moved

reasons can't explain - new blog location is as follows

http://tambaxter.blogspot.com

roller coasters

I LOVED roller coasters growing up. . . the higher, faster, curvier, loopier the better. I knew every ride at Six Flags and Carowinds. I knew the perfect seats and the perfect time of day to ride them (it actually makes a difference - some rides are faster early and some later). I lived for that feeling you get in the pit of your stomach right as you reach the top of the hill, or the beginning of the loop. The feeling that makes your heart race and your breath come a little faster. The feeling that although you have stood there and watched a hundred people come through the ride unscathed your trip might be different. The feeling of satisfaction felt when you completed the ride as if you had conquered Mount Everest - solo without oxygen.

In medical school I learned that all of these feelings are natural, and actually our oldest genetic response. From earliest human days, life was all about survival. We developed responses known as "flight or fight". When faced with uncertainty or danger, our body is hardwired to protect itself - to survive. Our heart rate increases to raise our cardiac output. This allows us to fight off danger or to run from it. All of these responses are triggered by the release of adrenaline from ,of all places, are adrenal glands.

Some people live for this response. They purposefully put themselves into situations that trigger it. These so called "adrenaline junkies" live for the "high" that they feel with all that extra adrenaline circulating around. I have been one of those people all of my life. It is probably one of the reasons that made me a surgeon. Nothing will give you more of an adrenaline surge than being in the operating room during a tricky or dangerous case. It was my own natural high.

Some people hate this response. Their adrenaline brings with it overwhelming nausea. Instead of feeling powerful and ready to take on the world, they develop feelings of impending doom and loss of control. The are incapacitated by the adrenaline. I fear that I am becoming one of these people. This whole job search thing is starting to feel like a roller coaster that never ends. I am beginning to wonder if instead of fighting for my "survival" if it wouldn't be easier to just roll into a ball and admit defeat. I know that there is still a fighter in me - I just need to find her again.

Mirror, Mirror on the Wall

I have often asked if some people looked in a mirror before they leave home. This question gets asked a lot here in Philly. As I wandered around a local outlet mall today, I caught myself again questioning people's "final check" before going out in public. After the 20th such person, I began to question my assumption - surely someone has a mirror. Perhaps they do check, but their mirror is just much kinder than mine.

I am currently at a medically healthy weight for my height and build. Is that what I see when I look in the mirror? Of course not. When I look in the mirror, it is never followed by affirmations. I am 10-15 lbs away from "thin", and 20-25 lbs away from "Hollywood thin". I look in the mirror and immediately catalogue all of my faults. I see too big breasts, big belly, butt that is a mile wide and sagging halfway down my thighs, etc.

I know that I am not a lone in this self defeating behavior. I have a friend who is tall, thin, abs to die for and beautiful. When she looks in the mirror - she only sees her thighs. Another friend who is tiny by any one's definition - she only sees breasts that are "too small" and broad shoulders. Why do we do this to ourselves?

Why can't we be more like these people I see around town. I saw a lady today about my height, but had me beat by at least 150lbs. She was wearing a tight halter and mini - quite frankly she rocked it. She rocked it because she owned it. I meanwhile had spent extra time hiding my "flaws" before leaving the house.

I am not suggesting that we all eat whatever we want and become grossly unhealthy. However, I am beginning to think that we should all give ourselves a break and more importantly a kinder gentler mirror. Will I stop trying to loose those last 15 lbs - probably not, but I will at least give try to give the current body a break from the endless abuse.

Chicken or the egg??

I have often been perplexed how certain people and things always seem to actually fit into pigeon holes. For example, a certain group of patients that I see with the same diagnosis (which I will leave out on the off chance someone who reads this has it) are all crazy. I don't mean a little different - I mean close to certifiable. It is well know among all in my field. Each field of medicine has a similar group. Does the disease make them crazy or do only crazy people get the disease? I had similar thoughts today when I read an article on MSN about astrology. Do I so perfectly fit my sign because I was born in April? Or have I adapted to fit my sign over the years?

Here is what it said:

Taurus, the second sign of the Zodiac, is all about reward. Unlike the Aries love of the game, Taurus loves the rewards of the game. Think physical pleasures and material goods, for those born under this Sign revel in delicious excess. They are also a tactile lot, enjoying a tender, even sensual, touch. Taureans adore comfort and like being surrounded by pleasing, soothing things. Along these lines, they also favor a good meal and a fine wine. The good life in all its guises, whether it's the arts or art of their own making (yes, these folks are artistic as well), is heaven on Earth to the Taurean-born.

It's the Bull that serves as the Taurean's mascot, and along with that comes the expectation that these folks are bull-headed and stubborn. Yes they are. Hey, this Sign has a Fixed Quality attached to it after all, so expect that things will occasionally grind to a halt. That said, Taureans don't start out with the intention of getting stuck. They simply want to get things done, and it's that steady, dogged persistence that winds up being viewed as stubbornness. Bulls are actually among the most practical and reliable members of the Zodiac, and they are happy to plod along, as it were, in pursuit of their goals. The good news for Bulls is that once they get to the finish line, they'll swaddle themselves in material goods. A self-indulgent beast? Perhaps, but if you toiled as laboriously as these folks do, you'd need some goodies, too.

Bring on the swaddling.

Gremlins

Since Hollywood seems to be in the process of remaking every film from my childhood, I am hoping Gremlins is next. I am fairly certain that I currently am living with at least 3. My friend Jess and her family were up this past weekend. Unfortunately, my place wasn't spic and span, but it was at least reasonably presentable. We enjoyed a nice weekend although I worked way too much of it. I was in house on call Sunday, and they headed back to DC.

When I came home on Monday, my apartment looked still in need of dusting ( I had hoped Micah would have a go at it), but otherwise as it had been on Friday. I threw in some laundry, had breakfast, and curled up on the couch for a nap. At some point, I woke up and threw in a new load of laundry, had lunch and moved my nap to the floor. Next time I regain consciousness it is 2:45 am and I am answering a wrong number call from my work phone.

After politely informing the caller that I had zero interest in his ridiculous consult, I looked around my apartment. I had been ransacked. There were dirty clothes in the hallway. . . clean clothes in the chair . . . dirty dishes in the sink . . . empty Indian food containers on the counter. . . and a full sleeping quarters in the middle of the living room floor. How can I (a fairly neat person at baseline) completely destroy my apartment in less than 12 hours? Appalled as I was, I did not clean up at 2:45 this morning. I crawled back into my comfy floor bed and went back to sleep. I am dreading going home today though, because I am afraid what the Gremlins have been up to while I was gone.

I'm It

I was "tagged" by my friend Jessica in her blog, and since my life is so boring I had nothing else to talk about - here goes.

8 Things I am looking forward to . . .
1. A Job
2. A place (state, city, dwelling) to call my own
3. A salary that soothes the pain of my sacrifices
4. Trips to visit friends that I haven't seen in way too long
5. Alex's wedding in Hawaii (I am so going)
6. Tennis lessons
7. Full night's sleep
8. Time

8 Things I did yesterday . . .
1. CPR (patient survived - at least he was still alive when I left)
2. Pulmonary conference (boring)
3. LONG HOT shower
4. Really good work-out
5. nap on my couch (I was post call in case you haven't figured it out)
6. America's Next Top Model marathon
7. "Grilled" a steak for dinner
8. Went to bed embarrassingly early

8 Things I wish I could do . . .
1. Find a job
2. Draw
3. Play tennis
4. Swim
5. Remember more often to be thankful for what I have
6. Eco vacation
7. Adventure vacation
8. Move to Tuscany

8 Things I am currently watching . . . (only the first with any regularity)
1. LOST
2. West Wing
3. Law and Order
4. Closer
5. Oprah
6. My second year resident trying to learn to open a chest
7. CTSNET for new job opportunities
8. my life pass by (kidding)

Okay - I think that is everything. Flying to Syracuse tonight for my job interview. Still hoping to hear back from Miami. New job interview for Univ of Mass - Worcester. I seem destined to live up North (teach me to move here in the first place).

Practicing Faith

The Lord is my shepherd; I shall not want.
He makes me to lie down in green pastures;
He leads me beside the still waters.
He restores my soul;
He leads me in the paths of righteousness
for his name's sake.

Yea, though I walk through the valley
of the shadow of death,
I will fear no evil;
For You are with me;
Your rod and Your staff, they comfort me.

You prepare a table before me in the presence
of my enemies;
You anoint my head with oil;
My cup runs over.
Surely goodness and mercy shall follow me
All the days of my life;
And I will dwell in the house of the Lord
Forever.

Running hungry

I have lots of friends who are runners. I have often blogged about how envious I am of these friends. They actually enjoy running. They run for fun, friendship, and that mythical runners high. Not me as I have previously stated, I run for what it does for my body. (The only high I feel during running comes from hypoxia.) Or I should qualify what it used to do for my body.

When I "got in shape" 4 years ago, I sensibly combined exercise and a healthy diet. It worked quite well for me and allowed me to continue at a "wouldn't kill me to drop 10lbs, but I look okay" weight for 3 years. As mentioned, I gained weight when I moved to Philly. I have gotten most of it off. However there's a catch.

