- In the September 22 edition of The Economist I ran across a review of Alan Greenspan's new book The Age of Turbulence: Adventures in a New World. Evidently, not everyone would naturally look forward to encountering this 530-page tome: ...nobody ever accused Mr Greenspan of being a lively speaker, let alone a born storyteller, and no reviewer could approach this volume with anything but a heavy heart and a sense of duty.
- From the same review, Who would have guessed that 500 pages in Mr Greenspan's company could slip by so easily?
- And finally, reading in amNewYork I ran across an article about possible subway fare hikes by the MTA. Obviously, most riders are opposed, and there were public hearings provided for them as a forum heard by the MTA board. Some, however, doubted the efficacy of their testimony in convincing the board and yet chose to testify: "I told my co-workers about it [the public hearing], and they said it was like spitting in the wind," said Sahre Davis, a receptionist and community college student from Greenpoint who also testified at a hearing. "I'd rather spit, because I know it will land somewhere."
Monday, November 19, 2007
Three delightful findings
Every day, no matter how much I'd like to forget it, has its bright spots, like getting to enjoy the snow flurries through the window this morning for about 5 seconds. Here are a few more from today:
Day of stress
I'm not a big fan of days like today. Not only was it the first day of a new rotation for me (obstetrical anesthesia), but it was also my first day back from a two-week vacation. This is the first time I've had more than one week off at a time since I graduated from medical school. The longer break was nice, but I knew it would be tough coming back to work.
It was tough to get out of bed to hit "snooze" on my cell phone at 0450. It was tough to go back to sleep, so I just got up after lying there a few minutes. It was tough to stay warm at the outdoor 125th Street station as I waited 30 minutes for the 0539 train which never came. It was tough to change in the locker room since I'd forgotten my combination. (All I could remember was Uncle Paul and Aunt Betty's shed's combination. That'll teach me to offer to rake the yard!)
And then I showed up to the labor and delivery floor where the stars, misaligned as they were, had three--and only three--anesthesia residents showing up for their first day of OB anesthesia. My assignment was the toughest, at least from my perspective. As the resident covering labor and delivery, I received any calls from the OB residents requesting epidurals, evaluated patients for epidurals, placed epidurals, and followed up on epidural patients. (Notice a theme?) I was also the first person called for emergency c-sections, which I would then coordinate with the residents covering the OB OR's. Then there were follow-ups from the day before, and the ordinary confusion of learning new paper work systems, new places to get medications, new kinds of medications, new mazes of corridors and rooms, new nurses' names, new obstretricians' names, and different ways of documentation.
And finally, placing my first few epidurals in OB was not a small source of stress. I'd only placed 4 or 5 epidurals before, and the technique is trickier than doing a spinal since a catheter has to be threaded. In addition, there is the constant danger of pushing just a millimeter too far and puncturing the dura with a large-bore needle (a "wet-tap," colloquially), leading to a severe headache for the patient, frustration for my attending, and embarrassment for me.
While placing an epidural in one particularly obese patient on whom I had trouble locating any landmarks, I thought my needle might be against bone at one point of the procedure. "Just a little more pressure," I thought. With that, the needle leapt through the rather crunchy ligament its tip had been buried in and landed a few millimeters deeper. The tension emanating from my attending who was standing at my side was palpable. I withdrew the stylet...no gush of cerebral spinal fluid! The stars had shifted, Fortuna's wheel was spinning, the Fates smiled upon me. The needle was in the perfect place. I wasted no time in threading the catheter and getting out of there!
I was mentally exhausted by the time I walked in my apartment at 1700. Even though I'd only worked a little over nine hours, the constant multi-tasking and the newness of it all was draining. Given that most people really like their OB anesthesia experience, and given that most of the stress was learning the new system, I think things will get much better quickly. Before long, things will probably take half as long as they did today. We shall see by the end of the month how my perspective has changed on OB anesthesia.
It was tough to get out of bed to hit "snooze" on my cell phone at 0450. It was tough to go back to sleep, so I just got up after lying there a few minutes. It was tough to stay warm at the outdoor 125th Street station as I waited 30 minutes for the 0539 train which never came. It was tough to change in the locker room since I'd forgotten my combination. (All I could remember was Uncle Paul and Aunt Betty's shed's combination. That'll teach me to offer to rake the yard!)
