My Ramblings

These days...

noreply@blogger.com (piotrrcola) — Wed, 20 Nov 2013 18:16:00 +0000

I text people like "yo I"m off until 130pm then I gotta stick a gigantic needle into someone's back"

Hospitals are not hotels

noreply@blogger.com (piotrrcola) — Sat, 02 Nov 2013 17:47:00 +0000

I have this dream where services are rendered round-the-clock, that we don't only do regular things during the day and tend to emergencies in the night.

My days consist of:
1. A third of my morning patients telling me to come back later in the day so they can sleep more. (no).
2. Conning nurses to teaching my patients how to take care of themselves.
3. Retreating somewhere quiet to finish my notes with Conan in the background.
4. Trying to fit in as much reading as I can get in. Interestingly, I do much much much more reading now, even with my limited time schedule than I ever did in the past. Feels like I'm in undergrad all over again.

The two current mistresses:

Shrink-wrap recently removed.

5. Appreciating the absurdity of hospital medicine.

I've been working on the keys to happiness in life and so far I still only have 2-3. There's a post I wrote a long time ago that summarizes two of them. I suppose there's one more:

1. Refer to post
2. Refer to post
3. Find 1-3 things worth spending money on and let the rest go by the wayside.

More on this later.

Finally some heat in this cold, cold land.

noreply@blogger.com (piotrrcola) — Tue, 22 Oct 2013 04:46:00 +0000

iCream

noreply@blogger.com (piotrrcola) — Sun, 06 Oct 2013 12:43:00 +0000

Back on service!

noreply@blogger.com (piotrrcola) — Wed, 02 Oct 2013 15:01:00 +0000

What is this? Coffee for ants!?

noreply@blogger.com (piotrrcola) — Thu, 19 Sep 2013 04:13:00 +0000

Delta you gotta stop giving these 'shot glass' coffee cups; IVE DONE 4 ALREADY.

Going to learn how to change my oil

noreply@blogger.com (piotrrcola) — Mon, 26 Aug 2013 22:43:00 +0000

No more jiffy lube.

Hello Mobil 1 European Formula, 5 quarts for $25 at Walmart!?

Post shift meal

noreply@blogger.com (piotrrcola) — Wed, 21 Aug 2013 21:29:00 +0000

Pizza, Nutella, coffee and pretzel pieces:

I got a fitbit

noreply@blogger.com (piotrrcola) — Tue, 20 Aug 2013 12:37:00 +0000

Trauma week:

OR: (eyes wide open)

Night shift with Conan

noreply@blogger.com (piotrrcola) — Sat, 10 Aug 2013 06:05:00 +0000

Shit has not hit the fan yet. Every one keep your guns and knives in the closet please.

Train to night shift

noreply@blogger.com (piotrrcola) — Wed, 07 Aug 2013 23:14:00 +0000

I was on TCH Neurosurgery a few weeks ago and I saw this.

noreply@blogger.com (piotrrcola) — Wed, 08 May 2013 06:00:00 +0000

Totally made my day. Sort of re-considered Pediatric Neurosurgery for some time. We'll see. The outcomes are good, but I heard about shunts and shunt malfunctions daily. Also, a lot of non-accidental trauma. :(

WHY ARE THEY ALL FOOD ANALOGIES. WHY. The chicken nuggets idea is particularly revolting.

Apartment hunting in Chicago

noreply@blogger.com (piotrrcola) — Tue, 07 May 2013 18:45:00 +0000

So I found a place to live.

It's nice. I think in the end, all I wanted was 1) Proximity to UIC and 2) utilities included.*

Now I just hope all the paperwork goes through without a hitch. Not that I have any reason to believe otherwise.

Nothing like cold oranges to really make your day. Also, Chobani pineapple greek yogurt.

See if you can spot the jar of Nutella.

I like the 'river through the city' feel.

So lucky there's a Starbucks on every corner.

*: Back to Voyageur's style sauna in the winter. I sure hope my landlord doesn't find this post.