Instead of my previously used method, I just changed my diet. I didn't starve myself - I just dropped my calories with smarter choices. I was happy that I could wear my clothes again, but not thrilled with the way I looked in them. My arms had lost all definition, my legs (once my best asset) now begged for cover, my butt headed in all directions but North, and we won't even discuss my abs. Therefore last week, I decided to recommit to an exercise plan - specifically running and weights.

I was actually quite excited. I had stalled on my weight loss and figured a little cardio on my previous diet would get things started again. Boy was I wrong. I have actually gained weight since I started exercising. The reason: I can't quit eating. I run in the mornings. Not because I am a morning person (as we all know) or because the books tell you that morning is the best time to exercise. I run in the morning because it is the most consistent time that I can count on being mine. I do best with schedules. I need someone to physically drag my butt into the gym evenings (where are you Jill?), but I seem to be able to get there on my own at 4am (ironic huh?).

However, the fall out of that early morning work-out seems to be a ravenous appetite for the rest of the day. I have tried everything - protein, starch, even fat for breakfast - all to no avail. I refuse to quit exercising because the sane person in my head knows that it is the right thing to do. I just need to quiet the insane person in my head that thinks - wow I ran this morning - "Let's have a cupcake." I am at least choosing to believe that I am building a very toned body under these layers of adipose. Just need to keep chipping away.

Comfort Food

When most people think of comfort food, they dream of mac & cheese, roast beef, mom's apple pie. Not me - I think french fries. I don't know why, but as long as I can remember, french fries were my go to food. I can pass up potato chips, baked potatoes, and mashed potatoes, but I have never met a french fry I didn't love. They quite simply make me feel better.

I needed feeling better this weekend. I was on call Thursday night. It wasn't a horrible call, but I can think of much better ways to spend the night. However, it left me feeling vulnerable on Friday. I couldn't keep up my sunny front. The reality of my situation overwhelmed me all of a sudden. I spent the car drive to my apartment crying on the phone to my mother. Once home I showered and took a nap hoping to sleep it off. It didn't work. I woke up in the same funk. I settled on the couch with a bag of Pita chips and hours of mindless television.

I decided today that my funk needed sunshine. It was actually a sunny day here in Philly. It has been cold and rainy all week so everyone was out. I started at the bookstore. Thanks to my mom, bookstores always have the ability to make me feel at least marginally better. I picked up a few books and then headed to the retail stores. I actually bought a shirt at Anthropologie. I am not sure that I will ever have the nerve to wear it, but at least it felt like a step outside my box. I hit all my faves - Ann Taylor, Loft, Talbots, J Crew, Gap. I didn't buy much beyond my books and shirt, but started feeling better.

Funny aside. . . I was looking at a ridiculously priced shirt at J Crew when I overheard a lady ask the salesman if they had anything smaller than the 00. It was a little big at the waist for her. I mean seriously. Double Zero!!! Should they even make a zero? Doesn't that by definition mean that you don't exist as a size?

I still was feeling a little overwhelmed by the jobless thing so I decided to stop for some french fries on the way home. I haven't found any great fries here. At home - Zaxby's are probably my favorite, but here I had to settle for regular old fries. Don't get me wrong, all fries seem to work, but I like to expend my wasted calories well. I don't know that I am feeling at the top of my game, but I at least no longer feel like jumping off a bridge. Maybe I will try the movies tomorrow.

Call Again

On call yet again - enough said.

Learning Challenges

My entire life, I have been told that I was smart. My parents, teachers, professors, attendings and friends all propagated this idea. It started very early when I was told that I was too smart to go to kindergarten. (My mom sent me anyway - supposedly for "socialization", but I think it was mainly to get rid of me during the day.) In first grade I was tagged as "advanced", and by second grade I was in a "Challenge" program. My biology advisor at Emory would argue that I was wasting my intelligence taking all those pesky liberal arts classes (ironically this professor worked at my liberal arts university). Deep down inside I knew it didn't feel "right", but can everyone be wrong? The answer - YES!

Why am I now certain that I am not very bright? Well, I could point out that I still don't have a job after 13 years of primary school, 4 years of college, 4 years of medical school, and 10 years of post graduate training. However, in my head I am still blaming that on the economy so we won't go there. My stupidity involves having to learn the same lessons over and over again. When will it sink into my head that the fastest way to get me to do something is to tell me I can't? Likewise the best way to get me to crave something is to tell myself that I can't have it.

Albert Einstein once said: The definition of insanity is doing the same thing over and over again expecting different results. Can I have my straight jacket in green? Obviously I am struggling with my diet again. I recognize that part of my frustration with my diet is probably related to my job stresses, but part of my diet frustration is my stupidity. When will it occur to me that regardless of how much I work out, if I eat like the boys I work with - I will weigh as much as the boys?

I miss sugar

It started innocently enough - it was my birthday, and I had a slice of birthday cake. One slice only - I promise. However, it started me back on a vicious spiral. I then decided a brownie for dessert with my family was okay. Surely no one can argue with chocolate covered strawberries. Well I do like the peanut M&M's - they have protein in them right? It seems that in my head, my diet is either all or nothing. I either make good choices all the time or I start eating crap and can't stop.

That one piece of cake turned the switch in my head. Fortunately, this time I was able to recognize that the sluggishness and malaise that I felt this weekend probably had as much to do with my diet as my sinus infection. Therefore, I decided to give up sugar in its entirety. Yep I said it, I gave up sugar. I am only one day into this latest folly, and can I just say IT IS HARD. I never realized all the places that sugar exists. They sneak it into my protein bars, my "no sugar" cereal, and my yogurt. We won't even discuss the "sugar substitute" (which I am also giving up) in my diet coke and chocolate - OOOH I miss chocolate.

I don't expect to give up sugar forever - let's be honest is a life without chocolate really worth living? However, I thought this would be a good detox for my recent sugar binge, and perhaps re kick start my healthier living plan. At least it got me to the gym and running today so it can't be all bad.

Diagnosis

Sinus infection. Not excited about it, but will take it over the H1N1 virus. I have been spared from allergies most of my life. Secretly, I have felt somewhat superior to my mom, sister and many friends who have bad seasonal allergies. I always thought that I had a better immune system that could recognize friend (seasonal allergens) from foe (viruses, bacteria). I guess this year is my karma catch-up. It started a couple of weeks ago. Late for spring some of you might argue, but you have to recall that my spring didn't start until a couple of weeks ago.

Strange that I spent all of my life in the pollen covered South, and it wasn't until I moved North that I developed allergies. I am crossing my fingers that this is a aberration year (on so many levels). In the mean time, I will just go on record as saying that sinus infections suck. I am sure that all the flying isn't helping, but still need to find a job so that can't be helped.

Paranoia

I don't usually tend toward paranoia, but here is hoping that I am today. As most of you know, I went to Miami on Thursday for a job interview. (I have no news in regards to the job, and honestly no gut feeling one way or the other. I have truly decided that what will be will be.) I flew back home yesterday, or I guess technically early this morning. The plan was simple enough. . . Leave MIA at 5:15 pm with an 1 1/2 hour layover in ATL to arrive in PHL at 10:25 pm.

The ATL screwed me yet again. I guess it sprinkled or something so they wouldn't let us leave Miami on time. We actually left the exact time we had been scheduled to land in Atlanta. Needless to say, I did not make my connecting flight time, but luckily it was delayed also. Long story short - I got back to Philly rather late last night/this morning. I unpacked necessities and went to bed.

Here is where hopefully my paranoia kicks in to place. I woke up this morning with a headache and malaise. I initially shrugged it off as a long couple of days and too much time on planes. I am still trying to sell that argument although I now have muscle aches and chills. I am sure this all goes back to my karma argument. I was laughing in my head at all the people on the planes in mask (in my defense none of them were wearing them correctly). Hopefully this is just tiredness, but I am quarantining myself just in case. I cancelled my plans for a nice dinner in NJ with my friend Beth and her family. I don't need the notoriety of being the local index case. Will keep you posted if I start to oink.

I'm goin to Miami

All day long I have had that Will Smith song stuck in my head. While I was trying to think about packing, trying to figure out what questions to ask, trying to operate on my patients - I keep hearing bienvenidos ay Miami. It is quite a catchy song so don't be surprised if you now will also have it playing in your head - sorry misery likes company.

I am heading down in the morning and back on Friday. Most of my Miami experience to date has involved a cruise ship so at least it will be a different side of the city. Trying to remain calm about the interview. What will be will be. Will check in when I get back.

Time Sure Flies

I am 36 years old today. It feels much younger than it sounds. My brain is somewhat baffled by the idea of my actually being this old. My body on the other hand, feels each of those years today. My parents and sister came up for the weekend, and I am exhausted. We went to Niagara Falls on Saturday, and to a local botanical garden yesterday. I was actually happy to come to work today so that I could sit down and rest.

The weather has been perfect (my parents would argue a little too warm, but they just don't understand how it has been). We are having dinner tonight, and they head out tomorrow.
I will try to post some pictures if I can ever reclaim my office. I am flying to Miami late this week for an interview, and Syracuse has been rescheduled for mid May. I am doing surprisingly well all things considered. I have decided that worrying will get me no where, and I have personal experience that things usually work out. I have to believe that I haven't come this far to hit a wall here. Will keep you posted.

Right in the World

I had an incredibly busy night on call that included no sleep and 3 changes of scrubs due to blood. I still have no job. I still have 15 stubborn pounds that refuse to go anywhere. However, my parents arrived today and I got a hug from my mom. How is it that a mother's hug can make it all right in the world? They should bottle and sell those things.

