The Move, Part 2

OK, so I said in part one that I’d post this entry “tomorrow,” but as usual, things got in the way. I also mentioned that I had some bad news that I’d save for the end for the end of the post, but I never got to it. Well, here it is: I have been living on a dial-up connection now since I got here. DIAL-UP. I pay for 2048kbps (2Mbps) DSL; I have been living on a roughly 42kbps modem connection. It’s been hell. Hearing the squawks and screeches of a modem negotiating immediately threw me back to my computer infancy. My power saw was taken away and replaced with a spork. My herbed brie on crusty sourdough with a glass of astringent, yet full-bodied cabernet was savagely replaced with a mayonnaise sandwich and unsweetened Kool-Aid. You get the idea…

But back to the move story…our little caravan got here just fine. Claudia stayed downstairs to act as the main traffic cop for the incoming workers, I was upstairs directing that which came up to either my study, the master bedroom/bath, or the baby’s room (or just right there in the middle!). As I was trying to huddle w/Claudia and get some organization, orient her to how I’d labeled the boxes for my study (by far the largest # of boxes for upstairs), once again, these harvester ants-on-crack were practically bulldozing us to get things inside. Things were starting to go so fast that there were boxes coming in unchecked.

Twice I had to call a “time-out” so we could survey what was going where and if some things needed to be temporarily placed elsewhere. These workers were coming in so fast that if you did anything else but point to a room, such as go in with them to tell them where exactly to put something, there was someone else already coming up the stairs as you came back out. Since I was the only traffic cop upstairs, I wasn’t paying attention to the bulk of boxes in my study. It was like playing Jenga getting stuff out because, I guess in an attempt to minimize clutter, they had stacked boxes 5-6 deep against the wall in multiple layers. Except that they had no care about which was my book boxes and which were lighter, soft-top boxes. I was not happy.

Related to exactly that, I had intentionally labeled the boxes in Spanish with room and appropriate “fragile” or “this side up” information to make it easy for the workers to deal with. What I didn’t count on was the fact that at least half of the workers couldn’t read. I was shocked. Mexico technically mandates at least the equivalent of a 6th grade education (I think that’s right–feel free to correct me), but it doesn’t take a long time being here to observe that it’s simply not enforced universally. Be that as it may, simple words like “sala” and “baño” (living room and bathroom, respectively) should be obvious with minimal education–we’re not talking about Pablo Neruda poems here–but one guy actually laughed about the fact he couldn’t tell what the box said. Amazing.

One worker specifically asked me during loading why I had so many book boxes. I said I was a med student, and I like keeping books regardless. He just shook his head and said basically that the book boxes I had was a lot/too much. (“pero son muchas [cajas]!“) I was practically paralyzed processing the irony of someone who is illiterate making commentary on whether or not I have a “reasonable” amount of books. I think I still am.

But where they lacked in basic academic skills, they certainly made up for with sheer labor, never complaining or questioning their need to do something (“I don’t do that,” is not part of their vocabulary). They helped me get a TV up on a ceiling-mounted stand that was in the bedroom, for example. That took 2 guys and me to make happen–no complaints. I also had one of the smaller guys scale up to the roof where the gas tank is (Mexico doesn’t pipe gas from the street to the houses directly) to open the valve now that we were at the house (thankfully, a one-time operation). Again, no questions. It’s understood that tips are involved, and I was probably more generous than I needed to be, but I was just so happy to get everything into the new house.

Unpacking, while still a chore, is at least a downhill ride. It’s about damn time!!

Feelin’ the love

Thanks to all who wished me a Happy Birthday on Monday via email, Facebook, telephone and telepathy. I really appreciate it. In the future, though, if any of you want to band together to get me a gift basket–not just limited to my birthday–the picture below is a nice example of a proper “man’s gift basket” that will sure to be received with much cheer and joy. I’m just sayin’…

The Move, Part 1

The good news first: I’m writing from my new home! I’d never have thought of penning a blog post until I was at least on the flip-side of the move–regardless of how un-unpacked we are–so this very fact is already a good sign. The bad news, well, I’ll save that for the end.

Like many students, our first place was a “starter” place since all of us get here not knowing our ass from almacenaje. Claudia was pregnant and the need to find a good house was paramount. I actually left the crap apartment early to come the house from which we just moved. The house is nice, but it’s far away from the hospitals I’ll be mostly at, and it’s not the most babyproofable–something we’d have no way of foreseeing as first-time parents. Following the advice of a local (bad idea), I got some fletes to do the job of moving into our now vacated house. Mudanzas is the proper word in Spanish for moving companies, but it implies “professional” movers for “big” moves, like Mayflower or the like in the US. So here’s what fletes got us: a beat-up, 1980s model Ford F-150 with a 6+-foot-high fence surrounding the truck bed.

