The Adventures of Aidan and Zoe

Friday, May 30, 2008

• Singing and Neurology Tidbits

  Aidan has been singing, a lot. His song choices are interesting. His favorite song is "Once Again" by Matt Redman.
  
  Jesus Christ, I think upon Your sacrifice
  You became nothing
  Poured out to death
  Many times, I've wondered at your gift of life
  I'm in that place once again
  I'm in that place once again
  And once again I look upon the cross where You died
  I'm humbled by Your mercy and I'm broken inside
  Once again I thank You,
  Once again I pour out my life
  Now You are exalted to the highest place
  King of the Heavens, where one day I'll bow
  But for now, I'll marvel at Your saving grace
  I'm full of praise once again
  Oh I'm full of praise once again
  And once again I look upon the cross where You died
  I'm humbled by Your mercy and I'm broken inside
  Once again I thank You
  Once again I pour out my life
  Thank you for the cross
  Thank you for the cross
  Thank you for the cross, my friend
  And once again I look upon the cross where You died
  I'm humbled by Your mercy and I'm broken inside
  Once again I thank You
  Once again I pour out my life
  
  He gets the verses a little mixed up (because I do and that is how he usually hears it, when I sing it) but the chorus is just awesome. It is amazing to see a four year old boy, sing about how he is all broken inside, he also likes to sing "thank you for the cross" and gets louder and louder every time. Unfortunately, whenever I get the video camera out, he sings it in a really silly way, or simply, not sing at all. I am going to make it a goal to catch it at some point.
  
  While bathing the kids last night, he started to sing, "Gloria....in excelsis Deo!" from "Angels We Have Heard On High." I hardly ever sing this song, and only sing this around Christmas time... No idea where he caught this one.
  
  At bedtime, I sing "Goodnight Sweetheart" to him, but I change the words a little bit, since the words about "I hate to leave" isn't all that helpful toward a secure separation, so we sing it, "It is time to close your eyes and go to sleep." It is so sweet when he sings it with me. Here are the original lyrics.
  
  Goodnight, sweetheart
  Well. it's time to go
  Goodnight, sweetheart
  Well, it's time to go
  I hate to leave you, but I really must say
  Goodnight, sweetheart, goodnight
  
  For most people, singing abilities are located in the right frontal lobe, whereas speech is in the left frontal lobe. For about 90% of the population, we are left hemisphere dominant and 'speech' is a dominant lobe activity. However, for people who are really musical, their musical abilities are also located with the dominant lobe. I would imagine Mozart's musical abilities are in the left brain. I would love to figure out where my abilities reside- for that, a fMRI scan would be needed, which would be expensive, and I really don't want to find any incidentalomas. (Tumors you find just because you looked, with no clinical relevance.) For most people, a right frontal lobe lesion (like a stroke) would take away the tonal qualities of their speech (among other neurological deficits) and a left frontal lobe lesion would take away speech. I think, left sided lesions are worse than right sided lesions. Although, right sided lesions could cause the most fascinating syndromes, like Alien Hand Syndrome! With a right parietal lobe lesion, one would not acknowledge their left side, and at times, even think their left hand is doing stuff that they have no control over, like an alien is controlling it. These deficits, the anosognosia and hemineglect, are short-lived, as the brain adjusts to sensory information. Therefore, as fascinating as I find this, I have yet to seen it happen in real life.
  
  Well, that is enough of the boring stuff. Here is the stuff I was alluding to earlier in the week. I am only going to mention a few, since I have big agendas today for studying.
  
  "Argyll Robertson pupils like prostitutes, they accommodate but do not react." (Seriously, who thought of this stuff?!) Interestingly, Argyll Robertson is the pupil condition that is one of the results of syphilis. The pupils are able constrict normal when a person look at closely held objects (during accommodation) but the light reflex is impaired, and therefore, the pupils are not reactive. I don't know why it is so important to know this, because syphilis is essentially a disease of yore, with the exception of immuno-compromised patients
  
  "Point and Shoot." Here is a simple one. It is a mnemonic to remember that in male sexual response, the Parasympathetic system is responsible for obtaining the erection (point), and the Sympathetic system is responsible for the ejaculation (shoot). Totally crude... But I think this mnemonic has helped millions of students in gross anatomy. There is no female version of the mnemonic. It is widely acknowledged that neurological studies of female sexual response is totally lacking. One can interpret this many ways...
  
  "When the eyes look away from the paralysis, the stroke is cerebral."
  
  "When the eyes look toward the paralysis, the stroke is pontine."
  
  So those two above are not all that fascinating, but a good way for me, who is currently information overloaded, to remember. There are also a few other things like this, like in lupus cerebritis, the symptoms fall into 3 "S" categories. Stroke, Seizures and pSychosis. Or in multiple sclerosis, these are the "I" symptoms, Incontinence, Impotence, and gait Impairment. Or in pellegra, the "D" symptoms. Dermatitis, Dementia, and Diarrhea. To remember these for what, I am not sure anymore.
  
  My brain is so full o f these minutia, that I dream about this stuff. And I am a little worried, that if I move my head too fast, these facts might fall out. And I am wondering if I re-read my favorite book a little too early, therefore, too many days in between to lose the information. Nonetheless, I will continue to cram today. Just five more study days!!!
  

Thursday, May 29, 2008

A&Z

While I have been studying, and feeling that time is standing still, the kids are still growing, thriving, and laughing, without a care in the world.

I recently found a classmate from college via facebook. Her husband is also a photographer- if you are in LA and in need of photos, check out his site. Also, Jaime does amazing flowers for weddings, check it out! She asked me how I find time to write in my blog.