Closure Complete

So it took a call from my chairman for them to finally do it, but I got my closure with Little Rock. They went with the other guy because he was a "slightly better fit." I am trusting my mom on this one that things happen for a reason. Hopefully the reason is a good one.

Closure

I have often thought that I missed a few lines the day they were passing out girl traits. While some of the traits I seemed to get double portions (shopping, love of chic flicks and books, vanity, etc) there are others that I missed completely. For example, I have never truly been boy crazy. I think boys make a very nice accessory, but are not a crucial part of the outfit. I have always been way too independent to want to be "taken care of" or "protected". I have never bought into the feminist argument that women can have it all. I actually think that women and men are inherently and probably even genetically different, and to say that we aren't ignores some fairly obvious science. I am not sure that I picked up the procreation gene. I like kids, but am not convinced that I want any of my own.

I say all of that to say this - I need closure. I am starting to get VERY angry that the people in Little Rock have not had the common, and quite frankly professionally expected, courtesy to call or write me and tell me that I did not get the job. I have accepted it, but someone should be "man" enough to tell me.

The interview itself I felt initially went well. We seemed to have good chemistry during my first interview, and I thought during my second at first. On Friday morning, I had breakfast with the Chief of CT Surgery. He spent the entire breakfast telling me how qualified both of the candidates were for the job. He talked about how hard the decision was going to be, and even went so far as to say that whomever did not get the job should not take it personally. Sometimes there is just a better fit with certain personalities. I was born a blond, and have resorted back to that color a few times with the help of my hairdresser, but I'm not dumb. I could easily read between the lines and realize that I was being let down. However, at no time did he just go ahead and say - sorry we have decided to go another way. What he did say was that we plan to make our decision fairly quickly, and will let you know by mid next week. (I also had a dinner that evening with the older cardiac surgeon. We will just say that he made an inappropriate comment related to the fact that my genes match, and move on.)

I am not complaining that I didn't get the job - Although, I think they are making a huge mistake. I would be perfect for this job. I have the required experience, eagerness, and already understand "how the South works". I get that sometimes you just don't get the job. What I want to know is why did I not get his one. Did I use the wrong fork? I think a debriefing is in order. It would be very useful information to take to the next interview. I need closure of this relationship so that I can move on - is that too much to ask?

Pity Party

I am currently throwing myself an amazing pity party. I have some serious A list guests - pity, loneliness, self-doubt, loathing, and despair. Depression RSVP'ed, but you know how he likes to make an entrance. I would invite you, but quite frankly I like you all too much to drag you to this one. I strongly encourage you to actually skip the rest of this blog and perhaps check in tomorrow when I hopefully will have found a ray of hope.

The most ironic part of all is what this may actually mean. I spend a lot of time preaching to my friends about cosmic justice. I had always believed (and guess still do) that you get back out of life the same Karma that you put in to it. Whenever I perceived injustice, I always mollified myself by saying that the person would get what they deserved in the end. Based on my Karma payment, I have put in some serious bad vibes. Where did I go so wrong?

I am obviously still upset about not getting the LR job, and my travel misadventures didn't help. I guess only Kris and my mom know about those. I was supposed to fly to Syracuse for my last job opportunity yesterday. (Despite an initial promising phone call, I haven't heard back from Miami so I take it they are also not interested.) Unfortunately, the weather didn't cooperate and my flight got cancelled. I spent 10 hours at the airport trying to get on a different flight to anywhere close, but finally gave up and came home. I went back early this morning, but despite four trips to the airport total and at least 10 gate changes, I never actually left the city. Now I have to reschedule, and get to spend the interim in my current state.

I have given up a lot to get where I am - my twenties for starters, and most of my thirties. Now I am staring my 36th birthday in the eye, single in a city where I am close to no one, and can't even find a job. Excuse me, I should get back to my guests. Talk to you soon.

My Clock Stopped

I am fairly certain that every time piece in my apartment is broken. None of them are actually moving at all. It has been 10:30 for the last 6 hours. I went to work this morning, but our second case got cancelled. Since I wasn't in the best frame of mind anyway, I decided to come home and make sure everything was ready for my trip this afternoon. BAD IDEA.

I got home around 9 am. I watched West Wing while actually working out (a novel idea for me as of late). I am about to jump in the shower. I should be completely ready to go by 11:30 - 12 at the latest. The problem - my plane doesn't leave until 4. What on Earth am I going to do all afternoon, but slip further and further into insanity?

Distractions

As my last interview did not exactly go as planned, I feel even more pressure for my next one. I fly out tomorrow for Syracuse, NY. I went to bed last night thinking about it, and was never able to turn my brain off. Despite my travel exhaustion, I laid awake all night worrying about my future. After about 7 hours (and several tricks later), I gave up and started my day.

The purpose of the day - DISTRACTIONS. Anything and everything that I could think of to stop myself from thinking. I am an embarrassingly easy person to entertain, but turns out I am incredibly hard to distract. I had some success, but also a fair amount of failure.

I started with a trip to the gym. I thought it would be appropriate since I spent 3 days eating like a college boy. I left after about 15 minutes - my heart just wasn't in it, and my head wouldn't shut up. I took an incredibly unnecessary trip to Target and an entirely needed trip to the grocery store. I rearranged my shoes. I cleaned my house from TOP to BOTTOM (at least it will be good for my parents when they come next weekend). I unpacked from my failed trip, and repacked for my next one. My superstitious side had some fun with this one - I am not taking anything that has been to AK to NY. I watched all my taped West Wing and Law and Order. I am going to finish the day with last weeks LOST and then try to sleep.

Syracuse here I come - keep your fingers crossed. Not sure how much more of this I can take.

Heading Back

Leaving Arkansas this afternoon. When I arrived here, it was hot and sunny - perfect spring day. As I leave Little Rock, it is cool and raining. Similar to how I arrived brimming with hope and leave with my tail between my legs.

Currently trying to pack. I purchased nothing while I was here, but am still struggling to fit my stuff back in the suitcase. Once upon a time, I envied my friends who traveled with their jobs. No longer. Turns out traveling isn't all that fun, and even the nicest hotels at the end of the day are still hotels. Guess it is true - grass isn't always greener on the other side.

Trying to hold on to optimism, but difficult today.

It's not you - it's me

I just finished breakfast with the chief of the division. I have a little break before I head out to view some real estate. I am now fairly certain that I won't be offered the job so it has taken a little of the fun out of it for me. Although it wasn't blatant, I had the distinct impression that I was being let down easy at breakfast. It was all done very nicely, but I think they are going with the other guy.

I will admit that I am a lot disappointed. The job is exactly what I dreamed, and it is back in the South which is perfect. I head to Syracuse next week, and will now have to move my hopes to there. Guess I will now go off and look at real estate that I never have a hope of needing.

My cheeks hurt

Another day of interviews today. I hope these guys don't compare notes too carefully because I feel like I am telling the same stories over and over again. I mean realistically how many different ways can you tell your life story and map out the next 10 years of your academic career? I am a little concerned that I have developed Bassam's fake smile (a friend of mine who always has the "perfect" smile for pictures, but it rarely actually makes it to his eyes). I do know that my cheeks hurt from all the smiling.

Had another heavy dinner tonight. Wow, do I need to hit the gym. I am looking at real estate in the morning, and then have some free time in the afternoon. I absolutely have to squeeze a workout in there, or I am going to be squeezing into my clothes again. I'll keep you posted.

Act II Scene 1

Arrived back in Little Rock today. Not without some drama. I was scheduled to leave Philly at 7:45 am. The weather was awful - cold and rainy. We boarded without difficulty, but didn't actually take off until 9 am. Can I tell you how boring it is to sit on a runway for 1 hr and 15 min. I had a layover in Atlanta. I was supposed to arrive at 10 am and leave at 10:50. Anyone that has flown thru ATL knows that depending on where your terminals are - connections can be tricky. We landed at 10:20, but as only seems to happen in Atlanta, there was a plane already at our gate. Therefore, we didn't exit the plane until 10:40. I had 10 minutes to get from A8 to D27. Let's just say I got my cardio in for the day, and found out what it is like to be the absolute last person to board a plane. Amazingly my luggage also made the connection.

I decided to rent a car so that I could explore the area a bit. Unfortunately, they were out of GPS systems so with map in hand I headed off to the hotel. As an aside, anyone traveling through Little Rock should spend some time at the Capital Hotel. It is an old relic that has been completely renovated and is GORGEOUS. I had a couple of interviews this afternoon, and then headed out for dinner.

Dinner was good, but I ate way too much. I am currently suffering through an "I feel fat" phase and my huge dinner did not help. (It was also the major problem with my packing.) Tomorrow is the "big" interview day, and we actually talk money. This is a very odd concept for me, but we will see how it goes. Since I was operating very late last night, and then had to come home to pack - I am heading off to bed. Will let you know how things go tomorrow. Wish me luck.

Packing 101

The idea seems simple enough. I will be gone for four days and three nights. I have an itinerary and know exactly what I will be doing and when I will be doing it. I have a huge closet of clothes from which to choose for said events. I simply need to place the appropriate clothes into my suitcase. How do I make this so hard?

