Walking Pool of Incontinence

Darron is having his annual fundraising basketball tournament on 12/19 for the Sarcoma Foundation for his late friend. You can find out more about it by visiting his blog, I'm sure.

Ever heard of a fistula? Probably not, because it's a gross topic. This article gives you an idea about the problem. Essentially, when tissue heals, sometimes it heals all wrong. A fistula happens when tissues heals incorrectly between two pipes - like the trachea and the esophagus (the windpipe and foodpipe), or the vagina and the anus - and leaves a permanent hole connecting them. In babies with tracheoesophageal fistula from an error in development, they gag and turn blue when they try to eat, because food enters their lungs through that hole that isn't supposed to be there. In vaginovesicular (vagina/urethra) or vaginoanal fistula after a difficult childbirth, a permanent hole allows urine or feces to dribble continuously into the vaginal canal. If any of you has ever dreaded the thought of getting old and incontinent, this is your nightmare: being a young adolescent or teenage mother - likely by crime or at least social/cultural choice, not your own - having a difficult labor, then shunned from society for being disgusting.

When my life seems so hard, sometimes my breath is taken away by how awful my patients' and other unfortunate people's lives are. There are so many worthy causes out there, but with the holidays approaching, please consider adding this one to your list.

I better be careful with this blog, lest it become too much of a party pooper (haha, no pun intended) and my vast readership takes a dive.

My Heart Bleeds

The article.

International Medicine

Not that it was drastically different from the norm, but it was a little more concentrated than usual: the international flavor of my daily routine, beyond the normal Spanish and Vietnamese.

I finished my emergency medicine rotation and am now readjusting to being back in the inpatient medicine setting. Of our patients, we currently have a Korean man and his wife who speak very limited English, a Spanish-only spouse of a man rendered stuporous, a Romanian-only, and an Arabic-only speaking patient.

I am constantly surprised by otherwise very intelligent and caring medical professionals, who don't seem to be able to relate to English learners. Even if they are nice people who aren't purposely being mean toward a patient for not speaking English well, they don't seem to be able to modify their rate of speech or vocabulary. The same happens even with native English speakers that just have less education. The doctors continue to use idioms or phrases and words that are more advanced, like saying, "we anticipate he will leave soon" instead of just saying, "we think he will leave soon." Sometimes the low-level English speaker glazes over when they are faced with a few difficult words like this in a row, and I can tell they have lost the thread of the conversation. But the doctor will continue on, oblivious that the person isn't making obvious his or her confusion, perhaps due to embarrassment over suboptimal English skills.

This happens to me all the time in Spanish. I appreciate Spanish speakers who have lived in the U.S. for a while compared to Mexicans at the clinic I used to go to in Mexico through the Flying Samaritans. Even though both groups spoke only Spanish, the ones who had come to the U.S. generally knew to use simpler Spanish words and slow down so I could follow along. The ones without experience with non-native Spanish speakers would just chatter along at the speed of light, or use colloquialisms I had never heard.

I think I'm a pretty good contextual comprehender; it's how I blended into American life as a teenager without knowing teenage lingo or many swear words when I came here. It helped when I was in the fire department, whether it was banter in the firehouse or with the public out in the non-standard English-speaking neighborhoods. It's proven helpful when I traveled in Europe and South America where I often understood the gist of what was being said even if I didn't catch all the words perfectly. But tourist conversations hardly compare to the gravity of medical explanations and decision-making. It's hard enough for the lay person to understand medicine as it is, without a language barrier to compound problems.

In any case, all my non-English speaking patients and their families seemed happy at the end of the day. In particular, the Spanish-speaking spouse was adamant yesterday that we call an interpreter when they transferred him to our service. My Spanish isn't great, but the translator was going to take a while to arrive, so we tried her out anyway in the interim. At first she was dubious, but by today, she was appreciative, smiling and waving at me as I walked by the room. Her otherwise healthy husband has been gorked out for a month, the doctors at the prior hospital hadn't been able to fix him or even tell her what the problem was, and she was freaked out. The Koreans too, they were sad that they were stuck out here in California when all they wanted was to get back home to the Midwest, but they were a little happier when they had a better grasp of their care.

In a place like California, no one is going to learn every language spoken and there just aren't enough translators. But I think simply slowing down and using simpler words so people can understand really helps them cope with their medical issues.

Veggies

About a month ago a classmate on his family medicine rotation told us about the hypertension (high blood pressure) clinic he was at that week. He remarked that he was going to try the DASH diet that we tell patients to follow, which stands for Dietary Approaches to Stop Hypertension. Essentially, it is all about eating 10 servings of fruits and vegetables per day, especially at the beginning of a meal before getting to the other stuff like meat, bread, potatoes, etc. So I decided to give it a try too, not even paying attention to reducing salt, but just concentrating on the 10 servings.

