Goblins!

Happy Halloween to all!

And a very happy birthday to Clara!

We have had 11 trick-or-treaters so far this evening. I think we had a lot more last year, so we still have tons of candy left. I'm sure it'll disappear right away if I take it to the student lounge at the med school!

Jasper has been very well behaved. We were really worried that the people traipsing onto our porch tonight would freak him out, but he's barely batted an eye. He's been extremely sociable in the last couple of weeks, even getting up to follow me around the house a bit. He ran some errands in the car with me today, including a trip into the pet store, where he was very well behaved and even sat promptly for a treat at the check-out register. Perhaps he will even be a real dog someday!

Past Halloweens have been much more eventful than this. When we lived in Norwich, we were just off of Main Street, and thus were part of the town trick-or-treating route that started at the school. The PTA even left a bag of candy on our doorstep for us to give out...though that was nowhere near enough, even when added to what we'd already purchased! Alex had to run to Dan and Whit's mid-evening to restock our candy stores. It was great fun, though, we sat out on the front step to hand out the goodies, and I spent most of the time gazing at my not-quite-24-hours-old engagement ring.

Alex and I also started dating on Halloween five years ago, so it's still kind of an anniversary for us as well. (Thanks Rachel. And Dave. And red champagne.)

A Blogging Machine

I have spoken before about blogging from the iPhone. Apple even has a commercial about it, you may have seen it on TV.

Well, that kind of blogging is done in one of two ways that I know of. The first is by using the Safari web browser built into the iPhone. It is the same as how I am blogging right now from my desktop computer, except it's on a mobile device. The second method, supported by a few mainstream blogging services, allows you to send an email to your blog. The email either becomes a saved draft, which you edit before releasing (again, via web browser), or it is posted immediately.

Well, that's all well and good, but the iPhone is such a capable platform that I think there is a better way. What I'll describe is a little specific to Blogger, partly because that's the platform I use, but secondly because it is owned/run by Google, which has some kind of development agreement with Apple (see the Google Maps application on the iPhone).

To turn the iPhone into a real blogging machine would start with a new iPhone application. You'll notice that there are currently three unused spots on the iPhone home screen (and an infinite number possible beyond) - this would be one of them. This application would have your logon information for one or more blog accounts, similar to how the Mail application has the account info for one or more email accounts. (As a bonus, these account settings would go beyond just logon information, but also include blog settings, preferences, etc.). Also like a Mail application, you would have an "Inbox" that would hold copies of your old posts, as well as an "Outbox" with drafts of new posts. Third, like the Mail application, you would have a fairly bare-bones compose window. The compose window would be laid out very similar to the compose window I am now using, complete with a series of formatting tools (bold, italics, insert hyperlink, etc.). The "insert picture" button would link to the iPhone's library, and allow you to size and crop images before uploading, in addition to determining the thumbnail size and justification (see Blogger's upload image window below).




Now, what makes this dedicated application better than the two traditional methods of iPhone blogging I mentioned above? The advantage over the web-browser based method is that you don't have to be connected to the internet to compose your next post. Like a mail application, you can draft and compose offline, then upload when you're connected. Although Apple toated Web 2.0 applications as being equivalent to iPhone native applications, there is a clear advantage in terms of user experience and performance in having the thing run locally. Compare a dedicated email client like Outlook, Eudora, Thunderbird, or Blitz to their web-based equivalents.

The advantage of a dedicated blogging application over the email method is that you would have access to the formatting tools I've mentioned above. Instead of composing emails, you are doing something more akin to word processing (a fine distinction, but one I feel is important). The blogging application, with its list of old posts and folder of draft new posts, seems a more tuned application.

Now, this is a good start, but it needs one more thing: an easier way to add content. Typing with the on-screen keyboard on the iPhone works, but is 1/3-1/10 the speed of using a real, physical keyboard. The images that you can capture with the iPhone are ok, but a way of getting images from real digital cameras would be nice. There is precedent for this: older iPods had an optional accessory that would allow you to offload images from your camera to the iPod's harddrive via USB.