Well, when I first married Hubby, I was finishing up second year in med school and he worked as a consultant. Everyday, he probably spoke at least 10,000 words at work to his clients. I spoke perhaps 200 to myself, as I sat there and studied, by myself. Therefore, when he got home, I would be trying to catch up. I suspected that I always had more words to say in a day, so perhaps I had 15,000 words to use daily, but only found outlets for 10,000 at best. To hear my every word, I think, is a lot for anyone person to handle. Imagine my glee, when blogging came along. I found an audience! These days, I do have more of my words with Aidan and Zoe, but still, I have more, since I actually speak less at work (always listen more, and when in doubt, stay silent to let the patient finish his/her thoughts.) Therefore, blogging is my way of getting my words somewhere.

It also helps to be able to type quickly. A few months ago, when I was really bored, I took a typing speed test on-line. I average about 80-90 words per minute. Who knew a typing class in 7th grade would totally pay off in adulthood?

As for studying, I am so sick and tired of reading about chronic pain. Back in 2006, the Medical Board of the State of California required all physicians (with the exception of pathologists and radiologists) to take some continuing medical education credits on the topic of pain and pain management. Since pathologists and radiologists actually never saw patients, they were luckily excluded from this exercise. Good grief. I think I had to spend 16 hours reading about pain, acute vs. chronic pain, nonmalignant vs. malignant pain and pain pathways, management...etc. It was seriously causing me some pain to read this stuff. Don't get me wrong, pain management is very important (and I suppose I haven't really experienced pain and therefore don't appreciate it enough- although one could argue that I did deliver Zoe sans epidural/pain management and so perhaps I am somewhat of an authority about this...) In practice, I see a lot of patients with complaints of pain, and I actually think the rating scale of pain is not the best way (and perhaps, nearly useless.) You know, when you go see a doctor with a pain compliant, you are asked to rate the pain from 0-10. Pain should actually be assessed functionally: What is the pain stopping you from accomplishing? Because, the pain medications that patients often seek are habit forming, and inevitably, as a physician, I feel really used as patients incessantly asked for more and more of Vicodin, all the while, the person who rated the pain as 9 out of 10 is sitting there and laughing at a movie on TV! For some reason, these patients often resist adjuvant therapy... I think pain ought to be managed aggressively, but at the same time, chronic pain should be treated like a chronic illness- to improve functioning, instead of cessation of pain.

Well, that was a whole lot of words. Maybe I should look into a writing career.

Wednesday, May 28, 2008

$

I have decided this, the best way to make money is to save money.

Since I hadn't been going anywhere, I hadn't needed to get gas. Hubby offered to buy me a tank over the weekend, just so that I don't have to do it, at the time, gas was $3.99, but we never got around to it. Yesterday, on our way home from school, it was $4.07, and I thought about getting gas, but getting nutrients into our children was more urgent. This morning, it was $4.13. On our way to school, my gas tank light came on, and so there was really no more escaping this, by the time I pulled into the gas station, it was $4.22. I gave up, and bought the super gas for my car, might as well, since it was already so expensive. I spent $70 for 16 gallons. One gallon of gas now costs about the same as a pack of cigarettes. Hmm. Drive or smoke. Gotta make some choices! (Just for the record, I actually don't smoke. As Aidan says, "Smoking is disgusting. Cigarette butts are disgusting."

When I went to pick up Hubby for a quick lunch, (no, I didn't eat him for lunch) we parked on the street, and I miscalculated and didn't quit put my Volvo into the designated brackets. Fearing a ticket, I was going to start the engine, drive forward 1 foot, but we thought, hey! We are able bodied people, we will just push it. I put the car in neutral, and Hubby pushed it into the right place. So we saved 25 cents! Woohoo!

Even Trader Joe's Joe's O's raised the price by 15% in the last week. It is now $2.29. Shocking.

So I think I need more forms of entertainment than keeping track of commodity prices.

But the best money 'making' deal here was that Hubby decided to fix the Mac Pro laptop himself. Like I mentioned a few weeks ago, the keyboard and mouse had suddenly died. The price quote from two places were both around $400, and would require me taking the laptop, and then picking it up later, which would have cost at least $10 in gas, and my time. My awesome Hubby fixed it in 10 minutes! Apparently, a wire had gone loose. He 'made' at least $410, tax free money too! Most of all, I am thankful that I don't have to go on a trip called "The Fellowship of the Laptop".

Anyway, I am going to go back to studying. Just as a teaser, I am working on a post about the random mnemonics out there for neurology. Things like, "Point and Shoot." I will elaborate later. For those of you who know it already, you know that the post will be rated PG-13.

Tuesday, May 27, 2008

All the Things I Rather Do

Eight more study days until The Exam.

As it is usual and customary for me, I have started a list of All the Things I Rather Do, that I will get to do after June 6. I want to read, inspired by my musicologist friend. (Those musicologists are crazy, they read so much, listen to so much music, and knows all these languages.) I want to get the house renovation project going, and maybe paint my house butter cream yellow, inspired by Gaby's mom. To meet up with other moms in the park, to 'develop' my private practice. And most of all, to NOT HAVE TO think about this exam anymore would be a huge relief.

Anyway, I should go, there wasn't much studying over the last three days as we were too busy having fun, relaxing, napping, eating, for me to seriously study. BTW, we had a new first yesterday. We took both kids, both awake, to the mall. Since we have childcare, I never take the children to the mall to actually buy stuff. We take Aidan to the Lego store for him to see what else is new, but other than that, I shop alone. What prompted the trip was that Aidan broke a shoe, his favorite shoe. How does a boy break a shoe is beyond me. Anyway, we needed a replacement, Hubby needed new jeans, and so off we went. Let's just say that as much fun as it was, it is actually quite difficult for both Hubby and I to look at something at the same time. It is more like take a baby sitter shopping, except you don't need to pay this sitter kind of thing.