It's hard! I'm so full after eating fruit and vegetables that I don't have room for much else. Of course, I also try to keep it reasonably low-fat, without actually going on an "official" diet. I don't pile on the butter, although I do use some to keep it interesting. And since I started this because I wanted to see if I could do what we tell patients to do, I also began to ponder how I could convince someone used to eating pretty unhealthily to start eating well. And I think the answer is in 1) changing expectations and 2) educating taste buds.

I was raised on plenty of veggies daily, and our minimum level was salad with dinner every single night. It was a very simple salad, but its mere existence got us accustomed to eating fresh vegetables, I think. Even for "movie night" where we had popcorn and chicken nuggets and potato chips, we also had carrot and cucumber sticks without fail. So even now I have a fundamental expectation that there will be some sort of vegetable to eat every day. In fact, if I don't have fresh veggies for a while, say I'm on a trip, I start really noticing their absence and missing them, just as I would unhappily notice if I hadn't eaten any meat or starch in several days.

A while back, my uncle Tom gave me bunch of veggies from his garden. They were delicious! And that is my second point. The typical Western diet is really just a super-saturated behemoth of taste. Like McMansions and SUVs, Americans tend to want bigger and more, like taking something sweet and adding something else sweet to it to make it even sweeter, instead of just enjoying the one sweet thing on its own. Like cake and ice cream with chocolate sauce. Deep-fried Twinkies, anyone? You get my point. It's just more! more! more!

In grade school I remember we did an experiment in science class when we were learning about the digestive tract and the enzyme amylase. The teacher told us that amylase starts breaking down starches into glucose in the mouth, even before the food gets to the stomach. And to illustrate this, we all took a bite of plain white rice. After several chews, the rice indeed started to taste sweet, and we were amazed! So really, veggies and grains have their own sweetness that we have trained ourselves out of being able to appreciate with our 30-teaspoons-of-sugar-per-can sodas. Of course steamed broccoli will taste bad when your taste buds are hungering for tons of cheese, salt, or ranch dressing; they're underwhelmed because they've been oversaturated for so long. But if you slow down a minute (take time to chew a little more and let that amylase start to do its thing) and actually learn to appreciate the subtlety of a vegetable, I think it starts to become a more enjoyable, and thus, sustainable operation. Growing your own is a great start, because you're already primed to have pride in and appreciate your creation.

This all is exactly the same as music or art or finances or NASCAR. To those unversed in it, classical music sounds all the same; so does rap or country music. Art can be pretty boring, especially modern art, which just looks like paint splotches to me, as can finance for those of us who just want to stick money somewhere and have it grow a bit. To the casual observer, NASCAR is just driving in circles. So appreciating fresh veggies is really the same as with anything; the more you take interest, the more you know, then the more enjoyment you get out of it, and eventually you will be able to discriminate higher quality from the crap.

I wonder if any of my patients will be convinced... what do you think? All right, back to the grind. I can't believe I wasted my study break thinking and writing about patients!!!

Attention Span

I find myself comforted by the fact that I get bored during long surgeries.  When they're interesting, surgeries definitely are fun to watch or to help with.  I like sewing people back up and feeling the immediate gratification, so I can only imagine the satisfaction that must come with opening up someone's heart and making it better.  But it's not worth spending a lifetime of not being able to take a break!  A few years back, one of our UCI surgeons had a heart attack during a super long surgery.  There was no one else who could take over, so he just had himself hooked up to a nitro IV and finished the surgery because he couldn't walk away and leave the patient flayed open on the table.  Now that's just craziness.  Admirable, certainly, but crazy nonetheless.

I find my boredom comforting because for a little while I thought surgery might sway me away from emergency medicine.  Switching to surgery as my specialty choice, however, would throw my life into a vortex, because every extracurricular activity I've done so far, my whole medical career foundation, revolves around emergency medicine.  Many ER doctors I know confessed to their utter boredom during their med school surgery rotations.  One, very near and dear to me and who shall remain unnamed - a certain Dr. P - fell asleep while he was holding a patient's chest open with the retractor!  So by being bored in surgeries sometimes, I know I'm on the right track.

Moments of Clarity

As I was getting bored during a surgery the other day, I realized that no matter how long the surgery drags on, surgeons can't just wander off to grab a bite to eat or get on the internet like I do to recharge before going back to studying.  And THAT, my friends, seems like a drag.

Another thing I realized today:  regret is a terrible thing to have.  They say, you usually regret the things you don't do more than the things that you do.  I think that's quite true.

