Stories from Thanksgiving

Our blog has recently been distracted by the long hours of residency and most of our posts are about the woes of internship. I hope this blog will take us back to our blog roots, funny stories about growing up with foreign parents. Recently, I hosted my very first friendsgiving. The night was a rousing success with plenty of food, and traditional board game fun. The party went off without a hitch, especially since I removed the extra bag of entrails I accidentally left in the roasting turkey before most of the guests arrived. It was during this evening I discovered I am turning into my mother by participating in her favorite past time - embarrassing people. I made everybody go around the table and state what they were most thankful for - since we have all only known each other for a few months, it was admittedly awkward. My fellow intern Sarah, who hates awkward situations, went last and was simply thankful that the awkward moment was about to end. However, I did not pull out my mom's awkward and embarrassing piece de resistance, which brings us to the heart of this thanksgiving story. Every year at the thanksgiving dinner table, my mom makes my little sister (by little I mean 1 and 1/2 years younger than me) sing a song with the chorus line "shaniqua don't live here no more.". You may be thinking, "I've never heard of that song, it is clearly made up." The song does exist, and awesomely, my mom thinks it is a hilarious song. A hit in the year 2001, the hip hop duo of Little T and One Track Mike hit it big with their one hit wonder "Shaniqua." Enjoy it yourself below:

Yes, the experience was surreal for us all at the first thanksgiving my mother demanded the song at the dinner table. Even more surreal for my brother-in-law's run of the mill american parents who were spending their first thanksgiving with us. Now it's a regular event, despite my younger sister's insistence every year that she does not remember the words to the song until she eventually gives in and busts a rhyme.

--By Farrah, who wishes you a very happy thanksgiving tomorrow

Things in the movie Babies not recommended by the average pediatrician

Once again a blog brought to you by the random and obscure shit available on Netflix instant watch. Here are some things not recommended when providing infant appropriate anticipatory guidance.

1) Riding a motorcycle while holding your babies

2) Co-sleeping

3) Letting your toddler hold your infant

4) Letting your baby suck on a piece of chicken

5) Letting your baby crawl through a field of cows

6) Giving your baby coca-cola

Overall, a very adorable movie, but there exists a point of adorable overload - this point was reached during the viewing of this film.

--By Farrah, who sees adorable kids all day everyday so her standard for cuteness is unattainable by the average child

Lonely Nights in the Baptist

Being on call is not as sexy as Grey's Anatomy makes it seem - well, at least for not anyone I know. There are no call room sexual hijinks, no flirting with cute, single doctors, and no dire emergencies (or at least in psychiatry). Instead, call is really busy and very mundane. I usually wander around the ED, very cranky and irritable, wishing that I had become anything else in the world but a doctor, wearing an old UNC sweatshirt that makes the Wake Forest security guards who are inevitably stationed outside a suicidal/homicidal patient's door, telling me "I don' like yo sweatshirt....I'm a [insert any other shitty ACC team here] fan." At 4 AM, however, no one wants to give a dissertation on why you are a Tarheel fan, no matter how die-hard you are about the Dean Dome, Dean Smith, and Roy Williams.

However, probably what I hate most about call is not the work or the scary/depressed/psychotic patients who have decided that 3 AM would be the time they would come into the ED with their crazy command hallucinations or decide to cut their wrists with that trusty old razor blade, but my loneliness. When I'm on call, I swear I hear the Britney Spears' chorus running through my head as if a soundtrack for my current state of mind - "My loneliness is killing me....baby hit me one more time."

For psychiatry, we do not have team structure call - I am literally the only psych person on call - no on site upper level or attending in sight. So I wander the halls of the Baptist alone in my solitude. I wander into a resident work room and see at least 6 internal medicine residents all hanging out together, joking about patients, having human interaction at 3 AM, and I get jealous of their comraderie. The other night I went to the friendly bagel shop to get their disgusting asparagus omelette bagel contraption, and as I waited in line, I saw 4 handsome internal medicine residents drinking their chai lattes at 3 AM, joking and chatting amiably. I enviously looked in their directions in the hopes that someone would talk to me, but they didn't - cliquish as they were. I grew irritable and thought, "Hey, I have friends! They're just at home...sleeping right now, but when they come back, we talk and joke just like your program." And so, I bravely trudge on through calls, counting down the hours before it ends, because after all, the night eventually does have to end, right?

--By Mariam, who realizes the shitty nature of this blog but was getting tired of Farrah's constant reprimanding, "I am keeping this blog alive since residency started, Mariam." This one is for you, Fars.

Vampire Weeknights

I've started to work the night shift in the emergency department, and I can tell you right now that I would make a horrible vampire doctor (or Dr. Acula). I do not look elegantly disheveled with perfectly tousled hair after sleeping all day like the vampires all the tweens are into these days. I certainly don't have the patience to stare intensely at anybody like that dude from the Twilight movie. I usually describe myself as a night person, but this schedule is really messing with my flow. I perpetually live in sweats transitioning from scrubs to PJs to workout clothes then back to scrubs. The workout clothes are simply prophylactic to encourage me to work out, lest my regular pants not fit after my month of elastic waistbands is over. I could conceivably get out of the house in the afternoon when I wake up, but it doesn't feel right. I feel like I'm living in a dream world where work at night doesn't really count, but I have to work all night, so my days are not terribly productive. I sit around waiting to work all night, and then I work all night. Sleeping during the day is not great either, light always manages to seep through the seams of my blackout curtains and Teddy often barks at the stupid birds chirping outside. This experience brings my complaints about residency up to two:

1) Night Shift
2) Residents who complain about residency

On to the topic of complaints, I know that everybody needs somebody to vent to about the crap you have to deal with during residency, but seriously every resident gets over worked with crap - stop complaining about it! Just get a little attitude adjustment and before you know it your month of torture will be replaced with different month with possibly less torture. I'm a little peeved at myself right now just for complaining about the complaints. But seriously, this is my conversation with any intern in almost any specialty - I have had this interaction on multiple occasions from 3rd year of med school till now.

