Here is the gallery where the quilt pictures are (plus some more from the same few days). I got an account on SmugMug a couple of months back because that’s where I really felt my “good” photos should live because I’d have control over the design, layout, etc. unlike Flickr. That said, I’m still moving stuff over slowly (read: barely) but feel free to bookmark the main gallery and check back as photos will be populating regularly. 

Ramona sent a nice card with the package, but one thing that stuck out was that she wanted the quilt to actually be used, not (I assume) tacked on a wall–or worse yet, left in a drawer. To that end I made a small video of my daughter with the new quilt that very evening. It’s nothing fancy, the lighting was off (it was almost bedtime, so only indoor light) and I overlooked correcting for WB or gain in the camera, but that’s not the point–the point was to show Ramona that her gift was received with the same care and affection with which it was sent, used immediately and often, and treasured forever.

Thanks Ramona!

For now, here’s a small list of some general comments to catch you up, in no special order (some of which will be expanded on later):

• I got some email wondering if my “Hiatus” post indicated I was going to seek psychiatric care or the like. Funny that, because I did actually call around to see what was available. Unfortunately, there isn’t anything available for “crisis counseling” on an outpatient basis for people who need short-term, more focused help but are functional otherwise. Therapists and psychiatrists are backlogged for weeks or months, so “emergencies” here are handled by inpatient programs akin to the state ward where you get to use crayons and clay for art therapy and ice cream snacks are used as rewards for good behavior. Um, no thanks.
• Instead of mental health care, I got treated to some hard-core health care: 2 hospitalizations with a sum total of 15 days inpatient stay involving multiple scopes, surgery and blood transfusions–oh my! (definitely much more on this later) I’m still on pain meds as I heal, so pardon the grammer and mispellingses for now.
• Shortly after I arrived in TX, I treated myself to a Blackberry Curve 8320 now that I was stateside and my cell contract had long expired, ripe for cheap equipment renewal. No more living in the Mexican data desert! (Actually GDL is totally wired for 3G–it’s just that there, the “3″ means you have to pay 3x as much!) Having mobile email and browser is schweeeeeet.
• In just the span of a couple of months, my daughter seems to have grown up so much, yet she’ll barely be two next month. It’s awesome seeing her slowly develop every day into her own person. It’s also clear to me that all the trauma we’ve gone through seems totally lost on her–as it should be–as I watch her happy as can be with the simplest of things. I’d go through 100x more just to make sure it stays that way.
• I still haven’t decided what do call my new domain (since Mexico Medical Student is obviously not applicable anymore). I am tending to pick a generic title that has nothing to do with medical school, just because I want to be prepared for anything, and more to the point, keep using it after medical school. I want to be happy with something long-term and not have yet another migration later.
• It’s nice to have TiVo actually doing what it’s supposed to do now that it can actually use US programming data. I watch so little TV anyway, but what I do watch, I’m fiercely addicted to. Right now that means Top Chef and Battlestar Galactica, both new seasons recently started. In Mexico, I used to always download and watch episodes in large chunks after-the-fact; now it’s almost torture waiting week by week like everyone else for what’s next.

Well, that’s pretty much enough to get an idea of what’s going on. Other than the medical stuff that will follow, there’s not been much. I do have to make one very important point to close this post, however. A few friends have asked how school search/applications are going, completely because they cared and wanted to know. On the blog, however, I will not be posting anything about any facet of any applications, status updates, prospects, etc. Medical school application is a rigorous and, frankly, competitive endeavor. There are enough lookie-loos from my school who (for reasons also to be written about) are in the same application pool as I, trying to transfer to other programs. I don’t need to divulge what I’m doing for obvious reasons. If anything is shared, it’s pretty much because something is a done deal well after-the-fact. Since my target is August, that means mum’s the word for a good while. I hope this is easily understood. Thanks.