Sunday, May 25, 2008

Good Golda

I was reading Hubby's blog, and he had quoted Golda Meir and her thoughts about work. So true.

Anyway, at church today, Boy Interrupted came up and asked Hubby about our plans to move to the South. Hubby was like, "What?!" He asked me about it on our way home, and as I replayed the discussion, sentence by sentence, Hubby said, "I thought you meant further south on the Peninsula!"

We talk about moving down the peninsula a lot. For a while, I worked down that way, and church is down that way, and at times, a very pleasant and comfortable life seemed to be down that way. I am reassured by multitudes that the last thought is not true. And I suspect it would fail me miserably. Hubby does not have any inkling to move The South. Even now, neither of us really feel the need to move down the Peninsula. The existing plan stands, we are going to stay put, at least until Aidan and Zoe's educational needs lead us elsewhere.

We are having a very relaxing weekend- everyone has been napping between 1-3 pm for the last two days, and I can scarcely wait to get in bed for tonight, and nap again tomorrow! We are also about to figure out our annual budget, yes, yes, the year is nearly half over, but better late than never. A time share for a Mini might be in the works with my father-in-law. That, would be so fun, and I mean, women who drive Minis gotta be always relaxed and fun, right?!

Saturday, May 24, 2008

Perks

I thought I had written about it, but in trying to trace it to make a link, there was no such entry. Either I am having transient global amnesia, or I am seriously sleep deprived.

On my flight via JetBlue to DC 3 weeks ago, as I sat down in my seat, adjusted my headset and readied myself to watch HGTV, I heard a flight attendant yell, "Is there a doctor on the plane?"

My first thought, "Hmm. Let there be another doctor on board. Please God, please God, please God." When it was silent for about 3 seconds, I dug myself out of seat and raced down the aisle. In my mind, I reviewed my ABC. Airway, Breathing, and Circulation. I thought, "Ok, we are still at the gate, if it is really bad, I will just hang in there until the paramedics show up and haul the person away." You see, as a psychiatrist, I have not actually touched a patient in YEARS. We use words.

What I found was a 3 month old baby, who just had a laptop bag land on her head. She was not even crying anymore when I got there, and was fully alert. Her cranial nerves looked intact, her autonomic functions were fine. The parents were very upset. The flight attendant was adjusting the bags, and the laptop bag fell out, and grazed the baby's temporal area as it obeyed the laws of gravity. My differential included awful things like epidural hemorrhage, subdural hemorrhage, coup/counter coup injuries, but I thought, "Ok, seriously, the baby is fine. She is fine! Really, self, she is fine!" I reassured the parents and they opted to not get off the flight.

I went back and checked on them once we were in the air and the captain and turned off the seatbelt sign, on one hand, what good was this, and on the other, I felt it was necessary, for the 'appropriate follow-up.' The baby had nursed and was as happy as could be. I spoke with the parents and suggested that they follow up with their pediatrician when they got home. In my mind, I thought, "If they had gone to the pediatricians right after the 'trauma', what would the doctor do?" Nothing more than I had done. All in all, I felt good about my 'medical care.'

The flight attendants were very appreciative, they said, "Thanks Doc! We will take care of you." I thought, "Dude, seriously, how are you going to take care of me? You don't even serve food anymore, and I just want to sleep!"

I was truly taken care of, on a flight the week after 9/11. While Hubby stayed in NYC for his MBA program, I was out here in the Bay Area for an 'audition elective'- in hope of matching at this awesome community program for residency (which I did.) Anyway, 9/11 happened, and it was just awful. I had plane tickets to go home that following Friday, and given that Hubby saw the second plane make its impact into the tower, he was devastated, and I was determined to go home. So I hopped on the plane, and as soon as we took off, I heard, "Is there a doctor on the plane? We need some medical help!" I got up to help- as a medical student. (Really, how much help could I have been?!) As it turned out, there was another doctor on the plane, this elderly gentleman, who was in clinical research (we were SO very helpful!) The passenger was this middle aged woman who 'couldn't breathe.' I did the physical exam (I had a stethoscope in my bag, no joke) and we conferred with the United Airline ER physician who was available to us via phone. We determined that she had a panic attack, and from the flight deck medicine cabinet, I gave her Ativan 1 mg. (Who knew planes are loaded with medications?!) The flight attendants were so nice to me, they offered me a first class seat, (I don't know why I didn't take it) and brought me all sorts of food, and sent me off the plane with 2 bottles of wine! Then, they sent me $250 United money for future flights.

Today, I unexpectedly got $100 JetBlue money in the mail! Awesome!!! This is a perk of being a doctor, that I did not know about! I love my job. (Or you might just really not want to fly with me.) Although, if I need to deliver a baby on a flight, I am pretty sure I could. I could also manage seizures, heart attacks. Appendicitis would not be manageable by me. By anyone, for that matter, on a plane.

Friday, May 23, 2008

• Suffering

  I decided to change the scenery and headed over to a Starbucks to study this morning. I got my hot chocolate, and as I sat down and opened my beloved book, yup, the one and the same- "Clinical Neurology for Psychiatrists", this guy started to chat with me. I tried to remain polite, but definitely curt- I did not, do not, ever want to chat with random strange, middle-aged, men, at Starbucks. As Aidan would say, "He is a random person to us!" Anyway, Gary wanted to know what I was reading, that it looked like a serious book, and of course, why I was reading it. Inevitably, I admitted that I am a physician, then he wanted to know where I worked. I didn't say, but rather, deflected that question. Then, he said, "Isn't it sad to know how all these people suffer?"
  