Me: how was your night?
Other intern (OI): *extreme exacerbation* I had to see (insert any number from 1 to 100) patients last night, and I still have to finish (insert any number from 1 to 100) notes! *prolonged sigh*
Me: Oh, I'm sorry, did you at least get to see anything interesting?
OI: Not really. *lets out loud involuntary groan as something on computer doesn't work*
Me: Well, you at least you get to go home soon?
OI: I'm so tired I can't even function right now *falls asleep in chair*

This is how the interaction should go:

OI: how was your night?
Me: TOTALLY AWESOME!

Ok, so maybe that's a little hypomanic reaction, but when you're sleep deprived you have an excuse to act a little loopy every once in a while (as long as there is no alcohol involved). I will admit Surgery gets worked harder than say Pediatrics, but if you picked Surgery, it's your own fault you're so busy (sorry Abby - I still heart you). At least the night shift slows down around 3 am and affords some free moments for blogging - live from the ED!

--By Farrah, who's nickname in the ED has been declared to be "Fawcett head"

NOVA special provides terrifying glimpse of the future

I did not buy cable when I moved for residency. So now instead of watching episodes of the Jersey Shore, I am forced to watch the random and obscure shows available on Netflix instant watch. I stumbled on a NOVA special called "Doctors' Diaries" that profiled 7 doctors starting in their first year of medical school at Harvard in 1987. I watched it mostly out of boredom, but also for a glimpse of what school was like for my attendings. The answer was anticlimactic - school was exactly the same for my attendings, except there was a higher incidence of women with shoulder pads and perms. They struggled through the first two years of medical school reading about the basics with little to no connection to clinical work. They arrived in the second half of medical school knowing nothing while they were pimped. One student was aggressively pimped during his neurology rotation, and he replied with "I don't know because it's only my second day of neurology" followed by a nervous chuckle - a response I used in almost every rotation in medical school.

Not only was school the same, the students were the same even inside the ivy-covered, prestigious walls of Haaahrvaard. There was a slightly creepy mustachioed non-traditional student, a few brainy book nerds, a no-nonsense tough girl, and an emotional do-gooder. Every student on the documentary was a foil of a student in my class. Their lives in medical school were pretty boring and simply told me the story of my past 4 years. The second half of the special, about life beyond the first day of internship to the year 2007, is where their stories went from boring to terrifying.

All of the men on the special were divorced at some point - the mustachioed man managed to squeeze in three divorces. Two of the doctors actually mentioned that treating their spouse like an intern led to problems in their marriage. I can't imagine the poor wives given scut work at home, and admonished when it wasn't done correctly. The book nerds went into academics and seemed to genuinely love their jobs (anesthesiology, ophthalmology), but felt bad about spending time away from their families. Dr. Moustache became overweight, started smoking, got asked to leave his job in the emergency department, and grew a new hairstyle to become Dr. Braided Pony-Tail and Beard. I couldn't really see what element of their lives as doctors was so difficult and was starting to get depressed.

Two of the women no longer worked as clinicians. The no-nonsense young woman became a cardiologist and then a research scientist for a pharmaceutical company. She stated she didn't want to worry about her lifestyle doing heart caths until the age of 70, and she was definitely not worried as she pulled her fancy Audi into the driveway of her massive California home. Another woman, the only pediatrician, delayed intern year to work for a non-profit and get her PhD, and eventually ended up running the same non-profit instead of working as a clinician. The overly emotional girl from medical school became the only female clinician, and was my favorite doctor on the documentary. She worked as an internal medicine doctor for an urban population, she focused on public health, and she seemed to be the only doctor that didn't flaunt the fact that she went to Harvard. The only downside to her story is that she didn't get married until age 40, and even though she's now happily married with children, it does seem kinda late.

After watching these stories, I was left with an image of the future with my family left behind unless I left medicine - it's not terribly encouraging. I hope that I don't become as tired and cynical as these doctors that trained before me. I'm not sure if you can win with this career I've chosen, but I'm guessing I will need a supernatural ability to balance the elements of my life. I think I better take up tightrope walking to practice.

--By Farrah, who was recently told by Mariam to be less sarcastic, pretty good, right?

The Five Stages of Accepting Your Pager

I had a pager in medical school, but it rarely made any noise. The nurses, residents, and fellows were far too busy to page a lowly medical student to see a procedure, and so the pager's only assigned tasks were to devour AAA batteries and to beep when it required fresh meat. Now my new residency pager not only devours AA batters (bigger is better), it's buzzer goes off with responsibility. The nurses need to page me for tasks at 3 am like "the patient in room 807 is gassy and could you please order some gas drops." I don't mind getting paged and checking in on the patients, but it did take a few weeks to get to this state of acceptance. I present to you my model: The Five Stages of Accepting Your Pager.