My Jewish Easter

Since I happened to have this past weekend off, and I knew the no fun job interview traveling was starting this week, I decided to head out for a fun trip. The winner (unlucky soul) of a "weekend with Tammy" - my friend Jessica in D.C. I ostensibly went down for the cherry blossoms. In reality, she has a 4 month old baby, and I needed munchkin time.

Even though the Jewish holiday of Passover started two nights earlier, Jessica still okayed my visit. She is quite the trooper. She had three days of non-stop family events, mostly hosted by her, and she still seemed eager for my visit. She is either a very good liar or a saint. I arrived a little later than planned on Friday (traffic was a bear), and got my first taste of Passover. Jessica still had in-laws in town so we all had Friday night dinner at her house.

I come from a very large Southern family, and we know how to have a big family dinner. I thought this was unique to my culture. Boy was I wrong. The competitive person in me refuses to admit that we may have been outdone, but boy was there a spread for dinner. I had my choice of 3 meat entrees, and decided to try 2 of the 3 with seconds. I ate, and ate, and then nibbled some more. I am fairly certain I ate more in 3 hours than I had the previous 3 days combined. It was delicious, and I am now a very big fan of dark chocolate covered Matzoh.

I did other things there besides eat, but I did nothing else quite as well. I got plenty of muchkin time. At 4 months, Micah has more hair than I did at 4 years. He is a very happy baby - lots of smiling and cooing. He has a great life (eating, sleeping, and playing) and seems to know it. We also headed out to a local neighborhood with beautiful cherry blossoms and GORGEOUS homes. I love driving through old neighborhoods and looking at houses. We ended the trip yesterday downtown at the tidal basin. I missed the peak of the blossoms, but the entire downtown DC area is so gorgeous it is still always fun to be there. We even got a chance to wander through the Museum of American History.

All in all it was a much needed respite from my life. Today I am back at the grindstone. Heading out Wednesday for my second trip to Little Rock - wish me luck!

If only wishing made it so

There is a disconnect somewhere in my circuitry. In my head, I have this picture of the "style" of girl I am. Up there, I am this boho chic girl that has a little of a bohemian flair. I am artsy and cultured with a little flower child thrown in the mix. I see myself with tattoos and a belly ring. I wear multi-colored unstructured flowing frocks with interesting hats and chunky jewelry. I have platform wedges and a gigantic handbag. I am in essence an Anthropologie girl. Anthropologie is a clothing store for those friends of mine who don't shop (come to think of it, how did I get so many friends who don't like to shop?)

In reality, I am strictly an Ann Taylor girl (non shoppers hang in there). I am a classic, traditional, dare I even admit boring girl. I don't have an artistic bone in my body, and have never hugged a tree in my life. I am a rule follower who doesn't even have her ears pierced. I wear structured straight lines with understated accessories. A walk on my wild side is a four inch heel, and my handbags tend to only hold a small wallet, phone and a set of keys.

How did this happen? How can I picture so clearly in my mind the girl I wish I were when I see the reality every morning in my closet?

Will Work for Food

Where did all the work go? It is getting to the point that I am a little embarrassed to call myself a resident. It is now 11 am, and I am finished for the day. Honest - finished for the day! I am going to waste a couple of hours studying, but that is all I have left today. What happened to more work that one thought you could handle?

Part of the problem this week is the Holidays. I have one attending leaving town to spend Easter with his in-laws, and another off for the next couple of days for Passover. Therefore, we had one case today - an easy one at that. I "had" to do it because the patient is incredibly vain and wanted a small incision. My reputation for small incisions is rampant and usually the source of much ribbing. This is the one time that it was seen as an asset.

I think the bigger problem is the economy. Even for us (life saving surgery an all). People aren't going to the doctor for problems. Therefore, they don't get their CXR with an incidental finding of lung cancer. The scary part is that all of those people still have lung cancer - we just won't know about it until it has spread and is no longer curable.

I am glad the economy is starting to show slow signs of recovery, but I am a stronger believer than ever that we need a more universal health care program. Good health should not be dependent on the economy. Period. It shouldn't matter if you are working this week or not if you have chest pain you should get to see a doctor. The current system is hurting and will continue to hurt us in the long run. We need a system where people are encouraged to stay well, not one that slaps band aids on people once they have passed the point of repair.

Okay - I am now stepping off of my soap box. I just wished a few Republican members of congress had to spend a few days in my shoes and see what I get to see.

Embarassing

A few days ago, I blogged about how out of shape I have become. I had recognized that it was true, but did not fully understand how true it is. In a bout of post call euphoria yesterday, I headed to the gym (after my nap of course.) I decided to run on the treadmill.

A little back story . . . I haven't exercised in a month, but I haven't run in SEVERAL months. However, it works for me and I want to be a runner if only I could get over that running part. I spent 30 minutes on the treadmill and ran just over half that time. I would run for a few minutes and then spend a few catching my breath. Luckily I had the workout room to myself because it was highly embarrassing.

Since my pride is now involved, I headed back to the gym today. My legs hurt to much for another go at the treadmill so I spent some time on the elliptical. I will tackle the treadmill again tomorrow. I refuse to be this out of shape this young.

Daffodils

I decided to walk to work this morning. I am not sure what led to such a notion, and in all honesty probably not my brightest idea ever - it was both cold and dark when I set off - nevertheless off I set. Dawn finally started to break after I stopped for coffee and I was at least able to appreciate the sights for at the last portion of my walk.

The sights are actually the purpose of my musings. For the first time, I actually saw true signs of spring this morning. There were daffodils, azaleas, and blooming pear trees. I think I even saw a cherry blossom. I have spent so much time complaining about the lack of these things I wanted to make sure that I remark on how happy I am that they are here. Reportedly it is even warm and sunny today. I have been breathing designer air and bathing in fluorescent lighting all day, but rumor has it tomorrow is also slated to be nice. Since by then I will have spent 60 of the 72 hours of the weekend in the hospital, I will be trying to spend as much of tomorrow as possible as far away from here as possible.

Hopefully spring has sprung and is here to stay.

Taken to task

I have been taken to task by my friend Jessica for unfairly hating the city of Philly. She thinks that I am currently refusing to see any of the positives and only concentrating on the negatives. She may be right, but hear me out. There are many aspects of this city that I enjoy a lot. Unfortunately as of late, perhaps related to my stressed state of mind and my growing frustration being a resident, I have chosen to ignore those aspects and only see the parts I don't enjoy.

I don't hate Philly. I have enjoyed most of my time here. I will most certainly return here to visit in the future. If given another option, I would probably not choose to live here permanently, but that has more to do with me than the city. It is actually very interesting how things work out. The entire time that I was growing up I couldn't wait to get out of my small town. I wanted to live in a large bustling city where there was always tons of stuff happening. I was going to have this incredibly exciting full and fast pace life.

I moved to my first big city in college, and had a blast. However, by the time I finished medical school - I needed a rest. I am absolutely positive that I could not have survived a surgical training program in a big city. Perhaps it is related to the way that I grew up, but the fast pace life takes a lot out of me. Turns out as much as I hate to admit it, my soul occasionally craves a slower pace to life. I like the stillness of sitting on a front porch watching the trees blow. I never would have believed that growing up, but it is what it is.

Don't get me wrong, I am by no means a country girl. However, I would love a nice small to middle size city with friendly neighbors and front porches.

Length matters

I know as a girl that I am not supposed to actually admit this out loud, but length matters. I'm sorry it does! We are simply kidding ourselves when we say it doesn't. And when did it become the collective rule that we were all willing to lie about it not mattering? I don't recall a vote, but yet I am supposed to go along with the secret "girl code"? Shorter is definitely better!!!

I am of course talking about the length of winter. (You should all collectively get your heads out of the gutter.) Yes, it got colder here than I thought it was possible to survive, but I survived it. It turns out that you can put on enough clothes if you keep layering. The toughest part of this winter of my discontent is its length. I mean COME ON! It is the first weekend in April - Easter is next week, and we are just now getting a couple of days per week in the low 60's. How do these people live this way?

I actually know the answer to that last question. They don't know any better. They don't know that March should bring flowers and grass and sunny days. Maybe if by some horrible twist of fate I spend another winter here I too will tolerate it better. I will mentally be prepared for winter well into April. I was not at a mental place for it this year.

I have actually discovered that there are lots of things about the south that people around here don't know. When I first came here, the misperceptions about life "down there" were annoying. I couldn't believe that people really thought such ridiculous things. I now find them amusing. I smile politely, nod my head and have two thoughts. The first - I can't wait to get back home to the south. The second - I am so glad that small minded people like you will never move there.

What a Week

I need this week to be over. I was on call last weekend so didn't get much rest. Worked a "normal" day Monday getting home around 7 pm. Who knew that would be my good day. This is the earliest I have gotten home since and I am on call this Friday/Sunday. . . so a LONG weekend ahead. I am on call again next Thursday, and then my travels begin. Luckily, my first trip is all for fun. I am heading to DC to see my friend Jessica, her new baby boy and the cherry blossosms. I just have to survive the next 7 days . . . I just have to survive the next 7 days . . . I just have to survive the next 7 days . . .

Addicted

Okay - I have a confession. My name is Tammy Baxter, and I am a TIVO addict. I realized I had a problem last night when instead of watching the show I wanted to see, I chose to read - not because it is better for me, but because I didn't want to wait through the commercials. I knew I could watch it tonight minus the commercials on TIVO.