  Indeed, it is awful to treat people who suffer. Especially in fields of neurology and psychiatry. We have diagnoses, but very rarely, good treatment. It is so true in neurology, for instance, in terms of dementia, only about 10-15% of dementia are reversible, and as much as text books all say that normal pressure hydrocephalus is a reversible dementia, it is only in theory, not practice. And while we follow patients who are demented overtime, there is just no good treatment. Even the latest medications out there, only halt the progression, temporarily, maybe by about a year. It is terrible to hear how my patients suffer, from the pains of a cheating spouse, to not ever getting along with a spouse, to a friend who suicided, to being abandoned into foster care at the age of 3, to reading about other families who lose children, it is sad.
  
  When I think about the patients I treat, I am often astounded that I am able to sleep at night. However, medical training has done that for me. I have been immersed in suffering for the last TEN years! Is it a bad thing? Maybe, maybe not. Like I said to Gary, "These people have families and friends to be sad with, they see me for an objective opinion." Nonetheless, I find myself getting tearful with my patients, a lot. Although, I am pretty good at disguising it now.
  
  Eventually, Gary caught on that I am serious about not chatting, and let me be. I had a very productive morning!
  
  

• Stuff...

  I am so sad to hear about Steve Curtis Chapman's daughter. It is weird that I wrote about him and his community yesterday, and to read about his family today. Certainly, I am sure that his community are supporting the Chapman family right now. While I cerebrally know that God uses everything to bless His people, in suffering, especially, suffering of children, I am at a loss. Nonetheless, I choose to believe that the God who loves us so unconditionally, will always protect us.
  
  In my quest to move to the South, the Phat Photographer actually said something quite surprising. "Sure, Honey, that sounds like a great idea." Poor Hubby had been quite busy at work, so much so that he was up until 1:30 in the morning. I think the stress is causing some thinning of his hair- and thus, he too, was charmed by the slower pace of life in the South. My dear faithful readers and friends in the Bay Area, just for clarification, we are not moving. (As matter of fact, we are renovating our house.) Definitely not to the South, unless God shows both of us some guidance/evidence, that would be beyond a reasonable doubt. More than clear and convincing evidence.
  
  I brushed up on my forensics yesterday- and so glad I did not go to law school. The cases sited were just a blur, and terms like, clear and convincing evidence, versus beyond a reasonable doubt, versus preponderance of the evidence, really, not all that interesting to me. Although, it is interesting that it is unethical to medicate a psychotic person to make such a person competent to be executed. (Apparently, only competent people can be executed.)
  
  Anyway, tomorrow, I am going to re-read my favorite book of 2008, "Clinical Neurology Review for Psychiatrists." Fascinating read, really.
  
  A side note, funny thing happened at 1:30 this morning- Hubby was coming into our room, while I woke up to go to the bathroom. My left leg had fallen asleep, but I didn't know that. So I got out of bed, started walking, and fell down, right behind the door, and at the same moment, he was trying to open the door, and found me, on the floor, unable to stand up. Funny thing is, I don't think there is medical term for 'leg fell asleep.' There is paresthesia, but that is really just the sensation of pins and pricklings, and paresis, inability to move. But both denote more than a few seconds. I will have to consult my favorite book about this. Neurologists have a lot of special words, hypalgesia, abulia, alexithymia, cateplexy, catalepsy, agnosia, anosognosia... seriously, neurologists are an 'interesting' bunch.
  

Wednesday, May 21, 2008

Move to the South

Ok, so the Phat Photographer has no idea that I am going to suggest this to him this evening over dinner. Ha! This is what happens when he leaves his wife home for 36 hours, and she deviantly tries to get to the end of the internet while she ought to be studying.

Hear me out about my new plot to move to the South.

For community! For some reason, I have 'met' all these women via the blog world, and they all live in the South. Their churches are alive, thriving, these women bring glory to God in their simple acts of mothering, grieving, rejoicing. I think is a BIG problem, that I am finding my community on-line. But that is another post for another time when I am trying to procrastinate.

For music! I heard a lovely song recently, by Mercyme, called "Bring the Rain."

I can count a million times
People asking me how I
Can praise You with all that
I've gone through
The question just amazes me
Can circumstances possibly
Change who I forever am in You

Maybe since my life was changed
Long before these rainy days
It's never really ever crossed my mind
To turn my back on you, oh Lord
My only shelter from the storm
But instead I draw closer through these times
So I pray

Bring me joy, bring me peace
Bring the chance to be free
Bring me anything that brings
You glory And I know there'll
be days When this life brings me pain
But if that's what it takes to
praise You Jesus, bring the rain

I am yours regardless of the clouds that may
loom above because you are much greater than
my pain you who made a way for me suffering
your destiny so tell me whats a little rain

[1st Chorus]

Holy, holy, holy
Holy, holy, holy
is the lord God almighty
is the lord God almighty
I'm forever singing

[2nd Chorus 2x]

everybody singing
Holy holy holy
you are holy
you are holy

[2nd Chorus 2x]

Go listen to it on iTune, you won't be disappointed. Anyway, I was mildly offended that the band, in their tour this summer, will not be in Northern California AT ALL. I mean, they are going to places like Myrtle Beach (I immediately alerted my only real life Southern friends, who actually do live in Myrtle Beach, SC) and they will be in Santa Barbara. But not the GREATER BAY AREA! So jealous. Besides, I have this secret (not so secret anymore!) fantasy to be in a band. At first, I wanted to be Sandi Patty (I am an 'older' woman inside) then I wanted to be Twila Paris, or part of Point of Grace. All these people, LIVE IN THE SOUTH. Tennessee, I think. Can you imagine, going to church with Steve Curtis Chapman?! Or all those other singers?!