I listened to most of the show already, and I’m slightly embarrassed of the times that it seems that I’m ignoring Dr.A’s quick questions. As was brought up in the chat room after the show, Dr.A was using a new headset, and apparently the mic volume wasn’t turned up enough. (This can be heard in the difference between our respective volumes on the archive.) However, when I was talking in real-time on the call, I swear I couldn’t hear most of the attempts when Dr. A. would make a quick 1-second question. On the archive, one can hear it objectively (ie, not talking at the time), and it sounds like I’m bulldozing over what he was saying. I promise that wasn’t the case. :/ I hope Dr. A. understands.

The universal advice I’ve received before, during, and after regarding my situation is, to be polite, “Do whatever it takes to get things fixed.” I agree, and I never intended to do otherwise. It’s also why I never complained online until the other day even though I’ve been going through this for 6 weeks now. I don’t want to get into specifics, but there is a very real chance that this will not be resolved to my benefit, and I have to start down the road of a “Plan B,” even though I can’t say for sure what that is yet.

Even though absolutely nothing has changed with school, I already feel SO much better having put all of this out there. The consequences/implications/etc. have been shouldered in private for too long and have gotten me absolutely nowhere. Things can’t get worse with school–they simply could say that all of this online shenanigans “prevented” them from giving me their Holy Dispensation, but that’s yet another abusive tactic because one can never know if that were true. The intended effect is drive a student into despair over “what could have been;” in my case, I simply go on the alternative course I’m already pursuing. The default answers have never changed from “no,” and “no.”

I’m not above groveling, but how can I grovel to a person that refuses to meet with me, that tells a “superior” at the hospital that I’ll be seen, then 10 minutes later tell me (through the inept secretary) that there’s no point in seeing me? I’ve never been able to break through this, so what do I do, kneel in supplication from the hallway and hope they see me on the way to a bathroom break? Video myself begging and send a YouTube clip to their email address? If this turns out to be about “Well, we’re offended that you didn’t do XYZ in person,” then their hypocrisy is one for the record books.

I have to work, and time spent sitting in a hallway on the off-chance said dictator may/may not be coming to the office that afternoon, combined with may/may not be willing to see me is time I’m not billing, money I’m not making to support my family in the absence of loans to fall back on. Every dollar in my bank account is because I worked for it this semester. Talk about responsibility–what respect is there for that? They seem to think I’m at their complete convenience (and sport), and as a lowly student, that’s true–to a point. They know I’m working, they know I have a family to support, they just “forget” (or don’t care) that it’s not all about me. If they’re going to be insulted because I make a phone call to check if they’ll be in before I waste hours (read: earned money) going to and from, waiting, etc. and make that a daily habit, they can do something “creatively promiscuous” with their expectations.

UAG may be trying to teach me a lesson, beat me down, whatever, but to what end? I’m playing for keeps, and here’s why:

I don’t have the luxury of wasting time. I am willing to sacrifice whatever of myself, but there’s a limit to what I’m willing to put them through. This isn’t about principle vs. pride. Steeped in old Mexican medical school traditions at the core (primarily dealing with 18-year-olds), UAG feels it’s their job to “teach” me humility, maturity and responsibility with their tactics.

Those two above teach me more about those in one day than any amount of passive-agressive bullshit by administration. The two above is where my faith, my hope, and my pride lie, not my school. If I’m going to sacrifice any part of myself further, it’s for them, not for the whims of UAG. My school is a replaceable commodity; they are not. If this constitutes my “bad attitude,” then so be it. Regardless of my financial debt, I will always remain far richer than UAG could ever be.

Obviously, as a med student with a research science background, I am not the “typical” parent one would use as a case study for following directions, but having used various brands of Tylenol (acetaminophen or paracetamol, if you prefer) for our daughter, significant directions and delivery variations DO exist. In the US, every brand of infant Tyelenol was in a concentration of 80 mg/0.8 ml. Look at that fraction. Some leftover from 5th grade fractions should be ringing about now regarding “same numbers on top and bottom.” (We’ll come back to this in a minute) The same 5th grade education should be telling you that mixing decimals and fractions, while not incorrect, is a no-no–much like leaving a fraction unreduced. Points off, no gold star. Mistake #1: When you’re dealing with…oh, I don’t know…the “lowest common denominator (LCD)” (har har) of society that’s going to read your directions, you might want to clean things up a bit.