“Oh, HELL no!” I thought when that thing puttered in. I mean, screw me, why not just get a rickshaw and whip my ass from behind as I pull my household? I was greeted by a guy who must have weighed 500lbs who handed me a clipboard and a pen from potato-sized fingers to write down all the data they really should have already had, seeing as how I gave it all on the phone. Just waiting for me to write down the destination address, any particular goods of “special value” (like I’d let them take it in the first place), etc. the guy had already started sweating. Mind you, this is the first week in December. In the morning. “Not good,” I thought, as I was genuinely concerned for both this guy’s health and my things. Turns out he was the driver and was responsible more to stay in the truck-fence-hybrid and ensure proper space utilization. The other two guys, if you put them hip-to-hip widthwise, didn’t even match the driver’s impressive width. I wouldn’t have figured either of them could lift much of anything.

In the end though, they got everything done, but it took two round trips back and forth, and even the then-drenched driver had to finally help. Just for sanity’s and my belongings’ sake, I also assisted. On top of that, the driver in particular was not very subtle when asking about a tip. Something inevitably gets dinged or bent during a move even with the best of movers, but it should be a major exception. With these people, there were far too many dings and scratches trying to fit everything into a ridiculous joke of a moving truck, as well as too-little muscle (and obviously experience) navigating the big stuff up and down. “Next time,” I told myself, “I’m calling professionals.”

And call professionals I did. This time, a well-dressed older gentleman came to the house, did an assessment (as opposed to an inadequate phone interview from the rickshaw movers), surveyed exit/entry widths, steps, etc., and gave me an amount on the spot. Wanting to be “proper” with these people, I called a day before the move to ask roughly what was an acceptable size to not have to be boxed, at it is hard finding large used boxes around here.

“Oh no, everything must be boxed,” an obviously older lady primly replied.
“Yes, of course; I’d never just leave loose items scattered about for them to move. I’m talking large items–at what size can I just leave things unboxed?”
“Well, our policies are quite clear,” she said, avoiding my question. “Our workers won’t move anything if it’s not boxed.”
At that point, I’d had it. I had no patience to deal with a pencil-pusher mentality when I was grimy, sweaty, and facing these people coming in less than 24 hours. “Well your surveyor should have indicated I have a washer, dryer and a fridge–do I need to find boxes for them too?” I asked, dripping with sarcasm.
“I can’t help you with those questions. You need to speak with Mr. Medina [the estimate guy] and he’s gone for the day [3:30pm?!?]–I’ll transfer you to his voicemail.”
Knowing at this point I was dealing with the laziest of the lazy or the CYA-est of the CYAs, I just did what I had to do with what I had. In the end, Claudia and I worked all Thanksgiving night (dinner? special day? HA!) and through the morning with no sleep to get everything ready.

The truck arrived Friday, 23rd of November at 10:00am. While shoppers were already in their 6th hour of hoarding in the US, my own Black Friday was just beginning. Things were looking good because 1) they were on time (a rarity) and 2) it was, as promised, a REAL covered moving van. Then in a surreal moment, like those clown VW Bugs at a circus, workers started piling out the side cargo door, one after the other. In all, seven workers showed up, including the driver. I wondered from what indgenous village they plucked these workers from, because the tallest of the workers was probably 5ft 2in (1.57m). The jefe was a bit taller and more “professional” looking, but even he was a bit on the puny side. I figured that the reason they sent so many was it’d take two of these guys to do the work of one strongman.

Before I was even done talking with the supervisor, I stared blankly in yet another surreal moment (I had no sleep, after all) as things were streaming out of my house carried by these little Mexican harvester ants underneath. And like ants, these little guys seemed to lift several times their weight. I had boxes of textbooks that made me grunt moving them around–med students, you know exactly what I mean–and these little Mayans had one in each hand and would have another box or trashcan or some item balanced on the back of their neck–down the stairs, around a corner–nothing stood in these guys’ way. I was in total awe. I actually felt shame at my own tubby, pasty-white, pampered, out-of-shape self as probably any of these little guys could easily outdo me, not necessarily in raw strength but most certainly in actual work. They moved so fast, I had to ask them to pause because I’d explain to one guy that some stuff over in the corner was going to be transported by me (such as my G5 tower and a padded satchel containing my life’s data in external HDs), but the next guy who wasn’t there to hear this, started walking off with it and I had to chase him down. More than once, I asked a worker not to take something for fear of it being dropped, since, well, worry-wort me couldn’t take that the tabletop glass was balanced on the dude’s head! It was absolute chaos. If there was ever such a thing as over-efficiency, this was it.