Combine these two ways of adding content and you get the second portion of making the iPhone the ultimate blogging machine: a keyboard/Dock. When the Palm Pilot was the PDA in the world, there existed a thriving market of third-party accessories. Several companies sold keyboards into which you could dock your palm pilot. Some of these keyboards were real marvels, able to fold in half or quarters, resulting in a footprint the size of the Palm Pilot itself. Something similar could easily be made for the iPhone, and contain the all-important Dock connector. When the iPhone docks with the keyboard, the on-screen keyboard is disabled, allowing you to view the entire iPhone screen while typing. This would be an advantage not only in the blogging application, but anytime you need to type with the iPhone.

Having actual cursor keys and the ability to select text, copy, paste, and so on would be a real advantage. One could even have dedicated hotkeys on the keyboard to take you to the Safari, iPod, Mail, and Phone top-level applications. The real clincher would be to have a USB port on the side, to which you could connect a camera and transfer images to the iPhone.

Now, all this tossing around of ideas is great, but what would it take to make it happen? As I said, this would best be done through the Apple-Google partnership. There are enough coders and user-interface gurus between the two, plus a unique knowledge of the iPhone's inner workings, to make this very slick. The keyboard could be done as such things have always been done for PDAs and iPods - through third-party development. Offloading pictures from a camera directly to the iPhone would be tricky. However, camera USB drivers can be fairly generic these days, and the iPhone is built on OS X. I think the software tools necessary exist to be able to implement it. Moving the pictures from the iPhone back to a computer during the next sync is already implemented for the iPhone's internal camera.

Ordinarily, I would keep all of this to myself, lest someone get rich off my ideas. However, I am putting it here for all to see for a few reasons. First - I'm never going to have the resources to do this myself (even patenting the idea would be too much). Second, there is a likelihood, in light of Apple's announcement of allowing third-party development for the iPhone, there's a chance that someone (perhaps Apple and Google themselves) is already working on this. Third, if someone does come out with this, based off of what's written here (a very long shot, considering the small readership), I can always point to this posting as prior art and make a fuss. Lastly, I just think this would be really freakin' cool, and want to see it happen.

Flu Shots...Fast!

The main excitement of the day for us was getting our flu shots. Mayo does a mass vaccination clinic each fall that is open to all employees. It's a practice run in case the Clinic ever needs to vaccinate a large population in a hurry (think bird flu or smallpox). They have a bunch of staff there to direct the traffic flow, and 10 or 12 actual vaccination setups with a data gatherer (to confirm you are who you say you are, and to enter you into the computer) and a nurse who gives the actual shot. 3500 people were vaccinated by the end of lunch today, and that was nowhere near capacity. It's SO fast, we were in and out in under 5 minutes! Very impressive, and nice and confidence-building in case there is ever a big epidemic. Relatively pain-free as well, since there's no time to even see the needle coming.

So, that's my public health plug for the day: get your flu shot!

Go Sox!!!

Like Red Sox fans everywhere, I can't quite believe that the Sox have won the World Series. Again! When it happened in 2004, I figured that it was my once-in-a-lifetime. Now once is twice...amazing!

Beckett! Papelbon! Pedroia! Ellsbury! (How cute is Jacoby?) Lowell! (Who we must re-sign. None of this A-Rod nonsense.)

Ah, life is good.

A good read

My current reading is a book by Bruce Schneier, who started off in computer and network security, but is now regarded as one of the best authorities on security in general. His latest book, for a popular audience, is Beyond Fear: Thinking Sensible About Security in an Uncertain World. The subtitle pretty much sums it up. This book was published in 2006, so it has five years' hindsight about the 9/11 attacks and the change in perceptions about security since then. He has quite a few things to say on the matter, both on the attacks themselves, the state of anti-terrorism security before then, and some of changes to airline security that have occurred since then. He largely eschews the political questions involved - security measures aren't Right or Left, but rather Good or Worthless. Mostly, he uses aspects of 9/11 and airline security measures as illustrations to instill the reader with a broader understanding of what security really is: how it works, what it can and can't do, what constitutes good security, and so on. In his approach, security isn't only walls, locks, and guys with guns protecting us against hijackings, bank robbery, and computer hacks. Above all, in every situation that requires security, he provides a framework for systematic analysis that forces a close examination of the real risks, the possible mitigations, and the trade-offs. He reiterates that all security systems can break, perfect security is a fantasy, and all security has costs, not all of which are monetary.

With all the fear mongering about terr'rists, and the various security measures (good and bad, effective and brittle) that have been pushed through using that fear as justification, it is, to me, a wonderful breath of fresh air to see someone dispassionately and intelligently examine what security is all about and how to evaluate it. I recommend it highly.