Stage 1: Brief Elation

July 1st is just a blurry memory overcast by my nervousness. There were not only butterflies in my stomach, there were angry giant pterodactyls. I was hyperaware of the weight of my pager on my hip, but with it's first buzz I was kinda excited. A page! For ME! I could now pick up the phone, dial the number, and say "Hi, this is Dr. R. I was paged." (I said Farrah, but still- I could've said Doctor if I wanted to). The cherry on top was they needed me, not the resident above me, not the fellow, not the attending, ME! It's nice to feel needed.

Stage 2: Denial

What is that buzzing noise? ... ... ... hmm, somebody's pager must be going off ... ... ... Oh CRAP! It's my pager.

Stage 3: Anger

At this stage, you start visibly cringing when you feel the first vibration, and your eyes narrow as you lift up the pager to see who needs you now. You start to recognize certain series of numbers and hold grudges against those numbers. For me it was 2811, which meant I had to go to a delivery. I can tell you right now neonatal resuscitation protocol is not enough training to let you handle what goes down in a delivery.

Stage 4: Bargaining

I'll take 500 pages in the next 5 minutes if I just don't get paged between the hours of 1 and 5 am.

Stage 5: Acceptance

At this point, I knew enough to handle simple problems I was paged with - "why yes I will write for some gas drops." I also knew how to reach somebody above me if I needed them. I could better understand the paperwork and how to write most orders. I knew the patients better by this time too so I knew which ones needed to be checked on before I even went to bed. The initial terror and nerves of residency were on longer operating at 100%, they were toned down to maybe 75% of capacity. I know now that no matter who pages me, I have backup and it's going to be okay.

--By Farrah, who's finds herself inadvertently slipping into a Southern accent several dozen times per day

Career-dropping

If I had a Match.com profile, my dislikes would include: the sitcom Two and a Half Men, tourist traps, and bragging. I absolutely hate when people brag about their fancy homes, cars, watches or their elite Ivy League education or the fact that they are the frequent object of admiring glances from the opposite sex.

How things have changed. Before I started residency, during my summer vacation, I wished that I could plaster "M.D." on my forehead so that the world would know all that I had accomplished. For instance, last month I was at our local department store Belk getting a gift wrapped at customer service. The elderly lady wrapping my box told me that she had an aunt that was a 100 years old and still lived at home and on occasion played ball with her grandchildren.

A thought suddenly flashed through my mind, I want these nice ladies at Belk to know that I am not an average customer, I want them to know I'm a doctor. So, as the lady talked about her amazingly healthy century-old aunt, I nodded in faux-admiration and casually inserted into the conversation: "That's so great she's healthy! These days people who are over-50 have so many diseases like hypertension and diabetes."

I thought I sounded knowledgeable without coming across as self-aggrendizing, but the lady continued to wrap the box with pink ribbon and did not ask me, "Well how do you know that?" as I had intended her to. This will not do, I thought. So, then I said, "I'm in the healthcare profession and people are so unhealthy these days! It's nice to see your aunt is doing great at a 100!"

And that did the trick. "Well, oh my gosh, what do you do?" the lady asked, finally going along with the script I had created in my mind.
"Well, I will be a doctor at Wake Forest in July."
"Well congratulations, that is just so great! What kind of doctor?"
"A psychiatrist," I replied.
At this juncture another elderly lady appeared from the woodwork. "A psychiatrist? You know you'll need a gun, right?" she exclaimed in her Gentile Southern accent. This, of course, was not the intended response and almost seemed as if it were a non sequitor and borderline offensive, mocking the career of a mental health worker who labors to ensure patients don't disappear into the abyss of suicide or psychosis.
"Excuse me?" I said trying to hide my annoyance.
"Well, those crazy people - they could hurt you! I saw it on the TV," she said, a firm believer of the scare tactics of the 5 0'clock news.
"I'll be okay. They treat us self-defense at orientation" (for the record, they do not). And so, with that I learned my lesson of casual boasting. It never does end well.

And now, that I have actually started my residency, answering pages with, "This is Dr. Qureshi" fills me with an unforeseen anxiety. I feel like a huge fraud - after all, who the hell is this Dr. Qureshi? Certainly not me; I feel like I'm playing pretend as my dad, who has been answering the phone with that line for the entirety of my life. Every time I have to answer a page on call, I never know what to say since Dr. Qureshi sounds so extremely prideful, and pride cometh before the fall.

And so, I try out different phrases, hoping one will fit comfortably; "Hi, this is Mariam, the new intern" or "Hi I received a page, I'm the new psych intern" or "Umm, hi did anyone page psychiatry?" or the now-dreaded but direct, "This is Dr. Qureshi returning a page."

--By Mariam, who is no longer an MS, and is now a PGY-1...Is that an upgrade or a downgrade? Jury's still out.

Bad Muslim Jokes

I was watching the latest episode of Party Down, a show on Starz that I am pretty sure no one has heard of but is actually really funny, and for the first time, I was offended by an offhand joke. In a rather farcical episode, the Party Down catering gang is at a gig for an after-party for the actors of a community theater play. Two of the main characters - Casey and Henry, her on-again-off-again love interest, are messing around with the costumes from the play backstage. Casey jokingly puts on a flamboyant pink burqa costume and Henry says, "I still can see your crudely wanton ankles," he says sarcastically.