First (Academic) Publication

Yay!!!!!!!!!!!

Sent: Monday, June 01, 2009 6:04 PM To: Swan, Pamela Cc: The Authors [authors-uciem.westjem-1584@cdlibrepositories.bepress.com]; The Editors [editors-uciem.westjem-1584@cdlibrepositories.bepress.com]

Dear Pamela Yamamoto Swan; Beverly Nighswonger RN; Gregory L. Boswell RN; and Samuel J. Stratton MD, MPH,

After careful review, your article "Factors Associated With False-Positive Emergency Medical Services Triage for Percutaneous Coronary Intervention" has been accepted by the editors of the Western Journal of Emergency Medicine.  You will receive a page proof prior to publication.

Thank you for your submission and we look forward to receiving your future scholarly work.

Sincerely,

Mark Langdorf MD, MHPE
Editor
Western Journal of Emergency Medicine

Conquering the World

Hooray for mutts!

The editors thank Darron Evans of Huntington Beach, CA for contributing this article.

CABG

CABG stands for "coronary artery bypass graft." I watched a patient's heart beating during a bypass surgery today. It was pretty cool, but not as awe-inspiring as I thought it might be. Am I too jaded, or too educated now to be stricken with awe? The weird thing was that the most memorable part of that surgery was when I told the surgeon the three standard expressions of Japanese surprise were: "Eeeeh?" "Waaaa!" and "Oooooh!" The whole room burst into laughter while the dude's heart was hanging out in the open. And THAT, to me, was the most remarkable part - that they were all so at ease even while elbow-deep in some guy's chest cavity that they could have a belly laugh during bypass surgery.

Ah, I so miss being at ease and good at what I do. People used to think this about ME as I stabilized and packaged multiple gunshot wounds, did CPR on heart attacks, and dragged myself half-asleep to put out car fires. Now I get excited about drawing blood. "Someday" can't come soon enough.

Unplanned

Just as we were sitting down to morning rounds to discuss our patients' treatment plans for the day, the traumas started rolling in. With five back to back, it was crazy - kind of like you see on TV, in fact. The most critical of the five was a girl in her early twenties, hit on the freeway during the morning commute. She had been extricated from her car by the FD and was unresponsive but with a pulse and breathing. All sorts of stuff was done to stabilize her cardiovascular system. Once it was stable she was taken for scans and tests, but she deteriorated again into unstable condition, so they finally decided to do an exploratory laparotomy. Basically, they sliced her open virtually from neck to pubis, a good 2-foot incision, and just started looking around for the source of bleeding. They found it - it was her spleen - and at the end of the day, she had: half her hair shaved off presumably to put a tube in her head to relieve the swelling or bleeding of her brain, a collapsed lung, a shredded spleen, 12 units of blood, a shattered pelvis, and major abdominal surgery. And no one knew who she was, so no one could contact her family.

The humane thought: I'm sure she didn't mean for this to happen when she woke up today. I hope they figure out who she is soon and call her family.

The med student insight: this must be the satisfaction of surgery, to see a patient from crash to fix, the beginning to end. But I still like being in the ER more than the OR.

The cynical side note: do not worry whether you wore clean underwear or not when you crash your car. We really don't care or look when we cut them off, and you probably will have peed or pooped in them by the time you get to us anyway.

Sad and Happy

We had a sad case today and a happy one.

A 17 year old kid was brought in after hanging himself because he wasn't getting along with his girlfriend and his mom. His mom found him on the floor of his closet, unconscious, because the belt broke. She of course followed the ambulance to the hospital, but he had regained consciousness by that time and was insisting he didn't want to see her. Some mother's day.

In another case, we had a post-operative guy (I'm on the surgery rotation now, on the trauma surgery team) whose pneumonia I found. So now we can treat it early before it turns into something really bad. The team gave me kudos, which was unexpected, as they usually just ignore the med students. I also get to do some things now that is not in the paramedic scope of practice. I got an arterial blood gas out of someone's groin and took out a chest tube, and helped staple a stabbing victim back up.

Paradoxically, I'm feeling better so far on surgery than I was on pediatrics. I say paradoxically, because peds is supposed to be all nice and fluffy and warm, and surgery is supposed to be harsh and unpleasant. The only hard part for me is waking up at the crack of dawn... I will never get used to that!

Well, Happy Mother's Day to my mommy and all the other mommies out there! May your children never bring you pain like the sad case today.

Phoenix

What does it mean to have self-esteem? Parents think their children having enough of it will prevent them from doing stupid things to mess up their lives. Books are written on how to acquire or nuture it. But what is it, really? Who has it? What happens when you wake up and realize you don't have much of it?