Oh, and the “it must be boxed” bullshit above? There were things I had no intention of them taking, such as brooms, mops, cleaning supplies, etc. since we had to do cleanup the next day. These things I never had in a box and were just in their normal place in the utility area. They took it all!! Dirty, clean, stray towels on the floor–you name it, it found its way on to the truck. I actually had to come up with a mental list on-the-fly of things that out of necessity I needed for them to take out of the truck.

Insanity. I didn’t actually do any heavy lifting but all the parallel action (and again, lack of sleep) had me completely drained. Except the day was only beginning, and it was now time to drive to the new house–me in one car, wife and daughter in the other–and the moving van in tow. The fun was far from over.

Part 2: The Unloading tomorrow, complete with a few discoveries I’m still dealing with…

Happy Thanksgiving

Happy Thankgiving to all of you. The above sums up perfectly what my TDay is all about: moving and that which will help me get through it. hehe

Moving sucks, period. As I get older (of which I’ll be even more reminded next week), moving becomes less of a chore and more of a kind of pathology. With all the stress, a toddler now, adding to the extra complexities of being in Mexico, there are times I feel outright paralyzed. The younger me took all the drugery in stride, looking forward to a new start. The older me takes the “new start” with more than a grain of salt. Unfortunately, I’ll have at least one international move to NY and a probably interstate move once stateside after my 5th pathway year. Both those events will be more of a production than this one, so I have to learn how to deal, or else.

I have discovered through this process that I’m a bit OCD. I am on the floor, clearing cables, dusty from months of stasis on a tile floor, and I intend to simply wipe them quickly through a dustrag before coiling them into a box. I look at a large surge protector with stains on it, probably from some spilled coffee or diet Coke, and think, “This simply won’t do.” I take a wet-wipe and remove the stains; after all, when else would I have taken the time to do this? Except that in doing so, I see that the whole cord is filthy. I don’t want to pack something grimy in a box destined for a new house, now would I? So I take an extra minute or two to go over the cord with the wet-wipe to at least restore its original, nondescript beige splendor. Repeat for everything else. With each notice of a new imperfection, my radar becomes more and more attenuated to fixing what’s wrong. Thankfully, I do catch myself before I’m trying to dust individual computer fan blades with a cloth-covered toothbrush, but my tendency to head down this path all the time is a bit of a concern. I don’t think it’s to the point of being a problem, just an obstacle to efficient, “get it done” time management–something that’s so sorely needed right now.

I had a nice dream of us going to a school-sponsored catered affair at a local country club tonight. Of all the annual school-sponsored events, Thanksgiving dinner is the one that’s done right. The wine, conversation, and cheer flows freely, professors mingle with students, and a good time is always had by all. Of course, since the movers arrive tomorrow morning, going meant that we would have been done early. *peal of laughter* I did think it would be nice, since we now have a babysitter, to take time amidst all the craziness just to have a nice few hours for us and just simply be, but last night it was clear going would be logistically impossible. Claudia and I committed to celebrating on our birthdays next week, in our new house–a moment I very much look forward to.

Today is about giving thanks. I am thankful for my family, for being in a position to be able to move into a better home, and even for being healthy enough to gripe about the process. I am thankful for my friends, in person and online, and for many new opportunities that have opened up for me in spite of being on hiatus from school. I am most thankful for my wife and daughter, who each in their own way challenge my patience in seemingly never-ending new ways, but in doing so make me a better person and remind me what all this is for.

The Week from HELL

Oh. My. God. I am so blissfully happy it’s Friday. I don’t care how those little boxes line up on the calendar, I’m marking today–THIS DAY–as the end of my week from Hell. Dante doesn’t know shit. To type it all out would take forever, but I’ll just hit the highlights.

One of the most frustrating things living in Mexico is how slowly everything moves. For many, life is like a permanent vacation, with few consequences for tardiness, because practically everyone else is the same way. It’s not trying to get away with as little as possible or being lazy, it’s simply at an ingrained cultural level, there’s no hurry unless there really needs to be one. Regarding a pending problem with school administration, I spent two days shuttling from office to office talking with people, each of them telling me their very reasonable side of the story, but always ended with, “But because of [problem with next-door office's issues], I can’t help you.” Repeat 5x, try to talk to person in charge but get met with secretary who specifically says they remember explicitly a phone conversation that was had for 90 seconds two months ago and how I’m incorrect. Oh, and I can’t see “person in charge,” because nobody knows when she’ll be back. Not her secretary, certainly not, who can’t (or won’t) even confirm if she’s in town.