I don't believe in censorship, and sometimes humor pushes the boundary of good taste. But I found this joke fundamentally annoying. It seems as if a new trend in comedy is to mock Muslim women's choice of modest dress. I haven't seen the new Sex and the City 2 movie (shoot me first), but I read in a review that there are hijinks involving "flaunt[ing] the flesh in front of Muslims." I find jokes where an enlightened Western woman shows off her beautiful tanned body in front of Muslim men and their covered women and the ensuing stares they encounter not funny at all.

Modest dress is a choice for most women, especially those of us who choose to do it in America. There exists no oppressive father (with a scary beard and outrageous temper) who tells their daughter in heavily-accented English, "You will wear zee hee-jab! I command it as does Allah!!!!" Of course, I admit, there are negotiations between parents and their kids when they are teenagers on what is classy and what is just plain hooker trashiness, but I assume that happens in white folks' homes, too. Classic example in Clueless, when Cher's dad says, "Cher, what is that?" when she's going on her "date" with the rather obviously homosexual Christian. Cher responds, "It's a dress, Daddy."
"Says who?" he commands.
"Calvin Klein," she states. There were many permutations of this conversation when I was a kid and wanted to wear some outrageously trashy Arden B. or Betsy Johnson shirt to high school, and my mother would argue against it.

And while I understand that some of us who do not wear the hijab make arbitrary choices on what we do and do not wear (no short sleeves or no sleeveless or no capris etc.), they are still our choices (not some ominous patriarchal figure who looms in the background at home), and they should be respected. Because on the whole, let's be honest, those of us who attempt modesty achieve it compared to mainstream America.

And I hate to be cliched, but the Sex and the City gals are not liberated in their scantily clad clothing. They are enslaved by it. Wearing low-cut tops or short skirts doesn't make you more enlightened or more free than a burqa-clad Muslim woman. Because men objectify you - you are not a sum of your parts, but just a faceless, mindless pair of boobs, ass, or legs to them. Female objectification is everywhere in movies (probably because of patriarchal male directors and crass American audiences). Ever seen a movie where the camera languishes over an actress's lean body (see: any Jessica Alba movie)? Or how about gratuitous female nudity, where an actress is dancing around in her undergarments for no apparent reason (ex. any Katherine Heigl movie)? Now that is female objectification. These kinds of movies make me want to put on a black burqa even in the 90 degree, sweltering summer heat of North Carolina.

--By Mariam, who apologizes in advance for not making this blog as funny as previous entries but blames Uzma K. for her influence in reverting Mariam back to her radical feminist ways.

Fixing the Finale of Lost

Lost left a lot to be desired in the series finale. Mariam invested 6 years watching the show and tried to convince me that the ending was touching and appropriate. I only invested 6 months in the show and hated that the last season was about the death of only one character who I didn't even like that much! Maybe I am more cavalier about dismissing the show entirely because I didn't invest 6 years in it, but still it was about 120 hours of television. I could have gone to the gym instead and burnt at least 120,000 calories! I know the writers want to leave the ending open to interpretation, but it is poor form to end a show about a lot of interesting mysteries and character interactions on an island completely removed from the island and its mysteries. I suppose the lost writers and die hard fans can keep their lame ending, but for people who just want straightforward resolution they should include a highlight reel of character events after Jack's death, much like the end of any teenager coming of age movie. Imagine the song Don't You (forget about me) by Simple Minds playing as screenshots come forward with a few sentences updating us on how things turned out. Here's how I picture things turning out.

PEOPLE WHO WERE ALREADY DEAD

Jack: Enough about Jack, no update needed.

Juliet: She goes on to marry Sawyer in afterlife part 2. She runs into Jacob one night at a Sushi restaurant. After some saki bombs, he reveals he wouldn't let woman have babies on the island because his own mother died after childbirth. Juliet slaps him.

Locke: Locke opens a walkabout company in afterlife part 2. Nightly boar feast and luau included in cost of package if you buy right now!

Sun and Jin: Live together in afterlife part 2 where they never speak Korean again. They sell oxygen tanks for submarines specifically designed for unconscious people.

Sayid: Lives a slightly fulfilling life with Shannon. They live in the suburbs of afterlife part 2 and join a really WASPy country club.

Charlie: Afterlife 2 treats him well. He has 4 kids with Claire, and teaches music classes.

Shannon: Eventually dies of an asthma attack and ends up in afterlife part 3.

Boone: Wanders around awkwardly, smiling and giving everybody hugs. Sometimes he sleeps with Shannon.

Alex: Stays in afterlife part 2 until she eventually finds Karl. They date for a while, but grow apart after she leaves for college at Brown. She eventually meets Detective Miles and totally hits that.

Rousseau: Marries Dr. Linus and cooks him french food in afterlife part 1. They have adopt a baby named Pierre. They abandon him after Rousseau and Alex remember the island and they move on to afterlife part 2.

Daniel Faraday: Wins over Charlotte with his super awesome muzak.

PEOPLE WHO MAYBE NEVER EXISTED

David (Jack and Juliet's son): Gets abandoned by his dad and mom mysteriously one day after his grandfathers funeral. He has a lot of issues about it until he crashes on a strange island with a group of strangers (including Sayid's niece and nephew!).

PEOPLE WHO DIED IN THE FUTURE

Kate: Escapes on the Ajira jet, and helps Claire raise Aaron. Dies in a tragic run away ferris wheel accident.

Sawyer: Starts a blog called Nickname. It is epically successful for its one liner wit.

