. You know, like a demo.

After taking half a tab of metoprolol this weekend (which had basically zero effect) I took a full tab today. And I felt...the same. I thought my heart rate was maybe a little bit slower, (it was maybe high 70s when I took the med, and when I checked it again it was low 70s) but how could I say for sure, I was sitting down, I'd had something to drink, I was chilling out in a Starbucks for chrissake--not exactly the greatest stress test in the world. Of course, you could argue that the fact that my heart rate was not higher after drinking coffee was diagnostic, but I had a chai, so who knows how much caffeine is in that? Anyway, I had dodged the worst case scenario (read: I WAS NOT DEAD) but as for the intended effect of the beta blocker, I still wasn't sure.

The one other thing that I wanted to do today was take a test drive to the hotel where the exam is being held. The oral exams are being administered there all week, and candidates are told a specific day and time to show up so that they're sort of staggered throughout the day, Monday through Friday. I know where the hotel is (thank you, Google Maps) and I know that it's only 9 minutes from my house, but given that it's a busy part of town during a busy time of day, and given that I am the novice driver you all know me to be, I thought it best to practice the drive.

Well, I drove to the hotel. But see, where this hotel is located is right next to the on ramp for the highway, and though I could see where the hotel was--if I stopped my car and got out, I could have actually walked right up to in in about 30 seconds--it was one of those things where I couldn't see any way to turn into the driveway, and once I passed the hotel it was all MUST TURN THIS WAY and LOOP BACK THAT WAY and DO NOT ENTER and THIS WAY TO THE INTERSTATE. I had been warned about this last week, but seriously, that area is a major clusterfuck. And so I was slingshotted in the traffic like a helpless projectile, trying to figure out how not to end up on the interstate and how to loop back to the main street, all while trying to avoid all these Atlanta drivers who were all honking and merging with their penis-substitute convertible sports cars and all giving each other the finger (honestly, I grew up in New York City, and I've never seen as many drivers give each other the finger as I have in my two years here). It was terrifying. But even though in my mind I thought, "This is terrifying," my body did not feel terrified. My body felt calm. In fact, when I finally got out of that traffic vortex and stopped at an intersection, I checked my pulse. Still in the 70s. So I guess beta blockade works.

I had to loop back around to the hotel a total of four times before I finally found the entrance driveway, by the way. And then I saw all these people walking around with suits and notecards looking like they were going to puke. So that made me nervous again. But only in my mind, not my body. My body was sipping boiling water and spitting out icicles. Yay for beta blockers!

Medicolegal addendum: Please know of course that beta blockers are not for everyone and that there are certain conditions that should preclude you from taking them, consult your primary care doctor before starting any prescription medications, etc. etc. ad infinitum

both a reassurance and a curse




When I went to take my written test for my learner's permit (probably a little less than a year ago), I saw this middle-aged guy at a computer testing station about two seats away from me with a book in his lap. Upon closer inspection, this book was a Myanmar to English/English to Myanmar dictionary. This poor guy was slogging through this test, word by word, flipping frantically through his dictionary trying to figure out what "merge" and "signal" meant in Myanmar before answering.

My first thought? Wow, that's rough. But if this Burmese guy who doesn't even speak English can pass his written driving test, surely I can too.

My second though? Wow, if this Burmese guy who doesn't even speak English passes the test and I don't, I am going to be extremely embarrassed.

As it was, I was probably just one question away from failing that written driving test. (Though to be fair, almost all the questions that I got wrong were related to various speed limits in various zones--couldn't I just look at the speed limit signs in real life?) But I passed. And I think about that Burmese guy sometimes still. I hope he passed too.

Anyway, the point of me writing this is because, well, obviously I'm taking the oral boards in a few days. And I'm not overly stressed about it, I think it will be fine, though of course occasionally, I will think, OMG OMG THE ORAL BOARDS OMG and I'll get a little anxious that I'll get nailed with the crazy obscure stem question about the quadriplegic achondroplastic dwarf newborn with mucopolysaccharidosis, and that my examiners will be a tag team known as "Bad Cop" and "Worse Cop." But several people have tried to calm me (and they said that this was the most comforting piece of reassurance, or at least perspective, that they themselves received before their oral boards) is that a good number of my co-test-takers are foreign nationals and actually don't speak English very well, so I, aside from being reasonably well-trained, at least have a huge advantage in the fact that I, you know, grew up speaking the language in which the exam is administered.