But compared to what I had to deal with financially, the above was a cakewalk. I was trying to get things set up to rent a house and do the signing, etc. on Wednesday. Tuesday, the day before, the realtor tells me that the owner wants everything paid in US dollars in cash. I don’t have a bank account here in Mexico; the US account we’ve always used does just fine here for ATM purposes, and there’s always the credit card route. However when you’re talking in the thousands of dollars, pulling it out of an ATM (in equivalent currency that’s worth 10x less, mind you) is just not possible. For a crippling 2.5 days, I was figuring out how to get money, ready to go in my account, here in my hand. I couldn’t do a standard wire transfer, since you initiate that in person. Online, there were rules about either being with the same bank in a different location or if a different brand of bank, I had to own the account. Both strikeouts. Adding insult to injury (but good to know), my bank has ALWAYS had a service to send money to Mexico for free. LOVELY! Thanks for letting me know, now that I am in Mexico and can’t go into a US branch to paper-sign the agreement form. The whole reason I agreed to pay the landlord in dollars was so I could write a check; in turn, he got paid in a much more stable currency. Only 36 hours prior did he discover that his bank’s terms for foreign checks were unacceptable (they were), and that set off the mad scramble. Since we’d already given notice here and they’re waiting for us to move out next week, the prospect of potentially scrambling for a place to live vs. not being able to change bank/international trade rules became a rock vs. hard place squeeze.

In the end, many phone calls with lots of small but incorrect details that cost me serious time, and energy. Just as I was going to explode, the last person I spoke to at the bank said, “Why don’t we just up your daily ATM limit? I can approve an increase to $2,500 per day temporarily for 14 days.” Um, last time I checked, I wasn’t moving kilos of Columbian snow, but THANK YOU for pointing out what had always been the easiest option that everyone else missed. Unfortunately, I still had to pay in cash dollars, which means pulling dollars out of my account via ATM into cash pesos, then buying dollars (at an obviously less-than-favorable rate), twice taking transaction/exchange-rate hits. But this is the last time this will ever happen, because when I go home for the holidays, I’m adding some services to my account–including the one I mentioned above that will allow me to wire rent money down here monthly so I don’t need to walk around with a briefcase full of multicolored Mexican money.

This is primarily being shared so all you would-be foreign medical students out there in the US–make sure you understand: you are NOT going to be in the US–whether it’s Mexico, Israel, Poland, or the Carribean–and how you’re used to dealing with things will change dramatically. No matter how much you think you can get acclimated, or you speak the language there, the reality is that there will always be serious, unforeseen events that can potentially make you reconsider if it’s all worth it.

On top of all that, work takes a turn for the worse when I find out that the application I was developing for one academic entity is really for an executive member of the Univeristy, because he wants to make sure it passes muster first before showing it to them. I find this out 36h before it’s expected. I’m a part time employee with some vague instructions on this and no feel/inference that this is a politically sensitive project, or I’d never have accepted it. (Large state universities are typical of malignant bureaucracy just like above; things have to filter down and percolate up in “the proper chain of command.”) Last night, I pulled an all-nighter and I got it done (and billed appropriately), but I still haven’t slept. I feel like hibernating, but I have to pack this weekend/week, Grand Rounds is Tuesday (compilation is on Monday, though), and movers come on Friday. HELP!

Feeling like a metal tube was rammed in my gullet

You’d think I was speaking figuratively, but actually, that’s precisely what happened. I had an EGD (endoscopy) the other day. It represented my first actual “procedure” here in Mexico which actually carried some risk/doubt about it. I had no qualms about my doctor per se, but previous (minor) experience as a patient and what I’ve seen as a trainee had already cemented the fear regarding crappy pain/analgesic management here. The reasons why are very complex and include cultural factors and a bit of severe government retardation in the way of what/how “controlled” substances are controlled. I don’t want to say something incorrect, about it so I won’t, but trust me–acceptable pain management standards are not a given everywhere and is highly stratified by economics as well. So when my Dr. finally arrived at the hospital, I asked about the sedation (something I took for granted when we had the office visit), and he said two words that made me just sink back in my pillow and know I was in good hands: midazolam and fentanyl. “Do what thou wilst, Dr. RotoRooter; I am thy faithful servant.”

The endoscopy room was big enough for two patients to fit, but since I was wheeled (already in the bed) after they started an EGD before me, they just parked me out in the hall for a bit. I got to listen to the banter (there was an actual anesthesiologist working the sedation) about the weekend, etc., and it wasn’t long before I heard that they were done. I made the mistake of peeking behind my shoulder into the room just in time for the doctor to be holding the ’scope handle practically above his head. A long black, striped metal (or some hard polymer) fiberoptic snake ominously dangled almost to the floor. It reminded me of those Sentinel tentacles from The Matrix movies. Seeing this thing in person isn’t the same thing as seeing it on pictures, TV, etc. The article above says it’s about “the width of a finger” — sure, if you’re Mike Ditka, maybe.