Book review (and esuing discussion) at Slashdot.

The Mooses in the Dells

We have just returned from a wonderful weekend in the Wisconsin Dells, an area in southern Wisconsin that is known for both its beauty (our main interest) and for being "the waterpark capital of the world" (duly ignored). Our friends Lucy and Steve drove from Chicago to meet us at a small cabin, rented specifically for its pets-allowed policy so that Jasper could join us. Everyone arrived on Friday evening, and we had a very jolly dinner at the Moose Jaw Brew Pub.

On Saturday morning, much sleeping in was had by all, followed by a leisurely breakfast feast. Eventually we headed out to Mirror Lake State Park, just up the road, where Jasper had a lovely romp.



We spent part of the afternoon browsing at an orchard, tasting apples. Ended up with Braeburns and Russets to bring back to Rochester, and a caramel apple for Lucy and me to split in the car on the way home. The rest of the afternoon was spent lolling about, enjoying the company and some good books! (I finished a re-read of a favorite book by Lauren Willig, who writes delightful stories about English and French spies during the French Revolution and Napoleonic era, a la the Scarlet Pimpernel, and then jumped back in time to start a novel about Eleanor of Aquitaine.) Here's a photo of Lucy and me on the couch, in a position that must be incredibly familiar to all of you who knew us as children. (That's Jasper in the middle, trying to look inconspicuous. And succeeding.) Lucy and Hilary with their noses in books? Ah, some things never change.



Then things got slightly more active. Lucy and Steve brought their Wii, which comes with some really fun sports games. The boys took a turn first (that's tennis they are playing):



And then the ladies (baseball this time...Lucy won, we decided that this would foreshadow a Red Sox victory later in the evening, since she has red hair...or something...whatever it was, it worked!)



After further sleeping in this morning, we celebrated Lucy and Steve's 1-year anniversary with mimosas! Then we decided on another hike, this time at Devil's Lake State Park. It was very crowded, which unfortunately meant that Jasper had to stay on his leash, but the views were stunning! Here are Lucy and Steve on the trail:



The lovely fall vista from the top of the bluff:


At another overlook:


Lucy and Steve coming back along the lakeshore:


We ended our mini-break with a fabulous vegetarian meal at The Cheese Factory before going our separate ways. We'll hope to see Steve and Lucy again in a few months, maybe in a new condo in Chicago!

Tricky Jasper

Jasper had a bit of a rough time when we were away...it sounds like he returned to his super-shy cowering days. Our friend Anna got him through it valiantly, and then our other sitter Kim was able to coax him out of his shell by bringing her own dog along. But I still felt very bad, so have been trying to spend lots of time with him since we returned. This is much easier since I'm on my research block, and lots of my work can be done from home.

Jasper, as some of you know, doesn't like our back stairs very much. This is his normal route to the backyard, and we're hoping he'll snap out of it eventually, but his approach is very inconsistent day to day. Some days, he'll follow us right out the door (especially if one of us is leading and the other trailing along behind). Some days, he'll stand at the top of the steps for minutes, staring back at us as if he has no idea what we want him to do!

Yesterday, I was heading out to rake leaves. After getting everything ready in the yard, I came back in to grab Jasper. Thinking it might be easier, I took him out the front door, which he has no qualms about. Then he trotted down the driveway before reaching the tricky part where he had to follow me around the car and through the gate into the backyard, with the scary trashcan looming nearby (yes, I often think that Jasper is secretly a horse, he has many of the same triggers. Luckily I'm used to looking at the world that way!).

I waited patiently as Jasper stopped-and-started his way though this zone, rewarding him with a pat and some soothing words as he finally scooted through onto the back patio. This whole process had taken 5 or 10 minutes. Then I unclipped his leash, turned to close the gate...and turned back around just in time to see his fuzzy tail disappearing through the back door! I had left it open, and Jasper had taken immediate advantage to return to safety. By the time I followed him back inside, he was once more ensconced underneath the coffee table.

Another 10 minutes passed as I coaxed him back onto his feet, then over to the back door, then waited out the kitchen steps fears before he was finally in the backyard again. This time I shut the door before letting him off the leash.

