Is it that time of year again?

It's nearly midnight and I've been pretty busy of late. My life has been relatively free of disablism, or ablism, whichever we're calling it this year. Which isn't to say it has been completely free, because the field of medicine is so full of ablism it's hard to tell where the one ends and the other begins.

So I'm merely going to paste in some some of my research about the relationship between health care and disability.

( Studies show. . .  )

April is not an appropriate month to be having a pillow fight. And this one lasted all day!

In fact, it is bedtime for sky bears. Please hibernate until at least November. December would be better.

Thanks,

Nightengale

(The song was one of my kindergarden favorites:

It snowed last night, snowed last night.
The sky bears had a pillow fight!
They tore up every cloud in sight
And tossed down all the feathers white!
It snowed last night, snowed last night.)

Happy Birthday batshua!

Yes, I know this is several holidays off, but I want to start thinking about it because of things like the price of Item #3 and the potential fatigue of #4.

Things I know.
1) I am going to Hogmanay in Swarthmore on Dec 31, 2008
2) I have off work from Dec 27 at 7AM through Jan 2 at 8 AM.
3) I plan to involve two airplanes
4) I will be pretty tired because I am working in the ICU for December

Things I don't know.
5) When I am leaving for PA
6) When I am returning to WV
7) Where I am staying while in PA and who I am going to be able to see while there.

If you have any opinions or input about items 5-7, please let me know via electronic means.

It's October.

It's snowing.

If I didn't order this, can I send it back?

I lived in New England for a decade but can't ever remember snow before Halloween before.

Happy Birthday jedibl!

This is something I posted on disabled_rage yesterday in proximal response to a conversation I had at work last week, and in longer term response to, well, every time I hear,

( I don't think of you as disabled! )

The PICU attending yesterday says he doesn't believe in "white clouds" even though he is known for being one. He believes we make our own luck by our own thinking. I'm known as a white cloud as well, and as reasonable as it seems, there's a certain flaw in his logic where my luck is concerned. Because there's a reason in medical school I called my cloud an "on call jinx" - I don't like it! And I refuse to believe my subconscious is so twisted that I've been doing this to myself for two and a half years.

( black cloud, white cloud )

But I just started a new LJ community to maintain in my CST.

It's called solo_cooking and it's for what it sounds like.

Those who cook for one sometimes or often may want to try it out. I know that includes many of you. The community will be friendly to omnivores, carnivores, vegetarians, vegans, flexitarians, kosher-keepers and everything in between.

It occurred to me lately what has consistently marked me as weird, while related in part to what I like and what I do, relates as much or more to what I dislike and what I don't do.

I've long quipped that my first social sin, in third grade, was not knowing who Michael Jackson was. My second social sin, and the greater of the two, was finding out and then not caring. Now I'm not saying my Sesame Street lunchbox would not have gotten some jeers anyway. But I wager my love of Beethoven might have been somewhat more forgivable if I had also liked Madonna. Or at least knew who she was.

Those friends of mine who are well integrated, socially, I think this is a big part of why. They seem to combine more unusual interests, like Scottish Country Dance, with more typical interests, like contemporary music or movies. At the very least, they can carry a conversation about contemporary music or movies without looking like a lost tourist from Mars. A weird hobby or two is quirky. A lack of any sort of knowledge base about normal hobbies is - just weird.

I noticed this recently with the new interns. They ask questions. And many of these questions I can answer, like how to use the computer system, call the pharmacy or admit a baby to the nursery. But then they ask about cafeteria hours and which cafeteria has the best food. I don't eat in the cafeteria. They ask if we are allowed to wear scrubs and how to get them. I have never voluntarily worn scrubs so except for the month I was required to wear them to the NICU resuscitation room, I've never noticed who was wearing scrubs where and when. And these are such normal resident things, the cafeteria and the scrubs, that not knowing the answer is a mark of true weirdness, even if there are perfectly good reasons for why I don't know them. Having reasons for not knowing obvious things is a mark of weirdness itself, I've learned.

