Merry Christmas Everyone

I've had a particularly busy November-December. Something happened, though, in December, just 5 or so days ago , that completely changed my outlook on life. Or so I'd like to imagine.

Residency has been going "fine" so far, but I had been feeling very anxious about getting enough reading done and doing a good job etc. and one of my seniors sat me down and tried (probably successfully) to set me straight with the whole "relax, everyone goes through this" speech. Then I decided to drive home the next day, and I crashed my car.

I was passing someone in the left lane, and the guy wavered toward my lane, so I nudged my steering wheel and my car started to slide (freezing rain pouring down this whole time, on the highway). My car first veers to the left, then I try to get control of it and it veers off dangerously to the right. It hits a mound of grass on the side of the road, and from there I'm really not sure what happened, all I know for sure is that I didn't black out. I just squinted hard, gripped the wheel and stared forward, and apparently the car flipped on its side for about 60 feet or so before landing on its wheels. I looked around when I had stopped but I couldn't find my phone. Some random people came off the highway and ran down to help me out. They called 9 1 1 and cut out the side airbag so that they could see how I was doing. Firemen came, ripped the driver's side door off so they could pull me out onto a stretched (collar and all, no injuries though) and paramedics took me to the nearest hospital.

I was discharged that day with no injuries and a negative CT scan. Minor concussion. This accident added a lot of perspective to the worrying I did for the first 6 months of residency, where I felt like I simply couldn't do anything right. If it were a smaller car, I may have been more seriously injured, or dead.

I'm not sure what will actually happen now. I want to say I'll change my worrying ways completely, and I'll start eating healthy , and I'll start exercising, but all of those things don't happen together. At the very least, for now, I should acknowledge that, if I can survive a car crash, I can survive a tough month of rotations with attendings making mildly dissatisfied remarks and making comments like "you have to know this" or "you guys should go home and read about this stuff", because on a tough rotation like ICU for example, the best play apparently is to just go home and sleep. "best" in the sense that it's the play that avoids burnout. Burnout is something I have to stay away from, I'm very near to it, and rest/reboot is the only cure. If there's no time for rest, the only way to avoid burnout is to effectively handle stress. If anyone has had any revelations on how to effectively handle stress, I'd like to hear them. For now, I'm just going to take a few seconds extra when I feel things starting to build, and once I acknowledge they're there, I'm going to stare down my stress until it dissipates. Clock time, not psychological time. Eckhart Tolle. Let's see how far that gets me.

Merry Christmas guys.

The Low Points

Many people look back on their lives and sometimes say "That was the low point". Well, for me the "low point" as it were seems to cycle every so often. I'm very unhealthy about what I eat, I'm very unscheduled about what time I wake up, whether or not I perform my morning or night routines, I barely exercise, and I'm generally unenthused about my job. Life has been this way for a bit over a week now, and I feel as though I'm being followed everywhere I go by an overwhelming feeling of pointlessness. I feel, at times, as though there's some eternal understanding that, whatever I do, I'm going to stay fat, I'm going to stay ignorant, I'm never going to learn everything I want to learn, I'm not going to be able to rise to the occasion, and I have managed to succeed and achieve whatever I have achieved mostly because of luck, randomness, having a good personality, the kindness and relatable nature of others, and other nonsense like that.

That's all a bunch of baloney. I need to snap out of this. The problem is, even if I do start waking up early, exercising, eating right (I have enough healthy food jammed into my freezer to last me a while), taking more care to perform my morning and evening routines (which, honestly relate more to shaving my face and brushing my teeth than any longer rituals that others would imagine), what's to keep me from hitting a psychological slump in another 2 months time and failing to take care of myself? I will have put back on all the weight I took off (I'm 142 now, slowly creeping upward) and I will have once again done a great injustice to my body, my mind and my way of life in general.

My greatest issue right now is, sadly, that I have to find something to make me want to stay sharp, physically and mentally. I don't feel like staying sharp physically because I don't see why I should if my shoulder tendonitis is going to inhibit me from pushing my body to the max...but I can still push myself and get a tough workout in without aggravating it. I'm pretty sure I can anyways. Pull-ups are difficult for someone like me. One would think being a doctor would prompt someone to know everything about everything, but the task is extremely daunting, especially when everyone around me appears to know more than I do, about everything. That doesn't mean I should stop reading altogether though. It actually means I should read more. But I don't.

