HOT!

What just made it to the top of my Christmas list? An A/C repairman. I spent most of Saturday out and about - work, gym, mall, Target, Publix, hairdresser, dinner and finally the theater. I was truly only home for about ten minutes between the hairdresser and dinner/theater to change clothes. I remember thinking that it seemed hot at home, but I attributed that to the mad dash I was doing around the apartment trying to pull together a cute look in less than 15 minutes. However by 3 am Sunday morning, it was obvious something was wrong. By 3 pm Sunday afternoon, the thermostat was reading 85 degrees - in my living room!!!!

I contacted the handyman that my condo owner has on retainer. He was away for the weekend. He originally told me that he would be happy to come by mid week. One quick email to my owner later, and he will be by this afternoon.

We will add this to the list of things that are only in Miami

I surrender

Real world 37: Tammy 0

Talking a good game

I am "enlightened" in the ways of self fulfillment and personal happiness - I watched Oprah.

Or at least I know all the right things to say . . . Time with friends and family is just as important as work. Money and fame can not buy someone to hold your hand in a rocking chair at 80. Prestigious careers provide little warmth on a cold winter's eve. I truly do believe that it should be about the journey, and not just about the destination.

Where I seem to fall horribly short these days is in the execution. And as my mother always tells me knowing right and doing right are two entirely different things.

I am not promising change over night, but am promising change. Time to start practicing what I am so good about preaching.

Fresh Start

Although Spring is usually the season associated with fresh starts, I can't wait until then so my fresh start begins today. Stay tuned for details. . .

Time Flies

Do you ever see the tv shows where they indicate the passing of time by showing you a clock where the hands spinning in fast forward? That is what my weekend has felt like. It seems only a couple of hours ago I was packing up my bag to head home Friday night, and now I'm packing a bag for Monday morning. Why can't the work week pass this quickly?

Would love to say that at least I accomplished a lot, but alas not so. I rounded on Saturday then had to head to a work picnic that lasted 6 hours in 99 degree sun. Today's only accomplishment was an exciting trip to the grocery store. Oh well - there is always next weekend. Why do I find myself promising that a lot.

Darwinism run amok

Darwin argued that species adapt to survive, and those that do not adapt perish. My body seems to have taken that concept to an unhealthy extreme.

My trainer is constantly remarking on how quickly my body adapts. She changes my training program every three weeks so that my body doesn't get used to it. I had perceived this as a good thing. I get to try different stuff at the gym so not only does my body not grow accustom, but my mind doesn't get bored either.

Then the last two months happened. As anyone who has tried to reach me can attest, the only free time I have had the last two months required that I leave the state or even the country. Otherwise, I work, eat and sleep. When I showed up for my training session yesterday, I realized it was only the third session I had made it to in the last 8 weeks (and I normally train 3 x per week!).

Turns out my body also adapts quickly to not working out. During my session yesterday, I had a whole new appreciation for the Biggest Loser contestants. The closest I have ever come to being physically sick from a work-out, and the first time I wasn't able to complete one in its entirety. This morning - walking hurts. We won't even discuss lifting my arms.

Let's hope that it readapts as quickly. If not, I'm in for a rough fall.

Owie

I got my flu shot yesterday. I would like to blame it on lack of sleep, hunger and exhaustion. While all of those statements were true yesterday, I get the flu shot every year so nothing really to blame. However, I forget every year how much it hurts. Can seriously barely move my left arm today. Will seriously be upset if I actually get the flu this year.

Complications

The dictionary defines the word complications as something that introduces, usually unexpectedly, some difficulty, problem, change, etc.

I am not a fan of unexpected. I am a planner - always have been. I like to know what is coming next and when it is coming. I am a surgeon so I am used to difficult, but I find that I don't like difficulties. There is a distinct difference there. Don't even get me started on problems.

As you can probably guess, I am currently dealing with an unexpected difficulty at work currently. Said problem is why I am still sitting in my office at 7:45 on a Friday evening. It is not that part that bothers me so, though perhaps that speaks volumes about my dating life.

What bothers me most about complications - proof that I am not perfect. And I try so hard to be.

Glory Days

Many of a rough day of training was survived by imagining the "Glory days" of being an Attending. Big salary, better hours, less stress, more control - all things for which I could look forward. Boy was I delusional. At least as a fellow, I would have gone home several times the last few weeks for hours violations.

Last Thursday I came home at 11pm, made a quick dinner, sat on the couch to eat, and my next conscious thought was at 6:47 am Friday morning. I woke up on my couch, still in my scrubs with my dinner still on the coffee table - untouched.

Tonight I finally got home before 9pm. How am I celebrating you might ask? I'm getting ready for bed. The heating pad is warming as I brush my teeth with the smell of Icy Hot still in the air. Oh, these are the Glory Days.

Losing My Zen

What a difference a week makes. One week ago today I felt fantastic. I was rested, relaxed - in a word rejuvenated. I felt ready to conquer the world. . . . Turns out the world wasn't quite ready to be conquered. It fought back, and hard.

Best. Trip. Ever.

Please disregard my prior entry. I no longer have any feelings of guilt regarding my recent Canyon Ranch experience. As a matter of fact, I am already ready to commit to a stay there next year. I now firmly believe that spending a week concentrating on nothing but yourself should be mandatory for . . . well everyone.

We arrived at the airport and was met by a driver who came equipped with a "little" snack of pita wraps, carrot sticks, apples, and homemade granola bars for the car ride home, but "not enough to spoil dinner". Things only got better from there. With an idyllic setting deep in the Berkshires, fantastic staff, a loaded gym with amazing trainers, a world renown chef and "hot" days in the mid-80's, they had me at hello.