And then I showed up to the labor and delivery floor where the stars, misaligned as they were, had three--and only three--anesthesia residents showing up for their first day of OB anesthesia. My assignment was the toughest, at least from my perspective. As the resident covering labor and delivery, I received any calls from the OB residents requesting epidurals, evaluated patients for epidurals, placed epidurals, and followed up on epidural patients. (Notice a theme?) I was also the first person called for emergency c-sections, which I would then coordinate with the residents covering the OB OR's. Then there were follow-ups from the day before, and the ordinary confusion of learning new paper work systems, new places to get medications, new kinds of medications, new mazes of corridors and rooms, new nurses' names, new obstretricians' names, and different ways of documentation.
And finally, placing my first few epidurals in OB was not a small source of stress. I'd only placed 4 or 5 epidurals before, and the technique is trickier than doing a spinal since a catheter has to be threaded. In addition, there is the constant danger of pushing just a millimeter too far and puncturing the dura with a large-bore needle (a "wet-tap," colloquially), leading to a severe headache for the patient, frustration for my attending, and embarrassment for me.
While placing an epidural in one particularly obese patient on whom I had trouble locating any landmarks, I thought my needle might be against bone at one point of the procedure. "Just a little more pressure," I thought. With that, the needle leapt through the rather crunchy ligament its tip had been buried in and landed a few millimeters deeper. The tension emanating from my attending who was standing at my side was palpable. I withdrew the stylet...no gush of cerebral spinal fluid! The stars had shifted, Fortuna's wheel was spinning, the Fates smiled upon me. The needle was in the perfect place. I wasted no time in threading the catheter and getting out of there!
I was mentally exhausted by the time I walked in my apartment at 1700. Even though I'd only worked a little over nine hours, the constant multi-tasking and the newness of it all was draining. Given that most people really like their OB anesthesia experience, and given that most of the stress was learning the new system, I think things will get much better quickly. Before long, things will probably take half as long as they did today. We shall see by the end of the month how my perspective has changed on OB anesthesia.
Monday, October 29, 2007
The marathon completed!
So the marathon is over! Last weekend was a good one. I got several hours' sleep on call Friday night, and by 0900 Saturday I was heading to Midtown to catch the Chinatown bus to Washington DC. (The Chinatown bus enterprise has expanded to include departures from Midtown which is much more convenient for me.)
It's always an experience to ride these buses, which provide a $35 round trip between NYC and DC. One looks for a small crowd of people with bags (usually six or eight people if one arrives ten minutes early) waiting on a streetcorner. It's important to verify with at least two others who speak English that all are waiting for the same bus. At the appointed time, or even a few minutes early, a white, generally unmarked bus will round the corner. At this point, people come out of the woodwork to fill the bus. I'm always impressed with how a group of ten people expands to sixty when the bus pulls up!
On arriving to DC after a thankfully uneventful trip, I descended to the Chinatown Metro station and stood a few minutes baffled by the array of ticket choices. It seems one pays based on the distance traveled, rather than a flat fare as in New York. It's necessary to save the ticket to exit the Metro as well. I decided on the all-day pass for $6.50 and walked to my train.
The Metro, I must say, was eerily clean and quiet. It reminds me much more of London's Underground than of the Metro system's older domestic cousin a couple hundred miles to the north. The trains glide up to the platform as soft red lights flash along the edge, warning the absent-minded straphanger stand back for the approach. The stations feature huge barrel-vaulted ceilings reminiscent of New York's 168th Street station, only newer, cleaner, and starker. On board the carpeted train, I saw two people, at once, stand and insist that a woman with a toddler take their seats. (Have I changed so much after 16 months in the city? Have I grown so callous, so aloof? My feeling is that if there is as little as one open seat in the car, the young mother can take that one and seat the child on her lap. No reason to give up MY seat!)
Alison lives off the Cleveland Park stop on "The Red Line." I was amused hearing the locals call the lines by their respective colors on the Metro map. In New York, tourists are easy to spot as they wrestle with maps in blustery Midtown, ride pedicabs through Central Park, or career* through the streets on double-decker buses. But an even surer way of being nailed as a tourist is to call the 1 Train, "The Red Line," or refer to the 4,5,6 subway as "The Green Line." Silly Washingtonians! To be fair, I guess they have no need to differentiate between express and local lines.