Medical school is designed, much like fire academy, to show you your lowly place. That you know nothing, or that the work you do is so worthless it is always repeated by someone else. There is a never-ending parade of exams, all orchestrated to assess how much you don't know. Rounds are structured so that people ask you questions you can't answer, or they ask you harder or more questions until you can't answer, then they provide the answer to show you that you don't know enough. Occasionally you get lucky and get it right, but usually the question is set up so the asker can deliver the answer, like a joke. And virtually without exception, your intellectual emasculation is in the presence of witnesses. There's a name for this: pimping. Rotations are scheduled so that every month or two weeks you are sent to a different hospital or neighborhood clinic - sometimes every day for two weeks - with different people, hospital hallways, security codes, computer systems, equipment, storage, forms, at times you even have to switch your brain over to the predominant language of the new locale. Even the antibiotics used for an infection with the same bacteria might have different resistances depending on the institution or geographical area you are in, so you could find that what you knew last Friday at Hospital A is the wrong answer on Monday at Hospital B. Or that what works for adults, due to whatever random biochemical reason, doesn't work for kids.  I want to shout, same species! same species! all the time.

If you can imagine changing jobs every month or two weeks and having to learn a whole new set of skills under pimping supervisors who you can't tell where to go, you are on your way to imagining a med student's life.  To add insult to injury, you are paying for the uplifting experience of being everyone's bitch.  Or maybe someone else is paying for it, be it your spouse or your family or the bank, then you are not only everyone's bitch who pays to be mistreated, you are also everyone's bitch who goes into debt to be mistreated.  That certainly doesn't bolster confidence in your own intelligence.  Even the fire academy was only for three months, and I was paid $10/hr for my daily beatings.  It is a wonder to me that medical students ever smile.  

Some of us have incredibly supportive, nurturing, caring significant others who don't take advantage of our state of constant humiliation to make us feel worse.  Others maybe have friends or family outside of medicine who can provide perspective that outside life isn't quite as punishing - it may be to some degree, but not at the steady pace of Chinese water torture as in medicine.  And then there are those whose inner Phoenix gives them strength from within, that reminds them that they are intelligent, accomplished, rational, sensitive, caring, and good.  That the mental torture may be pretty bad at times, but can be survived as long as one doesn't lose the broader sense of one's self.

Maybe self-esteem is really a little firey bird in your soul that rises out of the ashes of your emotional beatings to remind you who you really are, when you are led to doubt your own perceptions of yourself.

Teenage Lessons

What can you teach a teenager in five minutes?

I've been doing pretty well with my three year-olds, six year-olds, and I've been all right with the 17-18 year-olds, too. I've made a pleasant discovery that doctors totally take off diapers to check whatever, but then they get to say, "Okay, I'm gonna let you put him back together now," and go on their merry way. I can even calmly complete an ear exam with a screaming one year-old now, which I consider the crowning glory of my first pediatric outpatient week.

But those adolescents and early teens, they're awkward and weird and not at all like the other age groups. To be sure, I am the consummate professional, and always do my best to speak factually, without showing signs of discomfort.  Sometimes I just make a quick little speech about teenagers being at higher risk of STDs, drugs, etc. because 1) we don't have the time in one office visit to explore the depths of their bourgeoning sexuality and angst, 2) the pediatrician himself doesn't go near the topic but I feel like they should - even if briefly - hear the message we are taught to deliver, and 3) I've been told teenagers just want the spotlight to be off them and not have to talk much about themselves. I do all the things they tell us in class, to make sure the parent is out of the room when asking about sex and drugs, always reiterate safety, and let them know they can talk to their doctor if they want information.  I do the speech in front of the parents, skipping the personal questions part, when I don't actually think the kid is into anything yet.  But it bothers me when the parents look uncomfortable. I think, this is their kid and they're the ones uncomfortable here? Then I second guess myself: am I overstepping boundaries? I sure would want an authority figure drilling into my kid that they should avoid sex and drugs but be careful if they do decide to do them.  But of course I realize I'm not everybody, in fact, I'm not even a parent. So what do I know.

So what can I do... I guess just stick to the biological and statistical facts and be nice and polite and personable.  And bide my time until pediatrics is over in three weeks and I can go back to talking to adults about their sex and drug habits... you know, back to the easy stuff! 

I Don't Remember Saying This

To whom might I have said this? Back in December 2004? I've never even seen this article before. Another good reason to avoid the media, perhaps.

Highlights for Children - ER Editon

No one wears button-down shirts and ties in the ER, and the monitor behind us is blank. What other wrong things can you find in this picture?


And to be clear, I didn't exactly say all those things that were in quotation marks. This is why everyone knows - avoid the media at all costs!