This was way before I even had my first massage.

Did I mention that I had more than one massage, or did I brag about the undereye bag eliminating facial that I was willing to fly back to Massachusetts to repeat regularly when I learned that it was offered here at the Canyon Ranch Miami Beach? Perhaps I should tell you about the detoxifying ritual that involved scrubs, clay, and oil that felt like a little slice of heaven.

Don't get me wrong, the exercise classes were hard. Can we discuss 45 straight minutes of squats and lunges in a class aptly titled - Rock Bottom. Or perhaps the 45 minutes of crunches and planks titled - Melt your Midline. And I would recommend to no one 45 minutes on a TRX - it is a great piece of gym equipment, but only when used in moderation. However, the trainers were all so funny and motivating that you smiled as you worked through the pain. {In full disclosure, however, after 4-6 hours of daily exercising - my body is now hurting in places that I'm not even sure I learned in Medical school.}

I was even educated. I had my flexibility and posture analyzed, and learned that perhaps always skipping the calf stretches after running is bad. Turns out I have almost no ankle flexibility, and much of my hip stiffness is related to my super tight gastrocnemius and soleus muscles. Unfortunately this also puts me at danger of an Achilles tendon injury. I also learned that when standing I lock my knees which causes my pelvis to tilt forward anteriorly. This contributes to my hip tightness, over time can cause scoliosis, and worst of all pushes out my belly causing it to appear even larger. Needless to say, that is one problem I corrected VERY quickly.

Best of all, despite my travel woes (2 hours parked on a runway in ATL), I came back feeling refreshed and ready to take on the world - or at least my little corner of it. I would highly recommend it to everyone, and don't be surprised if you bump into me at the gym while you are there.

Guilt

Several of my Jewish friends seem to think their mothers have the market on guilt, I respectfully beg to differ. My Southern mother has been pretty facile using it as a weapon for quite some time now. Guilt has been a factor in many of a personal decision since a very early age. Guilt has forced me to be more honest, kinder, giving, prayerful and more likely to call my mother every few days. At the end of the day, perhaps this is what guilt is supposed to do - make us better people. (I guess one could argue a truly good person wouldn't need guilt, but I've never claimed to be a truly good person.)

I am currently experiencing guilt of a whole new variety - consumerism/selfishness guilt. I have both consumed a lot and been very selfish in my day, so unsure why the guilt is just catching up with me. Perhaps it is the current degree of self-indulgence that is igniting the flame of guilt.

I leave tomorrow for a 6 day / 5 night stay at Canyon Ranch - the one in the Berkshires. For the entire week, I get to work-out, eat healthy, relax with a friend, and partake of "spa treatments". I have three different massages, a full body wrap, a facial and an aerial adventure trip scheduled already. I am also planning to do a hike, kayak trip and paddle boarding.

While there is a huge part of me that thinks this sounds like a little piece of heaven, there is another part of me that is having intense feelings of guilt. It is so bad that I have been incredibly vague about my plans here at work. I am pretty sure that everyone here thinks that I am going away for a romantic week at a B&B with Carl. (Yes - I giggle every time they mention it.) When I am finally pinned down to specifics, I find myself lowering my head and muttering - as if I am ashamed.

It can't be about the money, because quite honestly I haven't had a moment of guilt about my Louboutin shoes and they cost waaay more than a massage - or three. Is it the pure decadence of it that seems wrong to me? Are my Puritanical Anglican roots balking at the idea of spending that much attention on myself? Why can't they rear their head in the shoe and handbag departments at Neiman's?

Guilt or not - I leave tomorrow at noon. Cell phones and other modern communication technology are strictly forbidden except for the privacy of our rooms, so I will be going "off the grid" for the next week. Hope to come back well rested, refreshed and with a little less guilt baggage.

No News is Good News?

Sorry I have been so quiet lately. I wish I could tell you it was because I was off leading such an exciting life that I had no time to write about it. Alas, that is very far from true. I have been here in very Sunny Florida, and can't even complain about the weather because as my mother keeps pointing out to me - it is hotter every where else.

I do have one new bit of advice that I can impart. Never get a haircut while in a funk. Made that mistake this weekend, and now I have no hair left. Anybody know any hair growing secrets?

treading water

I've been taking swimming lessons lately. (Or at least I was until my schedule fell apart.) I have never been a strong swimmer, and wanted to have the option of swimming for exercise in the summer when it is too hot to run. I also would someday like to try a triathlon.

I have learned a lot. It turns out you are actually supposed to breathe under water. (I have been holding my breath all these years.) I have learned the correct arm movements for a crawl, and I have also made my flutter kick more efficient. My backstroke actually looks like swimming now. All in all a good start.

However, when it comes to treading water - I suck. I have never been able to do this well. I move my hands and feet the way I am told, and as soon as I start to sink a little in the water - I panic. I know intellectually that I am just buoying in the water, but as soon as I start to go down some other part of my brain takes over and creates mass chaos.

From where does this fear come? I don't recall any near drowning experiences. . . at least in water. I have had plenty over the years in residency. Perhaps therein lies the answer. All of these years of barely keeping my head above water at work has manifested its way into my swimming.

I'm in Love

Exciting weekend news - I finally fell completely, madly, truly in love. I can't wait for you all to meet him. He is tall, French, debonair, exciting, and elegant. He is a little older, but very young at heart - or at least I imagine him to me.