In the end (and since this wasn’t a colonoscopy, that wasn’t a pun), it was a totally painless, non-traumatic experience. The crap they sprayed in the back of my throat to numb the gag reflex was the most foul thing about the whole process. I’ve experienced the ugly banana-tasting Hurricane(tm) spray, but this was like an un-natrual product of an organic chemistry lab experiment. It might very well have simply been lidocaine in ether for all I know, but it worked. Into the lateral decubitus position I went (I’d have worried if it was the jackknife position), and in went the Happy Juice.

Some minutes of prep later, (and time enough for the appropriate receptors to kick back and chillax on their little Barcaloungers) in went the scope. I remember being told to swallow, and a brief “WTF!” moment, but I guess once well past the upper 1/3 of the esophagus, it was a done deal. I remember bits and pieces of the video screen images, but not a complete whole (hardly “Ah, I see we’ve arrived at the lower esophageal sphincter” — not even close. More like, “Ooh, mucosa.” *drool*). Embarrassingly, the most numerous individual memories I have are of me burping. You see, they insufflate you with gas, sort of like laparoscopy so the camera has some visualization room, but it’s done as needed. Knowing this beforehand and burping uncontrollably, half-awake with a metal tube down your throat are two different worlds of experience, trust me.

After the deed was done, I just lay there and sort of semi-watched them type stuff on the computer screen and flip through images, selecting the ones they wanted to print. Still dazed, I remember talking to the nurse and had enough consciousness to realize 1) I was talking and what I was talking about, and 2) I was just talking random shit like a drunk who’s about to pass out, which is appropriate because that’s about what I was except, thankfully, I was coming to, not going out. At least I wasn’t trying to hit on her (so I recall). After more time passed, and some quick checks, questions, and so forth, I was led (on my feet–no wheelchair) carefully and directly to…THE BILLING ROOM.

Yes, my friends, this is where the account is settled before you leave. I had left a deposit before the procedure, but now it was time to pay the piper. It’s just totally different here, that’s all I’ll say. I knew all the costs beforehand, so there was no real surprise, but it was kinda “rude” to be still drugged-but-functioning, but settle your account first before leaving. I’m not OK to drive (and they verified I had transportation taken care of), but I’m OK to hand over cash and/or a credit card and sign financial forms. Riiiight….

Anyway, that’s my story. I found out that there was nothing wrong with me except for generically useless observations, such as probable chronic inflammation (pending histopathology of a couple of biopsy specimens), mild gastritis, and generalized esophageal mucosal edema. No Barrett’s, no ulcers, no nothin’. “Pale mucosa noted throughout.” Duh. My Hgb is actually up at 10.2, but my MCV is still in the mid-60s. My serum iron is low-normal, and TIBC is not elevated. Totally atypical presentation of iron-deficiency anemia. No, it’s not like I need transfusions or anything, nor am I unable to get out and about, but the fatigue does catch up with me, as does the reactive compensatory tachycardia, etc. which has severely hampered my trying to exercise more. We’ll see. I won’t go into more details of my personal bloodwork, but it’s a head-scratcher. I just wanted to share my EGD experience here in Mexico. Total cost for everything, including hospital, anesthesiologist and GI doc was just under $500 cash. As a point of reference for those who may be traveling here, mine was a nice private hospital so this procedure can certainly be found for cheaper, but for those used to US-based care, I wouldn’t recommend it. Oh, and the icing on the cake: I got a DVD of the whole thing! (and no, my esophagus will not be going on YouTube )

Good GI (and hematologic) health to all!

Down for the count

So after I type my last entry about lack of feedback, etc., I received an overwhelmingly positive response from you, my dear readers. As would be my luck, the day after posting it, feeling genuinely appreciative and inspired to be more consistent with writing, I got sick. And I mean sick.

I woke up with, uh, let’s be kind and say GI distress. No biggie, yet I hadn’t eaten anything out-of-the-ordinary, food from a different place, etc. Moreover, Claudia had no sx whatsoever, so I wasn’t concerned. By early afternoon, I knew something was amiss because I had been awake probably <1.5h since I woke up. Going back to sleep was such an involuntary response, I don’t even remember going back to bed from my room.

That’s when I noticed I was freezing. Anybody who knows me knows that I have a low tolerance for warm, stuffy environments and usually “run warm,” so for me to be cold when it’s clearly not cold outside was yet another WTF moment. By this time, Claudia knew something was up for sure, seeing me under two layers of covers in the afternoon perpetually asleep and shivering. I took my temperature around that time and it registered 102.5. Holy shit. It’s been years since I’ve had a fever. Even when I’ve had major surgery, my temp didn’t go higher than 101, and that was just during the few days post-op. And I was FREEZING.