Maybe I can practice psychiatry part of the time, and go sing? That would be awesome. And, housing is cheaper down South. I would probably make more $ as a physician there, I mean, who really wants to live in the South?!

I already know what dear Hubby will say, "Hmm, Honey, maybe you need to step away from the internet for a few days..."


The Math Game
very time I study for an exam, I figure out how many questions I need to get correctly to pass, then I add on a 5-10% margin, and when I get that many right on practice exams, I call it quits.

The problem is, I don't know how many I need to get right. I called the Board office, and the lady, as lovely and nice as she was, she couldn't/wouldn't tell me. Apparently, after everyone takes the exam, they toss out certain number of questions- inevitably, there are questions that make no sense, or all the answers are 'correct'. Then, they scale it somehow, and about 70% of test takers pass. That is a whole lot better than the California Bar, where only 1/2 of the people pass.

So will I be part of this 70%? I figure that the people who won't pass are those people who are foreign medical graduates- they typically don't test as well and have more difficulties passing all exams, from licensing to board certification. Are there really 30% FMGs practicing psychiatry? I have no idea. Then you figure there are people who are too narcissistic to study. Ok, so I am grasping straws. I MUST BE IN THE 70%!

Meanwhile, I seem to have this recollection that I need to get about 70% of questions right to pass. That sounds about right?! I have been working toward a 15% margin this time around though, just because it seems a little shameful that one only needs to know 70% of the questions to pass, that, and I really WANT to PASS! Good grief.

I called my former residency training director for an answer. I am sure he will call me back and give me a really long winded answer, and I can't wait!

While I am home 'studying', I am also chopping up a lot of fruit. This afternoon, I chopped up mangoes, cherries (pitted them first), strawberries, and a pineapples. The kind of fruit that one can just grab and eat are not favored amongst the children here, go figure that the tasty fruit would take more work. Besides, an innocent whole grape could kill Zoe, so all the fruit are chopped to little squares. Neurotic? You bet.

Until tomorrow...

Surprising
So I am a little surprised by a few things.
1. I thought I would be blogging less while I am studying. HA! I get so bored that I rather write about my random thoughts.
2. Apparently, when my patient has a psychotherapist, in addition to seeing me for meds, I am responsible for the ENTIRE treatment, not just medications. I guess I always knew that, since I make it a point to get in touch with these therapists and find out what is really going on, but still, to be legally liable...
3. Also, the overall safety of the prison is more important than individual rights, that prisoners can be made to be put on medications more easily than a regular Joe at a hospital.
4. Being female is a risk factor for Alzheimer's. Also, being female is at high risk for development of tardive dyskinesia. (I already knew that, but still surprised every time I think about it.) What a bummer.
5. In reading this blog, about Audrey Caroline, that in suffering, a Christian CHOOSES to believe in God and trust Him, even when it is extremely uncomfortable. I don't know why that is surprising, but it is for me. I suppose having been raised as a Christian, and never really suffered, I haven't really thought about it. God willing, I would have enough faith, when my time of suffering comes.

I have also been thinking, how bad it would be, in the grand scheme of things, if I don't pass my exam. It wouldn't really be THAT bad- I can just retake this. (I know a few Stanford psychiatrists who didn't pass this on the first try, STANFORD psychiatrists!) I go on and practice medicine anyway. My pride would seriously be hurt, but it wouldn't be the first time, and God knows, I am too prideful of a person anyway. Still, it would be bad. Please pray for me, that I will stay on task (that will need a miracle, or maybe just more discipline) and that I will be really good at guessing. Time to go back and read something new.

Tuesday, May 20, 2008

The Internet Changed Everything!

Since I last studied for a BIG exam, back in 2003, for my USMLE Step 3, the internet had changed EVERYTHING. Even the way I study.

As I review old PRITE (psychiatry resident in training exams), whenever I encounter something not familiar, I just google it. Seriously. What is Ganser Syndrome? Within 10 seconds, I know that Ganser syndrome is a factitious disorder, where the patient has mental illness symptoms for some unconscious reason that the person needs to be mentally ill. It is weird to be held responsible for this kind of information, because, in my community practice, I WILL NEVER SEE SUCH A CASE. Probably. But should such a person shows up, I would know. Now, if only I can be certain insurance will cover such a diagnosis. I doubt it. There is no DSM IV code for this illness. How can I then code it to bill? Maybe wikipedia will tell me how.

Youtube is also great for reviewing, seriously. Want to watch a movie of athetoid movements? Hemiballismus? How about a real Huntington's disease patient? It is all there! How exciting! I am such a nerd...

If the internet had been around when I was in med school, I bet I would have learned even more stuff. Maybe I would have mastered renal pathology, maybe. Just FYI, I think, the smartest physicians are nephrologists and ICU intensivists. You know the joke, right? Who doesn't know anything and wants to do everything? The surgeons! Who knows everything but can't do anything? The internists! Who knows everything but is just too late? The pathologists!

I need to stop myself, this nerd humor is excessive.

Monday, May 19, 2008

Concerned?!

As I was studying today, I realized something. That I thought my readers might be concerned that I need to study, since I actually already work as a psychiatrist.