“But Rico, nobody but math and science geeks are going to read the concentration.” Well, you got me there, but it’s still odd. Upon opening the box, you’ll find, depending on the brand, either a bottle with a dropper already built into the cap, or a separate lidded bottle (why?) and a separate dropper that you then put together, throwing the perfectly good original lid in the trash. Mistake #2: There are plenty of people who might just keep the two separate, and if they’re do that, they probably aren’t keeping the dropper sealed, away from dust, etc.

If you look at the dropper, you’ll find two markings: 0.4 and 0.8, or just one: 0.8. The dose for 24lbs or 2 years is given on the directions as 1.6 ml. Mistake #3: You’ve assumed that the LCD of the general public can add fractions, much less without a calculator while a feverish, screaming infant is in the background. In my opinion, worse still are the “Only use this dropper with [product]” so that the directions are foolproof, like “Fill dropper to the white line.” Yeah, but what if I have a Robitussin product, a Benadryl product, and a Dimetapp product that all use “special” droppers and all have no other concentration/volume information for dosing purposes on the bottle, not the long-thrown-away box? True, few people outside those in the “import/export” business have graduated cylinders or pipettes at home, but SOME information should be given plainly should that “special” dropper be lost.

We usually have things decently stocked from the US side for basic things since we travel back and forth often (especially my wife). However, we ran out of infant acetaminophen a while ago, and since Claudia was doing the shopping, she didn’t want to have to decide among all the various brands here in Mexico and bought name-brand Tylenol. At first I was shaking my head because she didn’t get a super-easy-to-find generic product, but then I saw the exquisite delivery mechanism.

Behold, friends: pediatric liquid oral dosing perfection:

The plunger is marked on both sides, one being volume and the other weight, for which the volume on the other side corresponds. Also notice the ultra-precise measurement graduations. It certainly doesn’t mean the plastic plunger is that accurate, but it’s nice to look at. Looking at the info, one finds the following concentration: 100 mg/1 ml. Look at the fraction on the US bottle: they’re the same! Except now that we’ve reduced the fraction like good 5th graders, we can make sense of this from any angle without having to multiply and divide decimal fractions. And as a bonus, since this long quasi-syringe and the bottle clearly don’t physically go together, there is a plastic housing for the setup to keep it clean in between uses. Even if I had several products from different brands, if they all had this, it would be trivial to know which ml/kg measured syringe belonged to which because there’s a clearly visible “Tylenol” on the plunger! Score 1 for Mexico. (God knows the way things have been here lately, Mexico could use some bonus points…)

Seriously people, this foolproof delivery system is where it’s at. In the US, pounds would be the unit for the general public, obviously, since asking people to do MORE math–and to use the eeevil metric system–would surely not be good for little livers everywhere. If all the pediatric OTC medicines in the US were to have had something as universal and consistent as this, one wonders if there would have ever been a recall.

“No problem,” I thought to myself. I just needed a tool to “normalize” the audio so that the mostly classical music doesn’t have the all the dynamic range of the natural louds and softs. Right now, a median volume would mean that soft passages would be unhearable and louder passages (though musically appropriate) would potentially wake her up. Then, I thought, “Wait–I can’t be the only person to have needed this. Let me Google this…”

I could have sworn what I was going to use was a tool/plugin that does “normalization.” After beating my head against that wall for a few days with no good results, I found that what I was looking for is what’s called dynamic compression. “Compression” seemed totally the wrong word to me, because to compress is to remove redundant data to fit a smaller space (and “decompression” would fill it back in). But NOOOO–some crazy group of audio engineers decided to call a limiting of dynamic range–that narrowing the gap between the difference of louds and the softs–”compression.” That’s what radio stations have been doing for years so you can hear everything in car w/o having to ride the volume control, as well as giving extra “punch” to certain audio frequencies so you think one station sounds better even though they play the same recordings.