Jasper did have a fabulous time once he was outside, though...we opened the back gate to connect our yard with our neighbors'. They have two very hyper border collies, and the three dogs romped and romped all afternoon! Jasper might even learn how to fetch this way, as one of the collies is a fetching machine, and Jasper was very interested in following her back and forth. He was so tuckered out last night, especially since we'd also gone for a run in the morning!

Remember the SAT?

I subscribe to a daily email called CoolPeopleCare. Yesterday, they sent a link to a website called Free Rice. It has a very SAT-like vocabulary quiz, and for every word that you get right, they donate 10 grains of rice to the United Nations World Food Program.

Beware, this is very addictive! But also very fun! (Yes, I am still a total dork. That will never change.)

I was happy to discover that medical school has contributed appreciably to my vocabulary—and in a couple of cases, so has reading historical fiction.

More About Maine

Alex definitely hit the highlights of the Maine extravaganza, which was a fabulous time! 4 books down, all British historical fiction. Two Elizabeth I mysteries by Karen Harper, Brotherhood of the Blade by Diana Gabaldon (who is one of my very favorite authors), and The Perfect Royal Mistress (that'd be Charles II's). More reading will be had this weekend, as we are off to meet Lucy and Steve in the Wisconsin Dells.

Here are a few more photos by Dad. Two are on the Marginal Way, a beach walk in Ogunquit.




The other features my fantastic Christmas present! Uncle Tom, who was my giftor in the big family gift exchange (names are drawn each year) came up with the amazing idea of a Vermont Teddy Bear. This one has a stethoscope and is wearing a white coat with Dr. Hilary written on it! It is destined to be shown off in my eventual office. Isn't it adorable? I could barely put it down.

Reunion in Maine

The family gathered at a rented house on the shores of York, Maine. The porch railing has a sign that read "Do Not Lean on Railing," lest you fall into the drink. Looking off the right end of the porch you could see open water - nothing to the east but Europe. That makes for outstanding sunrises. A good time was had by all: highlights included eating, reading, watching the Red Sox in the ALCS, more food, mid-afternoon naps, and an early Christmas (complete with no less than seven pies).

While back on the East coast, we also had the opportunity to see some of our college friends: a lovely dinner with Dave and Anne in Portsmouth, and coffee with Kristen before catching our flight back.

Expect more posts on this grand event in the future. I considered blogging from afar, but then realized that 75% of our readership was right there in Maine with us. That said, the iPhone proved to be a wonderful travel tool. I could access the internet to keep up with my favorite websites and news, check on flight status, and follow the play-by-play of games 5 and 7. The Maps feature was a real life-saver at times, pulling up road maps and directions for places I couldn't find otherwise. Oh, and I made a few phone calls.

P.S. some of these pictures were taken by my folks.

Jasper's Spa Day

Today was quite busy with preparations for our trip to Maine!

Before that chaos, I spent the morning and early afternoon in the electrophysiology lab at St. Mary's, watching defibrillator implantations. Beth and I have been trying to set this up for awhile, just so we would know what sort of procedure our interviewees will have gone through. As with all surgeries, we spent much more time hanging around in between procedures, waiting for patients to come and go, than actually watching the implantation itself, but we still got a good idea of what it's like. And I did get to wear a very zippy paisley-print radiation-shield apron!

Once I came home, I set about getting things ready for our trip, and making sure that the house was ready for our friend Anna, who will be staying here and looking after Jasper while we're away. Jasper got a bath in the bathtub, which worked out great...he didn't even shake water all over the bathroom, and stood quietly even when I was soaping up his face and then dumping water on his head. I forgot to bring the camera in to get a photo of the bath itself, but below is a shot from later this evening, with Jasper wrapped in a blanket to stay warm as he dried off. We also clipped his nails, gave him his heartworm-prevention chew, applied his tick-killing stuff, and trimmed around his eyes. Now you can at least see that he has eyes underneath all of that fuzz. Unfortunately that made a big glare in the photo that I'm not talented enough to get rid of...



Now I'm stalling to avoid packing. The Sox are losing so wretchedly, however, that it may drive me upstairs any minute. Ah, wait, they've just hit a homer! And another! And another! Hope springs eternal!

Jasper the Jigsaw Monster

The weather has been chilly and gloomy recently, except for Saturday, and today continued along those lines. Jasper only got a brief walk yesterday evening because of the rain, so this morning I took him out for a run. He was a bundle of energy, dragging me halfway around Silver Lake before calming down enough to run next to me. Usually he's quite well behaved on the leash, but I guess the combo of not enough exercise yesterday and the cold weather made him very frisky! He also ate part of a jigsaw puzzle overnight, so perhaps he was just trying to run off some calories. At least we know he's not lacking for fiber...