It's little things and big things. An attending last week asked if I was going to the fireworks for the Fourth of July. Now I know that fireworks come with the Fourth of July. I mean, if you asked me to make a list of things that are associated with the American celebration of the Fourth of July, fireworks would be right up there on my list. I once baked a Fourth of July themed cake, with icing and sugar fireworks, even. But it has never occurred to me to go see fireworks myself. Actually I hate fireworks. They are loud and I spend the whole time worrying they are going to fall down on dry land and cause a fire. These were my thoughts when my parents took me to see fireworks in elementary school, you understand, and they haven't grown on me since. Luckily she knows me well enough to take "I've never really cared for fireworks" for an answer. At least well enough that she blamed it on my startle reflex.

And then there's travel. The other day the genetics people were joking they would rather attend the annual conference of something or other this year, in Hawaii, than next year, in Pittsburgh. I can't even begin to get this to compute, because of course I'd much rather prefer to go to Pittsburgh. I live near Pittsburgh. Even the way I drive, it doesn't take me long to get home from Pittsburgh. I even know some people in and around Pittsburgh. I travel for two reasons: to see people I already know, and to go to events that only occur at a particular place, such as job interviews, work related conferences or Scottish Country dance events. I can't even fathom going somewhere just for the experience of going there, Hawaii or otherwise. I've managed to learn the script, a joking "oh that's rough" when someone tells me they are going to a conference in some supposedly desirable place, and it's exactly that, a script, held together partly by a mental list of places other people consider desirable. Because if I had to go there, it would indeed be rough.

There are other examples, of course, and then there's the subset of the things I do like, but for the "wrong" reasons. TV doctor shows feature heavily into this. I watch them to dissect the medical plot but don't follow the romantic plot. And of course I don't notice that the main character is physically attractive until I read about it on the internet. I suppose I should save myself some time and start assuming all TV doctor protagonists are meant to be physically attractive until proven otherwise.

It's different, of course, when the conversational partner is already a friend who is telling be about some interest I don't understand, and is willing to actually explain it to me. I am interested in the interests of my friends. Of course, my friends understand that I might actually require such explanations.

Obviously part of the solution would be to keep my mouth shut, at least when possible, and to try to wipe the Lost Tourist from Mars look off my face whenever conversation about - well - almost anything arises. The alternative would be for me to study until I have something positive, or at least non-negative and non-ignorant to say about pretty much everything the world expects me to like and understand. I'll get right back to you on that one, in about 30 years or so.

Over the past six weeks or so, there have been a couple of anniversaries in my life I've been thinking about.

College: 10 years

Mid-May marked 10 years since I had graduated from Bryn Mawr and June was my 10th reunion. No, I didn't go. For one thing, I was sort of busy here with that internship thing. For another, the people I call friends were largely not my year. If I wanted to see Backsmokerites from across the generations, the thing to do would have been to attend May Day, not reunion, anyway.

In the ten years since graduation, I was hired as a special education teacher, taught for five years, started and graduated from medical school, and then completed my internship. That's longer than the amount of time I was at Bryn Mawr. Even my years teaching amounted to longer than I was at Bryn Mawr.

BMC remains a profound influence on my life. Or shall I say Bryn Mawr-Haverford? My years really did amount to a Haverford academic degree coupled with the Bryn Mawr social experience. There's not a day that goes by that I don't think back to some experience from the Bi-Co. I'm fortunate in that I took my education with me, as Mary Pat McPherson advised us "the purpose of a liberal arts education is to make the inside of your head a more interesting place to spend the rest of your life."

I can't speak for the whole rest of my life, but the inside of my head sure has had an interesting decade.

Diabetes: 2 years

Two years ago, on June 30th, I walked down to my FPs office after a couple of weeks of extreme thirst, blurred vision and weight loss and had a fasting accucheck of 388. The next day I went into DKA and spent a week admitted to the hospital where I was a fourth year medical student. Of course it was the first week in July and there I was admitted to a major teaching hospital, cared for by interns who had been doctors for a few days each.

How many times have I told and retold this story?

In my line of work I am always taking care of kids with Type 1 diabetes. And I've got a few colleagues with Type 1 as well, so one way or another Type 1 is never far from my mind. You notice I call it "Type 1" for short and not "Diabetes" because it's an uphill battle convincing the medical world that a person can develop Type 1 diabetes at the advanced age of 30.

