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’…

Grand Rounds 4:10

GR 4:10 is up at Prudence, MD. Go read this week’s best picks of the medical blogosphere!

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.

Grand Rounds 4:09

¡Bienvenidos a Guadalajara, Jalisco, México! I will be your host and guide through this week’s best of the medical blogosphere. This is the second time I have had the privilege of hosting, and for that I’d like to thank Dr. Nick Genes who has seen fit to give me the nod for this week’s edition and keeping the Grand Rounds tradition going. Without further delay, let us begin…

Prelude:
Thanksgiving is two days away in the USA. This will mark the 3rd Thanksgiving in a row that I am not home to spend with the rest of my family. Perhaps I’m just a little nostalgic for home right now, but I really wanted to incorporate the holiday here in a way besides references to turkey, pie, and football (Go Packers!). Victor Hugo said (translated), “Music expresses that which cannot be put into words and that which cannot remain silent,” and like the last time I hosted, it is to music I turn once again to express myself.

In the Thanksgiving spirit, all of today’s selections will highlight American composers. Since all links here are set to open in new windows (or tabs), you can read articles while leaving this window playing in the background. In all but one shorter case, the selections are about 8 minutes each; I hope you indulge my desire to share. Enjoy!

When Aaron Copland burst onto the musical scene in the 1920s, American music would never be the same. While there were several important composers before him–McDowell, Herbert, Sousa–Copland was arguably the first to truly musical codify what it was to be “American,” by drawing from folk songs, cowboy music and other “popular” sources. Everyone knows Rodeo (the last part used in the “Beef: It’s What’s For Dinner” campaign in the States), but there was far more to Copland than catchy tunes. Here is the 2nd movement of his third symphony. The expansive, colorful harmonies and driving rhythms are so distinctly American, one just feels it.

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Editor’s Choice:
Sid Schwab at Surgeonsblog has a great piece about people’s need for magical thinking, particularly as it relates to “alternative medicine” and new discoveries. The post builds up steam (both momentum and ire) and finally culminates in a challenge bordering on the ridiculous (the whole point) to those who want to cherry-pick common sense. In a similar vein, Dr. Val comments on an infuriating decision by Medicare to no longer cover expensive, necessary treatments to lymphoma patients while at the same time, government dollars are wasted trying to legitimize the spurious benefits of homeopathy with more research studies. Craziness.

Coming back from the Twilight Zone to the ER (some would say that’s just a few steps away ), the truth always comes out eventually, as Bongi at Other things Amazni shares. It may not come via the patient nor the patient’s family or friends–it may require surveillance cameras to finally shed light on what’s going on. The delay, however, could be deadly.

And on the lighter side, Zac at Agraphia has a story about a particularly reptilian surgeon which had me belly laughing from a similar experience.

Mark O’Connor is of a newer breed of contemporary American composers. O’Connor draws his inspiration from the country and bluegrass aural traditions (handed down through playing, not written) and brings his formal training to transform it into something completely unique. O’Connor’s most famous piece is Appalachia Waltz, and O’Connor has arranged several versions, this one for solo cello. This is a slow, easy waltz, just like sitting on a porch looking at the mountains…

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Clinical Perspectives:
Here are two selections about burnout and emotional balance. Keith at Digital Doorway talks about having been all compassioned out. Third-year medical student Nick Gavin at NY Emergency Medicine has a post entitled Traumatic Disconnect where he explores the fact that empathy and connecting with patients don’t come automatically with the white coat.

Straight Talk from the Stanford ER’s Sean Donahue writes a good summary of how an ideal stroke response plays out, from EMS to thrombolytic treatment.

Nancy Brown at Teen Health 411 writes with suggestions on how to ensure an inclusive, positive holiday season for the whole family. With so many families being “go-go-go,” just pausing long enough to communicate openly is probably more than half the solution.

Ever wonder why your psychiatrist doesn’t take your insurance assignment (especially if talk therapy is involved)? Dinah from Shrink Rap explains why.