We went out on our first date Sunday night, and it was a smashing success. All the other girls were shooting me envious looks because clearly I was with the cutest guy in the place.

His name you ask - Christian Louboutin Very Prive Peep Toe Pump. A little bit of a mouthful, but I was never planning to change my name anyway.

It's true, and I am not ashamed to admit it. I have fallen in love with shoes. I can't imagine anyone is really all that surprised - we all knew the chances were pretty high that my true love would involve shopping and not a guy anyway.

The best part - he has lots of brothers and cousins. I told him that I would be happy to have them all move in with us. He thinks we should take it slowly at first, but I'm optimistic that we will get at least one more family member under our roof by Christmas.

Isn't it Ironic. . .don't you think

Why is it that when I want to sleep late, my eyes pop open by 6 am, but when I actually want to get up early and be productive, I can't seem to drag myself out of bed. As you could guess by my absence from the blog, I have been slammed at work lately. This has me not only missing my friends and regular meals, but also missing workouts.

My plan was easy - get up in the morning, head to the gym (a quick elevator ride downstairs in my building), half hour run, back upstairs for shower and still able to arrive at work by 7 am. It sounds attainable, and certainly not the earliest I have had to get up in my career. However, I simply don't seem to have the willpower. The alarm goes off, and the excuses begin.

I have friends who bike 20 miles to work, run 6-10 miles every morning, or take 5 am boot camp classes, and I can't put in 3 miles on the treadmill? Pathetic is what I think.

Dr. Baxter

Ten years of surgical training prepared me for lots of things. I can take care of bad lungs or a barely functioning heart without batting an eye. Ruptured aorta - bring it on. ECMO on pressors in the ICU - barely working up a sweat. Unfortunately, the one thing I am not sure my training prepared me for was to carry the title "Attending".

The running joke around any Academic institution is that becoming an Attending in the words of Darth Vader is to "give yourself to the Dark Side". The perception is that one becomes obsessed with billable procedures, lengths of stay, potential malpractice and insurance companies; and loses site of important things like patient care. While I am not willing to concede this point entirely, I will admit that I think a lot more about the cost of health care these days. However, this is not the crux of my problem as an Attending.

I now have a whole week day dedicated to filling out paperwork, "developing an academic career", talking to insurance companies, patients, and I'm pretty sure random people my office digs up off the street. I have two whole days dedicated to clinic, and unlike during residency I can't claim a pressing OR case to get out of it. On the two days I get to actually operate (or more accurately watch the residents operate), I seem to spend as much time darting to meetings which never seem to reach resolutions, catching up on dictations, and preparing lectures for the residents. However, this still isn't my biggest issue with the Attending title.

The Attending issue that I feel ill equipped to handle is the perhaps subtle but distinct line that separates you from everyone else. When I was a resident/fellow, the hospital was a ready source of friends for me. I would go out with the RNs, NPs, PAs and my fellow residents. They had similar hours, interests, and complaints. I tried that same path to success here, but met quite different results.

I am no longer "Tammy" - i.e. one of us. Now I am "Dr. Baxter" - i.e. one of them. It is no longer a group of colleagues with stressful jobs going out to blow off steam. Now it is a group of colleagues and "her". Regardless of the surroundings, no one can forget that I play for the opposition. The stories must be cleaned up for my hearing, the complaints are filtered, and there is always the insidious believe that my life must be all roses and sunshine because after all - I am "The Attending".

Perhaps the easiest way to cope would be to hang out with other Attendings. People unlikely to yell "Hey Dr. Baxter" across a crowded restaurant. However, this isn't as easy as it would seem. I am a good 15 years younger than anyone else in my division, and at least 10 years younger than most people in my department. I have the opposite problem in other departments, as the singletons are all fresh out of training, but their training only lasted 3-5 years so they are much younger than I.

Another potential fix is meeting people outside of the hospital. I would love to do this, but haven't figured out how. All that surgical training has left me ill equipped to have interests in the outside world. Even at the gym the other day, I heard someone yelling out Dr. Baxter across the floor. It turned out to be one of the anesthesia residents, and a source of endless amusement for my trainer who has now decided to use the title to irritate me.

I'm not saying that being an Attending is all bad. I certainly love my new shoe budget, the ability to do things my way, and control over my schedule. It is also nice to have a whole team whose job it is to make my life a little easier, and to take care of many of the tasks I hated when I was a resident. I want to keep these things and the old ones too. I admit it - I want to have my cake and eat it too.

Just a thought

I understand that it is South Florida, and almost already unbearably hot - so less is more. I also understand that tank tops and spaghetti strap dresses are very "in" at the moment, and great for this type of weather. I even agree that exposed bra straps are distasteful.

However, unless you paid good money for the eternally perky breasts at the doctor's office - PUT ON A BRA!!! That's all I'm asking - you could take an eye out with those things.

Trienta y ocho

So I've had a few days to settle into the mantle of 38, and must say so far it is a good fit. Like a good leather jacket or bag, my body is starting to show signs of wear and tear, but to me those are what give it character. I'm just getting my body worn in so that it handles well. I now know how far I can push it, and when I need to give it a rest. There is a lot of power in that knowledge.

I also like the self confidence that seems to come with age. I spend a lot less time these days thinking about what other people think about me. I am finally comfortable in my own skin. I can appreciate the value of me - warts and all. I no longer feel the need to try to achieve some unattainable perfection - I just need to be the best me that I can at any particular moment.