Fast forward to late afternoon, and I guess in a daze I put on some warm-ups (which in retrospect wasn’t all that smart) and I’d probably downed >2g of Tylenol by then. Re-take temp: 103.5. Now I have one of those fancy-schmancy arterial IR thermometers we bought for baby, and right about then I was thinking it was a POS–there was no way it was that high. I went to my closet, realized that the room should not be spinning, and fetched my trusty mercury thermometer from my “doctor bag” (which is really a $15 shaving/toiletry bag with handles that looks the part, and which has been gathering dust since the Spring when I last used it in community medicine), and did a real, honest-to-God oral temp. I got the thermometer locally, so it’s Celsius, but it read 39.5–just under what the fancy-ass one read and close enough to know this was for real.

I called a doctor friend, and he just flatly said, “You have an infection.” No shit, Sherlock. Thanks for wasting my first cell minute. “Go and get [GI-localized antibiotic combo only here in Mexico which has neomycin].” I made a joke about my kidneys, but he said it wasn’t an issue for the dose and the few days’ duration of tx. I asked why he suspected a bacterial infection and not a virus. He didn’t have an “evidence-based” rationale, but then again, we were talking on the phone and it’s not like he had any data. Basically, if it was bacterial, at least the medicine he recommended would get something going; if it was viral, I was SOL, but since the abx isn’t really absorbed, no harm no foul. I could live with that. Claudia, a super-trooper with my man-cold, whiny ass, fetched said med from the pharmacy down the street.

I had already switched to ibuprofen for fever reduction, but something changed by night-time as I was feeling hot as hell. It was about damn time something makes sense! Checked temp again: 104.2. Again, I thought, “No way,” and swiped it the other direction (as if the left temporal artery was going to read differently from the right one). 104.3. F*CK! Now I’m in full panic. I didn’t want to go to the local ER because 1) I’m not insured, and 2) I didn’t want to burden Claudia with me AND deal with a toddler who should be asleep while at the hospital. Besides, although I felt like death warmed over, it’s not like I was delirious or anything. I was able to keep down all fluids, was eating fruit, crackers, and other “easy” foods, so there was plenty of reasons not to jump the gun.

Thankfully, before I could start entertaining REALLY crazy things, the fever started coming down. I had already started cooling myself off externally, and I think between that and the ibuprofen, it started making a dent in my core temperature. By midnight, my temp was down to a respectable 101, and–strangely enough–I was sweating bullets like at no time prior. I’ll trade sweating for ER-bound fever anyday, and so the night began to finally wind down.

The next day (which seemed like days later, esp. since my time was so off w/all the sleeping), I felt absolutely craptacular. In spite of a lower fever (which never again went over 100), I seemed to be just as lethargic but now had myalgia as icing on the cake. “I have a geezervirus,” I joked to myself.

So this whole, near-pointless tale of woe is being shared to say that it took until this weekend for me to feel normal. I was WAY behind on work hours, so I’ve been busy catching up with those too. I felt horrible guilty about the timing of my last post and this little mini-absence, but I promise the above is true. There’s quite a bit queued up in drafts from bits of time I felt decent, so I’ll clean those up and get them posted. Thanks again for all those who commented and especially those that delurked.

Random thoughts on a Sunday

I’m telling you, I’m in blog weirdo-land right now. I was refreshing my newsreader, and I started reading some blogs I usually don’t get to, but I also have found myself commenting on certain sites that I usually don’t comment on. I then realized there were quite a few sites that I read far more often but don’t comment on with the same frequency. All in all, I’ve been writing on others’ sites more than my own. That has to stop if I’m gonna keep a blog. I don’t have that much time!

I’ve been really, really disorganized lately. Everything’s fine, no real complaints except for work, which has been as hellishly complex as the worst subjects of studying. If any of you grok what LDAP is, you can imagine the complexity and hassle of trying to migrate a major state university’s worth of data over the last 5 or so years (>100,000 people and associated computing resource entries over the time period) from 10-year-old software to something current. I’m not going to waste space on the specifics, but trying to “fit” bandaged-up crap that’s beyond aging, full of “custom” fixes, to something standard and current is a nightmare. When I was last there 3 years ago, this was the final thing I was working on, and I’m sad to say no real progress has been made. Hell, I don’t think they’ve even filled my old position yet.