My new endocrinologist calls it LADA. This is the pediatric endocrinologist I have been seeing since the only adult endo here fired me after a couple of months due to philosophical differences. I walked into the office of one of the two pediatric endos and asked if there was anyone else local she could recommend. She said "you weigh less than 50 kilos, why don't you just see me?" So I see her. Anyway, LADA stands for Latent Autoimmune Diabetes of Adulthood. It's a slow moving Type 1 that strikes adults. It fits in with my personal history of autoimmunity, and also with my father's adult diagnosis of probable Type 1, not to mention my long honeymoon.

I'm still honeymooning and it's downright frustrating. Honeymoon refers to the slow decline of pancreatic function in a Type 1 diabetic, down from slim to none. At slim, little blips of insulin get through every so often. At none, I can fully substitute my pump and my brain for my pancreas. I'm looking forward to none.

One piece of good news is, at 2 years post diagnosis, I've just about gained back the lost weight. Of course I still weigh less than I'd like. My current goal remains 100 lbs, although it would be appealing to get up to 50 kilos just to see if my endo would disown me.

I weigh and measure and count nearly everything I eat. Every breakfast, every meal eaten at home, every meal packed to eat at work. I ate out twice in June, less than that in May. I weigh cheerios and count grapes for pity's sake. So why is it that one morning I wake up with a blood sugar of 155, take insulin and eat breakfast and 2 hours later my sugar is 180, while the next day I wake up with a blood sugar of 156, take the same amount of insulin, eat the same breakfast and 2 hours later my sugar is 287?

Personally, I blame the Diabetes Fairy.

Med school: 1 year

July is the beginning of the medical academic year.

One year ago, the first of June, I graduated from medical school, waved good riddance and moved to West Virginia to start my residency. There's a few people I miss and I did have some good academic and medical experiences. But overall I'm more in recovery than in nostalgia.

So it was that on June 30th I was an intern and on July 1st I was a senior resident. Technically, second year residents are "juniors" but as the responsibilities are about the same, our program call everyone a senior who is not an intern. June 28th I was on call and running my major decisions by a senior resident. July 2nd I was on call and an intern was running all his decisions by me.

It's a steep learning curve.

Intern year is historically the toughest and in terms of hours and paperwork I don't doubt that, compared to the rest of residency. And yet compared to med school intern year was a piece of cake. Trusting the people you work with and for makes all the difference that way, in a position where I've long said the important things are patient care and self-education. I've sure cared for a bunch of patients and learned a great deal.

One year down, two to go.

First of all I have gallian to bl - that is, thank for Saturday evening. As soon as she heard I was moving to WV, she e-mailed me with the location of the nearest Scottish Dance group (2 hours north in Pittsburgh) and the nearest folk dance of any sort (Square Dance, here in town.) And I bookmarked the square dance website about a year ago now and then put it more or less on the back burner. Every so often I'd think that I should really check to see if there were any dance events coming up which I could actually attend. And then I didn't.

Until Saturday, May 31, when I clicked on the bookmark completely by accident and was met with a screen saying Square Dance May 31, 2008, 8:00 - 10:30 PM.

I had the evening off and was at physical baseline. No contraindications to square dancing that I could see. And - it was right there on my screen staring at me.

So of course after that I simply had to go.

So I packed up my asthmatic, diabetic, cerebral palsied self, loaded the address into my GPS and set off. At this point it became a contest which condition would "win out" or if I would emerge completely victorious.

I should mention my prior experience with square dancing. I took a semester of classes back when I lived in Delaware, after 4 years of Scottish. Unlike my 3 year steep learning curve with Scottish, I picked up square dance relatively quickly. Many of the figures were similar, so I had to just learn the new lingo and then translate not a whole new set of body mechanics. I should also point out this was about a year before my toe-walking caught up with my hips and my balance fell off the chart. But I've returned to doing Scottish reasonably successfully so long as I sit out a few dances here and there, so I figured I had a reasonable chance of success.

So I GPSed my way to the community park place where the dance was to be held and parked by some kids doing things on bicycles and skateboards that would have me in the nearest trauma center if I even considered them for a milisecond.

Years ago my lungs and I brokered a simple bargain. I keep them away from smoke and aerosols and pre-treat before exercise. They agree to tolerate a reasonable amount of exercise. So 15 minutes before the dance I pre-treated with the wonder inhaler Intal, complete with my long-coveted spacer device. The deal was upheld on both sides.