I find myself looking forward to this my 38th year. I am in awe of how far I have come, and can't wait to see where my journey may head next.

Weekend Warrior

I may have the wrong definition for the phrase Weekend Warrior. I competed in my first (and possibly my last) Super Spartan race. What exactly is a Super Spartan race you might ask - technically it is an 8 mile obstacle race, but it is almost one of those things that you have to see to believe.

It started with a nice one mile jog along the river. Not much different that a normal run for me, except there was dirt and not a boardwalk. The first "obstacle" was a small creek that we had to wade across. It was no more than calf deep, so easy enough to maneuver. The hard part was running with wet shoes afterwards.

After sloshing for another half mile, we had to crawl through a low tent for a 1/4 mile. As soon as you exited the tent, you had to immediately scale an 8 foot vertical flat wall. We had to help each other up and over. Luckily, I was given a knee up to the top, and then could reach down and pull my knee assist up. Then we both were able to drop the eight feet down the other side. Another half mile, and we reached an inlet of the bay. We were assured that it was only waist high, but my chin would disagree. Another 1 1/2 mile run, and we had to scale a twenty-five foot cargo net. I felt a little like Spider man.

At each obstacle station, you were warned that if you couldn't complete the obstacle the punishment was 30 burpees. I HATE burpees, so I had lots of motivation to complete the challenges. The next obstacle was a Rubik's cube. Finally, an obstacle that made use of my nerdy side. You only had to complete one side, and you are talking to the girl who wasted countless hours of her youth solving the cube. I was in and out in seconds, and must say I gloated a little as I walked by all the fit athletes doing burpees.

Another jog, and then we hit "the walls" - literally. There were six total: two you had to climb over, two to climb under, and two to climb through. Another jog along the water, and then the balance beam. Balance - no one said anything about balance. I fell off less than half way through, and did my burpees. (Will go on record as still hating burpees.) The next part was a 5 mile run through the woods. Let's just say that my nice runs along the marina did not adequately prepare me for a trail run, but I survived to the other side.

It went pretty quickly from there. We had to lug a cement block up a hill and down the other side. Climb a 50 foot cargo net, scale down a bridge on a rope, and then climb back up the other side, hit a target with a stone, crawl through mud on our stomach with barbed wire over head, "rock" climb along a wall, climb a water and detergent slicked wall using rope, and last get pummeled by Gladiators as we tried to cross the finish line. Proud to say that I had to do no more burpees.

All in all a pretty typical Saturday - right? My trainer Keri - who was the one that actually talked me into this crazy thing - started in a much earlier heat, but stuck around to cheer me on. If I had the energy, I would have killed her, but alas all I could do was smile.

Girl's Best Friend

I am blessed with wonderful friends and family. Yesterday, I lost one of my best. After helping me survive years of training, and a few years of retirement in Georgia, my beautiful puppy died yesterday.

No, but thanks for asking

I went to the Gyn today - routine visit.

My doctor upon walking into the room said "So are you getting busy?".

I quickly answered "Yes finally - very happy".

He and I were both talking about my clinical practice at work, but not sure the nurse standing in the room knew the context. Can only imagine the conversations she is now having with the other ladies in the office.

Cease Fire

For the last several months, my body and I have been at war. We'll call me the freedom fighters. I simply wanted to free my body from a measly 10 lbs that it has had in its possession for the last 15 years. My body, which we will call the Rebel forces, has stubbornly refused to concede so much as a pound.

I have tried everything, and I mean everything. I did a flush and a cleanse. I severely calorie restricted. I lowered my carbs. I massively increased my protein and tried higher calories. I gave up caffeine and sugar. When none of that worked, I consulted a nutritionist. She had me give up dairy, gluten and soy. I could now eat comfortably with the cave men.

I increased my training to three days a week. My trainer is pushing me so much that random people come up to me in the gym to comment on how hard she works me out. I run, stair master and elliptical 3-4 days per week. I have never been stronger or in better shape in my life. However, the scale hasn't budged a single pound.

I was slowly going crazy when I actually stopped a minute to think. I truly feel wonderful. I have tons of energy, and for the first time in my life, I actually feel athletic. I no longer obsess about calories or when my next meal is coming. I truly eat when I'm hungry, and stop when I'm full. I am at a perfectly acceptable weight, and can wear everything in my closet. Why am I so obsessed about a number on a scale and flat abs?

I then started to think of all the things my body has done for me. It puts up with a ridiculous schedule that rebels half it's age would struggle. It tolerates sleep deprivation, sporadic feedings, dehydration, long periods between bathroom breaks, endless hours upright, and a ridiculous level of stress. All without complaints, and without ever truly letting me down.

Therefore, I have decided to call a truce. At the end of the day, both sides are working toward the same goal - a healthy old age. If it is happy with an extra 10 lbs, and has some odd moral objection to flat abs - so be it. I concede. I will continue to work out and eat cleanly because quite frankly I must admit that I like how it makes me feel. In return I simply ask that it continue to allow me to survive and even thrive on my crazy life.

I promise to never do it again

So after almost a year and a half on the job, I finally decided to take my first vacation last week. Will never make that mistake again. The vacation - fantastic. Spent a few days at home, and then a few days here on the beach with my sister. Capped off by Broadway Across America production of WICKED. Excellent. The coming back to work - excruciating. Going back after vacation is never fun, but I am pretty sure it shouldn't be physically painful. Overbooked clinic to make up for the week off. Both partners out of town, so covering all the patients and consults. Oh, let's add some transplants to the mix. Following a heart harvest, a lung harvest, and subsequent lung transplant, I finally crawled into the sleeping bag on my office floor around 4:00 am today. No use going home as I had to be back for a 7 am meeting, and I have three elective cases today which I couldn't cancel. So now here I sit, two cases down and one to go, waving my white towel. I promise to never take vacation again if you will just make the beatings stop.