Coupon Fairy

Here's something Darron and I like to do:

Next time you go to a restaurant with coupons, take along the inevitable second coupon that you won't use in the next three days before its expiration date. Scan the room, and find a nice couple, the lone diner, a cute family. Then give them the coupon. It's always smiles all around.

The other night we picked a little family of a dad and his three kids. As they left, the teenage boy jubilantly said, "thank you for the dessert!" while the little kindergartener just smirked sheepishly and looked around nervously as his dad told him to "say thank you!" It was cute.

OPD Memorial

March 27th was the memorial, which I was able to attend.  My OFD buddy Linda said, "What?  You're driving up here after work?" and promptly bought me plane tickets instead.  She's an amazing person.

I arrived inside the Oakland Arena for the memorial early, but it sounded like the morning was an amazing thing to see, with the motorcades escorting the caskets to Oakland.  Freeways were jammed as miles and miles of patrol units, motorcycles, and fire engines made their way to Oakland.  I read that as they crossed into the city limits, each freeway overpass was lined with firefighters from Alameda County and elsewhere, saluting the motorcades below.

There were cops from everywhere.  In all the talk with OFD folks, as well as newspaper articles and online reports I read since then, I heard about so many departments that made the trek.  There were cops from all over California, to say the least.  An Emeryville firefighter told me there was a group of motorcycle cops from Orange County Sheriff's Dept. that left their motorcycles at her firehouse the night before, after the 8-hour ride up.  I heard Chicago PD made the 2100 mile drive out here, some PD from Minnesota also driving out.  There were 50 cops from Boston - I saw many of them myself - and I heard JetBlue donated a plane for 250 NYPD members to attend.  We saw Canadian Mounties, and I read somewhere that there was even a cop from Tokyo.  One department had their SWAT unit there.  I was asked why cops would drive out from so far away in their patrol units or motorcycles instead of flying in, and the reason is so all those cop cars could be present, to show solidarity and support. I saw many AMR employees too, and I heard Highland Hospital staff were there as well. Of course, several fire departments had members in attendance, and the majority of OFD was there, too.  I got to say hello to lots of old co-workers, even though it was for the worst reason.  Geoff, my old captain, as well as Heather, his friend from Emeryville FD, passed up sitting in the fire dept section so they could sit with me in the general section. It's good to have good friends.

I've never seen a memorial like this before, and I doubt I'll ever see anything like it again. The entire Oakland Police Dept. was in attendance, the motor units with their domed helmets and K9 units with their German Shepherds, non-sworn employees, and Animal Control too, as Alameda County Sheriff's, the CHP, and I even heard LAPD were on the streets to handle Oakland during the memorial.  There were so many people in attendance, a few thousand spilled over to the Coliseum to watch on the big screens.  When the honor guard took the flags off the coffins and folded them for the police chief to present to the surviving families, there was not a sound. There was an occasional throat cleared, the sound of men trying to control their tears, but nothing else.  No babies crying, no cell phones, no K9s whining, no sirens outside, nothing.  To say "you could hear a pin drop" would be too cliche, so I will say instead that in the whole arena where they play NBA basketball games and were maxed out to their 20,000 seat capacity, you would have been able to clearly hear someone dropping a water bottle or a plastic cup.  That's how quiet it was.  And it lasted for about 10 minutes.

There were many people who spoke in the ceremony, but the most memorable was the SWAT captain.  He was just impressive, with the perfect amounts of sensitivity, toughness, grief, inspiration, and praise for the four officers, as well as the rest of OPD.  He singled out and gave a heartfelt thank you to the citizen who rushed over to perform CPR on one of the first downed officers.  He too sighed a lot, but delivered the eulogy bravely and toughly.  He projected the air of one of those natural leaders, the type of man you flock to in fearful or uncertain moments.  After the general remarks and eulogies, each officer had their own.  I had long lost it at the beginning, the moment the bagpipes started playing, but Dan's part was the hardest.  The K9 units were impressively silent throughout the service, but when someone walked out Dan's K9, "Doc," to the coffin, he gave four or five barks.  It was the saddest sound all day, even more than the bagpipes or the bugle playing taps.   

At the end of the service, we saw four groups of five police, Coast Guard, and rescue helicopters, one group for each officer, fly above the Arena in Missing Man formation.  There was a 21-gun salute by the National Guard as well, which I later learned is the highest symbol of honor the United States can give.