Next I checked my sugar before starting. 54. Not quite 2 hours after a meal where I'd weighed every component except the carb-free tuna fish. Ah diabetes fairy, what a great time for an unscheduled visit. I chomped down some glucose tablets.

I turned down the first dance because it was a contra. I've never formally learned contra, and I know it's full of swinging. I don't swing well. My general sense of swinging is that it's a chance to have a larger, stronger partner pull me into a high speed spin in which he or she has all the control while I get the opportunity to try not to topple over. Not quite my idea of a swell time.

So I joined up the next dance, a square. Well it had been a few years, but the lingo made sense. The body mechanics made sense. The progression of the dance, that experienced dancers were screwing up left and right, to me made sense. My partner kept spinning me under his arm after the promenade, which is not how I remember learning to promenade, not how I saw other couples promenading, and not something I could adapt to over the course of a dance.

And then the swinging. I didn't like swinging before, when my balance was decent. This was a nightmare. I managed to keep one foot on the ground and sort of push off with the other. Badly.

For my second dance I accepted an offer to dance with this guy who was using a wheelchair. prydera should have been there. He was clearly a regular there. I remember when I was a camp counselor trying to adapt some folk dance for kids with chairs and was pleased to see that, like I had predicted back then, it did just - work.

Well one of the obvious side effect benefits I recieved is that I was free of 50% of the swing scare. I still had the risk of being swung, wildly, by my corner but my partner and I merely turned each other around like civilized people. Still 50% was too much and I finished that dance with my legs in full rebellious mode. I wasn't about to risk them with another dance, especially a circle dance mixer, so I tucked them behind the legs of a chair and willed them into submission.

I watched a giant circle mixer try to fall apart at the seams, and then accepted for the next square dance. Swing swing swing. By the end of it I could barely keep upright during the swings. My one leg was planted on the floor as they swung me, and the other sort of paddling ineffectively on the outside.

It was 9:30 PM when I declared defeat. Which is a shame, because when I wasn't swinging, just having swung or just about to be swung, I was doing well and having a great time.

Asthma and I stuck to our deal, the diabetes and I declared a truce, but CP and swinging? For now I think I'd better stick to Scottish.

In medicine, Technologically Dependent refers to patients who rely on machines for life, if not minute-to-minute, than at least day-by-day. Some patients may use oxygen at night or all the time. Some use feeding tubes for some or all of their nutrition. In Philadelphia I met a pulmonologist who ran a program for children who were on ventilators at home. We cannot sustain such a program here in West Virginia mainly due to our geography. Children on home ventilation need at least two trained adults in the household as well as nursing backup, and our mountains just make transportation too unreliable.

But even if I don't need technology to breathe, I pretty much do need it to do everything else including the delivery of my insulin. And let's face it, I have a love-hate relationship with technology. If I see a use for it, I embrace if. If I don't see how it would improve my life, I become a virtual Luddite. Take a CD player, for instance. I don't have one. I don't need one. I don't want one. When I want to enjoy music, I pull out an audiocasette tape and put it into the tape deck in my car. And I'm pretty content to leave it this way until all my tapes break or all my tape decks break. Or my car breaks. I didn't even want a car originally. I wanted a horse and buggy, for years and years, before I conceded the impracticality of it all.

And then there's the technology I almost forget IS technology. Central heating. A refrigerator and oven. The microwave, crock-pot, food processor. How many years I resisted even getting a food processor until I had a list of specific things it would do for me. The dishwasher (the one that is not named Nightengale) and the washing machine and drier. Heck, the 17 alarm clocks. Since my last windup broke, they are all things which run on battery or power cord. Sounds like technology to me. And I've even acquired a vacuum that vacuums for me which is good for my back and my breathing.

But what I really want to talk about are my two really high tech gadgets. Things which, a decade ago, I could not even conceive of their existence, yet have changed my life for the better. One is my tricorder - I mean PDA. I posted about the wonder of such a gadget when I first acquired it and the wonders merely increased over time. It contains an address book with phone numbers, pager numbers, e-mail addresses and directions. It keeps my appointment calender, something I had never managed to do with pen and paper. It keeps my blood sugar numbers on an Excel spreadsheet which I can transfer onto my computer. In fact all of these things I can transfer onto my computer. I have a data base of medications including formulations and dosages, oh so important in pediatrics where everything is dosed out by weight. I can even write a patient note on it in a pinch. One of my residency mates refers to hers as a peripheral brain, and for a couple of hundred dollars and something the size of a deck of cards, that's not a bad additional piece of brain to have.