Jacking with the dynamic range of the latest “Arcade Fire” track is one thing, doing it to a symphony or a string quartet is something different. Classical music is the domain of serious audiophile engineers analyzing acoustics in concert halls, obsessing over the minutiae of different polymer tiles, their placement, etc. all to provide the best aural experience for a live performance. When recording, mics are placed strategically to capture the ambience of the hall, but also throughout the stage. You want to hear the crispness of a freshly rosined bow on a string, the collective breath before a horn section’s opening, the higher frequencies in the “blat” of a low-brass instrument. Trying to dampen these subtleties is blasphemy.

“Baby Einstien” sells 22 minutes of toybox-synthesized classical lullaby crap for $10 on iTunes Music Store. That’s a serious cash-cow; even pop CDs are at least 50 minutes or so. Even if I bought both volumes, that’s not even 45 minutes of non-repetitive music. It is, however, homogenous in terms of timbre and volume, which, along with clever marketing, is why it sells. I’d rather have my daughter listen to the real thing, but I also have a practical need here as well. So imagine my own self-loathing when I subjected many wonderful pieces to a transmogrifying audio laboratory like a Maestro Mengele, removing the artistry, audio quality, and individuality to make a homogenous, similar, and ultimately inferior final product.

I’ll give an example: the “Adagietto” movement from Gustav Mahler’s Fifth Symphony. People in the know will gasp, “You’re putting her to sleep with Mahler!??” because Mahler is known for wide variations in dynamic expression, extremely long symphonies (>100 minutes), very busy and thick scoring (over 120 members in the orchestra, plus a choir at times), and did I mention long symphonies? Relax–this is a slow movement that is scored simply for strings and harp. I even have the relevant excerpt from the score here to follow along for those that want to for the musical sections below:

Note all the instructions Gus has provided above; the score is full of details, all about to be lost. This is the final 18 or so measures of the movement before heading into the buckle-your-seatbelts finale that comes immediately after. In this excerpt, 8 minutes into the movement, we go from quiet yearning to a final gushing emotional outpouring, to a complete fade to nothing. Gorgeous, heart-tugging, and although sublime, completely unworkable to put a child to sleep. Here is a picture of the original waveform in the audio editor (Apple Soundtrack Pro) and the playable excerpt below it:

Now, the bastardized, compressed audio. Note that there is a lot of artifact bringing up the volume from the low-amplitude sections, which you can visually see in the following graphic. This is the price one pays:

Upon finishing compressing 2h of music selections, they were transferred to a minidisc set on “Repeat,” and applied that night. I happy to report it was an unqualified success. I met the dual objective of both blocking out more external noise and giving daughter something to listen to that she can carry with her, even if only subconsciously, as she grows older to appreciate it more. Part of me feels bad for blasphemy I’ve wrought (ok, I’m being a bit facetious here), but Claudia and I certainly get more quality time as daughter gets more sleep, so too bad.

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.

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.

Last year, I was in my hometown, and my grandmother’s house is very close to the stadium where they do the fireworks/music-on-the-radio thing. Our daughter was a little peanut, less than 2 months old. I thought bright lights could attract her attention a little bit. She didn’t show much reaction at that age of course, but when some of the louder “booms” started happening mid-way through, she was NOT happy (understandably, as even I could feel the reverberation in my gut), so we just went home.

I mentioned all of that only to say this year, I know she’s going to go nuts with excitement. At 13-14 months, the louder, the brighter, the better. And this time, it’ll be with vocal approval, clapping, pointing, and general happiness. I wish I were there to see it. I thought about grillin’ and chillin’ here, but I really had nothing to grill. I’m low on money and am by myself, so I don’t want to buy a big slab of meat. I thought about hot dogs as at least an American substitute, but the best Mexican hot dogs are like the no-name not-sure-if-you-want-to-chance-it generic brands in the States. The “cheap” variety here are these disgusting, gray-pink Vienna-sausage-looking things, and Oscar Meyer brand dogs here will set you back almost $4/pack. Wrap your head around that one–Oscar Meyer, probably at $0.99/pack on sale in the US this time of year, is the “fancy import” brand. LOL!!