And that is a little reassuring, I suppose. But my second thought? Wow, if this Burmese guy who doesn't even speak English passes the oral boards and I don't, I'm going to be extremely embarrassed.

(Of course this is in no way to discredit those colleagues among us--my parents included, each Board Certified in their respective fields--who have tackled the extremely unruly language of English and managed to get through all the hurdles just as us native speakers have. I couldn't do what you have done. Bravo.)

grab bag questions




From the margins of my "Bored Stiff" book. Don't make fun of my scribbles, I'm just talking things out in my head.

ok fine

So I ordered this dress from J. Crew to wear to the Boards:




It seemed like the chances that I would wear it again were slightly higher if I got a dress rather than a suit, and anyway, it's a pretty cute dress and it was listed in the "work" section, so fine, YOU WIN, AMERICAN COMMERCE. It may need to be altered (there was no petite sizing on this particular dress and I'm only 5'2") but even if it's a little long, whatever, at least it won't be slutty. I have black heels and I have a cardigan, so I'm set--add a yellow beanie and a pot of tea and it'll look straight out of Wellesley in the 1960's.

(I know, I know, there's a V-neck, but don't worry, I have no boobs and therefore no cleavage, the effect would be the same whether the V-neck was in the front or the back.)

i'm not sure what the point of this entry was, except to remind you that we were almost on a reality show once

So one of my partners at work is one of the examiners for the ABA Oral Board exam, and for many years now, he has been giving mock orals to the younger doctors in the practice as preparation for the real thing. This year I'm taking the exam, so he's been very nicely availing me of his time so I can splutter through my various stem questions and clinical scenarios, and revealing to him all sorts of embarrassing deficiencies in my clinical knowledge base, like the fact that I can't remember Thing One about neurosurgical anesthesia, and that I get the effects of acetylcholinesterase inhibitors and anticholinergics all jumbled up every single time.

(Please note, it's mainly the words that get me confused. If I think of the actual drugs and classify them as "green sticker medicine" or "red stripey sticker medicine" I am fine.)

(Apologies to all, the above was some fairly esoteric anesthesia quote-unquote humor. As you were.)

Today I went over to his house after work for another mock oral boards session, and if there's one thing I learned from this--aside from the fact that when it comes to the Boards, pregnancy is a FATAL DISEASE--it's that grown-up people live in nice houses. Man, compared to his house, our house (granted, a rental, so we haven't made much of an effort to decorate) looks like two med school dorms collided with a secondhand toy store. I know we're young and we have little kids and we're going to be moving at some point in the near future anyway and blah blah blah, pick your excuse. But at some point, I feel like we're going to have to start living like grown-ups. When that point will be, I'm not sure. We had our chance when we were being considered for "Queer Eye for the Straight Guy," but I don't even think that show exists anymore, so I guess we're just doomed.

So! The Orals Boards. A week and a half from now. It will be good to have them behind me. Passing them would be nice too, because, you know, board certification and whatnot. Which reminds me--oh shit, I have nothing to wear to this exam. Everyone says "business attire" but seriously, everything even vaguely appropriate is at least seven (optimistic fudging of numbers) to twelve (I interviewed for med school in 1998 and have not bought a suit since) years out of date and also somewhere irretrievable, probably stuffed in a box labeled MISC TOILETRIES. I guess I could get some new clothes, but I am loathe to spend the money, especially considering that I may well never wear a suit again. What do I look like, Hillary Clinton?

ideal tenents

Well, that was a good discussion. We are a good bunch up in here.

So, I'm doing some studying for the Oral Boards, mostly boning up on areas that I don't really do every day anymore, like Peds, OB, and complex intracranial neurosurgical anesthesia. I am remembering a lot of things that I have blissfully forgotten. Like the many hours I spent holed up in those dark neurosurgical ORs dripping CSF out into a little baggie in an attempt to "loosen" the brain for my neurosurgical colleagues while they were digging around. And the delightful phenomenon of uterine inversion, in which the postpartum uterus actually turns itself inside out and pokes out the vagina. Ah, residency. Those were good times.

Anyway...