Miles: Finds a bag of diamonds in his pocket after landing on the Ajira flight. He becomes CEO of Oceanic airlines, but is removed after a duct tape repair scandal.

Claire: Runs a decorating company specializing in goth themed baby furniture in Beverly Hills.

Desmond: Escapes successfully from the Hugo-run island after Hugo decides to install a Star Trek-like transporter with his island magic. Lives happily with Penny and his son.

Richard: Sells eyeliner for men.

Lapidus: Works in Vegas as a Kenny Loggins impersonator, and writes a weekly conspiracy theory newsletter.

Walt: Uses his angst from his parents absence to start very promising acting career as a vampire on the CW. His strange magic powers that scared his stepdad in the first season really help him in his role.

Aaron: The dire warnings about him not being raised by his mother turn out to be wrong. He becomes a very successful marine biologist and is rumored to be dating Walt from the CW.

Ji Yeon: She channels her angst over her parents death into becoming the first female leader of the Korean mob. Think O-Ren Ishii in Kill Bill, Part 1.

Ben: Makes a lot of number 2 jokes with Hugo, especially after finding out from Desmond that the island is just a big clogged toilet.

Hugo: Hugo acts as the island protector until 2537. He is eventually replaced by Jar Jar Binks in an even more upsetting finale.

--By Farrah, who is 26 tomorrow

TV Doctors never write Medical Notes

There are only two doctor shows I can stand to watch on TV - House and Scrubs. Both of these shows were better in their earlier seasons, but after getting involved in the character stories I just watch out of inertia. Scrubs is probably more realistic, but House tends to have more interesting cases with entertaining Sherlock Holmes-type medical mysteries. The most annoying unrealistic thing about House is that the multiple overqualified MDs are in a never ending internship disguised as a fellowship for a specialty which does not exist. These docs can run any test in the hospital - MRI scans, cardiac catheterization, exploratory laparotomy, neurosurgery, genetic assays, autopsies, bacterial culture, breaking and entering. Every mundane test is run with the personal attention of doctors in perfectly tailored white coats without the help of any nurses or techs. The only mundane task these doctors are almost never seen, even miming, is the act of writing a medical note. Since my last month of medical school is flex time, I spend my time painting, playing guitar, and watching TV online. As I watched an episode of House in a feeble effort to exercise my already atrophying medical knowledge, I started to wonder what the medical chart would even look for an episode of house. In an exercise of pure boredom, here is what the chart would look like for the House episode "Brave Heart."

History & Physical

History: 39 year old male presenting with trauma, fell 30 feet from building

Family: Father, paternal grandfather, paternal great grandfather - death in 4os from heart disease

Social: Detective, Reckless because he thinks he's gonna die at age 40 like his relatives, unmarried, no children

Physical: 2 broken bones, severe concussion, collapsed lung

Assessment: Trauma stabilized, but unknown cardiac condition warrants an inpatient work up. Differential Diagnosis includes familial hypercholesterolemia, marfan syndrome, brugada syndrome, idiopathic

Plan: Admit to diagnostic medicine service, EKG, cardiac catheterization, genetic testing, routine labs

Progress Note

Tests: Negative

Assessment: Um... still probably genetic

Plan: Will get consent to exhume bodies of relatives (would insurance EVER cover this, put it on credit card, he's gonna die at 40 anyway!)

Progress Note

Interim History: Patient's ex-girlfriend presented to hospital revealing patient has a son.

Pathology on relatives bodies: Negative

Assessment: Um... still probably genetic

Plan: Get fresh pure squeaky clean bone marrow biopsy for genetic analysis (a little painful, but what's the pain of a child compared to cinching a farfetched diagnosis!)

Progress Note

Son's Bone Marrow Biopsy: normal

Assessment: Probably faking it = idiopathic, Will give patient imaginary diagnosis of Ortoli Syndrome, a rare cardiac disease treated with pills

Plan: Give patient sugar pills, discharge home

Autopsy Note

History: Patient collapsed 4 hours after discharge. Found in laundry room of apartment building by landlord. Pronounced dead on arrival by EMTs

Procedure: Post-mortem incision at midline of sternum revealed active bleeding. Patient comes back to life coughing and screaming in distress

Assessment: Not dead yet. Extreme Bradycardia. Differential Diagnosis includes sick sinus syndrome, metabolic disease, isolated anti-ro antibody

Plan: Transfer to ICU, start steroid treatment

Progress Note

Interim History: Jaw and tooth pain, patient pulled out own tooth with forceps from cart in room. Dentist analysis of tooth revealed normal tooth

Assessment: Source of pain could be bone cancer with paraneoplastic syndrome. Li fraumeni syndrome

Plan: Gamma survey to look for tumors

Progress Note

Gamma survey: normal

Assessment: Source of pain could be related to nervous system - hereditary sensory autonomic neuropathy type 1

Plan: Carbamazepine

Progress Note

Interim history: patient with continued pain and urinary incontinence

Assessment: Wilson's disease (is there a single episode where this isn't in the differential? seriously writers, it's just like Lost's obsession with dural sac rupture)

Plan: Penicillamine (why diagnose? just start treatment!)

Progress Note

Interim History: Dr. House heard the word "button" triggering the concept of heart attack button leading to the obvious next diagnosis of intracranial berry aneurysm pressing on brainstem

Assessment: Intracranial Berry Aneurysm

Plan: Neurosurgery for both father and son, then heartfelt reunion!