The memorial was a good tribute.  I'm so glad I went.  At the end of freshman year at Cal, I was stranded in Berkeley without a car.  I was going to live with Grandma in Lompoc and borrow Tommy's car that summer, but I needed a way to get down there.  So Dan gave me a ride.  He drove five hours down, politely said hello to Grandma and Grandaddy Lee, maybe had a cup of coffee, then turned around and drove the five hours back up!  He said he could go visit his own grandparents in Nipomo, but I don't think I ever really believed him - I'm still not sure he wasn't just being a really great person.  Grandma liked him, which of course says volumes about his character.  So I'm glad I was able to finally make the trip for Dan, just as he did for me, many years ago. I just wish it had been for a different reason.

Still There

I was looking around for more information on the OPD officers, when I found this on the OFD homepage.  I was touched that they hadn't taken me down.  Probably because no one can recognize it, but it's still nice at a time like this to feel like I belong to something.

Rest in Peace, Dan

It's hard to lose a family member.  It's sad to lose a friend.  It's sobering to lose an acquaintance.  What do you call it when you lose a fellow sworn public servant?  What if the fellow public servant used to also be a friend?  What if he was a friend and former co-worker and was murdered in the line of duty?

I knew Dan Sakai when we went to college together.  We worked at the UCPD where he taught me the ropes.  We were pretty good friends for a time, then he moved to Japan to teach English while I moved to LA to become a paramedic.  We were both the EMTs of our group at work, but he eventually continued the law enforcement path and I took the fire route.  In reading the recent news about him, I realized we were both hired by the City of Oakland in December 2000, he at OPD and I at OFD.  We popped up in each others' lives every so often, sometimes on scene at an incident in Oakland, sometimes outside of work.  I last ran into him a few days before I left the OFD.  Our engine and a few patrol units happened to converge on a Starbucks for some emergency caffeine.  We caught up a bit, his wished me luck in med school, and I wished him luck at OPD.  A couple months ago, I texted him out of the blue when I was in Big Bear, because I remembered he was from there.  Of course he asked me how med school was going and such, I told him to stay safe, and that text exchange was the last.

What is it about emergency services?  Is it having served in a dangerous place like Oakland together?  Is this what military people feel when they hear about a downed soldier?  What was it that I felt after 9/11 when 343 firefighters I'd never met died 3000 miles away?  It must be a bond of some sort, although I have a hard time describing it.  It must last even after one leaves their agency, because I still feel sad even though I'm not at OFD anymore.  When they swear you in, you take an oath to serve and protect.  But of course that means you swear to your crew and co-workers, too.  And when you leave, they don't swear you out.

Still, I am mostly sad because although we grew apart in recent years, he used to be a good friend and mentor.  It must be a combination of sadness for a friend and regret for someone who worked the same streets I did, because I wonder if I would feel this way about a similar friend in college but with whom I didn't serve the public.  I've had a flurry of calls with former UCPD and OFD co-workers over this.  I really want to go to the funeral.  I miss being around them.  I have not regretted changing career paths, but right now all I want is to be in Oakland and sit around a firehouse table or run into AMR or OPD on a call and sit around and BS or just look at each other, and know.  I feel stranded out here.  I requested the use of one of my two days off for the year so I can attend the funeral.  I hope they don't reject my request just because it's not for a family member.  There is a very strong tie among those who wear navy blue, and even though I gave up the blue on the outside, I think I will always be a lot of blue on the inside.

My thoughts to the families and the kids who will grow up not knowing their dads, particularly Dan's, who I think must be about three years old by now.  I hope their sorrow soon abates to pride.

Where I Stand

Today, math nerds everywhere celebrated square root day.  

You know how violas are the butt of the orchestra and tubas get laid?  And truckees are not too bright, engineers are lazy and medics are wusses?  Or PE teachers are gay and chemistry teachers are dorks?  Subgroup analysis abounds everywhere, even in this nice little tool to help me find my life's calling:

Blissful Ignorance

I like knowing things, as any person might, but there are some things I just would have been okay not knowing.  I'm having many such experiences on OBGYN.  I have had enough vagina to last me a long, long time.  And I have really seen enough infected ones to last me forever.  I also get to be at the hospital by 5:30am to go look at them.  The good news?  I have narrowed my prospective career choice by yet another specialty.

25 Random Things About Me

There has been one of those silly chain things going around online lately. I usually don't fall for or participate in them, but since I have not had a post recently and I actually succumbed and wrote something back, here it is for your passing interest:

1. Though I worry about certain things, I usually delete chain letters without a single thought to the karmic implications.
2. I love when it rains and I am in bed with nowhere to go.
3. There was a period when I dreamed about being murdered or committing murder every night or every other night. Now I have nightmares about dirty houses.
   