We had a very relaxed weekend, as usual. Alex started work on some new bookshelves, I did a bunch of puzzles and watched a lot of Gilmore Girls on DVD, we hit the farmers' market on Saturday morning, and so on. I have been so tired from rotations that I haven't been to the market in awhile...we like to go early, like 8:00, to get the good stuff, and Alex has been doing it alone while I sleep in. It was pretty amusing to show up on Saturday and have the Amish guy (best tomatoes ever, and he has them into November!) look at Alex and say, "ah, you brought the boss along today, eh?" Also good to say hi to our spinach guy (who is also our leek, garlic, and potato guy). His daughters have finally stopped looking horrified at the amount of garlic we buy every week. Perhaps they think we are fighting off vampires? Those are our two really regular stands, and then we spread out the rest of our purchases depending on what looks good. This week we picked up a bunch of extra red peppers to freeze for the winter. I've got to chop those up tomorrow...

Today I checked in with Beth to work on some research stuff, took my second year "medsib" Natalie to lunch, and then spent a delightful hour at the public library picking up books to read during this three week mini-break. I finally had to cut myself off when I couldn't stuff any more into my backpack. Most of it is historical fiction, in all of its lovely escapist glory. Feel free to send me book suggestions, I'll probably read through this bunch in a hurry, especially with our trip to Maine coming up on Wednesday! I also just finished Harry Potter 7 for the second time, it was even more satisfying of an ending this time around.

Alex is heading off to the gym in a few minutes, and I'm going to take Jasper out for his evening walk. I bought a new pair of running shoes today, but I think I'll spare them the mud on the river path. Maybe I'll break them in tomorrow morning.

V-A-C-A-T-I-O-N!

My neurology rotation ended today! I have definitely learned a lot and feel far more comfortable performing and interpreting the neurologic physical exam, which is something that I will use a lot in the future.

I think I'm swinging back toward family practice career-wise, though. When I close my eyes and think about being a physician five years from now, I really see myself as a family doc.

Now I have three weeks of "research." All of us are required to do 12 weeks of research in our third year (mine is all split up) and end up with something of publishable quality. I am working with a classmate and one of my favorite professors on a psychiatry project. In a nutshell, we're going to be looking at the relationship between anxiety disorders and implanted cardioverter-defibrillators. Once the project gets approved by the IRB (ensuring that we are properly protecting our research subjects), I will be doing interviews with patients who have just received ICDs. This will be both interesting and much more mellow than having clinical duties all day every day! So it's like a mini-vacation, which I definitely need after working hard (and not sleeping a whole lot) through the first three rotations of the year.

We're taking advantage of this brief window of scheduling freedom to take a couple of trips...we'll be in Maine for a family reunion next week, and then the weekend following will meet Lucy and Steve (my very best friend since we were six, and her terrific husband) in the Wisconsin Dells for some outdoorsy fun.

Jasper is learning a new command: "down" to lie down. We figured this would take advantage of his natural inertia! Once he gets it a little more solidly, we'll post another video clip. I'm hoping to have more time to work with him in the next few weeks...Alex has been responsible for teaching him this new trick.

It's gotten very chilly and gray here the last few days. I actually broke down and turned on the furnace yesterday (don't tell Alex). There's a thin rug on the living room floor where Jasper always sleeps, but I was concerned that he would be cold, so two nights ago I dragged out his dog bed and put it in his favorite spot. He's never shown much interest in it before, but he seemed to be content enough when I set him down on it. Yesterday when I got home from work, however, the bed was all bunched up under the table, stripped of its zipper and with the batting falling out. We've been finding little pieces of zipper around the house ever since. Now I'm trying to decide if a much classier LL Bean bed would be suitable or if that would just end up getting shredded as well...

Remote Blogging II

The last post was a test of the mail-to-blogger feature. The email I
sent was saved by Blogger as a draft post, which I then edited in
Blogger before letting the world see.

This time, I am trying the option to send an email that will be
directly posted to the blog, bypassing the draft stage (although I can
go back and edit it later).

And, while I'm at it, here is a picture, too. It is from an event at
the Seed Savers Exchange - a tasting of over fifty heirloom tomato
varieties.