Good lord this show is stupid laid out like this! But inertia is terribly powerful so I will likely keep watching.

--By Farrah, who spent the last 5 days babysitting her 2 year old nephew and who never knew she could pull off the unkempt mom look so well, several people told her to have a happy mother's day

Childhood STOLEN by American Girl Store

I recently went on a trip to Colorado with Abby. We spent a week dog sledding, skiing, and gazing at the magestic beauty of the Rocky Mountains. We did not decide to spend our last day outside in the refreshing barely-oxygenated mile-high air, and instead decided to spend it in the retail air of Park Meadows Mall where an American Girl Store had just opened!

Like all little girls, I begged my mom for an American Girl doll on a regular basis. My mom was a big fan of her daughters reading, so she happily purchased the six books of every series for me and my younger sister Sami. My favorite books were about Samantha Parkington. I read Meet Samantha, Samantha Learns a Lesson, Samantha's Surprise, Happy Birthday Samantha!, Samantha Saves the Day, and Changes for Samantha hundreds of times each. At the back of each book was a small, harmless-looking postcard that you could send away for the American Girls Catalogue which sold dolls based on the series. My mom didn't appreciate the series as much after the arrival of the catalogue.

Sami and I would spend days lovingly turning the pages of the catalogue (Sami focused on Molly because they both wore glasses). They were the greatest dolls you could EVER own. Not only could you have the doll, but you could get everything the doll had in all of the books! You could get Samantha's pretty pink dress from Happy Birthday Samantha! along with a tiny ice cream maker and a tiny wicker set of table and chairs. You could even get a matching outfit for yourself! However, the dolls cost around $85 just for a starter kit - doll, book, and maybe a brush. My mom dismissed our whiney begging, stating that she would get us the dolls when they went on sale. Sami and I knew, they would never go on sale. My mom eventually got us similar looking porcelain dolls at a lower cost that partially filled the massive void in our American Girl hearts.

When we saw the American Girl store had opened just a week earlier in Colorado, we decided to go. I have to admit that even at age 25, I was excited to see a Samantha doll in person - a little sad, I know. We arrived at the magical store, where glass covered perfect displays of all the dolls just like in the catalogues. There were a few new dolls that I didn't recognize - Josefina? Ruthie? Rebecca? LANIE? Who the f*** cares? Where is Samantha?!? I rushed through all the displays, but she couldn't be found.

Abby, Sami, and I aggressively elbowed children out of the way to talk to one of the salesclerks.

"Excuse me miss, where are the Samantha dolls?" Sami asked as we all backed the clerk into a corner.

"I'm sorry, Samantha has been retired. It actually happened a few years ago," she politely replied.

"WHAT!?!" we responded in unison.

She's only 10 years old, I thought, how could she retire?

"I was going to pass one on to my daughter!" I said loudly to the sales clerk, realizing in the same moment that - 1) I don't have a daughter and 2) to pass something on to a daughter you have to own it yourself first. I could have cried (don't worry, I held it together - a future pediatrician should not openly sob in a doll store), and we left the store sad and dejected.

Samantha now costs around $300 on e-bay - a little too much for me to handle. I'm guessing she's going to come out of "retirement" at some point to give a little sales boost to the doll makers - much like the Disney vault which gives you a periodic one month window to get a limited edition Beauty and the Beast before it goes back in the vault. I may get my sister a Molly doll for her graduation so she never has to face the horrible realization that she can't pass it on to her imaginary daughter.

--By Farrah, who is house hunting and considered applying for those HGTV shows about "My first home" but didn't want to look too Liz Lemon-y looking for a house to live in by herself

Blast from the Past: Journal Entries

Last week, Farrah invited me to her house. She lured me to Perrysburg with the promise of home cooked fish and a tantalizing glimpse into her diary from the 12th grade. My interest was piqued - what was Farrah like at age 18? I was almost positive that although her comedic timing wasn't as matured and developed in the twelfth grade, it was well on its way. After reading an entry from 9/12/01, I realized I couldn't be more wrong. Senior year Farrah was not the person I know now - she was so incredibly earnest, very angsty, and tragically very, very Republican. A perpetual fear of terrorism, straight from George W.'s fear-mongering speeches, was a continual theme from said entry.

This prompted me to tell my parents to bring my diary from its hiding place in my room so that I could reflect on what kind of dork I was. Here is an entry from 5/22/97:

In science, Hardy [my 7th grade science teacher who was the Heidi to my LC, the Goliath to my David] goes "any gum 2day." I said "no." She told the whole class I got a demerit. I want 3, then I can get demerit SH [study hall]. He [?] gave me tips on how to get a demerit. Then we were taking notes and my light arrow was pointing the wrong way b/c I had no room. She was checking my notes and couldn't find anything wrong. So she goes, "Why is the arrow pointing the wrong way" "B/c I didn't have room." She tore out the page and goes "Now u do." I hate her.

In English - British tea party. During break, I was asking Lauren something near my locker and Nathan walks past a & hits me on the butt (this time no long object). I was like "U perv." He blamed it on Brice. More LATER! I asked Mrs. Horlacher 4 a demerit. She said no. Then I started chewing my gum really loud & she says, "You're chewing gum, automatic demerit." I was all excited and I thanked her. After I left, she said, "What's her problem." Mrs. Gibson never gave me a demerit. I asked 3 times. In Pre-Algebra, Nathan told me to get another demerit, just in case.