I think I’ll just open a bottle of wine later tonight, watch a movie, and relax. I’ll need some calm-before-the-storm given tomorrow’s meeting. I don’t think Thomas Jefferson ever said, “¡Viva la independencia!,” but it’s all I got right now. As an aside, I don’t think any of the founding fathers would have condoned this disgrace, either, but I don’t want to ruin my day thinking about it any more.

Thanks to all the commenters who wished me (us) well; it means a lot to know that in spite of my more sparse posts as of late, that people still read, care, even have me on their radar. There’s a lot more I want to post about–and will–but before I get to some other things, I definitely wanted to give a quick update that all is well for now, and hopefully, for good (as much as can be). I definitely needed that to be the case if I am to focus without unnecessary distractions on the task at hand for the next 6-8 weeks until test day. As long as school leaves me alone and doesn’t get unreasonable about missed days or similar BS reasons (esp. with other students having rules bent all the time), I should be just fine.

Starting up the grindstone…

I need this trip badly. I need to hold my daughter once again, to remind myself of why things are worth it in spite of things seeming to be too hard. I need to spend time with Claudia in person instead of long-distance on the phone, where things always seem to be misunderstood and where it’s all too easy to say something insulated by distance that you’d at least think twice before saying in person. I need re-centering without all the stress caused by Claudia’s surgery and immediate recovery, the bullshit stressed imposed by school the last time with Kaplan–what a joke. It’s a fucking review course, people. If I’m not there for this lecture or that lecture, who cares? I sure don’t–not when family is involved. This isn’t coursework or patients, it’s lecture time that I paid for; I’ll do what I want with my time.

So here I am, waiting for the get-together soon. I’ve already spend some sorely needed time with the Niblet. She’s gotten two more teeth coming in and has progressed from “cruising” to full-out walking. (then squatting like an African bushman before standing back up and taking some more steps) Things with Claudia are going well so far, and I hope that the weekend continues to be one of healing for the marriage, and for me if I’m to go back for the home stretch before Step 1 with the motivation needed to succeed. There might be a light at the end of the tunnel yet.

All this pales in comparison to my main problem at the moment: my marriage. I’m not going to go into public details, but the constant stress of arguments from long distance, her newfound position of no comprimise, and being without my daughter in the process is wearing on me. Actually, I don’t fault her for the next 2 weeks or so, because that’s the length of her physical therapy. However, it seems that she’s in no hurry to come back. Things may change during that time, but I’m already sorely behind in all my studies with all the missed schoolwork, classes and time in general that I’ll never get back. I have always said I lack the gift of compartmentalization, and I’d love to have a nice dose of mental sectioning to say, “I’m not going to worry about that right now; I’m going to concentrate on my studies.” We have opposite effects by this situation: she’s empowered with the time off and family/friends on all sides helping with her, baby, opportunities for possible employment, feelings of indepdence with no pressures from anyone. I, on the other hand, am dealing with Step 1 prep, having a 3 bedroom house alone, and I still have to take care of the damn dog. Our dog is fine, don’t get me wrong, but it’s not like holding Lola is even a laughable substitute from the heart-warming, centering, reminds-you-why-you-are-doing-this-warm-fuzzies that having your smiling daughter (or even crying daughter) brings. Like I told Claudia, her worst day (pain notwithstanding–that’s different) isn’t even close to the plate-spinning juggling act I perform daily just to make sure things stay afloat financially, scholastically, emotionally and logistically.

And I’m losing the battle; the plates I’m spinning seem to be crashing to the ground, one by one. That will be revealed slowly through several posts–this is already getting a bit depressing. History has shown that I will probably pull through as before, but at what cost? The price seems to get higher and higher as time moves on. I’m on the verge of taking a semester off for financial reasons, I have 10,000 decisions and consequences to think through based on not only financial realities, but also all the uncertainties of the marriage and what I’m willing to tolerate with a seemingly indefinitely split household.