Terry from Counting Sheep tells a touching story about how a frail, blind nonagenarian had the power to halt activity in a busy OR staging area–in a good way.

Clinical Cases and Images Blog comments on the Perioperative Ischemic Evaluation (POISE) trial and how it might affect perioperative beta-blocker usage.

Some patients just “get to you,” and some do so without you realizing it before they’re gone. About a Nurse talks about one such patient and her struggle to find balance when you can’t even grieve because there’s still work to be done.

In Emergiblog’s first-ever guest blogger post, an anonymous Army nurse writes a letter of thanks to her fellow military nurses who serve our country by helping manage the healthcare of detainees. It’s another world entirely when one is faced with a potential moral dilemma for every medication/intervention, every patient, every day.

Tara Gidus at The Diet Dish shares why she’s especially thankful this year.

How can one talk about American music and not include jazz? Well, 1) Ken Burns already covered that history at length, and 2) I am focusing on classical music. Nevertheless, jazz’ universal appeal influenced many composers from around the world, none more so than American composers. George Gershwin is probably most recognized for this, evidenced most popularly with his Rhapsody in Blue. However, the work I’m featuring is the Piano Concerto in F, an unmistakably American work but rooted in a more traditional form. In spite of feeling a distinct “swing” at times, it’s completely written out and is very strictly timed (as evidenced by the orchestra’s accompaniment–there are no free-form solos as in Rhapsody) Here is about 1/3 into the first movement to the end:

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Patient Perspectives:
November is Diabetes Awareness Month. In a special feature, Amy Tenderich at Diabetes Mine interviews musician Elliot Yamin, former American Idol finalist and Type I diabetic, on World Diabetes Day. Stories such as Elliot’s are clearly inspiring for any diabetic feeling imprisoned by their illness. However, this can have an unintended counter-effect, as Kerry Morrone shares at Six Until Me. Just because a person appears healthy doesn’t mean they are disease-free.

In The Power of the Flower, Own Your Own Health talks about how physicians who tailor their communications individually to their patients win them over in more ways than one.

In Sickness and in Health, a chronic pain sufferer, has a nice, short post about appreciating the small moments of being pain free.

Of all the many incredible pieces Samuel Barber wrote, his “Adagio” is far and away the most known. The “Adagio” was first penned as the slow movement for his first string quartet, but was arranged by Barber once for string orchestra (which is most played by far), and again for a capella 8-part choir. It is this infrequently performed second arrangement that I present here. The music is set to the words of Agnus Dei:

Agnus Dei, qui tollis peccata mundi, miserere nobis.
Agnus Dei, qui tollis peccata mundi, dona nobis pacem.

Lamb of God, who taketh away the sins of the world, have mercy upon us.
Lamb of God, who taketh away the sins of the world, grant us peace.

The seemingly endless, ever reaching melody passes among all the vocal parts, finally culminating in a climactic chord and sighing quietly to the end. The tonality is never really settled until the final major chord, making one feel that after all of the yearning, peace is found at last.

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Healthcare Business and Policy:
The Executive Physician gives his thoughts and concerns on the concept of “cultural competence” as mandated by Washington and New Jersey and offers a more generalized solution.

Regarding hospitals and their attempt to maintain an edge–or at least financial viability–two stories are presented here. ER Murse talks about interhospital turf wars over a trauma level designation. When things get really bad, as HealthBlawg describes, sometimes it may be best to just pull the plug.

David Williams from Health Business Blog interviews the founder of DoubleCheckMD, a free, public web-based medication service that checks interactions and utilizes natural language technology to correlate patients’ symptoms, in their own words, against drug data. I was skeptical given the marketingspeak from the interviewee, but I checked it out before including it here, and it is worth a look.

Toni Brayer at Everything Health laments the whole SCHIP fiasco. I never understood the argument that because certain adults and/or families above a certain income level might be newly eligible (and improperly so, say opponents) if passed, why that would be reason enough to deny coverage (a non-partisan fact) to so many children.