Remote Posting by Email

This is just a quick test of the mail-to-blogger feature of Blogger (who hosts this blog). It is also a test of my ability to do this remote blogging from my iPhone. Cool, isn't it? With the iPhone on a desk, and not in one hand, I fond that I can do some decent two-finger typing at a reasonable speed. I just need to be sure to read it over before I send it, because not all of the auto-corrections are always correct. It is still really freaking good, though.

Next I might also try uploading a picture with this method. I might post later about some ideas I have for making the iPhone an awesome blogging platform.

Sent from my iPhone

Spinal Model

Occassionally something really cool comes down the pipeline at work. In this case, it's a bit of work for an orthopedic surgeon who is doing a very difficult spinal reconstruction around the new year. I think it is a corrective surgery for a congenital defect, but don't quote me on that. In any event, he wants a life-sized model of the patient's spinal column, based on pre-surgical CT data, so that he can plan things out better. I asked for this one, because it's such hot stuff. We use a special program to segment different tissues from CT and MRI data (in this case, bone). That same program can output a 3D model that can be understood by our CAD programs. A little processing later, and we can output that 3D model to our rapid prototyper, which is a sort of 3D printer that creates plastic models by extruding plastic layer-on-layer, like building a topographic map.


This picture is of a test piece I did last week, based off an image set we have from a different project. This is the first cervical vertebra, which connects to the underside of the skull. Unfortunately, the flat white plastic (and lighting) saturates most of the texture detail, but you get the idea. This is a very accurate rendering of a person's bone. We'll be doing the same for this orthopedic patient, except I'll probably end up doing most of the spinal column.

Jasper's Romp

I borrowed the video camcorder from my office this past weekend. We decided it was time to get some video of Jasper doing his thing, so that all of you out there could see it. It is difficult to believe, even for us, that this bounding and romping creature is the same wretch that we brought home from Mason City. It took him weeks just to stop leaving his tail between his legs. Now, a few months later, he is having a blast getting chased around and dipping into the river. So here, for his internet debut, is Jasper:



He still freaks, however, if you throw anything in his direction - so fetch is right out. That is why you see H running around as though the plains were alive with the sound of music.

Videographer I am not - both in terms of equipment and editing. Plus, we were doing this towards dusk on a cloudy day - so the colors are a bit muted and everything is dim. Ah well. It's a start.

On call!

I didn't think I should post yet again with no photo, so here is what I look like when I'm on call. Except tonight I'm lugging a reflex hammer and a tuning fork in addition to a stethoscope. I'm taking call with the neurology ER resident: she is a senior (4th year) resident who is responsible for seeing all the neuro cases that come through the ER and deciding how to treat them and whether they warrant admission to one of the inpatient services (general neurology, stroke, or neuro ICU).

Since her shift started at 6 PM (I've been here since 7 AM for my regular service as well), I have:
-studied for a couple of hours
-cleaned out two email inboxes and sent some emails (still not totally caught up, sorry...)
-read about human research subject protection and taken an online quiz so that I can access the Institutional Review Board site and do some work on my upcoming research project (my classmate Beth is doing all the heavy lifting on our project right now, so I can't complain a bit).
-scavenged a brownie from the on-call kitchen and realized that I'd much prefer Rachel's chocolate mousse
-reviewed the comments on a journal article critique I wrote for my OB-GYN rotation
-updated my PalmPilot
-posted twice to this blog!

I should've brought my gym clothes and gotten in a workout after leaving the stroke team around 4:30. You may ask why I can't just wear my scrubs and sneakers to the gym...Well, Mayo has a strict dress code, not just for clinic (business formal) but for the gym as well. Scrubs are strictly not allowed. Though, the gym dress code has recently been liberalized from forbidding sleeveless things altogether, to allowing sleeveless shirts if they were designed sleeveless (no cutoffs) and if the shoulders themselves are completely covered (no skinny straps). Shocking! They're still chasing down naked people in the new sauna, so clearly some folks aren't getting the modesty message.

Pretty soon I think I may try to take a nap. This shift lasts till 6 AM, then I need to go and "preround" (check labs and test results and do a physical exam) on the patient I picked up today. Also hoping to get a minute to dash across the street to Caribou and get some caffeine. Then lecture from 7-8, rounds (discussing the patients with the supervising consultant...known as an attending at most other hospitals) from 8:30 to whenever. I should be done by noon or 1:00 and headed home for a drowsy afternoon.