Eastern philosophy teaches not to work for the sake of results. It teaches to find purpose in the work itself, to be dedicated to the process. More of a "Journey not destination" type thinking. Either that or I'm misinterpreting things entirely. "We must be the same in praise and in blame" and "Be mindful about everything you do" echo in my head. I guess it's difficult to be mindful about something if I choose not to do it. What if I'm mindful about how I use my time? Might that help?

Two hours ten minutes

Giving birth is one of the most unglamorous things to which anyone can bear witness. A woman is forced to bear down on a group of muscles that force a 6 and a half pound human being through an otherwise deceivingly small orifice. I do not believe the brain can isolate the necessary muscles required to do just that, which is why half the women I've delivered in the last week on obstetrics service defecate on delivery. Again, unglamorous.

It's more or less the same as any other tough rotation I've had (they have, quite honestly, all been tough so far). I don't know as much as I probably should by now, the other residents are likely better than me, I'm not getting any extraneous reading done, and my feet hurt every single day. Significant changes have occurred in the time surrounding the rotation, though. I have been forcing myself to work out after work for the last 3 days. I've been eating well, I even played my guitar last night. Tonight I might do some reading if I manage to quickly arrange my patient data for Wednesday's clinic, so that I have a good idea of who I'm seeing before I see them.

This may all have something to do with me having just had a birthday. It was my birthday on Saturday, and while there was much partying on Friday (honestly it was more tame than I expected, but most people had to work the next day, residents on call and whatnot, and I don't drink), Saturday was spent in personal reflection over the year as a whole, the start of residency, and how I should proceed if I'm to live to see another 73 birthdays (I forgot to mention, the goal is to live to 100).

I may have had some of these thoughts while on vacation. I've noticed I've managed to reign in a lot of my "stress" feeling, and replace it with "yeah, okay, cool" feeling. As in "I don't know, and that's fine, and I'm doing my best" sort of thing. I think it's called positive thinking. It's quite the concept, I'm just starting to wrap my head around it. It doesn't mean I don't care about what happens, it means I try to be more confident that I can roll with changes and acknowledge my shortcomings and deal with them like a man. It's more or less believing in myself, if I had to rephrase it for the fourth time in 6 lines of type.

I seem to be fairly good at racking up deliveries. Thus far I've assisted in the delivery of 6 children. Obstetrics is very different from other services in that patients generally don't have a multitude of chronic problems. If they do, they're handled by the "complicated delivery" group, with whom a lowly family medicine resident like myself doesn't work. Others will have some obstetric issues, but there are only so many of those (and yet I still don't know them all, but I'm not worried about that!) On inpatient family medicine service, most of the patients in the hospital will be 75, 70 , 83, 64 , 58 years old, and will have ruined themselves with poor choices. I came out of the labour room exhausted Friday afternoon, ready to soak my feet in one of those whirlpool foot baths (no I've never done it, it just sounds soothing for some reason) and I made my way to the computer to write my note. Patient name? Baby boy blank. Room? Same room number as the mother. Age? Two hours and ten minutes.

End of vacation

72 hours remain before my obstetrics intern rotation, which is supposedly one of the more difficult rotations I shall have in first year. im glad im getting it over with early, and I suppose I should be glad it came after vacation so that I may be "fresh" for it in a sense. I am, however, not looking forward to having to essentially beast the next 9 months nonstop (and more months in second year following that, assuming my two weeks in second year are more appropriately placed). I spent my vacation at home in Toronto, doing absolutely nothing all stinking day for about ten or so days. nobody was home so almost all time in the evenings was spent with  my parents. I liked this vacation because, as I may have previously commented, im not that big on travelling. having said that, there is a vacationto cuba tentatively planned by one of my friends' brothers for May, and I may be trying to get in on that.

there are a few things on the docket for today. the car is in servIcing right now so im being really good about time management. Then I have to pick up my new lever action orange juicer (bed bath and beyond refunded the old electric squeeze juicer even though it was 90 days post purchase) and then I have to finish cleaning my house and have to buy some groceries because I promised a woman a european brunch after our bike ride on saturday. I've been to Europe and I still am not 100% on what that entails. We may have eaten too much pizza while we were there. Oh yeah, and I have to work out. Bought a new doorway chin up bar because I lost the bolts for the old one. if I dont end up using this one its gonna be a laugh and a half and I may end up returning it. if I do end up using this one...beach body for Cuba? Great abs are made in the kitchen though. I would be more interested to see how long my master plan of chicken and salad lasts. A dutch scientist in the news recently commented that sugar is one of the most dangerous drugs of our time, so im going to see how long I can forego it. I say this while realizing the machine squirted some sort of flavouring into my coffee . No good can come of this. Well, maybe some good.

