Seven things about me....

"You've been tagged! Nocturnal RN said it's the law so you have to do it! Write seven things about yourself and then tag seven other people."

If it's the law...guess I'll comply. I apologize if I inadvertently "tag" people who've already been tagged. What happens in that case?? What does 'the law' say about that?


1. Although I enjoy doing the doctor thing, I enjoy doing the mom thing so much more!! Actually I do only enough 'doctor stuff' to allow me to do the 'mom stuff' with grace and class (i.e. money and resources).

2. I've never been to the snow.

3. I'm afraid of heights. My feet get all tingly, and I actually start to feel like I'm being pulled to the edge and over the side of the building. So, eventhough I think going on the Amazing Race with my hubby would be tons of fun...I know I'd never be able to finish the race (much less actually win).

4. I love to talk. This is why I started a blog...so I could 'express myself' without subjecting anyone involuntarily to (even more of) my yapping.

5. I'm proud that my son looks like me. When I look in the mirror now, I see him. And I love my own reflection that much more because of it.

6. It makes my heart sing when my daughter tells everyone she wants to be a doctor "just like her DoctorMommy." Makes me feel as though she values what I'm doing, that she respects me...and that I'm setting a great example for her. That makes me feel like a good mother.

7. When I have discussions with my husband, I realize how smart he is...and I fall in love all over again. But, I also realize how little I actually know about anything not related to medicine...and that conjures up feelings of frustration with the 'process of becoming a doctor', which I feel is responsible for my uni-dimensional self, and lack of full development. Sometimes I feel like medicine has 'clipped my wings' and now I must regrow them, and learn to fly properly (i.e. remedial spiritual flying 101).


Respect level

This is so true.

Emergency medicine is unique in that, in general, the public sees us very differently than other physicians.

What Family/Friends Say
...You must really know a lot to be able to take care of whatever walks through the door.

Respect Level: High, right there with surgeons.

What Non-Emergency Physicians Say
...You guys are a bunch of hacks, basically glorified triage nurses. I can’t believe you know so much less about my speciality than me.

Respect Level: Slumming it with the family docs and psychiatrists.

(as expressed by Dr. Ten out of Ten)

What friends, family, and the general public think is so much more important than what non-EPs think!!


Our Thanksgiving

Hope everyone had a wonderful thanksgiving!!

This year, for the very first time, I decided to prepare dinner. I mentally planned for weeks...the recipes, the drinks, and how we would accommodate so many more people at our home. I didn't want to spend tons of money, afterall this was something that was supposed to be casual and enjoyable.

And the menu wasn't as simple as one might think. You see, we've been successfully eating almost entirely organic foods (which all seem to be from America), and even managed to cut out most dairy and even lots of gluten/wheat protein (because the ubiquitousness of that crap *cannot be good for the body*). Likewise, it's ridiculous how much high fructose corn syrup is utilized, in almost everything - except in organic foods. So we've inadvertently cut that out too (and I've lost 8 pounds in 2 months as a result of just these simple dietary alterations). It was important to maintain our diet for a guilt-free Turkey day so we got a smoked (antibiotic-free, hormone-free) turkey and ham from Wholefoods. We prepared our pasta (mac n cheese) with quiona and soy cheese. We made gluten-free stuffing and cornbread. Even the salt and pepper were organic. We are very proud to report....we stuck to our diet!! And our guests were very pleasantly surprised when the food was even *more* tasty than their conventional counterparts!!

After dinner, and dessert, we decided to take a trip the park and let the kids play. Everyone ended up involved in a great game of freeze tag (all the adults, and even the toddlers). Once home we were forced to watch Hannah Montana (after finally turning off football)...and shared great conversation!!

We were sad to see everyone go home, but can't wait for Christmas eve when we see everyone again!!

Malibu on fire...again.

Fires in Malibu...again?? I wonder if moving ever crossed the minds of the rich and famous. Maybe they should relocate 'Hollywood' to an area a bit less congested, and where the rich don't feel the need to segregate themselves into seaside hills to avoid the vast majority of ghetto/barrio Los Angeles. I mean, how many fires does it take...how many 'close calls' will they endure?


Safe (non-toxic) Toys for Christmas

Update: Very helpful websites (right at the top of my list as I do my Christmas shopping and such): http://www.healthytoys.org/, and Not Made in China.

Now there's GHB in our toys...in addition to the other shit, here, here.
As per my 'research' here are a few companies that seem to have a diversity of toys (both age appropriateness, ethnic representation, and price ranges) without added poison...