So, I’ve decided to get back on an anti-depressant. I won’t tell you which one because of HIPAA and all, but also because it makes no damn bit of difference anyway. I was commenting on Shrinkrap about the fact it’s all a crapshoot anyway. A doctor can have the right reasons to choose antidepressant A over antidepressant B, including side effect profiles, etc., but it makes squat difference in reality that a person will react in a predictable fashion vs. another. Different people will respond to different degrees given a certain medication, but if you block beta-1 receptors, your heart rate/blood pressure will go down, guaran-damn-teed. You give someone Adderall (assuming they’re not already a jaded meth addict), they will be pharmacologically stimulated. Moreover, in both these cases, you can use an independent, objective measurement like blood pressure to monitor the [side] effects of the drugs and know if changes need to be made.

Contrast that with a patient starting SSRI therapy, they might feel better after 2-3 weeks, might not. They might feel worse. Repeat for SSRI, choice 2: “Meh, I feel something, but it’s not like I feel worlds better.” Repeat again. If you could, in theory, measure the 5-HT/NE reuptake blockade to prove an antidepressant was working, it would have no predictable correlation to how the patient feels, which is my main point. Psychiatrists really have their hands full with complex psychoses, criminal disorders, etc., so I’m not disparaging them at all. It’s just that for people who just need the “fine-tune” knob adjusted to their personal, subjective liking, roll the dice because at that point, it’s craploads more luck than science.

Like many things, it could be my expectations are little high. I am just not feeling as good as I thought I would be at this point being out of school and concentrating on me and family. I have not started in earnest my exercise plan, and although nobody is making me feel “under the gun,” I know myself well enough to know that I need to nip this stuff in the bud before I look back and wonder where the time went. Not gonna happen this time.

Teething: worse for the baby or the parent?

OK, so I’ve about had it with this teething crap. We already have a high-energy, go-go-go, sleep-fighting, hell-on-training-wheels toddler (16mo) as it is. The two upper canine teeth are coming in simultaneously, and it’s about all I can do to keep it together. After the Tylenol and topical Orajel have run their course and the wailing STILL doesn’t stop, I start having sick fantasies of injecting *caine right onto her superior alveolar nerve for certain relief; if I’m a little too trigger-happy on the plunger and she doesn’t wind up feeling half her nose/cheek, well, it will wear off eventually.

Of course, in terms of development, this is also the period where screaming is a “normal” part of starting to assert themselves–aka, the “temper tantrum.” This is often accompanied by a complete loss of skeletal muscle tone as the child goes completely limp. If she were an adult, I’d be calling the neurologist. With wall-to-wall tile floors, this a great way to hit her head–making me not lose that neurologist’s phone number after all.

All in all, it’s been rough. I work from home now, so I’m around baby noise ALL. THE. TIME. All my noise-cutting tricks for studying are still being employed. I think I’m the only med student in the western hemisphere that actually uses ballistics/gun earmuffs as part of their study arsenal…and I’ve never owned a gun! But there’s my ace-in-the-hole secret weapon, fellow med students. If you can tolerate looking like a total dork (and at my age/status, it’s not like I’m trying to score), putting on what looks like headphones from 1975 combined with inserting foam earplugs first, will give you (theoretically) over -60dB noise reduction. Some people get freaked out with near-silence; they always need some ambient noise (other than the blood rushing in their ears). I am not one of them. There are only a few select genres of music I can listen to (and classical is certainly not one of them) that won’t have me audibly distracted, involuntarily processing the music instead of processing what’s on the page.

When I was a kid, it was determined that my auditory processing was not up to snuff. In the classroom, I often didn’t do what I was instructed partly because I just didn’t assimilate what was told to me. As an adult, this has not changed. Everything has to be written down. Thankfully, it’s limited to verbal auditory processing. As a musician with a super-finely tuned ear, one would be surprised that I have to think about what’s told to me a lot harder than most. I can musically process a song instantly, but I can hear the same song 10 times and probably recite one line of lyrics. If you give me the lyrics written out, such as on liner notes, I’ll remember most of them at first glance, because I processed the information visually. At work, people would tell me any number of things, and I’d famously say, “Send me an email so I’ll remember.”

I should clarify that this is a problem only if I’m not 100% “on task” with listening (which, for most people in busy situations, is almost 100% of the time). But I can’t audibly multitask. If I’m talking to you on the phone, you have my complete, undivided attention–not because I care so much about you (but of course, I actually do), but because I really have no other choice! You’d know if I started trying to investigate something around me if we were on the phone, because suddenly you’d hear, “uh huh…*silence*….what was that again?”

It’s this same “odd” auditory sensitivity that makes living with a loud, active, fussy (but thankfully healthy-as-a-horse) toddler a mental drain. The distracting auditory input that would be annoying to anyone is crippling for me (as far as high-level mental processing goes). The same goes with many different types of “noise pollution” around me. Am I making a problem worse by finding new and better ways to give myself quiet? Should I be going the other direction, slowly desensitizing myself so that I can cope better in the “real world?” I haven’t figured out how to accomplish the latter yet, but something’s gotta give. I can’t have complete quiet and no interruptions doing an H&P like we’ve done as students in the real world. One often doesn’t have the ability to scribble anything until, say, outside the hospital room.