When they gave me this pen

I'm on vacation at home right now. I'm not a big jetsetter/traveler type, I'm more of a relax and reflect type with my vacations, I like to use spare time to get my mind and my environment in order. Standing in 2 hours worth of line to make a flight on time, getting ripped off on cabs and having to recover quickly from jet lag isn't exactly my idea of relaxation, but for many I can see the appeal because I'm sure it's quite exciting.

In November, I'll be on house medicine again, and will have to decide whether to take off the weekend of my friend's wedding or the weekend of my parents' visiting. Perfect.

While I was on night float, a patient came in with his family. He was an older gentleman, very nice man (a rarity to find kindness and gratitude in the North American patient in this day and age) and he was dying of metastatic prostate cancer. In the last month, he had lost 15-20 pounds, had become more depressed, and had a resurgence of back pain. He had not been taking his pain medication as prescribed because he was "not big on taking medication" apparently. He was somewhat anemic, for which our hem-onc department was going to likely transfuse him in the morning, we were just there to control his pain overnight. As soon as we gave him his regularly scheduled medication his pain was adequately-enough controlled for him to sleep, but that wasn't the reason for which I mentioned him here. My interaction with this patient marked my first advanced directives discussion in my medical career. I went over everything on the hospital advanced directives checklist with him; Intubation, mechanical ventilation, these drugs, those drugs, chest compressions, defibrillations, pacing, placement of lines, surgical intervention, everything. The only things he didn't want were intubation and ventilation.

When I got into residency, I was gifted a black Cross ballpoint pen. It's nice and heavy, and it writes well. It's probably only worth about $45, but for a pen and for me, that's a lot. I always imagined myself signing various different things with this pen; prescriptions for patients when the EMR was down, car and house documents, medical office papers, medical license paperwork to be submitted to some regulatory body, personal cheques for important things or extravagances (which, in my life so far, have been few), etc etc etc. I never once thought, when they gave me this pen, that I'd be lending it to a dying man to sign his end-of-life in-hospital emergency decision checklist. It was a tough conversation. It also had to be done, and as far as I was taught, it is always best done by a physician.

Two months down

Two months of residency finished. Several truths have been revealed.

1) In residency, there is often work to be done after you official work period is over. I'm in family medicine, so for me this means finishing notes after clinic is done, or when I'm in inpatient medicine, going home and reading about patients that were admitted. Preparing for presentations is another thing that takes time, but at least in that aspect I'm actively reading and learning.

2) In residency, there is always paperwork and phone work to be done. My program is good in that there is no dictation, and also good in that there are electronic medical records that make handling of actual papers for note completion unnecessary. The problem is there's this thing called an "In Basket" on this one EMR program called "Epic", where random tasks are assigned to you every single day, and you're supposed to check the in-basket twice a day, a task which is impossible on night float, my current rotation. In-basket messages can involve simple things like "Authorize this refill" or it can involve complicated tasks like "Fill out this form" or "this person wants their electricity turned back on. Assess whether or not they have a medical need for it and then act accordingly." This often involves calling patients back and telling them "no" and then dealing with the belligerence of broke people who would rather abuse the system than contribute to society.

3) Residencies see even the worst patients. When I say "the worst patients", I don't mean just patients who have complicated medical problems. I mean patients who behave like scum. Patients who don't care that there's a nice doctor willing to help them, and that the doctor is trying the best they can, etc etc etc. I've interacted with two racist patients in the past month alone (I was born in India) and I only hope that I can one day obtain what my chief has : "alligator skin".

4) Everyone in residency has been through what I've been through. If I stay my course and push myself enough but not so much that I feel depressed and overworked, I'll do well. I landed a residency full of good seniors. Possibly some bad seniors, but mostly good ones. I plan to make the most of it, and if I'm not the best then so be it. Doing my best for myself and doing right by myself is all I can ask. So far, though, I'm the chief resident's dark horse to make intern of the year. If I don't get it, I don't get it. But it's certainly motivating to hear things like that every now and then.