Pep talk time

Okay, I have been trying to give myself a pep talk the last few days, and must admit it just isn't working. I think all of those years of surgical training when I tried to convince myself it wasn't really as bad as it felt just made me skeptical.

What dreadfully bad task am I trying to psych myself up for you ask? Swim suit shopping! Oh the horror.

Problem is that I live in sunny southern Florida, where you can pretty much wear a swim suit 10 months out of the year. Second problem, my last swim suit came from Target, several years ago. It is time to suck it up and go buy a couple of new ones. However, a weekend getaway to Libya sounds more pleasing to me than walking into a store and trying on new suits.

Is there any woman out there that actually likes to go swim suit shopping? And if so, can you please let me in on your secret?

Age is more than just a number

As much as I joke around about aging, I must honestly say that I never really give my actual advancing age much credence. I think it is partly because most of the time I don't feel old. I certainly don't feel like what I assumed 37 would feel. I can rise unassisted from a seated position; I have all my own teeth; and I can still recall where I left my car keys. It probably helps that I didn't get my first "real" job until a year and a half ago. When one plays Peter Pan for all those years, you really start to believe that your life is just starting. If my career is just beginning, I certainly can't be old, right? Lastly it helps that even though they skipped the blue eyes, thick wavy hair and height genes, my parents gave me pretty good aging genes. Considering what I have put my body through for the last 37 years, it has held up pretty well.

All of that being said, I felt everyone of my almost 38 years this week.

It is spring break here in South Florida. One local junior high school student had asked to shadow me for a couple of days to get an idea of the medical profession. I love what I do so am always happy to share my enthusiasm with others. He jumped through all the necessary paperwork and institutional hoops, and showed up to my office bright and early Wednesday morning. My assistant had walked back to my office to let me know that a very attractive young man was here to see me. When I walked up front, all I saw was a young kid. Sure he was cute, but most 4 year old are pretty cute. Sure this child was taller than me, and can legally drive a car, but he looks like he should still recall the taste of baby food.

As usual, cases were a bit late getting started so I asked if he had any questions. His parents are both judges, so he wanted me to explain the "process" to get to where I am. As I started listing the steps (college, medical school, research, residency, fellowship, etc), I watched his eyes get bigger and bigger. I had mentioned that although certainly not the norm, I had trained for 10 years. He was quiet for a moment when I finished. I could see him doing the math in his head. He was obviously raised well because the question he asked was the average age of most people when they start their first job. I smiled and told him my age. When one is 16, any age that starts with a 3 sounds old. Any age that will soon start with a 4 sounds ancient.

His reply - you could almost be my mom. It caught me a little by surprise. Not because it wasn't true - my mom was actually exactly my age when I was 16. It caught me by surprise because I was sitting in my office discussing college and senior year of high school with this very put together and well-rounded young man. I barely feel old enough to take care of myself most of the time - is it really possible that under different circumstances this semi-adult could have been my responsibility for the last 16 years? In the exact moment when the truth of that statement hit me, I must admit that I all of a sudden felt exactly like I imagined 37 would feel.

I asked him to help me out of my chair, and we made our way to the operating room.

The Company You Keep

My mom always advised that I should be careful about the company I keep. Her theory being that you are less likely to get into trouble if you don't hang out with people who make getting into trouble an art form. Not sure what she will think about this.

I just finished some CBLs (computer based learning) modules on human research. I want to enroll patients in a new study so I have to learn how to "treat them ethically." As one might imagine and hope, there are a million rules in place regarding research on humans. In fact there is a whole government agency called the Office of Human Research Protections (OHRP) that controls said research. A few of the rules seem ridiculously obvious - must have consent for research, must explain risks, must not lie to subject, etc.

There is one rule I find particularly disturbing. The OHRP has established certain "protected groups" that are either prohibited or extremely restricted as candidates for research. For example, children, mentally challenged and institutionalized patients have severe limitations on their use as research subjects. This I understand completely. However, one such "protected group" is classified as subjects in "Extreme Hierarchical social situations". Who falls into this group you might ask . . . military personnel, prisoners, and oh yeah - medical professionals.

Weekend Wrap-up

I titled this entry weekend wrap-up, but not sure which weekend I should wrap up. It has been a roller-coaster of a few weeks. Where to start? To borrow from Lewis Carroll - "Begin at the beginning, and go until you come to the end: then stop."

The beginning - well I guess that would take us back to the end of February. It was a beautiful time to be in Miami, so of course I left. I headed out to Scottsdale, Arizona for a meeting about lung cancer screening. The weather was awful - it was cold and rainy the entire time, but the meeting was actually quite good. It sparked a few ideas as to where I want my academic career to go and allowed for some great contacts. It was also quite entertaining. The conference was kind of a catch all of groups. There were thoracic surgeons, pulmonologist, medical oncologist, internist, radiologist, and basic scientist involved. The meeting is also quite international with large contingents from Japan, Italy, France, Israel, Germany, Canad, United Kingdom as well as US. You have never seen such a Hodge-podge of people and personal styles in your life. I joked to a colleague that an Anthropologist would have a field day. It was very obvious that "you are what you wear". It was very easy to place people into a profession and usually a country based solely on what they were wearing.