Alison's neighborhood was charming. She lives in a four story renovated building just a couple blocks from the Metro stop. The walk their takes one past cafes with sidewalk seating and an old two-story firehouse. She parks her silver convertable Mini Cooper in a dilapidated brick stall off the alley, and her granite-countered, wood-floored apartment is home to two cats, one if which is probably the fattest I've seen.
I left my bag at Alison's before meeting up with Adam & Ashley, and friends Ernest and Sharon back downtown. We rode to Ernest and Sharon's house in Arlington where we rested for the afternoon. Adam, Ashley, and I watched college football and dozed in front of the TV while Ernest and Sharon attended a Halloween party. Since it got late, I crashed on the living room couch for the night rather than spend an hour trying to get back to Alison's.
The alarm clocks rang early the next morning! We parked near the Pentagon and joined the throngs of runners and well-wishers in the march around the gigantic building under the cool, pre-dawn sky. After a long wait for the porta-potty and a generous application of anti-chafing lube, Adam was ready to begin.
Adam and Ashley before the race.
Adam and his cheering section. From left, Sharon, Ernest, Ashley, Adam, and Jonathan.
The starting line. It took at least fifteen or twenty minutes for all the runners to pass through!
The first stretch!
It's always an experience to ride these buses, which provide a $35 round trip between NYC and DC. One looks for a small crowd of people with bags (usually six or eight people if one arrives ten minutes early) waiting on a streetcorner. It's important to verify with at least two others who speak English that all are waiting for the same bus. At the appointed time, or even a few minutes early, a white, generally unmarked bus will round the corner. At this point, people come out of the woodwork to fill the bus. I'm always impressed with how a group of ten people expands to sixty when the bus pulls up!
On arriving to DC after a thankfully uneventful trip, I descended to the Chinatown Metro station and stood a few minutes baffled by the array of ticket choices. It seems one pays based on the distance traveled, rather than a flat fare as in New York. It's necessary to save the ticket to exit the Metro as well. I decided on the all-day pass for $6.50 and walked to my train.
The Metro, I must say, was eerily clean and quiet. It reminds me much more of London's Underground than of the Metro system's older domestic cousin a couple hundred miles to the north. The trains glide up to the platform as soft red lights flash along the edge, warning the absent-minded straphanger stand back for the approach. The stations feature huge barrel-vaulted ceilings reminiscent of New York's 168th Street station, only newer, cleaner, and starker. On board the carpeted train, I saw two people, at once, stand and insist that a woman with a toddler take their seats. (Have I changed so much after 16 months in the city? Have I grown so callous, so aloof? My feeling is that if there is as little as one open seat in the car, the young mother can take that one and seat the child on her lap. No reason to give up MY seat!)
Alison lives off the Cleveland Park stop on "The Red Line." I was amused hearing the locals call the lines by their respective colors on the Metro map. In New York, tourists are easy to spot as they wrestle with maps in blustery Midtown, ride pedicabs through Central Park, or career* through the streets on double-decker buses. But an even surer way of being nailed as a tourist is to call the 1 Train, "The Red Line," or refer to the 4,5,6 subway as "The Green Line." Silly Washingtonians! To be fair, I guess they have no need to differentiate between express and local lines.
Alison's neighborhood was charming. She lives in a four story renovated building just a couple blocks from the Metro stop. The walk their takes one past cafes with sidewalk seating and an old two-story firehouse. She parks her silver convertable Mini Cooper in a dilapidated brick stall off the alley, and her granite-countered, wood-floored apartment is home to two cats, one if which is probably the fattest I've seen.
I left my bag at Alison's before meeting up with Adam & Ashley, and friends Ernest and Sharon back downtown. We rode to Ernest and Sharon's house in Arlington where we rested for the afternoon. Adam, Ashley, and I watched college football and dozed in front of the TV while Ernest and Sharon attended a Halloween party. Since it got late, I crashed on the living room couch for the night rather than spend an hour trying to get back to Alison's.