In history, I found out who Betsy liked - Nathan W!!! She said in her note, "he's so foxy." So she's over NF. In art, me and Jenna drew our houses and William told all the guys about how I live near him. Then I was like, "One time I said hi to u & u ignored me." Then Ryan and Nathan W said, "If I lived in your neighborhood, I'd ignore u 2." Whatever! Guess what I found out, Mrs. Morrison didn't give Betsey a demerit 4 chewing gum. I hate her! In PE, Saira & Nathan F. broke up. Now they're going out again.

And here endeth a typical journal entry from my seventh grade year. To glimpse into my twisted seventh grade mind is truly enlightening and frightening. I barely recognize myself - a boy crazy Valley girl whose greatest obsession was a guy who barely knew she existed. Hardly the pretentious, liberal hipster who references 30 Rock and I am Charlotte Simmons regularly that I am now. Most importantly, after reading this blast from the past, I realize how important it is to keep a journal. If we can't look back at our angst-ridden teen years and laugh, at least we can feel infinitely superior about how much we have changed. Or how much we have stayed exactly the same.

--By Mariam, who is an MS4 and thereby, INVINCIBLE.

I promise we didn't couples match

Looks like both Mariam and Farrah will be residents at Wake Forest University. Good news, the blog doesn't die here!

Blog Submissions: Awkward Interview Moments Series

Welcome to a new series that will start after Match Day. Some of us have been through an exhausting, grueling interview season of fake smiling, wearing uncomfortable polyester-blend suits, and asking nonessential questions about programs that are all essentially the same. During these 3 months, most of us have probably encountered an awkward moment with an interviewer - whether it be on our parts or the assistant professor of [insert medical specialty] or current resident. And we want to hear about it! We will compose a blog about the most awkward moments we encountered on the interview trail 2009-2010. All submissions will be anonymous, and don't fret, overly cautious MS4s, this blog will not go up until everyone has matched. Blog readers, come out of the woodwork, and participate - send your most awkward interview moment to mariamq786@yahoo.com.

-- By Mariam, who will scream if anyone ever asks her, "Do you have anymore questions for me?"

Critical Analysis of a Tile: Part IV

The interview season is winding down, and while I have a pile of 15 thank you cards to write, I am taking a break to provide more blogging entertainment. So now back by popular demand, another critical analysis of drawings on tile.

Farrah: The size of these kites couldn't really generate enough lift when compared to the placement of the string and the size of the bows. The message of "be free" doesn't exactly make sense in a hospital setting. What is this child trying to imply? Be free of medical treatment? The parents who avoid vaccination aren't setting anything free other than a new epidemic of mumps. Be free of disease? How is being free of disease related to kites? If you set a kite free, it doesn't have a brain, and it can't feel the importance of its liberation. It might even land in a local river, suffocate a swan, and leave a baby swan behind who thinks it's ugly while it is raised amongst the ducks! Finally, these supposed "kites" look strikingly similar to a spermatozoa with a crude drawing of the mitochondria in the tail. I don't know where these sperm are going to "be free," but I do know it's inappropriate for children.

Mariam: I am wondering what exactly the association between hospitals and kites is, too, Farrah. But, really, who can fathom what kind of crazy shit goes on in a kid's mind? One interpretation is that the kid is stuck in the hospital and weird people keep waking him up to poke him and check on him, and maybe he wants to "be free" of the hospital and walk out AMA*. I highly don't recommend that because then insurance doesn't pay for your visit, and who the hell wants to pay a $30,000 hospital bill out of pocket? Also, I'd like to point out the inaccuracy of the tile as well - first of all, kites are not free - they are tethered by a string and held by a snot-nosed kid (such as the one who painted this tile). In fact, they are totally operator-dependent. If a kid wanted to make an accurate (albeit irrelevant) tile about freedom, he should have painted some birds. Now, birds are totally free.

*= Against medical advice

--By Mariam and Farrah, who spent this past week making jokes about Dr. Spaceman.

How to tell a residency program "I want to go to there"

When I was applying for medical school, I turned to the internet for help. For those frequent readers of this blog, we know how that turned out from Traumarama: Cake does not get you off the waitlist. However, I made it through, and now almost four years later, I am ready to take my next step of training by applying to residency. After the personal statement, the CV, and the interviews, I find my self agonizing over what to put in a simple thank you note. How personal should it be? Hand-written or e-mail? Who do I send it to? The program director? The program coordinator? The chair? My interviewers? I turned to the internet once again for help, and returned to the dreaded Student Doctor Network forums to find what the average gunner was doing these days. I then stumbled upon the following advice designed for the international medical graduate. It's actually pretty standard advice, but it does contain language that although entirely English, still distinctly reads as foreign. I've highlighted my favorite parts.

Writing effective Thank You Letter

You may wish to thank the program coordinator before you leave for the well organized trip. It is a very good idea to remind about yourself with a thank you letter sent to everyone you interviewed with. It is going to be much easier if you write your thank you letter right after the interview while everything is fresh. Touch the subjects you talked about, that will make it more personal and your interest more genuine. Use the forms you completed to refresh your memories. It is also a good idea to ask about a possibility of a "second look" interview.