Residency week 4

This week was our final week of unofficial orientation, the residency in which I am likes to put people in the shallow end before throwing them into the deep end. It's nice to know that one month of residency has been successfully completed, but I shudder to think that, next month, I'll be doing everything "for realsies". I'm going to do my best to clear as many questions as I can on the online question bank (something that every medical student reading this, if any, should get used to) and I'm going to try to chalk out time every day for reading. I'm not sure whether or not my great magnificent idea of commuting to work by bike is actually going to work out, but I intend to start riding in tomorrow and I hope it does work. It would be so legendary if I rode in every day, and I would lose so much weight.

I found a new app for calorie counting, something I seem to wax and wane myself into every now and then. I guess only time will tell how long that will last, though it seems as though it will last longer this time because I don't seem to be eating a great variety of food.

We went to the club the other night ( something I shall not be doing again for a while ) and I got a sense of how others feel when they are in my shoes. One of my friends was entertaining a visiting friend, and they were both drunk upon entering the club, a club that the first friend had suggested. Then this guy's friend gets drunk and leaves, and starts walking around outside. My friend was forced to pursue him, and then, upon leaving, I learned that they had left the club for a good hour. I didn't have all the information because I was angry at them for suggesting the club (to which I did not initially want to go) and then leaving shortly after making us all go in.

I couldn't believe when my friend told me that he was fine, and his friend was really drunk, and he had spent the entire night just taking care of that guy. He was not happy with how his night went, but that's how every night goes for me. I hadn't noticed how irritating it could get.

Residency week 3

Last week was a whirlwind.

Productivity-wise, I am at least 15% better at typing up notes now and navigating the system. Things are taking less time than they would otherwise take.

Bike-commuting-wise, I still haven't officially begun commuting to work by bike, which is something I plan on starting July 29th. I have, however, managed to sink even more money into this endeavour. I returned some stuff and bought some other stuff, will only provide details on everything if it actually works out for more than two weeks. I'm going to park my bike in the resident's lounge instead of locking it up outside, which brings me to my next point.

I've started to cut myself more and more slack as this last month has progressed. I'm still reading, but not stressing about it as much as I previously did, setting impossible goals. Now, if I get something done, good. If I want to get some sleep instead, that's fine too. The main current concerns for me are organizing my readings around whatever patients I am to see in clinic the next day, or around whatever patients I am to follow in hospital; pathophysiology, management algorithms, co-morbidities, side effects of medications, reading up on any relevant diagnostic tests, and even going through the patient's file and reading about how different radiological scans are interpreted. Nobody in this residency is out for blood, nobody wants to see me fail.

I have spent more money this week than I would like, but it honestly has just been for the picnic that we are having on Wednesday. It amuses me to envision returning all the picnic-related items at Target. I think I will need to bring a shopping cart to my car to fit the 5 chairs, the poker chips, the table,...I don't think we'll be playing with the poker chips though. I'll just set it up on S Note. Which brings me to my next point.

I bought my device. It's the Samsung Galaxy Note 8, and I hope to use it for absolutely everything possible. I just realized I may have forgotten to buy a screen protector for it.

I finally completed all my assignments for my first month, so now there's just reading remaining. Reading and reading and reading...

Today the Medical Assistant came up to me and said that a patient walked in to schedule an appointment with the clinic. When asked if he had a preference for whom he wanted to see, he specifically mentioned my name and said that he only wanted to see me. I guess I'm still doing some things correctly.

Residency week 2

I just finished my second week of residency, and this week was mostly clinic. It was considerably more difficult than I thought it would be, because I didn't realize how much research a doctor actually has to do every time they encounter a new patient in clinic.

Whenever we have a new patient in clinic on our list, which right now would mean any patient at all since we are new to the practice, we have to go onto our online database and dig up every test, every hospital visit, every medication change, every single shred of information in this patient's medical history that we can find. That way, when the patient actually arrives in our exam room, there should be no surprises, or minimal surprises anyway. These patient lookups take me quite a bit of time the night before, and some days end late since there are a variety of things to do in the evening. Sometimes there is short call at the hospital and sometimes there is duty at the free clinic, so the scenario arose where I came home around 8 45 pm and had to chart-review 3 patients for the next day.