This is Spinal Tap

So, one of the things that I was too tired to post about last week was my morning with the spinal tap nurse. Spinal taps (also known as lumbar punctures) occur all over the hospital in a bunch of different situations, but this particular clinic is for pre-scheduled patients. Their taps are an important part of their diagnostic workup (for lymphoma, multiple sclerosis, and so on) but are not a very acute need (like someone in the emergency room with possible meningitis would be).

There were two patients on the schedule, so in the spirit of "see one, do one" (thank goodness I didn't have to "teach one," which is the last part of the medical school triad), the nurse demonstrated on the first patient and then I did the tap on the second. I was quite alarmed at the prospect of sticking a giant needle into someone's back, no matter how many times I reminded myself that it was well below the end of the spinal cord, but just like that first cut in the anatomy lab, I had to take a deep breath and do it. The worst part was probably fumbling around with the setup tray, drawing up the anesthetic and getting the different needles on and off the syringes, feeling thoroughly incompetent and slippery-fingered.

I needed to give some extra anesthetic partway through (this happens, different people have different responses to the stuff), but as soon as I did that and repositioned the patient ("tuck your head down more! Bring your knees up farther!"), I got the spinal needle right into the desired space. The patient did screech once (apparently one moment of pain is pretty common at the moment of pushing through the covering of the cord), and luckily the nurse, anticipating my alarm, motioned frantically that everything was fine and not to pull the needle back out! Then we just waited for the appropriate amount of cerebrospinal fluid to drip out, and that was that.

There's a small chance I will get to do this again, either in the emergency room or on the inpatient floor, during the rest of my rotation. It's certainly something I'll need to be competent at as a resident...luckily, it turns out not to be difficult at all!

ps - I was reminded by A to explain the "This is Spinal Tap" reference. The best part of the movie is learning that amplifiers that go to 11 are, by definition, better. Now, that's my kind of math.

Too Much Time, followup

Not long ago I posted about a group of people, with too much time on their hands, who made a 21-foot X-Wing replica, complete with RC-controls and moveable S-foils. Well, they loaded it up with four M-size rocket motors and launched this weekend. As one might expect, the thing disintegrated during liftoff - it just couldn't handle the stress. A flood of star wars related humor is to follow, no doubt. Check here for the video.

Neuro Week 2

No posts from me this week because I have been at the hospital a LOT. I was on the general neurology inpatient service (there's a separate stroke service that I will be working on next week). In five days, I was there for 68 hours, including 34 hour overnight call (got a few hours of sleep then, so it could've been much more exhausting). This is similar to the hours I was doing on the internal medicine service earlier in the year, but I'd been told that neuro was much mellower, so it was a bit of a surprise! I do have this whole weekend off, though.

I saw some very interesting patients, learned more about doing the neurologic physical exam, and had some good lectures to prepare for the exam next Friday. Other than that, mostly sleeping!

Neuro week 2 leaves me not quite as excited about neuro as week one...on the other hand, that could just be the exhaustion talking. One of the neuro residents on my service this week did his whole internal medicine residency before coming back to start again in neurology, which is an extension I hope to avoid! I'd much prefer to make the right choice first time around, so that at some point I can actually have a salary and some control over my schedule. The advantage of neuro as a career would be a significantly higher salary and a nice steady schedule, especially if I saw outpatients rather than acute care things. Also the chance to be really expert at one narrow field. But it's hard for me to imagine giving up all the things I love about family medicine, like delivering babies (even in the middle of the night), taking care of kids as well as adults, and doing the coordination-of-care things that I really enjoy.

The doctors I'm working with certainly don't hold back with the career advice, so you, dear reader, should feel free to chip in as well!

Quick Post for 10/5

I've got nothing, so here's a picture of Hilary and Jasper

Too Much Time

There is much to be said for making something really freakin' cool, just because you can. Basing your opus on Star Wars gets you geek cred, too. However, there are sometimes when you really have to wonder - do these guys have too much time? A team built a 21-foot long X-Wing fighter, complete with movable s-foils and a little R2-D2 in the back. However, they went so far as to add SOLID ROCKETS to the thing, and RC controls for the wings. It actually flies; or, at least, they hope it will fly when it takes off later this week.