My latest acquisition, also about the size of a deck of playing cards, has widened my driving horizons immeasurably. It's a GPS device. The miracle of the GPS is not that it tells me how to get places. Googlemaps can do that. The wonder of the GPS is that it fixes my mistakes when I miss a turn or get into an exit only lane I can't get out of. Note the word is not "if" but "when." Because I do this sort of thing often, when driving outside my comfort zone. And I have a pretty small comfort zone considering I moved here 9 months ago. Point of fact, places I can drive automatically is restricted to work, home, the drug store and the nearer grocery store. I'm OK with the farther grocery store, contained in a complex with the book store and Target, during daylight hours only. Anywhere else requires concentration and when I drive it takes enough concentration to deal with things like speed and direction. A couple of months ago I got to Pittsburgh without a hitch in the 1.5 hours it was supposed to take, but took 3 hours of sheer terror to get back home because I could not find the freeway for love or money.

Panic no more. The GPS tells me where to turn, and when I err, it tells me how to solve my problem to get back on track. In the past month I have successfully gone to Pittsburgh and back, Arlington VA and back, and Charleston WV and back. If I turn the wrong way or miss a turn, a reassuring voice says "recalculating" and I know all will be well. I've even managed to explore downtown Morgantown which is not all that big. My only major prior attempt had involved my wandering around hopelessly lost trying to find my car before the meter ran out. Now I program my car's parked location into the GPS and take it with me on foot. I can follow it to any stores I've programed in (finally found the public library!) and when I'm done, simply follow it back to my car.

I still hate driving. I hate focusing on the road and the speed and the other drivers, and the being seated hurts my hip. I can't see myself comfortable driving in a city or a freeway at night any time ever. But for the local nighttime and long distance daytime driving, my hoizens have opened up big time. If the PDA is peripheral memory and my substitute dystonic hands, this one is my peripheral visual processing skills and a good treatment for my travel-related anxiety that is cheaper than therapy and relatively free of side effects.

I guess in addition to my insulin pump, I am otherwise medically technologically dependent after all. Not for minute to minute living, but for the making of the living better. And Luddite though I tend to be if I don't see the use, when I have a problem I'm glad the technology now exists to solve it. If only I could get the dishes to wash themselves. . .

Today has been declared Rare Disease day.

It appears to be a European phenomenon. Their website doesn't seem to reflect the sense of humor that must be involved in planning a recognition day on Fredrick's birthday.

I read about it on But You Don't Look Sick" which seems as good a time as any to mention in my irregular semi-annual repost of The Spoon Theory. As always I recommend this to anyone who is living with a rare illness or any chronic condition.

I'm not sure what criteria they are using to define rarity or if I would actually qualify. My diagnoses tend to be unusual but not out and out zebras - more on zebras in a minute. My real specialty seems to be atypical presentations of unusual but not out and out rare conditions.

To wit:

Type 1 diabetes at age 30. The incidence of Type 1 is about 0.4% in the general population. Onset in adulthood however is less common (although most of the Type 1s in my life were over the age of 20. Now my endocrinologist thinks I may have LADA, which stands for Latent Autoimmune Diabetes of Adulthood. People have heard of diabetes, some people have even heard of Type 1 diabetes, but who has heard of LADA?

Cerebral palsy, athetoid type. The incidence of CP is about 0.2%. Atheoid CP is currently only about 10% of that.

Hashmioto's Hypothyroiditis The incidence of this is about 0.3%. I am unable to find out how frequently it occurs in people who are significantly underweight but I suspect it is much, much lower.

The risk of having all three of these together I suppose would be 0.024%?

A word or two about Zebras. This is a medical slang term for a rare condition, especially one that is considered "interesting." The name comes from an adage that "When you hear hoofbeats, think horses, not zebras."

