Abdominal Distension

I've been stressing myself all day thinking about coming back to Charlottesville.  On the one hand, it's great to be able to sleep in my own bed again.  On the other hand, it's terrible to have to cook for myself.  How will I survive without a cafeteria and $22.50 in food allowance each day?

Well, Taste of Charlottesville heard my cries and came to my rescue.  Rohan, Sean, and I headed over to Alumni Hall to enjoy the annual offering of free food from the staple restaurants of Charlottesville.  Tonight's menu included wraps and Thai salad from Zazu's, fajitas from Baja Bean Co., stuffed mushrooms and spinach dip from Fry's Spring Station, sliders and crab cakes from the Virginian, sweetbread from L'Etoile, and much more.  And no, Taste of Charlottesville doesn't become any less exciting the seventh time around.  Geez, I'm old.

Speaking of coming back to Charlottesville, I had to stop along the drive to take some pictures of the Shenandoah Valley, which is in peak color right now.  Here's one of my favorites:

I know this kind of defeats the point of having four seasons, but can it just be fall all year round?  It's just... too... beautiful...

Ale-alejandro, Ale-alejandro

I've had a lot of good Mexican food in my day, but I've never had anything quite like Alejandro's in Roanoke.  Seriously man, their food is delicious.  I just got back from my second time there in one week.  I simply cannot get over their salsa bar, which features 12 different kinds of sauces for you to dip your chips in.  Why doesn't every Mexican restaurant do this??

And that's just the appetizer.  Then there's the entree... oh, the entree.  Feast your eyes while I feast my taste buds on this:

The only weird part of the night was when Randy and I tried to order beer.  There's a sign on the wall that says all draft beers are $1.50 off on Tuesday nights, but the waiter refused to give it to us.  When I tried to explain to him that it was 8pm and the deal was supposed to go until 9pm, he literally ran away from the table.  When he finally came back five minutes later, we just ended up each getting a bottle of Dos Equis because we were so confused.  I guess he won us.

Now, for those of you who have a Shelf exam in two days and have run out of ways to procrastinate, I just found a new website off of Christin's Gchat status called Damn You, Auto Correct!  My favorite post so far?

The age-old formula still works: Medical humor + Inadvertent racism = Hilarity!

I Am the Smartest Man Alive

As third year medical students on an inpatient rotation, it's expected that we go home and study our patients' conditions every night.  Typically, we present what we learned from our review of the literature during rounds the next day, especially with regards to how our therapies should be adjusted based on the latest treatment algorithm or clinical trial data.  Unfortunately, the responses I get from my attendings and upper-level residents usually go something like this:

"Yes, I'm aware of that study, but this particular patient doesn't fall into those guidelines because..."

or

"That's not a very strong paper, and from my own clinical experience, I've found it better to..."

or

"I completely agree with you, and that's why we started the patient on that regimen last night after you left."

Well, ridicule me no more, because today, I made what may have been my first productive contribution to medicine... ever.  My team is currently taking care of a patient with toxic shock syndrome who has been on IV vancomycin and ceftriaxone.  This morning I mentioned that in my readings, I had come across a paper that recommended the use of IV clindamycin, which inhibits ribosomal translocation and thereby decreases the production of TSST-1, the toxin that gives rise to all of the symptoms associated with the disease.  I also brought up the idea of discontinuing the ceftriaxone, since we were no longer worried about gram-negative coverage.  And Dr. Jaworski said, "That's a great idea; let's stop the ceftriaxone and start clindamycin."

BOOM!  Hand over that medical degree.

All the Pretty Horses

Thanks to Fall Back, I got to spend half of the weekend in Charlottesville, drive back late last night, and still get enough sleep to be semi-functional at work today.  And what a great half of the weekend it was!  I think I'm starting to become a hippophile.  Between Foxfields, the Harriman Cup, and the events that transpired yesterday, I can now say that my entire medical school experience has been a blur of activity with sporadic breaks for equine-themed events.

We had an early start to the day, as Timmy, Ned, Paul, and I arrived at the races around 11am.  There weren't a lot of people there yet, so we set up Paul's cornhole set in the middle of the infield parking area.  Several people who had apparently never seen a game of cornhole stopped to watch us play.  One of them asked Paul, "So you like to play cornhole, huh?"  Awkward!!