A sample Thank You Letter

Dear Dr. XYZ:

Thank you for the courtesies extended to me during my interview yesterday. Your program's atmosphere was inviting and warm, despite of unusually cold weather. I appreciate the way you made me feel at ease with informal conversation about the program as well as lifestyle in ZZZZZ. A site of the state capitol has impressed me.

I especially enjoyed learning about research opportunities at the program.

I liked a lot rounds with ward team directed by Dr. YYYYY. Her non-pressing style lets residents think and express their thoughts freely.

I was particularly impressed by the satisfaction of the current residents with the program. I feel like I definitely can fit into the team.

I strongly believe that I would be an excellent trainee. I really think that the program may benefit from my experience. Even though I had an interruption in practicing medicine, my current position helped to bring my skills up to speed. Whatever I could have missed prior to that, I will catch up by hard work.

I hope to successfully match with your program. Since it was my first interview I can definitely say that I rank your program as number one. But seriously, I will give you an update on my ranking in January. I am sure that the program will be at the top of my list.

Sincerely,

AAAA BBBBBB, M.D.

My very favorite part is the joke in the last paragraph. I had to read it several times before I realized it was a joke. Anyway, I finally settled on a nice hand written note on Crane & Company stationary sent to the program director and my interviewers. After the thank you note is still a mystery for me. I think there is some sort of program director calling program director protocol, but I don't know if I'm ready for that step yet.

--By Farrah, who is in Mariam's home town, which is smaller than you can possibly imagine and contains an abandoned gas station converted into a Jesus figurine and fruit stand.

The Poltics of Naming

When a group of 20-something girls congregate together, the discussion always veers towards baby names - what names we have picked out for our hypothetical kids regardless of our marital status. And my contribution to this conversation is invariably, "I will pick a name that is pronounced the same in Urdu and English so my kid won't have a weird name complex."

This is because I suffer from a so-called "name complex" because (Cosmo Confession) my name is actually pronounced Mur-ium, not the Anglicized Westernized version: Mary-am. When I was a teenager, I had no problem introducing myself to white folks as Mary-am. I didn't think twice about the identitarian politics associated with assimilating ones name to ease social interactions with mainstream society. I just wanted white folks to have an easier time with my foreign name, and so I was "Mary-am Qureshi." In fact, my Carlisle friends would tell me, "I love how your mom says your name: Murrrrium! Murrrrium!!" as they rolled their "r's" as if my mother was a sassy, sharp-tongued, South American tango dancer. Back then, I didn't have the cojones to say, "Yo, my mama says it the right way!" Instead, with a subservient smile, I would say, "I guess it's cool."

When I got to college, though, the politics of assimilating ones name became more complex. At Carlisle School, the vast majority was of Southern white people, whose only interaction with Pakistan or its people had been through a copy of National Geographic at the local library (sigh in the pre-9/11 days). At UNC, though, brown folks abounded - there were academics in every department.

When I took a women's study course my junior year of college, I discovered two horrifying facts: 1) my professor was a short, thin Indian lady named Dr. Chatterjee and 2) class participation abounded and this was just the type of subject where I'd be continually raising my hand. The first time anyone wanted to participate, Dr. Chatterjee would say, "Your name, please?" Even though I really wanted to participate in some of the riveting discussions about the gender politcs of the egg and the sperm and how scientific language made menstruation seem so wasteful, I held back for fear of how to say my name. Should I say "Mary-am" to appease my classmates or "Murrium" for the Indian professor? Now, at this point, dear blog reader, I can literally hear the groans from people like Amar or Erik Peterson as they collectively sigh, and say, "JESUS, why is this such an issue for you Mary-am? I mean, seriously, who cares? Can't you make fun of sick children or the homeless some more?" And in my defense, I can only say, yes, this may seem trivial, but it still haunts me to this day, and the egalitarian nature of self-publishing on the Internet allows me to post absolute shit if I want to on this blog.

In the end, I decided to raise my hand and participate in a discussion about women working "pink collar" jobs in the West Indies for Western companies and pronounced my name is "Murrium." I figured that a women's studies professor whose particular interests are in colonization and post-colonial gender studies would notice me selling out to Western hegemony.

However, the problem persisted, especially in medicine, where every rotation I had was filled with some brown person. I got confused literally at the start of every rotation. And so, I came up with some general rules to live by:

1) Say "Mary-am" to patients because usually they are small town white folks who have never seen a Pakistani and would get really confused if I said my name the right way.
2) If there are only white doctors around and white students, pronounce it "Mary-am."
3) If the doctor is Pakistani/Indian and everyone else is white, then pronounce it "Murrium" because the highest authority figure who is grading you matters the most, and you don't want them to think you are an Oreo (white on the inside, brown on the outside).
4) If the team is a mix of Pakistanis/Indians and white people, pronounce your name both ways depending upon whether the person is brown or white. I have to make sure that the other members of the team can't hear me during each introduction though. That leads to confusion within the team and no one ever saying your name because they don't know which way is the right way and are too lazy/embarrassed to ask. This happened to me during my pediatrics rotation in my 3rd year when the team was a mix of Bengalis, white people, Hispanic people, Indians, and Persians.

And so, this is what happens to you when you are a first generation American - I have now realized that straddling both your parents' culture and being an American is not as easy as they make it seem in heartwarming immigrant movies or that documentary they show you when you visit the Statue of Liberty. It involves a lot of complicated, minor and major compromises with your identity continually in flux as you negotiate the Old World and the New.

--By Mariam, who is so sorry she hasn't blogged in so long, but life got in the way.