So when a patient arrives at the doctor having symptoms, say, a cough, we are encouraged to think of horses. "Common things happen commonly" is another adage. In a young person we think of asthma. In an older person perhaps we think of COPD. Our minds are not supposed to jump immediately to Alpha 1 Antitrypsin deficiency, or cystic fibrosis or even tuberculosis.

But someone in the back of our minds we have to have heard of Alpha 1 Antitrypsin. Because if you've never heard of it, you won't know it when you see it. In other words, if you don't know what a Zebra is, you can't pick one out of a crowd of horses.

And sometimes zebras have a certain appeal to a medical student or resident. The genetic mechanism of CF is kinda neat. The genetic mechanism of asthma is. . . well I don't know anything about the genetic mechanism of asthma actually.

Having a Zebra makes a person medically interesting. Or at least their signs and symptoms are medically interesting. We call medical students into the room to see the patient and grill them on the pathogenesis. But it also makes one a medical liability. I've heard of Alpha 1 antitrypsin deficiency, learned about it in med school. 20 or 30 minutes of lecture were devoted to it, even. But it's asthma that I see every day, know the common medications and their dosages off the top of my head.

Even explaining Type 1 diabetes and an insulin pump to health care providers can be exhausting at best. Explaining a truly rare disease to your doctors who have never heard of it, or who remember a vague mention in a vague lecture some five years earlier is not just exhuasting but sometimes downright dangerous.

Common things happen commonly. So we learn about heart attacks and Type 2 diabetes and flu and asthma during our clinical training. But rare things do happen, and taken in aggregate they don't happen all that rarely. I've seen Rett's Syndrome more than I've seen appendicitis, although with my personal history I may not be a fair example.

I don't like surprises, so before I go into a patient's room I spend a minute or so collecting any information I can get about who the patient is and why he or she is there. Sometimes all I have to go on is an age and vital signs, but a little digging brings a chronic condition to light. And sometimes I learn that the patient has a condition I've never heard of or was only barely mentioned in my training. I try to jump on a computer and hit the highlights before I walk into the room, mainly so my questions to the patient will make sense. Occasionally I have suprised a patient who has never before encountered a doctor familiar with Charcot-Marie-Tooth or Cyclic Vomiting Syndrome. But having heard of a condition is in no way a substitute for being comfortable with the care of a person who has it. And ultimately I am going to be left with more questions than answers, which is horridly unfair to the patient who comes to me for help.

Having a chronic illness places a burden on the patient to become an expert in her or his own condition. This is true with common as well as rare conditions. I learned about Type 1 diabetes in medical school but the practical knowledge I've gained comes almost exclusively from my own experiences. Which is great when I go see a patient in DKA, for me and for that patient's care. But when I see someone with Type 2 diabetes, a very common condition, the patient is on his or her own to tell me what medications are taken and how often and what blood sugars have been like. Some of my patients can rattle off this information and some take "a white pill in the morning and a blue one at night, or two if I need it." And still the patient and I are fortunate I know what questions to ask, some idea what the white or blue pills might be. If the patient has a condition I've never heard of, who is truly helping whom?

And is there any way to help optimize our care of our patients with rare diseases besides increasing medical school and residency to about 10 years each? And any way for those of us living with rare conditions to help optimize our own care without having to go through medical training ourselves? I haven't any good answers. But I think an awareness day, if medical professionals were actually aware of it, might be a good start.

Along with all the other residents in my hospital, I have been enrolled an irritating series of e-mails designed to help with my future career plans. They encourage me to start thinking about what sort of practice I want by asking myself a series of deep probing questions. On the latest e-mail was this gem:

5. What Are My Preferences Regarding Scope Of Practice?

a) I would like my practice to be ambulatory-based only.
b) I would like to include an active hospital practice,
c) I would like to include practice in a skilled nursing facility
d) I would like my practice to include obstetrics.
e) I would like my practice to include surgery.

How about f) I would like to be a Developmental Pediatrician, which is an outpatient specialty with no procedures by definition, practicing in an academic setting and on salary. I am thinking of doing mostly autism, with some NICU follow-up, possibly participating in a spina bifida clinic. I need 2.5 more years here, then a fellowship in Developmental-Behavioral Pediatrics, then I don't need to figure out what kind of job I want, I need to figure out who HAS the jobs. . .