I haven't been keeping up with any of my actual medical reading because there's been all this clinic research and scattered other things to do, so the plan for next week is to do all the research today (based on however many patients are already posted on my list) and then, during the week, have time to review medical knowledge as the need presents itself. An additional problem is that I am not getting everything done despite having only one patient to see each hour, so I'm trying to work out a better system for that. So far, the best I have managed to come up with is

1) Start the skeleton while the patient is being roomed and then
2) Walk in and start blasting out an HPI and PMH while simultaneously talking to the patient, and then obviously review all the meds and problems with the patient, then
3) Do as much of the note as possible based on a skeleton so I don't have to type anything fresh out.
4) After 30 minutes (really hoping the first three things get done within 30 minutes) precept to the attending and tell them only the History of Present Illness and Past Medical History relevant to the problems that have to be dealt with by us, at this visit
5) Furiously copy down the plan in its entirety and make to-do check boxes for all the orders to be placed 6) Place all the orders quickly while the attending is talking to the patient.

I went out yesterday and, despite the usual shoddiness where eligible females are concerned, managed to land the number of a human resources manager, who thankfully was only 1 drink deep at the time. I don't know if we'll actually end up going out, but for some reason my friends were very impressed, borderlining on shocked. We'll see if anything happens with that, will update either way.

Residency week 1

The first week of residency is nearly done, and it rolls right into the next week. I was on floor duty the entire week, and managed to learn just how much procedural knowledge is required to become a functioning resident on a medical inpatient unit.

I have this tendency to not observe the order behind things; when a 1st year resident is allowed to speak, when they should, to whom they should speak, what they should mention, etc. I've managed to keep that in check for the most part today simply by stopping myself before I say anything and by placing a premium on whatever I say.

I don't know everything about my patients, and anyone who's following this who's in the medical field will tell you that, in medicine, it's imperative that you know everything that's going on with all of your patients. If you have been assigned a patient, the senior should not know more than you do about a certain test that was ordered for the patient, or about a consult that was put into the chart, or anything for that matter. You should have all the raw data available, so that you can hand it to your senior and your attending who will, in turn, teach you valuable medical knowledge that you add to your knowledge base. Hopefully.

The toughest thing for myself and my colleague to do has been to balance basic intern duties (writing notes and reading about diseases) with other incidentals that fly in our faces (admissions, floor calls, fall codes, code blue scenarios). This juggling act is at the very heart of residency, and it's something I plan to polish tomorrow with an early start in order to get my readings done in the morning before I head to the hospital, and a fresh to-do list with plenty of space on it for additions and cross-outs. That and the detective work I have to do every time there's a new admission, those are two things that I could really improve on the most.

I ran to a code today and ended up doing chest compressions. She didn't make it.

Sober Balls

I've been out last Friday night and the Friday night before that. On both occasions, I'd be out with my residency friends and they'd be drinking heavily while talking to tons of women, grabbing them on the dance floor and grinding on them, and occasionally getting a number. I don't really operate that way, so I didn't do any sudden grinding (for lack of a better term), I didn't talk to every woman who crossed my path (though I did talk to a few), and I didn't get a single number. Honestly, out of most of the women who I saw in a specific club, bar or other venue, I wasn't sure I'd get along happily with them since, being drunk first of all, they were in a completely different state of mind than I was and secondly, although some of these women were indeed quite attractive, going to a bar and dancing with men to get free drinks out of them doesn't seem like a hobby I would want a future wife to have. That's what I'm after, by the way, a relationship that one day (years into the future) leads to marriage. I'm not really after flings or something casual, because I guess I'm tired of it at this point and I would rather move on from that. My friend did this thing after we exited the club where, still considerably drunk, he walked out onto the street (and I would roll the car with the other three guys in it, watching the spectacle unfold) and tried to talk to every free woman or group of women on the sidewalk. When drunk, he had zero approach anxiety, and to be honest I thought this to be a fool's errand because I thought most of those women would just be trying to get home. Turns out at least one of them (a first year internal medicine resident at some other program in the area) gave him her number, and may or may not pick up when he calls (assuming he hasn't already called).

On the drive home, I started to doubt myself after seeing the success my friends were having with women in the club, however superficial it may actually have been. I wasn't interested in what they were achieving but I nonetheless had to repeatedly tell myself that it wasn't my area of expertise, it wasn't where I was best at picking up, nor was it full of women who were 100% amenable to conversation.