I can't say that this is the first time I have done this. The only shows that I watch consistently are Oprah and LOST. I also record West Wing - which is ironic if you consider I have the entire series on DVD, but I digress. I haven't watched any of these shows real time in months. Granted I am not usually home for Oprah, but am not sure that would change anything. I am almost always home for LOST and choose to watch it the next day or my favorite wait until it is about 30 minutes in and start watching the recorded version. It finishes only about ten minutes later than the "live" version minus the commercials.

They say the first step is admitting you have a problem.

Shapeless

So I have past out of shape and moved right into the shapeless category. Let's just say that I have been less than stellar about going to the gym these days. I would love to blame my job which is usually my go to excuse, but I spent most of the day on the couch yesterday doing nothing. My excuse for not going to the gym - I didn't want to.

Why can I not get myself motivated? Part of the problem is my perception that I don't have to work out. For reasons that are beyond my understanding, I have been able to continue to lose weight despite my laziness. Ergo I don't "need" to work out. Now the obvious answer to that is I could lose weight faster or perhaps eat more if I were willing to expend some calories in the gym, but we really shouldn't confuse my whole premise with facts.

The even better reason to go to the gym is that I am horribly out of shape. I just climbed two flights of stairs, and was short of breath when I reached the top. We use ability to climb stairs without shortness of breath as a criteria for lung resections. Luckily I don't smoke and have less chance of lung cancer because I am not sure I could qualify for a resection. One would think at least my competitiveness gene should kick in a little here. My friend Kris ran 10 miles this weekend - all at one time. My friend Bree ran 20 miles - on purpose!?! I have no desire (nor quite frankly the ability) to compete in their leagues, but shouldn't I at least care about looking like such a slacker around them?

Call musings

I am on call today. Woke up late so have spent the entire day "running behind". I had a take back for bleeding this AM (I didn't do the original case), and am now actually sitting at my desk studying for my boards. Thought I would share the words to one of my new favorite Sugarland songs.

It Happens

Missed my alarm clock ringing
Woke up, telephone screaming
Boss man singing his same old song

Rolled in late about an hour
No cup of coffee, no shower
Walk of shame with two different shoes on

Now it is poor me, why me, oh me
Boring the same old worn out blah, blah story
There is no good explanation for it at all

Ain't no rhyme or reason
No complicated meaning
Ain't no need to over think it
Let go laughing

Life don't go quite like you planned it
Why try so hard to understand it
Irrefutable, indisputable
Fact is

Yeah, the irrefutable, indisputable
Absoluteable, totally beautiful
Fact is psssh it happens.

Rip-Off

I wear my "real" work clothes for about 1 1/2 hours a day - an hour in the morning for rounds, and 30 minutes at the end of the day on the way home. The rest of the day I wear hospital provided pajamas - which make no one look cute (sorry Dr Ray). Despite my part-time use of my clothes, I pay full price for them when I buy them. I also - it turns out - pay full price when I dry clean them. I can't believe how much it costs to dry clean clothes.

Okay, not entirely true. I once knew how much it cost, and then I got fat. For the past several months, I have mostly worn scrubs. Now that I can wear my clothes again, I have rediscovered the cost of dry cleaning - and I am not a happy camper. I am not even exactly sure what they actually do to my clothes. I have a sneaky suspicion that they simply hang them in a steam bath, put them on a hanger and give them back to me all the while trying not to laugh. (Sorry by the way for my long sentences - I have been trying to learn to love Faulkner, and it seems to be rubbing off.)

At least my clothes last a really long time argues my dad. What girl on the planet wants her clothes to last forever? I really can't justify buying the new really cute black pencil skirt when I have 6 at home that are still in incredibly good shape. Although Kris would argue that idea never stops me from buying a new denim skirt. Obviously I picked up my dry cleaning today. I vented and now I promise to move on.

FOUND - one dose lost optimism

Perhaps my 8 hours of mindless television yesterday were not a complete waste. I went to bed last night, actually fell asleep and slept the entire night (this is unique for me as of late.) Even better, I woke up this morning feeling something I haven't felt in a few months - optimism. It hasn't told me yet where it went or for that matter why it finally decided to come home, but I am so happy to have it back.

I have let this job search business "steal my joy" to quote my friend Kris, and made me forget how much I actually love what I do and what a great life I really live. No more. I will continue to actively pursue the jobs that I have on the table, and continue to look for more, but I will no longer allow the process to take away my enjoyment in life.

Marathon Training

Unlike my friends Bree, Kris, Meg and Jill - I am not referring to running. I would probably be much more healthy if I was. However, the marathon training that I did today involved my television. I don't watch a lot of television anymore, but I occasionally have weekends where I completely turn into a couch potato.

This was one of those weekends. My channel of choice - Oxygen. I started a Sunday marathon of America's Next Top Model, and have been hooked all day. Very sad, but true. We won't even discuss all the things productive that I could have done this weekend. Besides, I don't have time - I need to go root for Danielle in the next three eliminations.

Enough with the black

Given the amount of black worn in this city one would have thought I got confused and accidentally moved to New York City. All I can say is enough already. Why is it that people think head to toe black 24/7 is a good look? No wonder everyone is grumpy here - they have NO color in their life.

I have been aware of the fondness for black for a while, but it seems to be intensifying. Shouldn't spring bring color? I walked downtown this morning and I kid not - I saw exactly 3 people not in black. I live in the City - I saw a lot of people this morning. People even dress their kids in black here.

Well, I have caved on a lot here, but I stand firm on this. Most importantly, I don't look good in black. It is just not my color. I don't know if it is that I am too pink or my hair too fair, but it looks harsh on me. I will take navy or brown any day of the week. Maybe everyone else here had my problem with weight gain in this city and this is their way of coping. I'll take Michelle, my nutritionist, any day of the week over such a depressing wardrobe.

Not that I am counting

Not that I am counting, but I have 103 days left in my training. Really not counting the 3,550 days of training that I have already completed. I have 13 days of call remaining not including the 14 hrs and 3 minutes that I have left on the call that I am currently suffering through. Two days before spring is "officially" here, not that Philly seems to care. We won't even discuss the infinity of time that I seem to have left before I find a job.

Obviously, I have too much time on my hands today. As mentioned, I am on call. We all know how much I love call, but for some reason today is even more INCREDIBLY, EXCRUCIATINGLY, ASTOUNDINGLY painful. My ADHD (attention deficit and hyperactivity disorder for any living under a rock) is at an all time high. I actually know 1 year old children with greater attention spans than mine. I can't concentrate on anything. Today alone, I have tried to study, tried to write a paper, tried to teach the medical students, tried to read a journal article, tried to read a newspaper article, and tried to listen attentively to my junior fellow's marital troubles - the only success I have had so far is to go completely out of my mind.

At least I am off this weekend, although I am not sure what I am going to do with myself. The way I see it I have two options. I can medicate myself into a deep coma and sleep the entire weekend, or find something to do that requires so much concentration to stay safe that I can actually distract myself from the thoughts swirling in my mind. I'll keep you posted.

Spring where are you?

Okay - mother nature has had her laugh. I survived a winter in Philadelphia. Something I might point out I have no desire to ever experience again. Therefore, I deserve my reward. SPRING. It doesn't have to be 80 and sunny. I would take 60's at this point. We reached a grand high today of 43F. Come on - it's mid march. It is time for this joke to be over. Don't even get me started on the wind. I know March is supposed to be windy, but this windy?

I don't even have promises of spring. No tree buds, no green grass, and not a daffodil in sight. Who would have ever thought I would think of 99F and 90% humidity as the good old days.

Bangs @!@#$

Any woman who has ever had bangs and decided to grow them out understands the above title. If you haven't today's post if probably not for you. I "tried" bangs for the first time about 5 years ago. I started slowly with long tapered bangs. I liked and decided to progress to full single length bangs when I moved here to Philly.

I really like them at first. I would probably like them better if I had less fine hair, but after 35 years I have almost made peace with my hair's texture. Of course, I can never make my hair look as good as it does the day I leave the hair salon. I think it is multi factorial, but mainly related to the time or lack there of that I am willing to invest in fixing my hair. I particularly like the fact that it hides my ginormous forehead and the large wrinkle I have developed there.

Why them would I decide to grow them out? Two words - OR hat. I spend most of my day with my hair pulled back and up in an OR hat. I actually have several cloth printed hats that I wear in the operating room (no surprise here that I found a way to shop for OR clothes.) Because I have fine hair, I have to wear a fairly tight hat to keep my hair out of sight. If I wear a loose bouffant hat, my hair slides out the sides. I challenge anyone with bangs to put on a very tight hat and wear it for 10-12 hours. Let me know how your bangs look when you pull it off. I have tried everything to keep them from coming out in 47 directions, but nothing works well.

Thus, I am growing my bangs out yet again. Most frustratingly, I had JUST grown out my bangs. If you are to scared to get your hair cut for 3 months, bangs tend to grow out. When I finally caved in and got a new cut, I was talked into bangs again. I am currently at the incredibly irritating part where they are way too long to be bangs and way too short to be side swept. I fix it most days by wearing a hat. Too bad that won't work for my interview. I doubt the all men that I am interviewing with will understand about growing out bangs. I just have to assume that they are men and probably won't notice.

Philly weight

No secret to anyone that has seen me the last 8 months, but Philly was not good for my waist line. I am only now willing to admit it (since I've fixed it), but I gained 25 lbs when I moved to Philly. Not good. At 5'2", I show 5 lbs up or down - I have absolutely no where to hide 25 lbs.