Random Costa Rica pic to see if anyone finds it lol

noreply@blogger.com (piotrrcola) — Wed, 01 May 2013 23:51:00 +0000

Saw this at the VA while on the phone

noreply@blogger.com (piotrrcola) — Sun, 07 Apr 2013 16:51:00 +0000

haha

A saga begins

noreply@blogger.com (piotrrcola) — Fri, 29 Mar 2013 19:51:00 +0000

Two weeks ago, I matched. What I matched into is not important (to you), you will know me as a poor MD for years to come. But I am relieved.

To be perfectly honest, I was terrified to the point that I was watching a movie to get my mind off things, sitting on a very comfortable couch, waiting for that email. I'll paste that email in a bit. But before, I want to share something I've kept secret for years. My Fall 2004 grade report.

BIO

325

GENETICS

50015

3

B

9.00

M

427

ADV CALC FOR APPLC II-AP-HON

58500

4

C

8.00

PHY

301

MECHANICS

59545

3

B

9.00

PHY

101

LABORATORY FOR PHY 301

59590

1

A

4.00

GPA: 2.72

Oh my god. That winter I had gone to my uncle's house and was in a full panic when I saw the report. I wasn't getting into medical school, forget residency. If things didn't change quickly, I thought, I was ending up on the street, and I saw myself doing so, with a ragged beard, occasionally dropping by at home, only to leave once I couldn't take the disappointing looks nor money any more. I once painted a bleak picture of myself living in a trailer home (and doing some heavy duty illegal filesharing). The bleak pictures I create for myself are not over. But for once, I will take a breather and pretend life is not jumping from one crisis to another.

I urge you to (re?)read the post I made when I got an acceptance to medical school. The medical school saga is almost over, and has been a success. Same goes for Step 1 and admissions and interviews. I did catch some peaceful shuteye that night.

Anyway, here's the email!*

Congratulations! You have matched!

Check the Match Site at https://services.nrmp.org/r3/ on Friday, March 15, 2013, at 1:00 PM eastern time to find out where you matched. Because you are matched, you are not eligible to participate in SOAP and you will not have access to the List of Unfilled Programs.
NRMP Staff

Follow us on Twitter: @TheNRMPLike us on Facebook: www.facebook.com/TheNRMP

That's it! If this epic man child can climb from a 2.72 to hopefully being an attending neurosurgeon in 7 years**, pretty much anyone can.

In any case, thank you, UIC.

*: Social media, ugh.
**: 4+5+7(+2) = 16-18 years.

Change we can believe in

noreply@blogger.com (piotrrcola) — Tue, 29 Jan 2013 04:03:00 +0000

Obama was elected President in 2008, the year I started medical school. His re-election has come and gone, but I still haven't graduated. One day (it's approaching?). MD? What the f***.

I am glad I haven't changed much. I still see medicine and all it has to offer in a romantic light. I'm still a fool. I don't say much but someone recently told me my CV and experiences all scream "academic physician." I bet deep inside, I still believe that whittling away constantly at the unknown will eventually produce something of significant value. That's probably not true, but it does increase my chances.

Physicians are fascinated by suffering*. You'd think it was the opposite, but everyone sits and analyzes the failures. What happened? When was he first diagnosed? Then what happened? What happened two weeks before death? If you ever start to encounter a series of questions like this, let me just pare it down for you - the questions they're really asking is - What was that one singular moment that caused that monumental decline?

Take these two cases:
1. 63 y/o male dies 7 months after a diagnosis of glioblastoma multiforme.
2. 28 y/o female dies 4 months after contracting TB.

The first is interesting to me, but the second begs the question above. AIDS? Pneumonia? Car accident? What else happened? Physicians are fascinated by suffering.

Speaking of glioblastomas, look at this thing:

Terrifying isn't it? Sort of like an astronomer looking at the blistering surface of the sun, or a computer scientist watching his code compile, or getting on an expressway using an onramp that's downhill.**

Maybe it's the fact that after 100 years of research, mortality has not even doubled. Or the fact that people throw dozens of agents at it without significant benefit. Or the idea that even with a perfect resection, it always comes back. Like an intracerebral manifestation of evil, sending a chill wave across my torso.