To send this edition off on an uplifting note, here is the finale of Howard Hanson’s, second symphony. Hanson is practically synonymous with the Eastman School of Music in Rochester, NY. He also wrote this symphony at a time when most composers of his day saw romantic, melodic music as an anachronism, preferring instead to embrace the atonality that was emerging from Europe. Hanson, a consummate melodist, unapologetically subtitled this symphony “The Romantic.” While Hanson is not as universally known as Copland, his legacy also lives through all of the Eastman students who have carried some of his spirit with them.

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Culture and Media:
Christian at MedJournalWatch presents a absolutely fascinating case study in Africa about body image issues (!?!) and a surprising trend in the perception and desirability of body fat.

Jolie Bookspan at The Fitness Fixer shows how she performed martial arts movement analysis “old school” with high speed film years ago. Later, she returned to this area, except she was the model FOR a computer and even had her moves included in a video game. Cool stuff!

In the spirit of both Thanksgiving and the upcoming holiday season, Paul Levy of Running a Hospital shares his daughter’s essay on Salon.com about fruitcake and family tradition. It’s an extra click from his post, but the Salon article is an excellent read and well worth the extra navigation.

Canadian Medicine talks about how Canada’s health department warned against using a Chinese preparation of caterpillar fungus. Gee, ya think? I wonder how those meetings went. “There’s a fungus among us!”

Postlude:
I hope you enjoyed this edition of Grand Rounds! I hope everyone has a safe and happy Thanksgiving. Regardless what country you’re reading from, I know there’s something to celebrate and be thankful for–after all, you’re alive and reading this, aren’t you?

Grand Rounds leaves Mexico from Puerto Vallarta a few hours away and sails for the Philippines, home of next next week’s host, Prudence, MD. ¡Adios y buen viaje!

GR Ship Has Sailed

El plazo para mandarme sus obras para Grand Rounds ha terminado.

(Translation: Like MC Hammer, it’s too late for a comeback.)

Dosing OTC Pediatric Meds

It’s been about a month or so that various OTC infant cold-allergy manufacturers [semi-]voluntarily recalled their products in light of dosing mismanagment. Our little one has never had any OTC medication from these recalled “infant” products, so I don’t have any experience with them. In addition, I can’t get my hands on any of the products now that they’ve been recalled to see what could have caused such problems. I mean, how hard can it 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.

GR 4:09 – Tick Tock!

Just under 25 hours left to get your submissions in! I was getting worried when Friday I had probably only 12-15 entries. Let’s just say that the flood began early this morning…perhaps everyone was waiting to get off of work. Nevertheless, there’s always room, so get yours in!

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!

Submission information for Grand Rounds 4:09

I will be hosting Grand Rounds next Tuesday, November 20th! There is no theme for submissions, though I will hint that the fact that Thanksgiving (in the US) two days later might have something to do with the edition. Nevertheless, feel free to send me whatever it is you’d like to be included.

Some relevant info:

• Send your submissions via email to enrico-[at]-mexicomedstudent.com with the subject “Grand Rounds” and the URL of the post for inclusion in body of the email, along with just a sentence or two of a summary. The summary helps when I look back through my mailbox and I can match the post in my mind with the URL.
• Most importantly, all posts must reach me by Sunday, November 18th at 5:00pm CST (6:00pm EST). Sorry for the Sunday, but I’ll need a little extra time this year because I’ll be starting a house move that week. I’m sure all of you can sympathize what that’s like. Any submissions received later than the above will automatically be forwarded to the next host.
• I may not include all the submissions I receive; I just wanted to say that up front. I will always strive to be inclusive, but I reserve my editorial prerogative to do what’s best for the edition.
• As soon as you’ve posted something and feel it should be included in next week’s edition, send it to me then. It’s a great help to get at least some posts before the weekend.

I hope to deliver a solid edition on the heels of such great presentations as of late. Let’s have some fun!