The alarm clocks rang early the next morning! We parked near the Pentagon and joined the throngs of runners and well-wishers in the march around the gigantic building under the cool, pre-dawn sky. After a long wait for the porta-potty and a generous application of anti-chafing lube, Adam was ready to begin.
Adam and Ashley before the race.
We waited for Adam at mile 9, but somehow all four of us missed him! And that, in spite of real-time tracking available online: Adam's dad would call Ashley periodically with updates; the service also will text-message cell phones with updates on the runners' progress. Sadly, we weren't able to see Adam again until the finish line. Here's his final approach:
Wearing a medal proudly!
I didn't have too much time to hang out afterward; the others dropped me off in Chinatown for me to catch the bus back. As I waited, I ran into Becky and Carolyn, two friends from Baylor who both then went to church with me in Dallas. Becky lives in Washington now, and Carolyn was up visiting her.
It was a fun, but tiring, weekend. I arrived at my 125th Street station around 2200. It was somehow comforting to be back to the density, the noise, the dirty, screeching subways, and the cool night air of New York City.
Congratulations, Adam!
Saturday, October 27, 2007
The Marine Corps Marathon
Most of my regular readers know that I've been training for the Marine Corps Marathon for several months. The big day is Sunday, October 28, in Washington DC.
I'll be there, but I won't be running. Since I've been out of the world of blogging lately, I haven't had a chance to update the blog about my knee injury sustained in late August. I went out for a 12 mile run one Saturday and felt fatigued throughout the entire run. I also noticed my hamstrings seemd a little tight.
After only 6 miles, I was feeling so fatigued that I cut the run short, and around that time I noticed a little aching in my knee. "Nothing to worry about," I thought. "A little ice and ibuprofen will take care of everything."
Not so. The pain got worse, and for the next few days my knee hurt with nearly every step. I took two weeks off and then ran another short 6 mile run on a soft surface, and the same thing happened.
Given that I'd had knee problems five years ago, I decided it was wisest to bail on the marathon, which was fairly disappointing given that I'd come so far. My long runs were up to 16 miles, and I was beginning to consider a brisk 8-mile run "short."
I attribute the knee injury to less than ideal training leading to inflammation. I was working in the ICU at the time, and I'd been doing long runs on the weekends without doing as many short runs during the week since I was so busy. The key to successful training, however, is a gradual buildup in both long run mileage as well as total weekly mileage. Perhaps since I wasn't giving my joints the mild stress of short runs during the week, I didn't benefit from the strengthening they would have provided and therefore became injured when I attempted my longer runs.
In any case, my medical school friend Adam is now in Washington DC from Texas to run the marathon, so his wife Ashley and I will cheer him on! Most immediately, I have to pack after a night on call and make it to the Chinatown bus pickup spot in Midtown in the next 45 minutes!
Friday, October 26, 2007
Mavis' birthday
On Saturday, October 20th, a few friends and I drove an hour upstate to Bear Mountain for a picnic and hiking trip in celebration of Mavis' 29th birthday. The weather was perfect, the sky sunny, and the leaves were just starting to change.
Here's a picture of the five of us that climbed into Mavis' little Corolla for the day: Jonathan, Gloria, Mavis, Mauricio, and Clay.
A view from close to the top. Strangely my first thought was that if this were the view from Washington Heights, about how far away would the Empire State Building be?
Looking down at the park area where we first arrived. We picnicked by the small lake in the lower left-hand side of the picture. Nearby was a German festival. The river flowing from left to right in the picture is the Hudson.
On the way down, we noticed 4 or 5 deer that seemed to let us get very close. This one was looking directly at me, but then turned her hed just as I snapped the picture. She must think she looks better in profile.
Here's a picture of the five of us that climbed into Mavis' little Corolla for the day: Jonathan, Gloria, Mavis, Mauricio, and Clay.
A view from close to the top. Strangely my first thought was that if this were the view from Washington Heights, about how far away would the Empire State Building be?
Looking down at the park area where we first arrived. We picnicked by the small lake in the lower left-hand side of the picture. Nearby was a German festival. The river flowing from left to right in the picture is the Hudson.
On the way down, we noticed 4 or 5 deer that seemed to let us get very close. This one was looking directly at me, but then turned her hed just as I snapped the picture. She must think she looks better in profile.
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