But I have, in the past few days, made one very firm career decision.

When I finally have my own office or other designated workspace, the following notice will be posted prominently:

"Surprise Policy: All surprises must be cleared by Dr. [Nightengale] at least 24 hours in advance. Last minute requests may not be honored.

Example the first:

As a habitual toe-walker, a few weeks ago I dropped a jar from top of refrigerator onto my toe and fractured it.
(It's fine now. I only sought medical care because I thought it might need stitches, not because it was acting broken. It didn't need stitches and I'm sure it's healed up by now.)
Also, the first few days after breaking my toe, it didn't hurt much. What hurt? My shoulder. Why did my shoulder hurt from breaking my toe? Why, from putting more weight onto my cane in an attempt to keep off the toe, of course.

Example the second:
My computer's e-mail program would receive e-mail but not send.
Finally I called Comcast to check settings.
The "Send" setting was entered correctly.
The "Receive" setting was entered incorrectly.
I fixed the "Receive" setting. The computer now sends e-mail perfectly.

Example the third:
A nurse tapped me on the shoulder, and I startled and fell, for the first time in months.
The reason the nurse tapped me on the shoulder? My shoelace was untied.
And she was afraid I would trip over it and fall.
The ultimate in irony? I have never tripped over a shoelace in my entire clumsy 31 years.
In fact, today was the first time I think I've fallen because of a shoelace. Oh well.

The patient is a 6 month old Dell laptop who presents with a 3 month history of progressive internet difficulties. Three months prior to admission the owner noticed that her e-mail program, the new generation of what used to be Outlook, no longer sent e-mails. It still recieved e-mails from both her commercial and medical school accounts, and her commercial account allowed her to send mail through webmail.

In addition, approximately six weeks prior to admission, the owner noticed difficulty remaining connected onto the internet. In the course of an evening she would get logged off several times. Rebooting the computer or modem had no effect, nor did switching to a new ethernet cable. Unplugging and firmly replugging the cable provided temporary episodic relief; however the problem progressed until the computer no longer got any internet signal from the modem. It would still pick up wireless sporadically, however this was not reliable as a permanent means of internet access.

Past computer history positive for a difficulty with modem installation upon moving in June, where the owner had to uninstall and reinstall the modem drivers for the modem to work. (The intial modem in April installed without difficulty and worked with both USB and ethernet cables). Also she has been entirely unable to install the wireless router which arrived with the computer in April. Multile attempts to install the router have not only been unsuccessful but have prevented the computer from using ethernet to communicate with the modem. Only by uninstalling and reinsalling the modem was the modem able to work with ethernet again.

On review of systems, the computer's screen, keyboard and harware not related to the internet appear to be functioning within normal limits. All software besides e-mail are also functioning normally. The owner denies any trauma to the machine and notes that it has been carried around considerably less frequently than any of her prior computers.

Social history reveals an owner who is reluctant to be separated from an otherwise functioning computer for any length of time and worries about the many hours spent in the medical school library for internet access during this admission.

The computer, modem, router and assosciated cables were admitted to this hospital's Help Desk on Monday for further evaluation and treatment.

Still working on some posts I've been thinking about for months. . . but for this morning:

1) I have a job I like and that seems to like me. It's kinda amazing to feel safe at work. It's not perfect, I don't love every minute of every day (I have a low tolerance for doing "sick visits" solely for gardasil, for instance, and waiting 5 hours in clinic between patients) and I don't adore everyone - but that's OK. Work isn't about loving every minute of everything - that's rose-coloured spectacles. It's about generally being content in a generally healthy place and I'd say those things are met in spades. The only things I really have to worry about are patient care and learning, which is as it should be.

2) My long-time dream of a website for doctors, medical students, premeds and other health professionals with disabilities is a reality! We have webspace hosted by a new disability wiki, message board space and as many wiki pages as we want to create. (The link, Doctors with Disabilities on this page. The beauty of the wiki format is that anyone involved can update in their CST. Which is good because med students and residents have ever so much of that.

3) As promised to myself back in Feb of 2006 I now have a vacuum which vacuums for me, purchased with my first month's earnings. So far it has needed redirection a few times (getting trapped under my couch and such, or getting my hair caught in the brushes, sigh) so I don't think I'll be leaving it alone in the house any time soon. But just the prospect of having a vacuumed floor without aerobic labor and medium-lifting. . . Amusingly, on the same day I brought it home, there were new articles in both Wheelchair Junkie and Disapedia about the wonders of Roomba.