Seriously, no need to be concerned. I have already passed my licensing exams, and am holding my California medical license. With that card, I can practice ANY specialty. Brain surgery? Sure! What is stopping me is the fact that I can't afford the malpractice insurance I would have to pay to actually practice neurosurgery. You see, to be able to buy a plan, I would have to prove that I am a neurosurgeon, which would require documentation to show that I actually finished residency in neurosurgery. Other than that, I COULD be a neurosurgeon.

As for why I need to study, well, let's just say that exam covers a lot of stuff, stuff that I actually don't use in my day to day practice.

For instance, the diagnosis of alcohol dependence often comes with a number of co-morbidities. It is important, for this exam, to know that
a. in men, antisocial personality disorder is the #1 co-morbidity, and another substance dependence is #2.
b. in women, anxiety and depression are the most common co-morbidities.

There are also 2 types of alcohol dependence.
Type 1: Milieu limited
Type 2: Male limited
And another system that parallels the above categorization.
Type A
Type B

I was a little disappointed, when I read through the review of anticonvulsants, that "Gabapentin is not metabolized in humans." But it did not tell me which animals can metabolize Gabapentin. Inquiring mind wants to know!

Alas, I digress. Why am I taking this test? Well, according to my residency director, to have Board Certification from the American Board of Psychiatry and Neurology is becoming increasingly important. (Although there are a bunch of old-timers who never did get certified.) It is important to me, because, when I have my certification, I get a 5% raise from my employer! Unfortunately, to be actually certified, I would have to pass the Oral Exam. I won't even be allowed to take this Oral Exam until September of 2009, assuming I pass this written portion on June 6th, and I will probably have to go to MISSOURI for this. But, I will do that for $!

Monday, May 19, 2008

Day #1

My first official day of education leave! I will accomplish so much! I will study the monographs, I will do old exam questions, I will be awesome. Well, in theory.

So far, I said good bye to Hubby and the children. Hubby will be in Kentucky for two days on a business trip. He graciously offered to take the kiddos to school, just so he can spend more time with them. They were dressed, fed, with all their bags packed. I, on the other hand, am still in my jammies, without breakfast.

The biggest dilemma now- where should I go to study? Studying at home inevitably means nap time, or clean up time, or make dinner time. To go to B&N would probably end up being Real Simple time. The library would be the same. I really miss having study pals- during med school, I would find a friend, or two, and head over to Borders or B&N, sit there for hours, chat occasionally, but having someone there really cuts down on the wasting-time-reading-celebrity-gossip. Although, I have this burning desire to read about Jenna B's wedding.

Anyway, gotta go. Probably won't write very much in the next few days, except to write about random things I will be cramming.

Friday, May 16, 2008

• Hot...

  I should add one more sentence to my previous post- the amazing thing about the woman who was my patient's ride, was that the two didn't know each other previously. This particular church had 2 worship services, and understandably, their paths never crossed. It didn't stop R from being so generous with her time and energy though!

  It has been very hot out here- even for us, since our city has a reputation for being cold and windy. I started to think about how the summer days of my childhood wwere usually this hot in Taiwan. My mom used to let my brother and I run around in our underwear (!) all summer long. We would spray water INTO the fan, to let it spray back out at us. Totally safe, I am sure. We made lemonade, with real lemons and limes. She cooked green bean soup, which was 'cooling'. Whenever we had our writing lessons (yes, my brother and I took writing lessons, to know how to write short stories) she would wait for us at the nearby hospital, with my little sister. They would enjoy the air-conditioning in the lobby, and they napped. In retrospect, what she did was amazing. My two kids do not nap on the go, and for her and giddiemon, it was just the way of life. Maybe this is the reason how giddiemon can fall asleep at the airport, at her GATE, and miss her flight.

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• Bonus Benefit

  I am meeting many interesting patients in my private practice. Aside from getting to know intimate details of their lives, I am also learning about their places of worship.
  When we moved to the Bay Area from New York, it was a no brainer that we would go to a church plant, supported by our NY church. Therefore, we didn't church hop at all. It is now then, so interesting to hear about various churches through my patients, and their experiences of them. My private practice is located within a Christian counseling organization- so the organization gets a lot of referrals directly from local churches, some even have special funds for people who can't otherwise get help. It has been amazing how some of these communities support one another. I once got an urgent referral from a pastor, and the church arranged for transportation for the patient to come see me, all within 2 hours. (I only work there once a week, so if an urgent call misses my 'work' day, the wait is automatically one week.) This patient's ride waited with the patient to see me, then went home during the appointment, and was planning on returning in 1 hour to take the patient home. When I decided that the patient needed to go to the hospital, this lovely woman took the patient to the ER AND waited with her! Amazing.
  
  

Wednesday, May 14, 2008

Wednesday Musings

Since Wednesdays are my 'study' days, I have some time to muse.

Very little studying happens on Wednesdays. It is actually my errand day, take care of everything day. Over the weekend, the keyboard and mouse on our Mac laptop quit. Hubby connected it to our iMac's keyboard for the last few days, but obviously, not a long term solution. I took the ailing baby to the Genius Bar this morning, and lo and behold, I met up with the same Genius who helped us last time when the battery died. Seriously, this laptop had caused quite a few problems. Anyway, the Genius wasn't able to help me, and gave us the suspected diagnosis: we need a new keyboard/mouse. And it required a hospitalization of three days. I called Hubby and told him about it- since the laptop really belonged to Phat Baby Photography. I offered to take it to the laptop hospital next week, during the first of my study weeks (really, very little studying will happen, ever.) Then Hubby said, "Well, just as I suspected. Let me think about repairing the keyboard, because, maybe it would serve Phat Baby Photography better as a server." AH! The dreaded S word- every few months, Hubby would talk about the lack of storage, and inevitably, the subject of acquiring a server would come up...