Let me enjoy my pizza and Coke Zero*** please! (Heated up in a hostel oven).

*: In good and bad ways.
**: Try it
***: Nothing more refreshing than a cold Coke, but I can't afford the calories, so Coke Zero it is.

Hostels

noreply@blogger.com (piotrrcola) — Mon, 28 Jan 2013 01:39:00 +0000

First I thought this concept was ridiculous when a friend brought it up. But I've been using them like no tomorrow. I don't need an entire hotel room! Just a bed and a shower. Perfect.

When I was in LA a few days ago I was at a hostel in West LA, which... was okay. My first American hostel experience. The bathrooms were a bit dirty, the bed was "made" and I could feel the springs dig into my side when I slept, and the towels were a bit musty. The internet was fast and it was a convenient location so I rolled with it. People also kept coming in and out of the 8 person dorm room and slamming the door. COME ON.

Last night I stayed in another one in SF, this time, $29 a night, but so much nicer. Much better breakfast, nice beds to sleep in. The downside being, downtown SF is loud at night. I also rediscovered how good toasted bagels are.

In my morning tiredness I also fell off my bunk. This being the result:

Look at those bird-like Frodo Baggins legs. Jesus, I need to moisturize. (and work out) (and nurse my bruises). If I was some old lady, I would have had a vertebral/hip fracture from that fall. But everything turned out okay. I muttered "ow" and moved on to take a shower and get some coffee.

I came back to get my stuff before my bus to LA left and a German guy who was sleeping in the same room accosted me in broken English as I packed my stuff - "UWoau man, was that you who fell off the bed this morning! I saw that man are you okay!"*

Yes, damn it, I'm fine. Feeling a bit worse now that it was witnessed.

Anyway, will let you guys know more about this Santa Monica Hostel I'm heading towards. I'm also fairly certain we (CA shuttle bus) left someone at a Burger King in the middle of no where since he could not be found.

*: Deliberately left out commas for emphasis

Post, D, Post!

noreply@blogger.com (piotrrcola) — Sun, 20 Jan 2013 22:05:00 +0000

Christ, I need to start writing again. My goal for 2012 was to surpass 2011. Yeah right. 5 posts? Are you kidding me? No wonder I've been going crazy.

I was on a flight back to Houston from LA and I was reflecting on myself over the last year, how things had changed, etc. I feel like I've slowed down a little. The me from years ago would easily look down on the me from today. At the same time, I also feel like I've grown less cocky.

I'm almost done with my interviews, got 2 left (to be done within a week) and then I wait for match day, which is a spectacle. Leave me out of it, please. Can't I just wake up on match day, look at my email, and go back to bed? Sleep. That's what I want. Going to med school is like running a series of marathons.

I'm working in Starbucks right now, on my Thinkpad (for writing) and iPad (for reading). It looks ridiculous but it works well since my Thinkpad is outrageously slow for more than one app open. My battery cycle count is 649. Holy shit! This nuclear powered battery still has a lot of life in it. I think I'll clean out my Thinkpad (read: getting rid of old star trek episodes but don't worry, they're somewhere else too..) and use it until it dies. Which will be never, because I got this before the Chinese screwed with Thinkpad design.

How about some formatting?

noreply@blogger.com (piotrrcola) — Sat, 09 Jun 2012 20:47:00 +0000

I send a lot of emails. I recently wanted to purchase a pair of UFS-20 stands (off ebay/craigslist) because I'm not paying $100 for two pieces of metal (off the Bose/Best Buy website). The guy responded with "yes, where do you want to meet?"

No capitalization, no time-wise greeting, no greeting at all. Are you kidding me? Lots of people add 'thanks' to the bottom of their email and it essentially means nothing. Sort of like:

Like - "Hi, did you have a chance to read that paper I sent you? Thanks!" Just a reminder/formality so you don't sound like an ass. But time-wise greetings? Awesome. No one says "Good morning" and doesn't mean it (especially by email). The same goes for good afternoon / evening / night. You also have to think about when they'll open the email (is when the greeting should be applicable for).