I flew back from the conference, and had barely recovered from the jet lag when I was off again. This time for a Women in Surgery Career Symposium. I wasn't exactly sure what to expect, but ended up enjoying it immensely. There were no communal bra burnings or male bashing parties. It was simply a group of women who all happened to be surgeons across a spectrum of ages and career developments coming together to see if we had anything to teach each other. Turns out we probably do.

I think it is reaffirming to hear that your story is not unique, and that other women face similar challenges. It is also great to hear how they manage said challenges. No use re-inventing the wheel is someone else has already figured it out. There were lots of talks about work-life balance, surviving a male-dominated culture, academic achievement, and being the woman in charge. I picked up great tips, and heard some interesting statistics. On the upside, women in Thoracic surgery is up almost half a percentage point. We now constitute a full 2% of CT surgeons, and 10% of current fellows are female so the number should continue to improve. Even better, we are no longer in last place - neurosurgery was kind enough to take over that spot.

More sobering was a talk by a economist from the WAGE project. It stands for Women Are Getting Even, and is a look at the gender gap. Don't you just love that title? (By the way, Jessica you should probably be sitting down for this next part away from all sharp objects that you could throw.) As a college graduate, a woman over the course of her working life time will earn $1 million dollars less than her male counterpart. For those of us who obtained professional degrees, the difference is $2.25 million. All I can say is that is a lot of shoes!!!! Part of the talk was a call to arms, but it was also part how to negotiate a fair and equal salary. They have workshops around the country that I would highly recommend to anyone interested.

After the meeting, my roller coaster veered a little off the tracks. It started when the Valet notified me that my car had a flat tire. It got worse when he admitted that they had noticed it the day before, but had failed to notify me. You would not believe how hard it is to get a flat tire repaired on a Sunday afternoon in Clearwater even with Roadside Assistance and AAA. Was eventually off, and headed back home.

Unfortunately, the closer I got to home, the worse I felt. I shrugged it off, and went to bed. Monday was a catch up clinic day for me, so I barely had time to breathe. I was still having GI upset, but assumed it was something I had at the conference. Tuesday I went for my yearly physical, and was pronounced to be in good health, but old. My fault for being called old really - I walked right into it. My doctor was complimenting me on how much weight I had lost since my last visit, and "how good I looked." I expressed my frustration to her about the last 10-15 lbs that don't seem to go anywhere regardless of what I do. Her medical advice - she reminded me that at my age, certain bodies are just unobtainable without plastic surgery. Can we just say ouch.

I shrugged it off, and went back to work. By Tuesday afternoon, I felt so poorly that I actually went home at a decent hour. The rest of the night was mostly a blur. I spent most of it curled up on the bathroom floor in a fetal position constantly examining my abdomen to make sure it wasn't "a surgical belly". I came into work early Wednesday and sent my PCP an email explaining my issues. She obtained some blood work, and promptly started me on some antibiotics. The working diagnosis was e. coli infection. The antibiotics helped with the abdominal pain, but it was Saturday before I could tolerate anything by mouth other than Gatorade.

Since I was not feeling well, I decided to take it pretty easy. Fate was fairly uncooperative. I had a full clinic on Thursday which I followed with a lung transplant, and then got up early on Friday for the second lung transplant. As long as I didn't challenge my body with food, it left me mostly alone. Not ideal, but it worked.

Saturday morning after rounds, I decided to even attempt a work out with my trainer. Luckily she took it pretty easy on me because I had been sick, but must say it wiped me out. I spent Sunday at a "team building" retreat. I don't really understand the science behind these retreats. They mostly seem to devolve into a complaints session, and since it started at 7 am on the morning we all lost an hour with the time change - I can assure you that there was much about which to complain. I finished up the day with a pedicure.

Which I guess brings us to the end. I am now back at work and on my way to my afternoon clinic. I have a relatively light week this week which is good. I have some paperwork to catch up on, and want to get to work on some of these Academic ideas that sparked. It also wouldn't kill me to start in on my now four weeks of laundry. I always new some good would come of my shopping addiction.

Please sir, I want some more

Not Oliver's gruel - though thank you Mr. Dickens for the line - I want more weekends like this one. It was absolute perfection.

My trainer was out of town this weekend, so I got an extra work-out in Thursday. Thus allowing me to sleep in a little on Saturday. I ran to the hospital for quick rounds, and then headed off to Sawgrass Mills Outlet Mall with a friend. Between the wonderful weather, great company and President's Day sales, I was hard-pressed to leave. Finally made it home just as the sun was setting with a very loaded trunk. Wonderful dinner and a cute Jen Aniston chick flick and the night was complete.

Sunday was a day off work, so a lazy start. Pulled it together by early afternoon to head down to the pool. Two hours of the most perfect weather, great music and complete idleness - I could so adapt to that lifestyle. Quick visit to the nail salon for much needed mani/pedi, then out for another great dinner with friends. Why can't all weekends be exactly like this one?

Back at work today. The hospital is taking President's day off, but the University isn't. Therefore I am at work, but can' get anything accomplished. Very frustrating. Planning to leave early and do a little more sitting by the pool. If I keep up this pace, I may even have a tan by summer. Fingers crossed.