This is one of those unforeseeable things I didn’t know I’d have as rough a time with. The other is social isolation from working at home/not seeing classmates, but that’s for another post.

Belated update: No longer a med student

A thousand-mile journey begins with that first step, and so too does a long-overdue blog post also begin with the first words. You just have to start or it’ll never happen. That first step of a journey is pretty much the only one guaranteed to be 100% directly towards one’s goal. I mean, you don’t take the first step of a trip to the North Pole going south. You try for all the other steps on your journey to be equally directionally efficient, but detours happen, large and small.

I am on one such detour right now. The title is true, but I admit it is a bit “sensational” to get you to read further. The unvarnished truth is that I am not in school this semester by choice. I completed my 2nd year. Done. No doubt about it, grades official. Instead of plowing ahead and making the academic, clinical, and physical leap to the hospital setting, I decided instead to take a breath after having the wind knocked out of me so many times recently. What more natural academic break would med school give than the traditional space between 2nd and 3rd year? So to put the title in perspective, no, I’m not currently a med student, but I am not quitting. I will be resuming exactly where I left off in January, thanks to my school having rolling semesters. So in essence, I am giving myself a 5-6 month break.

Why am I doing this? Simple: “Physician, heal thyself.” My life was no longer in control, at least not to a standard needed to excel in school nor to be happy with life. Several pending health issues, a marriage going through some serious valleys, numerous separations from daughter, being shafted by my school regarding my USMLE timing for petty bullshit reasons, and certainly not least, crippling financial hardship (my loan year was months away from cycling yet I was approaching zero in the bank with a wife and child to consider) were the main factors pushing this decision. I could have been stubborn and said, “Fuck it–I’m no quitter; I’m going ahead anyway,” and people could have even applauded my determination. But I’d be a ticking time bomb, literally ready to psychologically detonate at any moment with the increasing pressure. Practically speaking, it seemed wiser to handle this on my terms in a “controlled” fashion than push ahead and wait for said meltdown in the middle of a semester where it would have academic impact as well. Speaking from the heart, though, there are certain decisions just feel right independently of all the mental masturbation of pros and cons, to-do lists, spreadsheet forecasts of finances, etc. One can’t ignore such realities completely, but some decisions in life live “in the gut”–in this case, borne out of some archetypal survival instinct–and I had to concede the silently obvious. The final thing I needed to do to seal the deal was work it out with my job to ensure I had the funding to work these months since not going to school meant no student loan money. Once that was settled–literally days before classes resumed–it was like a huge weight was lifted from my shoulders. I was sad that first Monday and Tuesday when I knew all my classmates were starting without me, seeing the emails fly back and forth about all the scuttle I was not there to experience, but in my heart I knew it was not yet my time–there were more pressing matters at hand.

In spite of my waxing philosophical above, don’t think this is all touchy-feely goodness. I still have the issue of what the hell to do with my USMLE Step 1, for example. There are no good solutions, but the “proper” decision, not taking any risks with the ECFMG, is to take it upon returning to school. That’s 6 months away and feels like board suicide for someone who had geared up prep to take it yesterday. I am constantly reminded that details of various fungi, adrenal gland enzyme deficiencies, and properties of Class Ia anti-arrythmics are certainly draining out of my recall at a nice flow rate every time I even attempt to pick up a study book. However, I have to trust myself–I am certainly no dummy–and that I can figure out a plan to minimize the leakage in the interim and re-prep (which for a 2nd go-round should be faster/easier) over the holidays and still have the confidence I’ll get the score I’m capable of. It’s hard, though, to have that self-discipline for something so specific when your life is not currently revolving around it.

In the end, this, like all the other things on my plate, are challenges I have to rise to meet. I’m not handling everything as neatly as the words on this post, I promise you, but I hope to get there. Claudia is on board with me, my daughter’s back, and we can finally be a family again, settled in here in Mexico for good. 3 months of Claudia living out of suitcases and various family members’ houses as she did her surgery, therapy, and other things back home reminded her that home is, as we say in Texas, “where you hang your hat.” Our home, the place we as a family call our own as long as I continue my studies, is here in Guadalajara.

Hopefully, my temporary status as med-student-in-limbo doesn’t affect whatever readership I have. I know I’ll always have my true blog friends, but I promise that in spite of not having personal medschool stories to share for a while, I still have lots to say. My stories of the next few months may not be sexy material for Grand Rounds, but they will as always be honest, unique, and hopefully interesting, too. I hope you are here to read them.