I thought about it a bit more the next day, and that evening (yesterday evening) I went to a greek food festival. The day itself leading up to the greek festival was quite shitty in general, because everybody cancelled for this afternoon in the park I was planning, and then I went to the hospital to put things in my locker and discovered I couldn't park my bike as close to the entrance as I wanted to park it, meaning I'd have to plan on going there earlier. Then I was already late for this greek festival, so I drove out and hit a closed road. Taking a ten minute detour, I hit ANOTHER closed road. Either my GPS was incapable of maneuvering around these things or I hadn't figured out how to program it to avoid them, so I just ended up coming back home and then heading out to the greek festival, showing up an hour and a half late.

Upon arriving there, I noticed my friends were in line and hadn't eaten yet, which made me think I wasn't inconviently late, but still very much so. If they had already got their food, that probably would have been quite bad.

While we were in line, my friend was eyeing some rather attractive women of the right age (I found it impossible to tell which women were too young and which were too old) and decided we should try and talk to them. However, he was unusually nervous about where to sit so that we could end up talking to them. At first, some seats near them were not taken and some were, so we ended up actually doing this massive loop around the entire eating tent before we actually went and sat down next to them. I was confused as to how the guy who would walk up to women on the street and start forcibly introducing himself to all of them was all of a sudden disinterested and hesitant to talk to four beautiful women who were sitting at a table all by themselves. We sat down, and he didn't say a word to them, just started eating. I figured hey, this guy's the man, he's gonna sit down and in ten minutes he'll have everybody eating out of his hand. Nothing happened, neither him or my other friend, both guys who were bragging about how well they were doing at the club, neither one of them said anything to these women.

I realized, at that point, that this was where I have historically done best. This is the classic "Day Game" scenario, where you meet a woman who is most likely sober and it's the middle of the day and there's no loud music playing. This is where I was previously most successful, so I figured hey, now's my chance to show these guys what I can do. Every interaction normally starts with an opener of some kind, something funny or interesting to break the ice. If nothing comes to mind, it can be just "Hey, I'm _____ and these are my friends" but I've found those to be less successful. I have the most success with the situational opener, that's where there's something about the situation that's particularly amusing or interesting and you point it out. I went "excuse me" and I asked all four girls which of my two friends actually looked greek, and before they could answer I asked them which of them were greek. Then after some negging and further jokes, I introduced all of us and they reciprocated.

Where this could have fallen apart (and classically does) is where everyone reveals what they do for a living or where they go to school, and at that point I normally try to make either funny or interesting comments about it, usually I say more thought-provoking things to which a woman would react. When drunk in a club, a woman doesn't normally react amazingly to stimulating conversation about her work. Surprisingly, I carried through with this point-of-no-return per se, and subsequently got it to the point where the women around me started asking about us when there was a lull in the conversation, like we were the ones being picked up. At least for the first ten or fifteen minutes, I was more or less the only one holding these women's attention. Four gorgeous women and I was fearlessly negging them and joking around with them. One of them left to continue the work she had to do for the event, and then I continued talking to three of them. Then my friends joined in and the 6 of us ended up talking for 2 and a half hours. I was really funny that night, a bit dramatic at times but funny nonetheless.

When the time came for them to leave, the problem with the group dynamic was that I couldn't really tell which of them if any were into me. Probably none of them, but in any case I told the other two that, since my friend was getting this one girl's number, the two of them would coordinate social activity with the rest of us. Then one of the two to whom I told this said "Hey, you should come to my birthday party next week" and so I was pretty much forced to get her number. I told her we'd be on call on Saturday and Sunday that weekend, not realizing it was day call but still it was admittedly sub-optimal as a scenario where we'd actually have time to go out and stay out. She then suggested I or we come to the next thing she was involved in the next weekend, which was a party at some place in downtown Pittsburgh where she's doing a promo for Bud Light. I should probably mention, though, that these girls were all in university and they're all pursuing professional careers.

I got her number and, after they left, my friend had to sit down and eat because he hadn't managed to eat while talking to them (another thing I miraculously managed to do). At this point, I told my friends that this is part of the reason I don't drink anymore. One of them asked what I meant, and I said that, if I were drinking, I'd never be able to do what I just did that day with those women. Every initial interaction I've had with a woman on any meaningful level has been while sober, and I tend to do best when I'm thinking clearly. My friends were impressed with my ability to carry on a conversation and fearlessly open four women the way I did, so the other friend of ours who was with us that day said I had "Sober Balls". I don't know if the name will stick, but at least now they won't keep trying to get me to drink every time we go out, because now I've finally managed to demonstrate one good reason to stay sober.