After that, I went to Costco. I hadn't gone there in weeks! And it was a nice surprise to see that the Costco pizza price had not been raised. A slice of combo pizza remained at $1.99, which was amazing, actually, since the prices of everything needed to make that pizza- the cheese, wheat, transporting the vegetables, had all gone up at least by 30%. Gotta love Costco! I was obviously hungry, since I bought... about 40 chicken sausages.

I should go and actually study for a few hours before I make dinner, fold laundry, and maybe, take a quick nap (yeah right.)

Monday, May 12, 2008

Photos

Alexandria, Virgina is so beautiful. I love the architecture- the ways these Virginians filled their containers are amazing. This little alleyway is just behind the Alexandria Courthouse, the courthouse is to the left, and the the right wall marks the back of some fancy homes.



I even looked up real estate prices, and considered what Hubby could do there for a living. No, we are not moving to Virgnia. Not this year.

These are my sweet Scripps friends, class of '99. Since their reunion won't be until next year, this was a mini reunion for me.

Monday, May 12, 2008

Fun was had by All

As I had last blogged, I was on my way to DC. It was a great trip- I made new friends, caught up with old friends, and saw a dear friend marry her sweetheart. The trip made me realize a few things.

1. I am super goal oriented. When I landed on Friday morning, at 7:30 EST, I thought, “Alright, I am here, let’s just have the rehearsal NOW, and have the wedding an hour later. I am ready to go. What? I have to wait for the rehearsal until tonight? And the wedding won’t be until TOMORROW? How grossly inefficient! Get it together people!”
2. My Scripps friends are very opinionated. To hang out with them is a totally different experience than to chat with my California friends- in a way, these Scripps people just constantly butted heads. About everything. However, we have agreed to disagree from long, long, time ago, and so, at the end of the day, we are still friends.
3. And we couldn’t be more different. In a way, it is shocking we are friends. We have different life styles, different goals, different interests, we look different, and in a way, if I hadn’t met them at Scripps, I wouldn’t be so certain that we would be friends! However, I love this about these women. God is constantly challenging me to love them, especially because they are so different from me.
4. It is good for Mommy to go away for a few days. The children had a GREAT time with Hubby- Zoe even preferred him, which I think, made Hubby feel awesome. The house, was not happy I was gone, however. I had never seen my house in such a state: toys, boxes, clothes, clean dishes, EVERYWHERE.
5. Talking on the phone with Aidan is a sweet, sweet, experience. We talked every evening (all two of them) for a good while, he told me what he ate, what he did, and how he was dressed. He asked very good questions too, “Who else is at the wedding? What are you doing?” And most importantly, “When are you coming back?”

The wedding was in Alexandria, Virginia. It was beautiful. The weather was terrible. As much as I enjoyed my 60 hours of children-free-life, I was ready to be home for Mother’s Day. Nonetheless, I had some re-entry difficulties: I had gotten used to dinning without the chaos of children! I will post some pictures from the weekend very soon, as well as some post-dinner mess at our household.

One last thing, Aidan has started to call me, “Dr. K! Dr. K!” When he really wants my attention. It is all very funny.

Thursday, May 08, 2008

The White People!

No, this isn't an entry about race. It is about Storm Troopers- or as Aidan calls them, "White people!"
Here is the best part of the Jedi Training Camp at Disneyland. Aidan LOVED this. Enjoy!

My flight to DC is in about 4 hours. I have stocked the fridge with curry chicken, rice, edamame, mac and cheese, steamed apples, steamed carrots, strawberries, grapes, string beans, and broccoli. Their lunches are packed for tomorrow. The dishes are done. The laundry is done. May the force be with Hubby this weekend!

Wednesday, May 07, 2008

A Whirlwind!

We made it home! It was a very full weekend, of seeing old friends, family, and of course, the rodents at the Happiest Place on Earth.

We left with 4 suitcases, 2 car seats, and 1 pack-n-play. We came home with 1 new shirt for A&Z and me, and a new pair of pj pants for me. But minus 1 pair of my old pj pants, 1 pair of Aidan's shoes, 1 pair of Aidan's pants, 1 of Zoe's onesie, and 1 pair of Hubby's jeans. We really like to wear old clothes on trips and leave them behind!

We met a potential new member of our family- my bro's GF, nearly fiancee. Wendy was/is SO sweet and kind and beautiful. Looking forward to spending more time with her in the future.

Aidan drank a LOT of juice during this trip. Usually, we are a juice-free household, but on the road, juice is EVERYWHERE. Breakfast, lunch, dinner, planes, all the gatherings, had juice. Might as well let him get it out of his system. I felt really badly one evening. We were dinning at Cafe Orleans, and after offering Aidan various options to order for his dinner, he seemed so unimpressed and unwilling to decide. We told him that if he didn't give us an answer regarding his meal, whether he wanted ratatouille or mac and cheese, he wasn't going to get anything. So he didn't eat ANYTHING for dinner. I felt so bad. But alas, he made a choice. (I vowed to be a mother who would not beg my child to eat anything, ever.) Anyway, as I was tucking him in, he saw Hubby munching on some bagel chips (!) and he looked at the chips so longingly. I asked him, "Aidan, are you hungry?" After looking left and right, and so sheepishly, he said, "Yeah, Mommy, I am hungry." I still stuck to my plan, "Well, Honey, that is why we eat at dinner time. You can catch up tomorrow at breakfast."