So you know that we just moved in October into a house that we are renting from some nice folks (see: Southernism!) who had to move up to Philadelphia before they were able to sell the place. The house is a little old, and probably not the most enviro-friendly of dwellings (windows not weatherproofed, no low-flow toilets or showerheads) which makes it somewhat expensive from a utilities point of view, but it's a great neighborhood and close to Cal's school and easy for Joe to get to work and blah blah blah boring talk. Anyway, we have a one-year lease at this house, which seems kind of like a long time when you're a student, but for me just makes me think that there's barely any point of unpacking because what's the point, we're just going to move again in a few months anyway. Which is mostly fine, since we don't mind living among the boxes and we never have people over anyway (30% due to embarrassment, 70% due to anti-social tendencies). Anyway, the boxes are great for covering up all the outlets that Mack finds inexplicably fascinating and for building various child-proofing barricades, like in Les Miserable. (Primary intent of the barricade in Les Mis: defiant show of uprising! Secondary intent: to keep Gavroche out of the computer room.)

So I was fine with us living like shantytown people and had frankly stopped noticing the boxes, but then our landlords were in town this past weekend and wanted to come by and check out the basement, as there had been some flooding a few months ago and they wanted to survey the damage. They didn't give us very much notice, so I spent the better half of Saturday afternoon cleaning what I could and shoving what else I couldn't clean into a variety of unlikely to be opened closets. But there was nothing that I could do about this:




All our Christmas decorations are still up. Yes, all of them. Tree, stockings. The lights are even still hanging in the windows. And I'm sure I didn't need to point out to you that Saturday was the first day of spring. Awkward!

Anyway, after some uncomfortable silence in which the owners pretended not to notice or were decided whether or not to say anything, I cheerfully told them that since it was almost Easter, we just decided to leave up the decoration from Jesus' first birthday party and celebrate clear through April. I think they bought it.

the rewards of delay

So at some point I guess I should start studying for the Oral Boards in April. I'm not terribly stressed about it (the thing about being an attending is that every day is the Oral Boards) but that's not to say that there aren't things that I should brush up on before I walk into the actual test. I got very lucky in that the Spring exam is being offered in Atlanta (usually people have to fly in for the exam, it's only offered at two somewhat random cities per year--San Antonio TX, anyone?) so that makes everything a little easier. The fact of having to fly into town for an exam and check into a hotel room the night before you get grilled by a panel of stone-faced examiners raises the stakes somewhat--however, there's only so much I can get worked up about a test that I can take 10 minutes away from my house.

I put off taking my Written Boards for a year because I was in the middle of finishing up the manuscript for my book, or the first version, anyway. Though there were times I did wish after the fact that I had just taken my Writtens on schedule (as it was, I only ended up studying for about a week this summer, so it's not like I was luxuriating in all this extra time) but being on the schedule that lands me taking the Oral Boards in the city where I live is a huge plus. See, kids, procrastination does pay off. (Note to any actual kids: Ignore the preceding sentence. And also, say no to drugs.)

P.S. Don't forget to check back later today for the first installment of this week's new comic, "Residency vs. Baby, a Critical Comparison."

i already used up all the brainpower i might have otherwise used to think of a title for this post

I've decided that to study for my written anesthesia Boards (which I will be taking the first week of August) I will start reviewing 10 practice questions a day, every day, up until the week before the exam, at which point I might step up my game somewhat and start some sort of a cram-a-thon. Ten questions a day is certainly not too onerous, but the only time I have to do it is at home, after both kids are asleep and before I go to sleep, usually a window of about five minutes, seven if I decide to brush my teeth. And this amount of time does not exactly allow for careful review of the source material.

So I guess I have to start going to bed a little bit later. This should not be a big deal--after all, didn't I stay up late every night in college, back when I was a weenie little premed and could only dream of the glamourous life that I lead now? (See: today, I got a free bagel! With cream cheese! BEHOLD, THE POWER OF THE MEDICAL DEGREE.) But the thing is, I've started seeing sleep as sort of an investment for work. As in: if I don't get enough sleep, I cannot think quickly and perform my job well, and this is not good for my patients. And therefore, I have to be in bed by 9pm or else PEOPLE WILL DIE. I know this makes very little sense--I didn't get enough sleep as a resident and I was taking care of patients then--but somehow being the one who is ultimately responsible makes me take everything a little more seriously. And if treating what little is left of my brain to the minor pampering it requires to function well, then by all means, put me in bed before it's dark outside.

Anyway, I did my ten questions for the day. And now I updated my blog, albeit nonsensically. And now I'm going to bed.