Because everything else is exclusionary, including Chrismahanakwanzasolstiyulmanay which also has too many syllables.

WHOC stands for Winter Holiday(ies) Of Choice. I think I'm one of the people who coined it, circa 1997. It was a joint venture, at any rate. And I'm trying to get it to stick because I think it solves a lot of problems. It solves the problems of people who celebrate one or more Winter Holidays that may or may not be the most common or expected ones. It solves the problems of those who celebrate one Winter Holiday but associate with those who celebrate a different one. It solves the problem of not knowing what Winter Holiday another person celebrates, and so not wanting to say the wrong thing. The only real problem I see remaining unsolved is that of people who celebrate no Winter Holidays at all and I'm open to suggestions on this one. This isn't a problem I've personally encountered.

WHOC encompasses the Winter Holiday Season, which runs at least from the day after Thanksgiving (US) through Twelfth Night, and I'm considering an extension through Chinese New Year and/or Imbolc/Candlemas/Groundhog's Day. I could also be persuaded to start it early enough to include Diwali

WHOC-friendly greetings include "Happy Holidays" or "Happy Winter Holiday." Gifts can be given labeled "Happy WHOC." One can say "I'm going WHOC shopping" or just "Winter Holiday Shopping." Time off from school is for Winter Holiday Break or just Winter Break. We call the others Fall, Spring and Summer Break, after all. Greetings like "Merry Christmas" can and often should be given to those who are known to celebrate Christmas. Similarly, "Happy Hanakuah," "Happy Solstice" and "Happy New Year." I guess my point is that one should either know someone well enough to know her/his WHOC, or just give the generic greeting or gift.

For the record, my WHOC is Hogmanay.

Less important is what it ( isn't, and why. )
Happy WHOC, whatever you C!

Current Mood: thoughtful

My bedroom is clean, including the closet, but not including the bookcase that needed to be emptied, glued back together, duct taped back together and re-shelved. The glue is still drying. Also, there's something wrong with the glue - it is way too watery. I'm trying to heat it up to improve its viscosity. /Elmers Glue geekery

Any idea what can be used to replace lost shelf pegs?

Any sane reason why I should continue to keep a c1996 "Macs for Dummies"? Keep in mind I haven't owned a working Mac computer since c2000.

The cleanness of the bedroom does not include vacuuming.

Nor does it include sorting through CDs, which I can do at home, and floppy disks, which I can't.

OK, maybe the bedroom isn't clean. But all the clothing is put away and all the non-bedroom stuff has been relocated. So there. Furthermore, my laundry is caught up.

24 hours ago I would have said my dishes were also caught up, but now there seems to be a shortage of spoons again. Literal ones. The figurative ones are doing OK.

I expect the kitchen will be clean by the end of the day. Until I, you know, go into it again to 1)cook and/or 2)eat.

Any ideas, besides old-fashioned elbow grease, to get burnt lentils (and I mean burnt) off the bottom of a formerly but no longer non-stick pot?

The bathroom needs to be cleaned. Especially since a bunch of items from the bedroom were (correctly) summarily moved to its counter.

The living room needs to be cleaned.

And vacuumed.

The first thing I plan to buy when I start earning money again (1.5 years hence) is one of those vacuums that vacuums by itself.

But it looks better than it did when surgery was swallowing me whole.

The deadline for the basic room-cleaning is the beginning of WHOC break.

The deadline for everything, including video sorting and paper sorting, is the end of WHOC break.

I'm writing it down here so that the public declaration will guilt me into following through.

Also today I discovered Athena's Web. Other Mawrter alums (who aren't there already) should consider stopping by!

Also today I started researching residency programs so that someone will hire me 1.5 years hence and I can afford a robot to vacuum for me. Also so I can afford food, heat, meds and transit tokens. So far I've located 69 programs within my tentative geographic boundaries. And I've begun The Spreadsheet.

All in all, a productive day, with quite a few hours left in it.

Current Mood: tired
Current Music: "69 residency programs on the spreadsheet. . . "