I am not sure exactly what happened, but I have a few ideas. I of course tried a cheese steak, but didn't love it. My bigger problem was telling myself as long as I didn't eat huge proportions that I could eat whatever I wanted. Therefore, a bagel every day for breakfast, slice of pizza for lunch, etc. etc. I also decided for some reason that the gym in the basement of the building in which I live was not convenient enough so I quit working out. Although I can not lie well to others, I seem to do it very well to myself.

When it got to where none of my clothes fit anymore, I finally started believing the scale. Not only could I not afford to buy new clothes, but I was unhappy with how sluggish I was feeling. I am very happy to report that as of this morning, I am back to my Nashville weight. I say my Nashville weight because I gained 10 lbs when I moved from Augusta to Nashville.

As an aside, moving seems to be a bad idea for my eating habits. I am not sure why, but hopefully I will now find a place to settle for a while. My weight can't afford all the ups and downs.

No stopping here, my goal is to end my Thoracic training at the same weight I started it. So 3 1/2 months and 10 lbs - got to keep working.

Sprung forward

Check back in next week when I am enjoying light until 8 pm, but as of today - I HATE daylight savings time. Of course, I am on call this weekend so no slow adjusting for me. Even worse, I am in house on call today - no one hour less call for me, just having to be here one hour earlier.

My patients also seem to not be fans. I can't say that I blame them. Who wants a doctor waking them up at what feels (and yesterday was) 5 am just to tell them they are doing well and get to spend another day in the hospital. Let us just say I didn't make fans this morning.

I have spent the rest of the day in the operating room opening a redo sternum and explanting BIVADS. The one good thing about call here - it reminds me each and every time why I am SO HAPPY that I picked thoracic over cardiac. Give me ruptured esophagus at 2 am any day of the week.

At least I am post tomorrow and it is still supposed to be gorgeous. I really need a mani/pedi before the job interview.

Following my mother's advice

I have been noticeably absent from my blog for the last couple of weeks. I have a good excuse. I was following my mother's advice. She actually did tell me as a child (on numerous occasions - I was a slow learner) that if you didn't have anything good to say it is best to keep quiet. Therefore, I have kept very quiet for the last few weeks. I have been in a funk, the likes of which I had never been in before, and am only just now emerging.

I would like to point to one single thing as the cause of my recent funk, but in all honesty it is multi factorial. There is of course the job, but I think several other factors not all of which I want to talk about also contributed. A big one has been the weather. It is not just the fact that it has been cold. As a matter of fact, I am quite proud of how well I have handled the cold. I whine about it, but have learned how to layer up and go about my business. I think it has more to do with the length of this winter. I have always claimed that I have seasonal affective disorder, but now I am starting to believe that I really might. Seasonal affective disorder is a recognized condition that causes some people to become depressed in times of less light (i.e. winter). It has something to do with melatonin release the details of which I never bothered to completely understand. It is a recognized illness, and my intent is by no means to make fun. I so get it.

Despite the recent snow storm back home which left my parents powerless for 3 days, spring has been in the air. My dad's biggest complaint about the snow was that his fruit trees were already blooming and he is now certain they will die. Friends and family back home have already started thinking about softball and lawn care. Grass is turning green and flowers are blooming. Sure it is occasionally still cold particularly in the morning, but the weather is turning and you can smell spring.

It has not been that way here. We still had snow banks from the prior snow when this one came through. My car has turned a permanent shade of gray from all the snow and salt. The trees are still very far from leaves and no flowers are blooming. The winter started early and is going forever! I never paid much attention to that weird groundhog until this year. Back home, regardless of shadows, you knew that by the end of February you would start to have some good spring like days. Maybe it is just because he is from here, but the groundhog seems to know what he is talking about here. At least that only means a little over a week left of winter.

Today the weather is actually "nice" by Philly standards. I also have a job interview in Little Rock. Perhaps a combination of these things have lifted my spirits. Regardless of the details, I am happy to be somewhat closer to my chipper self.

A.W.O.L.

I went a little nuts today. It is no surprise to anyone that I have been a little stressed out by this whole lack of a job come July thing. I have been trying the whole brave face thing, but my better demons definitely did not win today. I blame a slow day at work. We only had one case this morning, so my entire day was finished by 9 am. I should have finished a couple of chapters that I am writing, studied for my boards or read the stack of articles on my desk. Instead, I sat down at my desk and freaked out.

I made the mistake of looking at a calendar to see when I was next on call. I then realized that in 3 short days it would be March. In my head, I had plans to be filing for privileges at whatever hospital I had decided to grace with my presence. Instead, I still don't even have a solid lead on a job much less offers. I honestly felt that my head was going to explode.

As a diversion measure, I decided to call and schedule a massage. I had promised myself one as a diet reward. When I went to set a date, I asked when was the next available appointment. I was hoping for an opening this weekend. Imagine my shock when she said they had an unexpected opening today at 12:45. I didn't think twice - I took it.

Then I got really nuts. I left the hospital. I didn't talk to anybody, make sure things were covered, and nothing was going on with patients. I just left. Absent Without Official Leave. I did keep my phone with me, but usually would have put a lot more effort into being available and making sure everyone knew where I was.

It was exactly what I needed. I can actually shrug my shoulders again without a searing pain in my head (I carry my stress between my shoulder blades.) After the massage, I decided to continue the destressing with a little retail therapy. As I am still on a budget, and have no job, I only ended up with two purses on great sales, but I had a very nice time. I looked at two really adorable denim skirts that were very tempting. However, the idea of having to tell Kris that I bought another denim skirt was scarier than their prices so I left them both at the store.

All in all it was a nice break with reality. Now back to the drawing board for the job search.

Flashbacks!

There is one book almost guaranteed to make any person that has ever been to medical school pale. It is West's Respiratory Physiology. And yes, it is as boring as it sounds. It is also incredibly complicated and way over the head of almost any medical student that doesn't have a Physics degree. I recall too vividly the hours I spent trying to understand that book. I even had two versions, the "real" book and the essentials (basically the Cliff notes version). I couldn't make heads nor tails of either.

As we all know, respiratory physiology is somewhat important in my line of work. I have thought about rereading West's over the years, but the sinking feeling in the pit of my stomach wouldn't allow me to pick it up. However, I have a lecture tomorrow on Pulmonary Physiology. Therefore, I decided to conquer my fears and make peace with West's. Ten years have passed, and I like to think that I have matured and learned a lot in those years, but I still don't get this book. I mean really, wouldn't English have been a better language in which to write it? Okay, I will not let this book win - back to the beginning.

Sick and Single

Despite my occasional grumblings to the contrary (see Valentine's day), I actually still enjoy being single. I think to be a good girlfriend, wife and/or mother requires a certain amount of selflessness. The ability to inconvenience yourself for the convenience of others - all the time. I am not even close to there. I am not even in the same zip code. I hope to be there some day, but I am able to recognize that I am not yet. A part of me still secretly becomes frustrated when my friends can't "come out and play" at the last minute. Stories of spouses being late from work, dinner needing to be prepared and children needing around the clock supervision confound me. Don't get me wrong, I understand the irony. I have the worst job on the planet for making plans, but who is surprised that I want my cake and the ability to eat it too.

That being said (and hopefully not alienating all of my friends) - I HATE being single and sick. The odd thing - I am not looking for someone to "take care of me." I get quite pathetic and grumpy when I am sick and should best be left to my own devices. I hate being sick and single because there is no one to call the ambulance. Perhaps it is knowing too much, over thinking, or I concede I am just nuts, but every time I am sick at some point I convince myself that I am dying. I actually go so far as to figure out how it is going to happen. My imagination can then picture my decaying body alone in my apartment for days before anyone even realizes that I am dead. (I admit a certain inclination for dramatization.) The only thing missing is the cats (sorry - still don't like cats even if they would work well for the scene.)

Needless to say, I am feeling better. At least no longer convinced that I am dying. Back at work today although because I am truly feeling better or was becoming bored out of my mind at home I can't honestly say.

Felled by the flu

It started yesterday afternoon. I had been sitting on the couch for most of the day watching television. I had a whole list of things I needed to be doing, but couldn't get the energy to do any of them. I was wrapped up in several blankets and had the temperature turned up to 75 degrees, but still couldn't get warm. Then, the fevers started. Next the body aches. By this morning, even my toenails hurt. It felt as if I had been run over by a bus.

As much as it kills me to admit it, I am fairly certain that I have the flu. I had it once before (my fourth year of medical school). Since that time, I have been very careful to get my flu shot each year. If you have never had the flu, I can't say that I recommend it. It mostly feels like an enormous effort is needed to just breathe. The shot has worked until this year. Ironically, this is one of the "good" years - where the shot actually covers the flu strains that are out there. So much for modern medicine.

Cupid

Did I ever mention that I am not a huge fan of strange child like creatures that walk around with bows and arrows? I mean - that can't be safe. What about the whole putting an eye out thing? What type of message are we sending to children? Okay, perhaps I am just a bit bitter today - Valentine's day - that I am spending alone in a cold city with no one to snuggle up against. Will hopefully be better tomorrow.

Nuts!