Also, if I write "Have a good weekend", I mean it. If it's Sunday, and your weekend sucked, give me a call and we'll do something about it.

Enjoy this picture of me from years ago:

A fucking lifeguard, that's what.

Family medicine in the 'burbs

noreply@blogger.com (piotrrcola) — Mon, 28 May 2012 19:22:00 +0000

My family medicine rotation is in Baytown, which I'm not terribly enthused about. I show up in the morning, round on the hospital patients in the morning (3 or less), then go to the clinic. Outpatient medicine can be interesting or as boring as you make it out to be.

I've probably had more appreciation in the last week than I have in the last year.

The attending also introduces me as Dr. Dash, which I'm not sure how to take. It always starts off as "Here is my medical student [doing fine..], Dr. Dash [ohgodwhy.jpg], and he'll be asking you a few questions." I don't think I ever want to be called that actually. I'd rather use it in case I need to throw down the hammer.*

What you don't see out there (directly) is death and destruction and that's a nice change of pace. It's nice to not hear that some patient isn't coming to clinic because they threw a large pulmonary embolism and fell face first into a bathtub or developed DIC a week ago and bleed out from every orifice.

I read this piece a few days ago : http://www.nytimes.com/2012/05/27/opinion/sunday/when-doctors-grieve.html

It's true. More importantly, I remember when I was on ICU, where a good 30-40% of my patients died within days of admission, I developed this furrowed browed look whenever I was down about my patients. It could have been interpreted multiple ways.

Are you furrowed because:

1) you realize you could have done more or
2) you're here too late and you don't want to deal with this, or
3) you're actually distressed by this patient dying or
4) some other miscellaneous cause.

Other people on my team had more unambiguous reactions. On top of that, after the "viewing" of the body and before the body would be transported down to the morgue, the family would leave the room, some would shake my hand and say "Thank you, doctor"

First of all, doctor?
Second, thank you? For what, exactly.

Baytown is a nice break.

*: Recall the short coat hammer from a few posts ago.

Getting things done

noreply@blogger.com (piotrrcola) — Sun, 27 May 2012 19:22:00 +0000

I may have figured this out. There are two keys to making life simpler & better.

1. Automation - Automate everything. Bill pay? Automate. How often do you need to look at your bill and dispute charges? (Look at it anyway). Rent? automate. Dividend reinvestment? Automate. Morning routine? Automate. Become that robot so everything goes smoothly. Make a checklist and follow it religiously.

2. Tolerate (and be good) at things you don't want to do but have to do - This is crucial. I'd rather be reading about family medicine or gliomatosis cerebri or something, but I have to do these evaluations. Or clean my place. Or cook for tomorrow. Or think of a schedule for later today. No thanks. Maybe one day I can automate all of that too.

I just finished reading Better by Atul Gawande. It's a good book. Reflects that quote 10,000 hours to mastery? I believe that.

A few years ago, I was roaming around my dad's office, looking at posters, pilfering sodas and coffee creamer and I came across a poster, most of which's details I don't remember, but I remember there was a huge picture of an aircraft carrier and it was advertising "carrier class" reliability (with respect to server uptime).

I looked it up a few days ago, and here we are (wiki):

In telecommunication, a "carrier grade" or "carrier class" refers to a system, or a hardware or software component that is extremely reliable, well tested and proven in its capabilities. Carrier grade systems are tested and engineered to meet or exceed "five nines" high availability standards, and provide very fast fault recovery through redundancy (normally less than 50 milliseconds).

99.999%. That's a goal worth shooting for.

Second week on neonatology

noreply@blogger.com (piotrrcola) — Mon, 02 Apr 2012 22:48:00 +0000

Babies. Very small babies. I come in the morning, and they're all wrapped like little burritos with their heads sticking out. Wrapped - three blankets, each tucked in three different ways, as if you wanted to ensure they could never ever get out of their burrito-blankets if they wanted to.