Perceptions

Isn't it interesting how two people can witness the same accident and have two entirely different stories. Many different factors both conscious and unconscious play into how each of us perceive the world around us. Two recent examples:

First - As many of you know, I haven't been overly enjoying my work environment lately. My unhappiness bled into discontent with my non-work self. An old friend came into town a couple of weeks ago. She had a medical conference nearby, and decided to spend a couple of days on the beach before heading back somewhere cold. She regaled me each evening when I got home with her great relaxing sun filled days. She walked on the beach, laid by the pool, read on the day bed - some days she didn't even have to leave my building. It sounded so good that I even left work early a few days to get in on the fun. It only took a limited amount of time, and the presence of a friend to change my perception. I was able to let my happiness at living outside of work color a better attitude for work.

Second - Valentine's day. It is not my favorite holiday. I perceive it as a day where smug couples point their fingers and laugh at those of us who are single. I recognize that my perception is influenced by my being not part of a couple, and less about the actual holiday. I don't think I personally have anything against St. Valentine, but will admit that I have said some unflattering things about him today. I have many friends who love Valentine's day. They spend weeks planning, they decorate, they buy gifts, etc. etc. These friends are all part of a couple. I am sure that also greatly affects their weird affinity to a Saint - particularly since most are not Catholic.

One only needs to look at my text from today to see both sides of this coin. My coupled friends and family have all texted me wishing me a Happy Valentine's day. Many of my single friends have also texted, but we will just say it wasn't to wish me a Happy Valentine's day. Bitter - party of one

Sunshine state

And now a word from our sponsors . . .

Yesterday morning I pressed pause on the drama that is my life. The original plan was to compete in the Warrior Dash in Orlando this weekend. My plan was to drive up on Friday and enjoy the weekend. Plans changed when my partner decided to leave town on his weekend on call. However, I refused to concede my day off.

I started the day with a leisurely breakfast and a little Matt Lauer. I then headed off to the gym. My trainer was going to the Warrior Dash so I had changed my Saturday workout to Friday morning. It was a much better idea before I had to reschedule my Wednesday workout to Thursday night. I would not recommend two hard circuit sessions within 12 hours, but I survived. After a little time in the steam room and a hot shower I was off again.

Needed to stop by the VA briefly - am covering Cardiac surgery there next week (Don't ask). Work accomplished - off to the mall. Theoretically I needed conditioner from the Aveda store, but in reality I needed retail therapy. Unfortunately the stores didn't get the memo. I couldn't really find anything that I wanted. After leaving with only a lone skirt, cuticle cream and the needed conditioner, it was time to head back to the gym.

No, I am not a masochist - it was not another workout. It was a massage, and not just any massage. I had booked a 90 minute deep tissue with David. It was truly much needed torture. I didn't realize how knotted up I was until David decided to unknot me. Although painful at the time, I now feel like a million bucks. I topped the evening off with a great book and a bubble bath.

Today has been mostly catching up on paperwork that I have been avoiding for weeks, and a grocery store run. It has been a fantastic hermit weekend. (Don't worry I still hate cats and actually am headed out to dinner with a friend tonight.) I push play on the work world again tomorrow, but at least I had a much needed commercial break.

I choose happiness

A while back, my best friend sent me a necklace with a pendant on it that said "I choose happiness". She is incredibly great that way. She seems to always know when I need a pick me up and I will get a random card or package in the mail. It is always a little reminder that there are people in the world who have my back. Oprah may have her Gayle, but I'll keep my Kris.

This necklace has become especially important as of late. To say that things have been a little strained at work is something of an understatement. It has nothing to do with patients, and everything to do with politics. We have had intrigue, collusion, conspiracy and deception - all add together to make for a great book, but not such a great working environment. It would be very easy to get caught up in the "plot" of it all, and must admit that I was for a couple of days. Then I found my necklace.

I was rooting through my jewelry drawer looking for a necklace to wear when I saw it. I mean really saw it. I read the pendant and to take the Oprahisms a little further - had my "aha" moment. At the end of the day, happiness is a choice. There are times of absolute sorrow, fear or anger, but most of the times we can take our emotions where we want them to go. We can choose to get caught up in the pettiness going on around us, or we can say "I choose happiness." I choose to believe that things happen for a reason, and at the end of the day we all get back what we put out into the world.

I will continue to be the best me that I can be. I will accept that the only person that I can control is myself. I will choose happiness and the rest of the chips can fall where they may.

Thanks Kris.

Having A Moment

I'm having a moment - and unfortunately it's not a good one.

Very long story not worth getting into, but let's just say life in the real world isn't everything it is cracked up to be. Sometimes I wonder if I work at a hospital in an "academic" center or I accidentally took a job with five year old children at an elementary school.

I am a 37 year old woman. All I ask is that all the people older than me (which is almost everyone that I work with) act their age. Simple enough right?

Trust no one, and start looking for an escape hatch.

Weekend Wrap-up

Even though it started off with a less than stellar date, I am happy to report the weekend turned out pretty great especially for a call weekend.

I won't bore you with the date details, and believe me bore you it would, Saturday dawned warm and beautiful. After a morning of rounding and interviewing surgical candidates, I headed for a quick trip to the bookstore. Not only picked up a couple of books on photography - my new hobby, but also got my first of twelve "real books" to read this year.

I am starting with Decoded by Jay-Z. Surprised? Me too, very pleasantly so. It was so beautiful on Saturday that I curled up on the day bed for a couple of hours and dug in immediately. The book so far is fascinating.

I was finally able to pull myself back inside and got a few things accomplished. Laundry, dishes, etc. (I lost my cleaning lady over the holiday so need to either find a new one or find a mop. Bet you can't guess which way I'm leaning.) Made a quick trip to Steve Madden for some new sandals I had seen in a magazine as a reward for the cleaning. Motivated by Kris, I even got a mani/pedi and my eyebrows now actually look like eyebrows. A quick stop by Whole Foods for some dinner that was consumed while watching Julie and Julia on TV.