When we weren't playing cornhole, we were either eating free samples from the kettle corn station, which was run by this insanely cool and insanely bizarre looking man and his wife,

feasting on the delicious nomz at the tailgate that belonged to Timmy and Ned's friends,

trying to crawl through the ladder golf set without touching any of the borders,


watching Randy somehow beat all of the girls in a game of Limbo,

cheering on the races,

breaking the rules of the raceway,

or simply enjoying the beautiful grounds of Montpelier as we strolled away into the sunset.

The only thing that was missing yesterday?  Christin, who is quite possibly the only person I know who loves the triad of dressing up, watching horses, and day drinking more than I do.  You'd better be here for this next year, Christin!!

Zero Tolerance

I like to think that I'm a pretty open-minded person.  I didn't judge the patient who was being hospitalized for her fifth alcohol detoxification.  I didn't look down on the patient who was looking at inevitable amputation because he refused to take his diabetes medications.  I didn't scoff at the patient who had full-thickness burns on both hands and forearms after trying to simultaneously light an entire pack of fireworks.  When patients suffer, I can't help but feel bad for them, even if their circumstances are created by their own life choices.  What's most important to me is that I do everything I can to help them get better (even if that involves simply writing a note and putting it in a chart, knowing that nobody will ever read it again).

My policy for not making judgments goes out the window when the the same person who is making irresponsible decisions has a child.  If you're 16 years old and can barely take care of yourself, you probably shouldn't be having your first child.  If you're a cocaine addict who has already lost custody of your first child, you probably shouldn't be having a second child.  And if you're living on disability and two of your five children from four different men have developmental delays, you definitely shouldn't be having a sixth child by yet another man.  It's downright irresponsible to bring a child into this world that you know you can't take care of, and yet I have met each of the three people above.  Sure, I still feel bad for them, but I feel much worse for their children, who may never have the chance at a successful life thanks to their toxic environments.

On a brighter note, did you know that the song Like a G6 is performed by Far East Movement, an Asian-American group?  I didn't realize this until earlier this week, when I heard that they were the first Asian-Americans to make it to the #1 spot on the Billboard Hot 100.  Far East Movement, I'm really happy for you and I'mma let you finish, but Sammas is the greatest Asian-American musician of all time.  OF ALL TIME!

Clean Catch

The poor baby.  He's had the most difficult first two months of any infant I've ever met.  First, he was born with duodenal atresia and gastroschisis, requiring emergent surgery.  Then, he had a myocardial infarction and coded on the floor.  His recovery was complicated by cardiac tamponade, which had to be treated with pericardiocentesis.  And he's still never been home because of continuing failure to thrive.

In spite of all this, he's still the cutest baby in the world.  At least, that's what I thought until today.  I had just picked him up and set him down in my lap.  I was gently rocking him back and forth, trying to get him to go to sleep, when I suddenly felt unseasonably warm.  One second later, I came to my senses, and realized that he had peed through his diaper and all over me.

Fortunately, I was wearing scrubs that I could easily change out of.  Unfortunately, his pee stain laid directly on my crotch since he'd been resting in my lap.  I had no choice but to cover myself awkwardly during my whole walk to the scrub machine and locker room so that it wouldn't look like this 24-year-old in a white coat had just peed himself.

TootSweet

When babies get upset, they get TootSweet, a liquid solution that's 24% sucrose.  You can drip some of it on their pacifier, and they're so absorbed in sucking on the delicious flavor that they completely forget about whatever was bothering them in the first place.

When I get upset, I get leftover Halloween candy.  For some reason, everyone on the Pediatrics unit decided that the best thing to do with their Trick-or-Treating leftovers was to bring them all to work.  We have innumerable plastic pumpkins sitting on every table, filled to the brim with delicious candies.  Don't they know how weak I am, and how easily I give into temptation??

I ate so much candy yesterday that I vowed not to touch a single piece today.  But my taste buds had other plans.  By the time I left work, I realized that I had eaten a packet of candy corn, a packet of M&Ms, a packet of Skittles, and a packet of Whoppers.  ZOMG, SUGAR RUSH!!

It's weird; I actually don't like to eat sweet foods.  I rarely eat desserts, and I never crave cake or pie, always opting instead for more of the entree.  But when it comes to colorful candy marketed towards five-year-olds, I can't even put up a fight.