A doctor friend of mine here who had a child early on (he was like 20 at the time) never really worked things out with his then girlfriend, moved on, and is now a FP resident after working some years as a GP. His daughter is now 7, and he says that the big picture dictates that if I say that school is my #1 priority, I am never to take my eyes off of school long enough for it to slip from its #1 position. If I have to take time off to get things centered, fine, but it’s to serve my greater academic success, not a personal emotional indulgence or a quick-financial fix (ie, not solving the problem permanently during my time off). While that seems heartless and simplistic, his point was that when he was done, he found his daughter was still there, his family was still there, his friends were still there, etc.–everything that he was convinced he lost or was going to lose was, in fact, simply the product of a myopic mindset. Family and friends will respect and understand what’s going on provided they are shown the steadfastness and progress of one’s endeavor.

Let’s see if I can pull that off.

The recovery, however, is a different matter; which, with an 11-month-old, is why I’m still here and not back in school as I should have been this last week. I hope to be back by this weekend, but it will probably be Monday or Tuesday that I’m back in Guadalajara. I have this stupid-ass midterm for Kaplan USMLE Step 1 prep, but that’s another post.

Another post is also the 12-inch laceration I received in the pre-op area of the hospital while Claudia was getting gowned, and especially fun–the 12 hour wait it took to even get the wound tended to apart from the original shoddy dressing done to keep me from bleeding everywhere. Yes, folks, this is while my wife was in surgery, recovery, and the sweet delicious afterglow of the application of a fentanyl patch. Like I don’t have more to worry about here.

So, as you can see, the blog has been temporarily paused, but not just because I’ve been busy. The surgeon wanted Claudia closeby, and her family lives in a city 45 miles away.  My parents’ house is out because of a very unfriendly set of stairs, so the next choice was my grandmother’s.  Plenty of space, nice yard, mostly quiet. However, my grandmother’s house has no internet connection (as well as being so infernally hot that it would melt any computer components left on for any length of time). To steal time away to fire off a post/email is defintely doable, but not when you add the drive to another location, so more soon. All is well with Claudia, which is the main thing. I’m being beaten like a Hebrew slave taking care of our daughter full-time as well as helping around the gimpy better half. With all this childcare, I’ve gained new respect and appreciation for my wife. I’ll take studying any day…sheesh.
More soon…

When people think of Mexican food and what accompanies it, the first thing that pops into peoples’ heads is tortillas. For the most part that’s true, for those dishes that it goes with, but for far more versatility, Mexicans go for good old bread, just like most of the world. For those not familiar with true Mexican food, traditional white bread are made in small loaves, about 8 inches (20 cm) long, called bolillos (pronounced “bowl-EE-ohs”). Depending on the region and other factors I’m not familiar with, it could be called birote, or if scored in thirds instead of lengthwise, telera (perfect for Cuban sandwiches).

Growing up on the border, I was used to a bolillo that was almost indistinguishable from a mini-French baguette: a firm, chewy but thin crust, and soft/pillowy on the inside. Coming to Guadalajara, I was met with oblong pieces of rock suitable for loading into a torpedo tube, which, after hammering a good two hours, one might get something edible at the very center. I would ask a clerk if these were day (nay, month) old breads, and he assured me, almost insulted, that they were put out that very morning. The thing is, here preservatives are never used for staple foods since people go to the market constantly. Bread lasts maybe a couple of days sealed; fresh corn tortillas might be coaxed into living 4 or so days with Ziplocs and the fridge. It’s not that they go rotten, they just get hard. Tortillas, bolillos, etc. are things that, especially for a family of any real size, are bought and/or delivered daily. Packaged, sliced bread in the supermarkets are different, of course, and they are identical to what Americans would be used to. We’re talking the real food of the Mexican table here, not the supermarket version. In spite of my making fun above, few things are as satisfying to the soul as a good, fresh, still-warm bolillo.

So what do you give a teething, fussy, hungry baby? Day old bolillos!!! Cut an end-piece of that hard bread in a chunk sized way too big to fit in her mouth completely, and you have 1) a nutritious food (no preservatives, just water, flour, leavening and a touch of salt), 2) a solid, organic object for her to rub her gums better than any plastic teething ring, and 3) something that is light enough that she can hold with one hand (unlike many of the teething rings) and gain coordination and independence. The 3 gallons of saliva she produces in one hour is just the right amount to slowly but surely soften the bread into minute bits that she can easily handle.