Today back to the hospital which took longer than it should and resulted in my missing church, but at least everyone ended up alive and well. This afternoon, I finally tackled the huge stack of papers on my dining room table, and finally made my budget. It really wasn't as painful as I thought, although my mom did point out that the making of the budget isn't the hard part - it's the keeping of the budget.

Ended the afternoon with some Spanish lessons and catching up with my cousin who I hadn't talked to in a while. Another quick trip to the hospital to hold the Pulmonologist's hand, and now I'm snuggled up on the couch with a mud mask watching Oprah's All Stars.

All in all (and I realize this officially makes me old) a good productive weekend. Let's just hope I can continue the good behavior into the coming week.

Multi-tasking

Okay - have been doing okay on my resolutions.

I spend a few minutes each morning with a cup of coffee or hot tea sitting on my balcony watching the sun come up over the Atlantic. Not hard to remember to be thankful then.

I haven't honked at a single car, but must admit I have said some unkind things about some of my fellow travelers.

Haven't started a new book yet, but have been very good about my face care.

Where does that leave me? Oh yeah - a budget. I actually downloaded a budget software program that supposedly makes budgeting fun. Doubtful, but plan to start filling it out tonight. However, must admit that prior to my new period of economic responsibility, I also bought new bedding and a new camera yesterday. I knew I wanted both, and didn't want to have to account for them in my new budget. (I didn't resolve to become an adult overnight.) The camera is a Canon Rebel T1i, and I plan to take a photography class - can we say new hobby anyone?

Not even close

So we seem to rip off quite a few British shows here in this country. Many with a great deal of success - All in the Family and The Office just to name a few. However, I recently caught one of the latest and it was horrible. Unfortunately in writing this, I am having to reveal one of my closest guarded secrets. Here goes. . .

I love the BBC version of Top Gear. It is hilarious. For those of you who don't happen to have BBC America, Top Gear is a TV show about expensive cars. Yep that's right - I said that I really enjoy watching a TV show about cars. In my defense, the first time I watched I was just being polite. I was at my friends Beth and John's house, and he was watching it. However, since that time I have been hooked. Although the show is ostensibly about cars, it is truly about the cynical and quick witted three hosts. Sure you get to see some amazingly unaffordable cars with incredibly loud engines, but you keep turning in to see what Richard, James and Jeremy are up to this week.

Therein lies my complaint about the new American version that I accidentally caught the other day on the Discovery Channel. It is at it's heart a car show. The three hosts seem completely devoid of humor and or cynicism, and instead see their job as telling me the latest about whatever car they are previewing that week. This is not why I watch this show.

Thanks but no thanks. I'll stick with the original.

Better late than never

Obviously my first resolution should be to stop procrastinating. However, as I plan to make resolutions this year that I can actually keep - it is not on the list. My delay is partly due to the cold my family was kind enough to leave me when they left on Saturday, and partly related to my actually giving my resolutions a lot of thought this year.

Instead of dreaming big as I am apt to do, this year, I wanted to think small. Instead of grandiose plans to cure disease, end hunger, and establish peace all while eating perfectly and dropping thirty pounds, I wanted to force myself to come up with a specific list of things I hope to accomplish this year. A TO DO list if you like. Here goes:

1. Put myself on a budget - might as well start with the hardest one first. I am loathe to admit it, but it might be time to grow up and act responsibly. If I plan to do any shopping when I retire to Italy, I need to start saving for it now.

2. Practice Spanish at least 2 hours each week. I have now lived here for over a year, and although my medical Spanish is quite good, my conversational Spanish needs some attention. I have the resources and the opportunity to practice - I just need to do it.

3. Take better care of my face. I have good genes and have thus far been relatively lucky, but I need to actually start putting some effort into caring for my skin. Luck and genes won't hold out forever, and my face isn't getting any younger.

4. Read 12 new books this year. I love to read. However, I forget this too often and get distracted by other things. This year needs to see a little less reaching for the remote or computer, and a lot more reaching for the book on the nightstand.

5. Spend an hour each Sunday catching up with friends and family. I struggle during the week to catch up with friends. The timing just never seems right. During the weekends, I plan to catch up, but always seem to get lost in the hubbub that is a weekend. This year I plan to set aside one hour every Sunday to talk to someone or ones that is important to me.

6. Repress road rage. I have allowed Miami to turn me into an angry driver. I can't fix the amount of bad and overly aggressive drivers, but I can fix my reactions to them. Less horn blowing and more letting go is definitely in order.

7. Develop two new hobbies. I know way too many people (particularly surgeons) who never have an answer to the "what do you do for fun" question. I am afraid that I have become one of them. Shopping should not technically be a hobby, and as you can see by #4, my reading isn't what it used to be.

8. Spend five minutes each day giving thanks. I have a very bad habit of focusing on the negative. I may be driving home across the bridge with the top down, a nice ocean breeze, with a beautiful sunset behind me, but all I see is the traffic. Time to look around and be thankful for the blessed life I really lead.

9. Do four things this year that scare me. I have become too comfortable in my old age. I need to challenge myself a little. Nothing ventured - nothing gained.

10. Do four unexpected things. I am WAY too predictable, and have spent my entire life doing what was expected of me. Time to shake things up a little.

I will keep you guys informed as to how I am doing. Wishing you all luck with your own resolutions, and may we all have a fabulous 2011.