I have always been a big nuts person. Notice that I did not say that I have always been a bit nutty, although that point is probably debatable. I love nuts of any kind. My favorite is probably cashews, but it doesn't top the list by much. I even recently learned that I even like Chestnuts (which I personally don't think technically qualify as a nut, but I digress). I had never given it much thought until the recent peanut recall.

I had only caught snippets of the recall. A short snippet on CNN or on the computer. However, Monday as I sat down at my desk to have a snack, I became more interested. I tend to keep protein bars in my desk for snacks and quick meals when I am having a busy day. I have a low boredom threshold as we all know so I tend to keep a variety. As I pulled out my Luna "Nutz over Chocolate" bar Monday, I had a brief thought about the peanut call. I am not sure why, but am so glad I did. I decided that it would be smart to make sure that my "healthy" snack wasn't going to give me Salmonella.

Good thing that I looked. Not only was that brand part of the recall, the particular lot that I had was thought to be potentially contaminated. So much for my snack. I then proceeded to look through my work stash. Every single bar that I had in my desk contained nuts and was on the list! Since I have been eating on these bars for a while, a part of me rationalized that they were probably okay. Then saneness took over and I tossed them all in the trash - better safe than infected. When I got home yesterday post call, I decided to go through my pantry and throw out anything that was "on the list". I had quite a few items. Turns out I am a sucker for anything with a nut flavor. Just happy that I didn't end up getting sick. Time to try the Lemon Zest bars.

Genetics?

I enjoyed genetics in school. It all seems relatively simple. You have two parents that each contribute one gene to each trait. On the surface, it even seems to work. My brown eyed dad and blue eyed mom have one child with brown eyes and one with blue. Of course, my sister somehow got my dad's long eyelashes to go with my mom's blue eyes, but I'm not too bitter. It would seem that we should all be a perfect combination of our parents. I may have gotten my dad's eyes and the "Baxter" round face, but anyone that has ever seen pics of my mom at my age will agree that all the rest of my features come from her. I also am 4 inches shorter than my nearest in height parent - where are the genetics there. And don't even get me started on how my friends Kris and Bassam have a blue-eyed son or a red haired daughter!

This whole genetic rumination started today in the gym. I have decided that I have a congenital absence of deltoids. I have pretty good upper body strength. It is a combination of having to position patients at work, and preferring upper body workouts over lower body ones (what seriously depraved person invented the squat?). However, I have never had strong deltoids. I can complete full sets of curls with 15lb weights, bench press 50 lbs, but I am still doing 5lb military presses and struggling. We won't even discuss my poor lateral raises. Is it possible that I was born without the requisite triad of muscles that make up ones shoulder? I watch TV and salivate over Kelly Ripa's delts and one of my favorite movie scenes is the dance in American President - Annette Benning's shoulders are to die for. It is even more frustrating to read everywhere about how the deltoids are the "easiest" upper body to build. On what planet?

Sorry, but I am no longer convinced that Gregory Mendel guy had a clue.

Catch Up

Sorry - don't worry I didn't freak out about the 10 year thing and go crazy. (Okay, I did kind of freak out, but that isn't why I haven't blogged, and I would argue that I went crazy years ago. ) Life just got a lot busy, and I have been spending time learning lessons.

Lesson: Snow has good and bad points. Allow me to explain. It had snowed here several times already - at least by my definition. You have to remember that back in Georgia snow flurries if only seen briefly by a street lamp constitute a snow storm. The 3 or 4 snow "dustings" that we had gotten here already certainly qualified as snow in my book - at least they did. Wednesday last week, my definition changed. The word started spreading late Tuesday. Snow was coming - the real kind. Not exactly sure what to expect, I set my alarm clock early so that I would have extra time.

When I woke up that Wednesday the entire world was white. We had received 6-8 inches of snow - OVERNIGHT!. Needless to say this was an entirely new experience for me. I had unfortunately parked my car the night before on the roof of my parking deck, so I got to start by pushing snow off my car. After a treacherous drive in - Georgia drivers should not be allowed on Philly streets in snow - we had a fairly busy day. I had expected none of our patients to show. The roads were much clearer for the drive home, and then it got COLD. We didn't see a day out of the 20's until this past Tuesday. The snow melted a little and then overnight we got 2-4 more inches.

Freshly fallen snow is quite beautiful, and there is something breathtaking about looking out over a city or old university covered in snow. It also is warmer when it snows. The really cold weather seems to come right before or after. Besides the obvious driving issues, snow just gets very messy. Grey slush on the streets and sidewalks is not attractive. Snow bluffs covered in debris also not attractive.

Lesson: High School Students are "special". I was on call last Thursday (as I am this Thursday), and it was a truly horrific night. Up the entire night save about twenty minutes with patients trying to actively die. As part of my new volunteering kick, I had agreed to speak to a group of high school students in a Medical Occupations class on Friday. I went with one of our OR nurses who happened to have a daughter in the class. Not to pat myself of the back or anything, but I do fairly well sans sleep up to a point. The students came very close to that point.

The first part of the class was harmless enough. We simply introduced ourselves, and talked a little bit about what we do and how we came about doing it. Then we opened the room up to questions. Most of them were pretty predictable and standard, but there was one girl who was way out in left field. Her first question to me (I guess as a warm up) was about my accent. I had already admitted to being from Georgia, and had even commented that this was my first "real" winter. Her question was how did I turn my accent on and off and when did I decide to do so. Huh?

I wasn't even sure how to answer, and then they got worse. I had been asked about how I decided to become a surgeon. I told a story of "my" first case as a medical student. It was a butt abscess in an HIV patient, but I loved it. The question that I was then asked by the left fielder - "Do you think that it makes you disturbed to like to cut people?" This was then followed by a question regarding dealing with the "arrogance of surgeons." I gave laughing answers, and then made a point to ignore her hand for the rest of the time. Give me homeless people any day over high school students.

Lesson: Money is not everything. Bet you never thought you would hear me say that statement. Last weekend I had the opportunity to pick up a couple of NP shifts in the cardiac surgery ICU. I thought, how hard can that be? They write a few orders, pull a few tubes and transfer patients to the floor. . . plus it payed $100/hr. The plan was 6 hours on Saturday and 4-6 hours on Sunday. Reality was 11 hrs on Saturday and 13 hrs on Sunday.

Turns out when you moonlight in your own facility, they don't buy the whole "I'm just the NP" argument. We also had a unit that the wheels had fallen off of. They had 5 cardiac rooms running last Friday night with emergencies. They all were still incredibly sick on Saturday and a whole new group got sick on Sunday. I have never worked harder in my life, and that includes during my internship. I made a ton of dough, but it was no where close to worth it. I may feel differently when I actually see the money and have had more time to recover, but I am not certain.

Lesson: Be careful what you ask for. I had complained recently that we weren't doing enough cases. Well, this week fixed my little red wagon. I have pretty much gone home each night, crawled into bed and woke up 6 hours later to come back in to work. I am post call tomorrow and have the weekend off. I currently plan to sleep for a good portion of it. Time not asleep may very well see me on the couch imitating a potato. I will happily guarantee that nothing productive will come from this weekend.

Well, I think that is the majority of my lessons. I am long winded as usual, but what else is new. I will leave you with this really cool quote I found in a magazine recently.

"Finish each day and be done with it. You have done what you could. Some absurdities have crept in; forget them as soon as you can. Tomorrow is a new day. You shall begin it serenely and with . . high a spirit."

Yikes!

Isn't it amazing how one simple letter can change your whole day? I came home from a relatively painless day at work, and checked my mail. Not unusual, I had a letter from Emory Alumni. I assumed they were asking for money as usual - I wish!

No, instead of asking for a few thousand dollars (which would have been less painful) - they wanted to invite me for my 10 year reunion. Not mind you my ten 10 college reunion - MY 10 YEAR MEDICAL SCHOOL REUNION!

I can't believe I finished medical school 10 years ago. I know it sometimes feels like a lifetime, but I tell myself that is just from the lack of sleep. According to my letter today, it was an ACTUAL lifetime ago.

Most depressing - I still don't have a "real" job. I'm going to bed and pulling the covers over my head.

Wilted!

I love this picture - it is so perfect for how I feel today. I am not sure it photographs that well, but I bought these beautiful flowers at Trader Joe's. It has become my new thing to buy flowers for myself each Friday. When I bought these, the daisies were of course not wilted. They were incredibly cheerful and energetic looking daisies. That was Friday. Today when I came home from work they looked exactly like this. I couldn't help but to burst out laughing. These flowers somehow had the same weekend that I did - I don't recall seeing them at the hospital, but they certainly look like they were there.

I drank the Kool-Aid

So for several years now, I have tried to convince myself that I was different. (I know that I am definitely unique, but I mean something else.) I have told myself that I am not the "typical" Thoracic surgeon (for this blog Thoracic includes both heart and lungs). As a specialty, we are often admired and respected, but not the ones that you are buddies with. I arrogantly believed that I was wasn't like them.

Today I found out differently. I was given the "opportunity" to go to a Medical Oncology national meeting being held here in Philly. Today's topic was the treatment of lung and esophageal cancer - so of interest to me. National association meetings are unique experiences. I can still recall my first trip the the American College of Surgery. Today was my first opportunity to see how the Medicine guys did it - let's just say differently.