Ecobusiness also had a link for toys
Organic Toybox (they sell lots of Melissa and Doug toys, that are made in China)*

(*be sure to check the individual toy on the website; some still have supposedly "safe" toys made in China - such as Melissa and Doug; and apparently playmobil sold it's soul by manufactoring some of it's "mini" line in China).

Individual toys:
• Battleship
• Bicycle Playing Cards
• Boggle Jr.
• Candyland
• Chutes and Ladders
• Clue
• Connect Four
• Crayola Crayons *
• Life
• Louisville Slugger
• Monopoly
• Mouse Trap
• Operation
• Parcheesi
• Play-Doh *
• Pop-O-Matic Trouble
• Radio Flyer Discovery Wagon
• Scrabble
• Sorry
• Stratego
• Tri-ominos
• Trivial Pursuit
• Yahtzee
• Melissa and Doug U.S.A.*
-many puzzles
* Some play-doh and crayolas aren't made in America. And Melissa and Doug = made in China too, sometimes. Be sure to check the box on these.

Cool site that my offer help - Multicultural Toybox
Not Made in China is a great site.

Tips for buying toys that don't kill your kids: The Green Guide.


the process...how long does it take to become an emergency medicine doctor?

I have the pleasure of mentoring students in various stages of "becoming doctors." A common question asked is "wow, how long does it take to become a doctor?" So I decided to break it down for y'all...

Grade school - middle school.
I've always wanted to be a doctor. My grandmother was an LVN, and my mom an RN. So the next 'natural step' was for me to become a doctor.

I've always been a good student, and was placed in "the good kid pile" very early in grade school. Fortunately I had parents who really advocated for me, and essentially *demanded* that I be placed in 'accelerated' classes. This worked to my benefit...and put me on the 'advanced' pathway to college prep.

In high-school.
I was very active. I played varsity sports...and essentially had a major afterschool activity every season. Fall sport, winter sport, spring sport, and summer activities...including band-camp. My mother was able to guide me to good/practical health related 'volunteer opportunities.' I did all of my homework, and never missed an (entire) day of school...since starting school. I took pride in my school work...and was paranoid about a negative smudge on my 9th grade "permanent record". I had a social life via sports and school activities, boyfriends, etc. I was somewhat of a teacher's pet...always. Took some honors classes...avoided AP classes because I wanted my GPA to be as high as possible. And at our school, honors classes were also graded on a 5.0 scale, without the stress of an AP test in the Spring.

Took the PSAT, SAT, and ACT. Applied to tons of colleges. Got into each one I followed thru on. Decided to go 'away from home' to school some 3000 miles across the country. I also had a few sports scholarship offers...but decided I wasn't really that interested in sports and had only participated in sports to have a social life.

In college.
I had a full academic scholarship...meaning I had to work my ass off to maintain eligibility. One C grade (in any class) would cost me my scholarship. In college I did the 'nerd' thing. Vice president of the chemistry club...tutoring...honor societies. But, I also pledged a sorority...and become increasingly popular and involved with Sorority Life. All the while, doing my homework, and going to class. I certainly hadn't moved 3000 miles to fuck around and flunk school.

I did research...published a paper in toxicology. I volunteered. I became a Girl Scout Troop Leader. I honestly didn't do much in the way of healthcare related activities while in school, however, when I came home for winter/summer I'd do a bit of healthcare volunteering.

My major was chemistry. Many people don't realize that a degree in biology isn't necessary (or even preferred) for medical school application. Actually, an undergraduate degree wasn't required at all....just the fulfilment of the prerequisites (but everyone had a bachelors).
Each summer I had an organized 'activity' planned. A summer enrichment program, a research position, a healthcare related job, etc. I did MCAT prep course...and subsequently took the MCAT.

I was invited to apply to a local medical school early, and was accepted. This was awesome, and meant that I would save a tremendous amount of money by subsequently only applying to medical schools I'd prefer to attend. The deciding factor was location...and ultimately I didn't take the early acceptance, and came back home to attend school close to my family.

Medical school.
Most of the students were much older than me. The average age of our first year class was 30 years old. Many students had PhDs, masters, or other awesome and interesting experiences (such as working as an engineer, architect, running a business, computer programmer, etc.) I certainly felt....intimidated.

Despite having taken the required classes, and even having a chemistry degree with a biology minor...the classes were very...detail oriented. Everything that's taught in undergraduate science is covered in the first 3 lectures in medical school...everything!! On day 4, everyone is on equal ground. I actually don't think the undergraduate classes helped at all...because in medical school they teach you everything they want you to know.