4. I am not always grumpy in the morning.
   
5. I am currently a Disneyland annual pass holder. I never thought I would be one of "those people."
   
6. I know a Robin, a Hawk, a Jay, and a Bird.
   
7. I have always wanted a pet, but the one time I actually got one, I couldn't handle it.
   
8. I found a job four days after moving away to college. I worked at a bookstore. It lasted a few months until the creepy old stock guy with cigarette breath started standing too close to me on his breaks.
   
9. I eat sausage and hot dogs, but I don't eat pepperoni.
   
10. Of the things I used to do for work, I miss driving with lights and sirens the most.
    
11. When I was born, my dad was surprised to find I was the ugliest thing he'd ever seen. 
    
12. I am addicted to Dear Abby.
    
13. I never ditched or got detention in high school.
    
14. The longest I've stayed awake at once was 46 hours. At the 43rd hour, I played pickup basketball with the guys after work.
    
15. I like frozen yogurt better than ice cream.
    
16. My first career aspiration was a novelist. I started writing a novel when I was twelve. I quit because I hated my childish writing but didn't know how to fix it.
    
17. I am neither a leader nor a follower. I often wander off on my own.
    
18. I have only broken up then subsequently gotten back together with one man. 
    
19. Once when I was a new driver, I was so angry at something I actually called someone to pick me up because I didn't think I could drive. 
    
20. Excessively bubbly people seem either insincere or a little slow.
    
21. When I was a kid I got really good at sneaking peanut butter, which we weren't allowed to eat because it would stick to our teeth too much and give us cavities.
    
22. My mother used to let me run around in the snow in only diapers.
    
23. I buried a dead mouse on the way home from school once because I felt so sorry for it lying in the sidewalk. When I got home later than expected, my uncle said he was going to write a book called, "101 Excuses by Teenagers."
    
24. On the other hand, I used to chop off the heads of ants as a child and watch the headless body run around.
    
25. I have occasionally stood in front of the mirror making funny faces at myself and cracking up when home alone.

Anyone else care to share random facts about themselves?

Big Bear

Our Big Bear stay at the Honeymoon Hideaway did not last long. There were several little things that were suboptimal yet tolerable, until we spent nearly three hours trying to get out of the driveway the next day! We imagined it would be icy in the morning, so fighting all natural instincts to wake up early, we waited for it to warm up before we set off around noon. Darron had tire chains, but the incline of the driveway coupled with the ice proved to be insurmountable and we learned the feeling behind the phrase, "snowed in." Our entire day was shot just trying to leave the cabin.

So we very nicely brought this to the management's attention and requested another option. For our trouble, we were upgraded - for no extra charge - to a grand, new cabin that slept six, had marble countertops and stainless steel appliances, a jet jacuzzi, pool table and darts board, two decks, a fireplace, a heating system and effective insulation, and best of all, a driveway we could drive in and out of!

From then, we could not be stopped except by our own vacationy laziness! As it was midweek and the crowds were gone, we went on a peacefully (mostly) solitary walk around the frozen Big Bear Lake, built a snowman, made yummy dinners (one night Darron made the most perfect s'more ever), went skiing where Darron avoided smashing his head for once and I avoided having shoulder surgery again, read books, watched cable TV (remember, I gave away my TV and Darron only has snowy analog network channels!), explored the neighboring town, and also visited the little local Moonridge Zoo, which takes in injured or orphaned local animals, or sometimes even abandoned exotic pet animals. 

We saw retired San Diego Zoo arctic foxes, owls of many sorts, a black bear who was found as a baby abandoned and starving in a watermelon patch, some bison, bald and golden eagles and hawks who got cataracts and went blind from pesticides or were shot by ranchers, a mountain lion, a squirrel with vertigo that was found injured after he fell out of his tree, a tortise named Speedy, a very nervous African hunting cat called a serval, and these young timber wolves. So mournful and eerie. If you've never heard a wolf howl, hit the "play" button below.



And we adopted a snow leopard named Milo for a year. Snow leopards are an endangered species, very rarely seen in Central Asia, and never below 5000 feet elevation, which is probably why he's in Big Bear. Our little adoption fee goes toward feeding and caring for him, though watching him eat, it probably only buys him two days' worth of food! You can read about all the animals' stories here.

Tom's Niece

Turns out Tom is not the only one in this family with perfect pitch (aside from our more actively musical family members, undoubtedly).  Darron came up with an electronic tuner, and I hit A right on the money! followed by E, D, and G.  Now I just need to dust off that ol' violin and record a few albums to pay for all those lessons that apparently taught me this vastly useful skill...