So you approach the crib, very cautiously. Like a ninja. Survey your territory. Where's the nurse to give you disapproving looks while you're taking apart the burrito-blanket? Not around? Excellent.

Then you look at your little masterpiece. Boy or girl? Doesn't matter. Survey your territory. Find out where those corners are. You've got less than 10 minutes to unravel the burrito and listen to the heart. Like a bomb. More importantly, mess up the unraveling with sudden or improper movements and you will unleash the fury of a thousand dragons.

Slowly, you start to tug at the corners of layer 1 of the burrito. Sometimes you realize you have to turn the baby. Can't arch its back at all, else it'll wake up. You then do some complex calculations in your head, find out where to provide pressure points and roll that burrito like a plane banking into a turn. Boom, blanket corner out.

Rinse and repeat. Do your exam. Finally, very quickly wrap that baby up as fast as possible while still maintaining movements around its principal axes. Often, the baby will wake up. All you need to do is rub its back while making clicking noises from your palate - tk tk tk tk tk tk tk tk tk tk - and it calms down.

Leave the poorly wrapped burrito in its half awakened state and rain down some burrito destruction elsewhere.

Sometimes, it'll wake up completely and start crying. You have to pick it up and hold it (support its neck!).

In that moment, right after it stops crying, it fidgets. It fidgets like never before. He's fed, consoled, hydrated, warm, evacuated* and ready. Its sole purpose in life is to get away from you. It knows nothing else. It puts 100% of all of its energy and every underdeveloped neuron it has into strategizing ways to remove himself from your vicinity/arms. And your job? To employ some Red Queen Hypothesis business to keep three steps ahead, and not provide any kind of feedback but a firm grip. Turn into the human Cesar Millan and show him who's boss. Do it right and he becomes terrified at your sense of control and awe-struck at the show of confidence.

*No. 1 and No. 2

Outpatient paediatrics

noreply@blogger.com (piotrrcola) — Wed, 28 Mar 2012 03:13:00 +0000

I spent 2 weeks on the mobile clinic, which... is kind of cool? Two fully equipped exam rooms, refrigerated medications, a mini crash cart, two nurses, two doctors, one med student and that goal to get every kid in Houston immunized.

Ridiculously cool.

After a while, you learn how to give vaccinations. The giving part is not nearly as bad as the consoling part, and every age group needs their own system.

Babies - no prep required. Snap your fingers in two different directions, flash your penlight so they reach for it, and the moment their hands go up - Bam! right in the Vastus lateralis.
Little boys - little boys cry* far too much, almost more so than the girls. Just do it. They'll realize it wasn't so bad.
Little girls - less crying**, but it's more dramatic. Minimal prep required, although they will need consoling afterwards. Stickers, pencils, hugs, what have you.
Older (7-10 y/o) boys need reminding of how macho they are. Usually come in with slick gelled up hair. Dude you can't have hair like that and be afraid of this needle? Right? Jab.
Older girls are a bit more mature than the older boys. Usually not problematic.

These schools we visited were much nicer than the one I went to, but I'm not so sure about the teachers. They also all ate fried crap for lunch so naturally there were kids that weighed more than me - > 165lbs.

Also, taco trucks and mexican bakeries galore. So cheap.

*: This type of cry being "my god this is going to hurt"

**: This type of cry being "I have accepted death as my fate"

I haven't posted in a while

noreply@blogger.com (piotrrcola) — Thu, 22 Dec 2011 22:03:00 +0000

And the end of the year is approaching, which means I'll probably take a trip through my really really old posts.

You might, too.

Pretty much.

BIO	325	GENETICS	50015	3	B	9.00
M	427	ADV CALC FOR APPLC II-AP-HON	58500	4	C	8.00
PHY	301	MECHANICS	59545	3	B	9.00
PHY	101	LABORATORY FOR PHY 301	59590	1	A	4.00