My medical school was a very laid back school. Of course there were the gunners, but overall, everyone helped everyone else (beware - this varies widely from school to school). It was important to do well on all tests - especially the first 2 years. And the testing schedule was mid-term and final, twice a year. Not many opportunities for quizzes or extra-credit.
- If you didn't pass an exam (despite the curve), you had retake the course during the summer...and retake that exam thereafter. If you didn't pass the course in the summer, didn't take the course in the summer, or didn't pass the exam you failed previously after completion of the course...you had to repeat the entire year of medical school.
- If you fail 2 exams...you have to repeat the entire year.
- If you fail an exam in a course that's not offered in the summer...you have to repeat the year.
- And finally, if you fail a course...you have to repeat the entire year.

-this happens to a handful of students each year.

There are about 9 classes in year-1. Gross Anatomy (plus lab), physiology, microbiology/histology (plus lab), pharmacology, introduction to clinical medicine, preventative medicine (statistics - which was hard as hell), biochemistry (which was so difficult, even our PhD *biochemsit* had difficulty), nutrition, primary care/family medicine (their lame attempt to try and persuade us to consider a career of horrible lifestyle and inadequate compensation).... In year 2, and the end of year 1, the subjects were organized into organ systems. First year more normal stuff...and second year learning how/why things go wrong. So, you see, it's quite easy to fail an exam...

Before you can do your clinical rotations in 3rd year, you have to take and pass the USMLE Step 1. You get one chance before you fall behind. If you fail a rotation in 3rd year, you have to repeat that rotation. And if you fail the exam at the conclusion of the rotation, you have to retake the exam...possibly repeat the rotation. (The 3rd-4th years of medical school are much easier than the first 2).

In 4th year you take USMLE Step 2. Some schools require you pass this exam before they grant a degree. Ours did not require passage, only that you sit for it. During years 3-4 you're doing rotations that interest you, and trying to pin down great letters of recommendation. You're trying to meet people in your field of interest by going to mixers, and department meetings/gatherings. You're trying to honor the rotation (by doing everything asked of you, being very humble, and taking the abuse). Perhaps, if the specialty is competitive, you're also participating in relevant research that will lead to publications with prominent staff. You may be working to qualify for consideration for an invitation into AOA (Alpha Omega Alpha) the medial honor society that's recognized nationally. The evaluation comments written by your professors/attendings is content for the Dean's Letter (the letter that the medical school will send to the residency programs when you apply...kinda like a final report card).

There's the very cumbersome process of residency application via ERAS. Very expensive interview travel. My specialty choice largely depended on what was locally available as I had no desire to move out of my house, much less to another city or state. In SoCal, everything is available. I matched locally...didn't have to move...and started internship.

Was what everyone says it would be. But when you're 26, single, and totally psyched to be a doctor FINALLY...it wasn't so bad. During internship you have to take the USMLE Step 3...and pass it. This must be done to apply for a California State Medical license. And, you have to have a State license to advance to your 3rd post-graduate year (as an American graduate). FMG have an extra year.

-this causes programs here to lose a handful of residents depending on the competitiveness of the specialty. Unfortunately primary care spots have a high proportion of FMGs and consist of more 'borderline' students who may not test well...hence their inability to secure a more competitive residency. So, many of the FM, peds, IM, and psych residencies lose residents as they fail Step 3.

In addition to the long hours, and scut work...there are monthly 'progress' exams in preparation for the inservice exam. The inservice is a board-like exam...and some programs will use this exam to determine whether to allow you to graduate from the program. Also, the residency programs have to give you *permission* to sit for your boards after you've completed the program. If you do poorly on the inservice, they may not allow you to sit for the board exam.

While a resident you may decide to work hard for chief resident consideration. This will give you a tremendous edge on fellowship applications, or on specialty job applications.
After residency you become board *eligible*...meaning you're eligible to sit for the specialty board exam. Many specialties only offer the exam once a year, and may consist of 2 or more parts. Written, oral, practical, etc. So, certification may take 2-3 years. And some board exams have an exceptionally low pass rate...so multiple attempts are expected. (All the EM jobs make very little distinction between board eligible and board certified in their hiring practices or priveleges granted...however, some places will pay more once you become certified.)