Thoracic surgery meetings are funny to me. If you put a lot of Thoracic surgeons in a room, you are guaranteed a lively debate (if not a true fight), lots of arrogant bragging and an incredibly formal proceeding. For the meeting itself, everyone in the room will be in a black or dark blue business suit - including the women (few that they are). I wore dark green once and stood out like a sore thumb. For the evening events that call for casual - no blue jeans or dockers for us. Mean wear dress pants with a sports coat - tie still a necessity. Women wear nice pants/skirt with twinset or other equally formal top.

Although we think nothing of calling each other out during presentations, the rest of the conference has a very polite, but formal air about it. He may call you an idiot trying to kill people during your presentation, but will be smiling and telling you about a similar case that he had during the break. It is all about being seen and heard. You have to "play the political game". All conversations involve some topic that is being presented or relevant to the specialty. No small talk here.

Food is always plentiful, and coffee until noon and alcohol in the evenings is a must. The prime seating in the room is always the back rows. I think mostly because no one stays seated for long, too much ADD in the room. People freely wander around the back of the room and play on their Blackberries. Anyone feels comfortable interrupting the speaker at anytime for questions or comments.

This is my comfort zone. These are the things that I am used too. This is not how the medicine people do it - by a long shot. I show up in my suit (which I can finally fit into again), and am one of the few. The only others were all my Thoracic surgery colleagues. There were people in blue jeans - they don't even let our technical staff wear blue jeans. People quickly filed into the conference room and took their seats near the front. No one had to come out to the buffet and threaten people to come inside so we could get started. During presentations, no one spoke or got up or played on their phones. People only asked easy questions, and never openly disagreed with the presenters. During breaks, conversations were about children, sports and vacations. I felt like I was on Mars. Turns out I am much more of a Thoracic surgeon than I thought because it all felt wrong. Turns out I like formality and inattention and contention - it makes things interesting.

The content of the conference was okay. It reinforced what I already know. Medicine guys spend way to much time thinking about things that don't seem to make much difference in the long run. All I can say is pour me another glass. Turns out the Thoracic Kool-aid tastes pretty sweet to me.

Academic days

In Academic medicine (doctors who practice at teaching institutions) there is something known as an "academic" day. For surgeons, it is a day where you don't operate or have clinic. The time is supposed to be used for academic pursuits - i.e. bench research, paper writing or other administrative issues. Of course the residents don't get these, but the attendings seem to enjoy them immensely. Yesterday I took my first ever Academic day.

We had no cases yesterday - not sure why, but it just worked out that way. Therefore, I decided it was a waste of time to even come into the hospital. (The second year resident was on call and had to be here anyway.) Now you are probably thinking - great, she finally wrote that paper and finished those two book chapters she has been complaining about - well you would be wrong. My academic day consisted mostly of grooming with a little inauguration thrown in.

I got up at regular time and went to the gym. Turns out that there is actually a decent number of people at the gym starting around 6 am. I showered and had breakfast. By then the inauguration was starting to get interesting so I spent the next 3 hours sitting on my couch. . . tears streaming down my face at times. (It was in my opinion a fantastic ceremony. I am so excited to be living in this Country at this Time.) I had a hair appointment at two which took 3 hours, but the good news is that I actually like it. No horror stories like last time. I went to a real salon. The hairdresser thought it was hilarious that I had been so traumatized that I had not had a haircut in 5 months. I followed the new do with nails and finally trimmed up that uni brow problem. By now it was 6:30. Guys just don't understand how time consuming grooming can actually be.

I actually did participate in some academic pursuits - we had journal club. Sitting around eating shrimp while several "famous" cardiac surgeons yell at each other is actually quite fun. I would highly recommend it. All in all I got a new President, hair cut and nails out of the day. I would say it was a very productive day for "academics".

Trouble with expectations

Why do I even bother? I make all these fabulous plans for my post call day, and fate always intervenes. Since you haven't heard from me since Wednesday, you can assume life has not been normal. My transplant Wednesday night actually went fairly well. We finished by 1 am so I foolishly thought - I'm going to get a couple of hours of sleep. I tucked him into the unit, made some quick rounds on the floor and was heading to the call room.

Didn't even make it past the door when I got called for a consult to the MICU. Can I just go on record as to how much I hate the MICU. For some reason, to work in the MICU you have to forget everything that you ever learned in medical school, and spend all of your time trying to figure out how to get surgery involved in your patient's care. As a cardiothoracic surgeon, I am usually protected, but not always. The incredibly frustrating part is that it was a ridiculous consult. I spent one hour trying to nicely explain to the intern, resident, fellow and ultimately attending why it was a ridiculous consult. At 3:30, as I saw my chances of sleep slipping away I became progressively less nice. I don't think I actually called the attending stupid to his face, but I did imply that he had no knowledge about that to which he was speaking.

I finally convinced them that I probably understood ECMO better than they and let the MICU. This time I actually made it into the call room, and had actually crawled into bed. I hadn't quite closed my eyes when my phone went off again. Type A aortic dissection being flow directly to the operating room. Needless to say that sucked up the rest of my night, and a good portion of my morning.

When I finally walked into my house Thursday, I crashed straight into bed. I didn't even shower first which I never do, but I was afraid I would fall asleep in the shower. I woke up briefly for an early dinner, and then fell right back asleep. I accomplished absolutely nothing on my list - not one single thing. Friday after work I ran to the grocery store. My plan was oil change on Saturday and grooming on Sunday. I made it to my car on Saturday, but unfortunately not much further. The President-elect was in town, and traffic was a nightmare. I grew frustrated and went back home. Sunday there was snow on the ground so I decided I could live with my unibrow for a little longer.

If you are keeping track - 1 for 7.

Post Call Days

I am on call today - so you might be wondering why I titled this blog post call day. The reason - post call days are the only thing that gets me through the call these days.

I am SO sick of call. I understand that I will be "on call" for the rest of my life. However, I only have 5 1/2 more months of in house call. In house call, for those who haven't had the joy of experiencing it, means that you come in one morning and go home the next day. You literally spend the night in the hospital taking care of the patients. I thought I had finally out ranked in house call after my second year at Vanderbilt, but they still do it here. Call nights are usually busy, but even the quiet ones are not restful. It is like standing under a guillotine waiting on the blade to fall.

Tonight is not a quiet call night. I am currently waiting on a pair of lungs to show up for transplant. In the meantime, we have 28 patients in the CTICU, 68 pts on the cardiac floor and my own thoracic patients. Unfortunately, I have never even met the cardiac surgeon that I am transplanting with tonight. He normally works at a different hospital and rarely takes call here - until tonight our paths have never crossed. This adds a little extra anxiety to the case because I have no idea how he "does things" so it is learning on your feet.

The one thing that makes tonight bearable is knowing tomorrow is my post call day. Prior to the 80 hour work rule restrictions, that statement didn't mean very much. You worked just as hard your post call day as you did any other day. However, the restrictions have been good for something. It is now federally mandated (so we do it most of the time) that we go home before noon the day after our call day. This may not sound like much to you, but this is a whole 6-10 hours of the day that I normally don't have to act like a normal person.

And boy do I have plans. The list of things that I would like to accomplish tomorrow is incredibly long - it always is. What will actually accomplish often depends on how bad the call night becomes. If I can pull off a couple of hours sleep, I am hoping for a mail run, Target run, oil change and pedicure/brow wax. If I get no sleep, I should go for the oil change, but will probably whittle down to the brow wax and pedicure (girl has to have her priorities).

Here's dreaming of post call days.

New Appreciation

So almost every day of my operative life, I injure the lattismus dorsi muscle in some way. I either move it out of the way of my axillary thoracotomy or plough right through it for every other thoracotomy. Of course these are the lats on other people (my patients precisely). Yesterday as I mentioned, I worked out my upper body for the first time in . . . well forever. This evening, my lats HATE me.

It is not that a little soreness feels good because you know you worked out thing. It is my arms can't be raised higher than waist height. I should be concerned about driving home. However my biggest concern is that I still have to go close a chest. I did a sternotomy so that ENT could take out a big thyroid cancer. Putting the sternum back together is mostly about technique, but some chest strength is required. I am going to be embarrassed if I have to ask the ENT resident to push a wire thru the sternum for me.

According to my schedule, I am supposed to work out lower body tonight. We will see what time I get home. I am on call tomorrow so should really suck it up and go regardless, but should and will are not always the same for me. Oh well, off to try to close a chest.

What was I thinking?

Back at my fittest, Jill had talked (bullied - semantics) me into lifting weights. I never learned to like the abs or glut exercises, but really enjoyed the arm exercises. I also enjoyed the results. I had truly toned arms and really enjoyed wearing sleeveless shirts for the first time ever. Like many other aspects of my fitness, I had let the weights go.

As part of my New Year's resolutions, I wanted to reclaim them. I had already restarted the eating well and cardio, but wanted to reclaim the toning. I am trying to figure a way for Jill to quit her general surgery training (I mean come on - she is in the last year - what else does she need to know?), and move here to train me. She is without a doubt the best work-out partner I have ever had. She completely kicked my butt, and never let me wimp out or get away with any BS. However, until I can make those arrangements, I started retraining on my own.

Did I mention that I started today? I did upper body. You know how they say the soreness doesn't kick in for 24-48 hours? - that has me VERY scared. My arms are so tired that I could barely lift my arms to shampoo my hair just now. We won't even talk about how poorly I shaved my pits. I am seriously nervous that I may not be able to move my arms by this time tomorrow. Stay tuned.