For about a peso per bolillo (literally a dime), I’d say we’ve hit paydirt!! The little one doesn’t care about the value or benefits–she just says, “Keep ‘em coming!”

P.S. The picture above is funny because trying to cut a hard bolillo with a butter knife as shown is about as futile an act as I can think of. That’s why it’s still there, embedded, like Excalibur waiting to be freed. (Okay, I went a little too far there, sorry.)

P.P.S. The word bolillo is also be used as a derogatory term for a gringo or “White Man,” since obviously it refers to white bread.

A warning to those wanting to go abroad (and I should pause to remind people that Mexico with all its accessibility to Americans, is still VERY much a foreign country) for medical school who are married or will soon be: be careful. I thought we’d have it easier than most–we’re both originally from the same area growing up on the Texas/Mexican border, her Spanish was better than mine when we moved here, she saw this as an adventure from day #1–all the right ingredients. Surprise! Living here (and I’d imagine anywhere foreign) wears on you. I have school to occupy my time, and while it does also give its own unique blend of crapola aside from the academics, at the very least, I share the experience with 150+ other students. A spouse of a medical student is already somewhat widowed; add to that mix separation from their family/support structure, loss of a professional identity since they can’t work here (unless they are Mexican citizens or get special dispensation from the government (good luck!)), and you have a setup where they feel really useless really fast. Add a new child to the mix and it can turn into a festering cauldron of resentment. More than one spouse has packed their bags, and when I found out that’s what Claudia wanted to do, I did the best thing and understanding and supportive husband should do: I lost it.

We’d been here before, but looking back, it was more overly-exaggerated impulses (which she’s more inclined to than I) that didn’t really last. Cooler heads would prevail, and things would get better. With our daughter and the hardships of dealing with an obviously hyperactive/clingy baby, neither of us really had time to build up our reserves. The whole vacation of constantly “getting things done,” and then when the film shoot was over, switch to “Ok, let’s get ready to leave” (which for us means shopping for things to bring across that we can’t get here, on top of all the stuff people normally deal with) — we were just burnt out.

I do think a break could be good for us, but I don’t want to be without my daughter; however, having an unhappy mommy isn’t good for her either, so what do I do? Again, I dig deep into the well of my soul, and provide the most honest reaction I could: I freaked out again. (I’ll post about this later, but I’ll quickly mention the fact that dads get no respect, as conversations with family members quickly showed–mother knows all, father is an attachment to do labor mother can’t (not unlike attitudes towards weddings, except there I agree)). It turns out she’ll need a knee arthroscopy, so she’ll be going home later this month regardless. My hope is to have things worked out by then so she can go with my being 100% supportive, even though I hate the separation.

There’s been more going on academically and personally outside of this, but since I want this blog to be first and foremost about me–something for me to look back on–I wanted to make sure I wrote something about the above, even if it’s painfully personal. I tried, perhaps lamely, to turn it into a teaching moment for those wanting to embark on a med school journey far from home of some of the things that aren’t obvious about dealing with everyday things, the things that sneak up on you and before you know it consume everything. I am not a person who can compartmentalize my emotions very well. If things aren’t going well “at home,” it bleeds into my studying, my sleep, everything. I wish I could be one of those individuals that say, “I won’t worry about that right now,” and while I can get better, I can’t fundamentally change who I am. I will be the doctor that goes to sleep (ha!) thinking about the labs post-op, wondering what I’m going to find, fussing about this or that, because nothing ever changes for me because I walk out the door. I carry work home, and I carry home to work. At least I’m consistent.

So there you have it–the long, drawn out version of “There and Back Again” for the last six weeks or so. I promise I’m back for good. As a friend told me during my “hiatus,” blogging is a low priority given everything going on, but I need it. I don’t know why, but I have to write, and sharing in general is something that’s always been at the core of who I am. I have no idea who is still reading this, but if you are, thank you. More soon.