After residency completion.
For Emergency Medicine, there is an ABEM written exam in November. If you pass it, you then apply for a spot to take the Oral component. The Oral component is offered in Chicago, twice a year. You are randomly assigned to Spring or Fall. If you pass the Oral component...you are then BOARD CERTIFIED - a diplomat of the American Board of Emergency Medicine. After becoming board certified, and meeting other 'experience criteria' you are allowed to add FACEP and/or FAAEM after your "MD" to indicate that you are a residency trained, board certified, practicing, competent, ER doc...(which we all know may or may not be true).
So, to go from high school to board certification:
4 years of college - prerequisite classes and the MCAT.
4 years of medical school - Class exams. Rotations. Ass-kissing. USMLE Steps 1 and 2.
1 internship year - USMLE Step 3. Medical license.
2-7 residency years - Inservice exams each year. 80+ hours a week of indentured servitude.
After graduation 1-2 years - Board eligible. Board exam components.
*optional fellowship 1-3 years - take specialty board exam (written and oral); then take sub-specialty board exam after fellowship completion.
Board certification - 13+ years after graduating from high-school. FACEP. FAAEM.

Take a deep breath, relax, and pace yourself...becoming board certified physician is a marathon indeed!!


Gangs and other Random Stuff

See, it happens even at "good" hospitals. UCLA-Olive View had a young guy drop dead in (near) the ED. Unfortunate, but hopefully helps demonstrate the *widespread* issue of ED overcrowding, excessive/unnecessary work-ups, and highlights the impact of inadequate hospital bed capacity and closure of County EDs and hospitals. It affects everyone, even affluent "Valley folks." It's unfortunate that many people just don't appreciate the full impact of a problem until it affects them directly. I mean, didn't people heed the lesson of WWII?

In Germany, they came first for the Communists, and I didn’t speak up because I wasn’t a Communist;
And then they came for the trade unionists, and I didn’t speak up because I wasn’t a trade unionist;
And then they came for the Jews, and I didn’t speak up because I wasn’t a Jew;
And then . . . they came for me . . . And by that time there was no one left to speak up."

Just maybe..."if (wo)men and elves join together we can protect middle earth", from the Dark Lord Sauron, and his undead Nazgûl servants, instead of "minding our own business" and waiting for *our turn* to be destroyed.

It's not just Olive View, King Drew, or County hospitals. Overcrowding, increased errors, and inadequate care is happening *all over* people...everywhere. This is not a poor people, brown skinned, welfare, housing project, trailer trash, ghetto, problem.

Also interesting in Los Angeles news...

"Racial Cleansing" of African Americans by Mexicans in Los Angeles neighborhoods. You don't have to go to Darfur to get a taste of this...apparently. And this is the city of the rich and famous, where "the streets are paved in gold." Hollywood and Malibu.

And last but not least...Emergency room manners:

If your spouse (usually the sensible one) drags you in for the stroke that you had 3 days ago and you still have facial droop, slurred speech, and one-sided paralysis do not state that “My wife made me come in” when I ask why you’re here. Just tell me what the fuck you’re here for. And after I put you in line to go back to the ER do not send your cringing hand-wringing co-dependant family members up to me every 15 minutes to ask if it’s your turn yet. IF IT WAS YOUR TURN WE WOULD BE CALLING YOUR GOD DAMN NAME. The window for stroke treatment was 3 hours. Now that you’re long past it you’re looking at a lengthy rehab. After 3 days another hour or four won’t make a lick of difference. Your anger, frustration, worry, and regret will not get you in any faster. As the slow truth of your stupidity sinks in do not glare at me.

Do not tell me that you “Can’t breathe” in long rambling 20 word sentences.

Similarly, do not tell me that little Shantiqua is ‘bleeding bad’ with her 1cm cut, that your bullshit pain is 10/10, that you are suicidal when you took 3 Tylenol instead of 2 (gasp!) after mommy grounded you, or that because your emergency is the worse that you’ve ever had, that it’s the worst that could possibly happen in the sum total of human experience. I’m supposed to act like your story is the saddest tale that I’ve ever heard. It’s not.

The worst thing is doctors that not only won’t see their own patients, but they send them into the ER with a wildly unrealistic set of expectations. “My doctor told me to come in right away and to go right back! He said I was too sick to wait in the lobby. He ordered you to do tests, they are (stop me if you’ve heard this one before) ON THE COMPUTER”. I’m not taking shit for orders from some lazy-ass, wart burning, boil lancing, sprained ankle rotating, sore throat examining general practitioner who has assessed you OVER THE PHONE and doesn’t even have ER privileges.
I'm still recovering from my ABEM oral board exams (trying to work shifts in order to 1) pay my bills since I've been gone; 2) make money in order to pay down my credit cards after using them to charge everything that taking these exams entail...travel, hotel, suits, board prep courses, exam costs, and so forth and so on....)

More insightful posts forthcoming....