Cultured

Our LA field trip:

I'm not a huge museum person, as anyone who has been to one with me can attest, but I wanted to see the Getty for its architecture and the views were supposed to be fantabulous!  Turned out to be foggy with visibility of like o.1 mile, but it was kind of cool to be high up on the mountain in a neat place in the wispy, drippy fog.  Made me feel like I was in Star Wars, in a place like Naboo.  Darron wasn't keen on going, but he ended up enjoying the art quite a bit (and I finally learned what Rococo style is), so that made the acculturation all worth the $10 parking fee.

A couple of hours later we headed a few miles away to Beverly Hills.  On our way we found some irony. For lunch, I am so sick of Mexican food that I never eat it if I can help it, but we went to a place that made oh-the-best Mexican food I've had in a long time, if ever!  Today it finally occurred to me why I'm sick of it:  it's because it's ALL the same.  Everywhere you go, it's all the same.  Burritos, enchiladas, fajitas, tamales, flautas - with 50 bajillion Mexican joints to choose from around here, it's all the same!  But this place, they had the most interesting Mexican food ever, and it wasn't some sort of fusion food - their recipes came from their ancestors (or so they say).  Darron ordered horchata too, and although I usually don't like it, this stuff tasted just like liquid rice pudding!  And the corn tortillas, which I also don't generally like, were so soft and fluffy.... mmmm, sooooo good.  It was all good.  My Mexican taste buds were revived in this oasis of yum.  The price was not bad either, compared to the cost of an ordinary lunch elsewhere, for the resurrection of a cultural cuisine.

After our wonderful gastronomical experience, we wandered over to Rodeo Drive for a little window shopping.  I have to say, the famous Rodeo Drive didn't impress me much.  For one of the priciest shopping destinations that the stars all go to, it was only two blocks long, with the same stores you see in major cities everywhere.  There were even a few storefronts with "For Lease" signs and carelessly hung butcher paper in the windows.  It was a very uninspired place, save for the Mikimoto store.  We dropped in and found one of the employees to be nice and chatty, considering we must have looked like hobos compared to their normal clientele.  We learned a few tidbits about pearls, the economy, and "luxury-class" shoppers.  These shoppers have not been immune from the economic downturn because, as the employee put it, "they have money, but they're scared money."  And about pearls: the golden pearl is the most rare and from the Tahitian seas, while the smaller white ones are cultured in Japan.  Earlier at the Getty we learned that when Mark Antony first met Cleopatra at a feast she threw for him and was surprised at its opulence, it's said that she threw a pearl into her wine and drank it to show him that luxurious excess didn't concern her.  Now that's brave money!

The Griffith Observatory was our final stop.  Since its 4-year renovation, it looks great!  If you haven't been there since 2002, it's worth another visit. The new reclining seats in the planetarium and the show itself are nicely redone.  Did you know that the earth "wobbles" on its axis one full turn every 26,000 years?  For this reason, astrology, which is based on readings from 2000 years ago, is off by about a month!  Does this mean I'm actually a Sagittarius?  I should go read my astrology book again and see if that explains the complexities of my character!

Altogether, an acculturating day.

(Disclaimer: future blogs are likely to be much shorter.)

New Year's

I don't do New Year's Resolutions because they rarely last past the 2nd or 3rd, then I feel like a loser, so why inflict pain on myself needlessly?

Darron and I did a bunch of nothing today. It entailed:

• Sleeping in until 11am (early morning today!).
• Eating cereal.
• Taking a shower.
• Checking the news and email.
• Studying the Industral Revolution by way of teaching Darron to use a sewing machine to mend a rip (he said he felt "so domestic" - and he's a fast learner).
• Watching Darron take a nap.
• Eating a sandwich and some soup.
• Checking the movie listings to see if there are any movies out that we haven't seen (there aren't, except some really bad ones).
• Putzing around while Darron went home to clean dishes before I drove over to meet him for dinner.
• Writing this blog.
• Helping Darron brainstorm the notable things that happened to him last year and coming up short.

It's a good thing we have stuff planned for the rest of winter break!  We're going to Big Bear next week to ski and play in the snow for a few days, since it's only three or so hours away.  Tomorrow we're going to the Getty Museum, then grab lunch in Beverly Hills on the way to the Griffith Observatory for a little science and sunset action, then maybe some stars (you know, Venus is really bright and close to the moon right now, and Jupiter was visible very close to the moon a couple weeks ago).  The best part?  The museum and observatory are free, as is celebrity hunting! Aside from the once-again-cheap cost of gas, the only cost will be for lunch... one place I found has lunch entrees for $9-12, so considering we are going to spend the whole day in LA, we're going to make out like bandits!  Sure beats going to The Happiest Place on Earth for a whopping $69 apiece (food not included).

So... hurray for cheap entertainment!  Hopefully a trend-setting day for the rest of the year.