Zoe liked to get up early, 5:15, during this whole trip. Hubby practiced his photography skills with her each morning- I think Hubby will post those at his blog. It gave Hubby a lot of time with her, since I went back to bed. She enjoyed walking around, smiling at people, and not napping. Aidan did really well on the trip- loved every minute he had at Disneyland, especially the Jedi training camp. He also started to make friends while standing in line. "What is your name? My name is Aidan. I am 4 years old. My sister is 1. Her name is Zoe. How old are you?" Imagine that, ALL DAY LONG. He also peppered me with these questions, again, ALL DAY LONG. "Mommy, what is the dark side? Why does Darth Vader wear a mask? Why is Darth Maul's face so weird? Why do they want to do bad things? Why don't they love God? Why are they so scary? Why are the Strorm Troopers bad?" Did I mention that this went on ALL DAY? So much so that when I tucked him in bed last night, I told him, "Honey, I don't want to talk about Star Wars anymore this evening. No. More."

There won't be much posting in these next few days, because, I am getting ready to go to DC on my own for a wedding!

Thursday, May 01, 2008

Weird People

It is time for a post about weird people. I know a lot of weird people, so to actually get mentioned in a post, these are truly weird people.

Over the weekend, we went to Aidan's favorite hangout joint in B-game: Tapioca Express! He loves the popcorn chicken, and of course, a fruity tapioca drink, BIG tapiocas. At this location, there is a "hotel" next to it, it is a "hotel" because it is actually a weekly hotel (short or temporary long term housing, depending on how one looks at it), and full of hmm, interesting/weird/high people. I have my sources to confirm this. Actually, half of the time when I am walking around there, I am expecting to run into patients. But anyway. So there we were, sitting, sipping, eating, chatting, and Z was walking around with a big straw. A woman came up, said how cute Z was, and then proceeded to PICK HER UP, all the while saying that the straw wasn't safe. As I saw her hands go underneath Z's arms, I reached out, picked her up, and said, "We are fine, thank you." She sort of backed off.

One has to be fairly boundary-less and intrusive to PICK up, not just pat on the head, or pinch the cheek, or whatever, a STRANGER's child. Also, giving parenting advice to strangers also not so good.

The other weird person to be described today, is actually the handyman (K) to our town home complex. We had quit a bit of run-ins with him recently. When we had rented the club house for A&Z's party, he had called to say that he thought we didn't clean thoroughly enough- Hubby had vacuumed THRICE. I had offered to go back and do that again, but he said that housekeeping was coming and not to worry about it. (So why did he give me a hard time in the first place?) The following week, we got a bill for the clean up fee. I called the manager, and as it turned out, K WAS the housekeeping. Truly. Weird.

As we are embarking on some home renovation projects, we found some water damage to Aidan's room. The manager sent K over to look at it.

Ding Dong! (3 seconds later, knock, knock, knock.)

K: "Does your door bell work? I didn't hear any movement?"

Me: (Thinking, I can't teletransport myself, dude.) "Sure it works, it was just taking me a second. Could you take off your shoes please? We have a young toddler."

K: "No, I can't take off my shoes. I have a foot problem."

Me: (Thinking, what? You NEVER take off your shoes, even while you are sleeping? Like the shoes are GLUED to your feet?") "Well, it is really important to us to keep it clean."

K: "Well, I guess I can't come in then."

Hubby intervened and suggested plastic bags. I got the plastic bags. K just put them on, didn't tie them or anything like that, so the bags are dragging, slipping off, a total fall hazard... We went up stairs. He looked at it for 2 seconds.

K: "You just noticed this now? Never before?"

Me: (Thinking, what does that matter? Either way, there is a leak. It is not like it has been hurting me, and it really isn't very noticeable, actually.) "Well, What do you think?"

We talked about this for a minute. Then I pointed out some cracking next to the window.

Me: "What do you think about that?"

K: (Sort of rolled his eyes.) "That is from the foundation cracking, very common, around the windows."

Me: "The foundation cracking? What do we do about that?"

K rolled his eyes some more.

Me: "You know, K, sometimes, when I am talking to you, you seem to be quite condescending. This is obviously not something I know, and I have to ask questions to understand the problem better."

K: "Well, I am very busy."

Me: "This is part of your job. I didn't ask for you to come, your boss sent you. If you are too busy to do this, you should tell your boss."

K: He rambled on about something about the foundation (by the way, it just cracks and nothing is to be done about that!).

Later, while he was out getting his ladder, I told Hubby that I confronted him.

Hubby: "Man, I wish I was there to see that!"

All in all, there is water damage. (No kidding.) They are going to send a roofer guy, and I will have our contractor do the sheet rock, and they will send me a check.

Although I think I am going to try to get them to pay for fixing the crack around the window. The foundation does belong to the home owner association, after all. Just like the exterior walls belong to them. We do, however, own the interior walls, the doors, the knobs, the kitchen sink.

We live in a strange, strange, set up.

Writing about weird people reminded me that I was going to write about proper ER etiquette. When I was there with my maternal grandmother a few weeks ago, there was this family that we shared the trauma room with. They guy had supraventricular tachycardia (SVT- something above your ventricles making the heart beat WAY too fast) who was cardioverted. He was already stable, just hanging out for further observation. His wife came over, looked at my grandmother, and said, "How old is she? What? Only 87? She is so young? She will live through this, she still has a lot of time."

Rule #1: Stick to your side of the curtain.
Rule #2: Don't say if people are going to live or die (unless you are the treating team, that is.)

That is pretty much it, for proper etiquette.

Maybe Rule #3 would be needed, like sermons, points should come in sets of threes.

Rule #3: Don't leave the hospital with a central line. (This will require a story, which I will tell when we come back from the Happiest Place on Earth.)