A treatise on reading too much into things

Last week, there were three instances where I could have easily read way too much into things. Today there were two such instances, and anyone more socially inept than me would be wise to heed my advice in this area. I have a history of doing this, and I've recently begun with a brand new social network so I thought I'd mention these instances that I've successfully managed to simply gloss over instead of running the hamsters in my brain.

Last week, some girl needed a ride to the car rental agency so I gave her one. When I told her I was going, she took a step toward me and I waved, and she waved back and I left. Did she take a step toward me to try and hug me? Is that supposed to mean something? No. It means nothing and 9 times out of 10, anyone who would say otherwise is over thinking the situation.

Today, I walked past a girl on my way into the conference room. There were 5 rows of tables and she was in the last row, I went to sit at the second row. I was focused on ACLS reading today, and 20 minutes after I sat down she got up and sat down next to me and asked, in her own words, why so serious? I explained to her that I had my game face on. Should I read into her getting up from her own seat and moving her stuff to sit next to me? No. No I should not. Sometimes people just want to sit wherever they expect most of the people in a group to sit, and that's more or less exactly what she did.

Today, as I was leaving the training area, a girl and her friend walked by and, despite having no prior conversation with me, she stopped, turned around and said "Bye, bye Jeremy! Bye!" Should I read into that? No. She was just being nice, maybe she even pities that the Internal Medicine Program Manager thinks I'm very talkative, or that I sometimes went out of my way to make jokes during orientation. There's such a small, slim chance that any of these women are interested in me, versus the overwhelming likelihood that they're just being friendly. Reading too much into things is a classic rookie mistake, gentlemen. Don't make it.

Pot Committed

Today I had my first day of ACLS training, and for me it was a recertification so for the most part, it went quite smoothly. The only additional issue I had to address was to memorize all the different amounts of medication to give, and at what times to give them, and at what times to shock someone and how many joules to use. I didn't remember being as specific the last time I certified in ACLS, but I did all the necessary memorization the night before, so it was fairly straightforward for me.

I don't know how smart these people are who I'm working with, and while some of them were better with all this stuff being presented to them today and some of them weren't, the reality is I still have basically no real idea of how smart these people are. It's scary to think that my partner on my first month of residency will come in and just destroy me academically and procedurally at all aspects of inpatient family medicine. The problem is, to avoid that situation from happening, I have to do a fair amount of Harrison's Internal medicine reading which I haven't been doing because the residency keeps throwing nonsense procedural paperwork and certification business at me. For example, today I learned that I am supposed to buy my books through the residency coordinator, who gives a book list to UPMC, who searches for them off a website and acquires them and then passes them back to her. There's no buying off amazon and simply acquiring the reimbursement in CME money. This meant that, in order to secure the ebooks I wanted, I had to go online and search for them on this database I had never used before, and find books that were horrendously overpriced (which doesn't really matter to me in a sense because of my CME money) and then had to note down their ISBN numbers and email the website coordinators about books I hadn't found. With any luck, they'll update their database before I submit my list and I won't have any problems. Being occupied with all this and with buying things from REI so I can commute to work by bike, I ended up taking up quite a bit of time today. My hobby-related purchasing time, however, has been filled for the next week. This leaves Tuesday, Wednesday and Thursday evening to do nothing but read for the upcoming house rotation.

The title of this post is based on my purchase today at REI. It was unexpectedly large since an item which I thought was going to be on sale ended up not being on sale. I guess I just manage to surprise myself sometimes with how many of these ancillary purchases I manage to make, so I said to myself, ha, I'll fool them. I'll buy the things I want, and then I'll actually use them! That'll teach them to sell things that they know most people will just throw into the back of a basement cupboard. I know they don't actually think that way, but I really do hate spending money on myself. Unless it's something glaringly necessary, I can't bring myself to buy something that I think may somehow lead to joy. I was and still am even more uneasy about the purchases I made today because I know how few people commute to work by bicycle, let alone residents who would do it.

There's a phrase in poker known as being "pot committed". I'm terrible at poker, but I understand it to indicate a stage within a round of play when someone has put a significant portion of their total playable chips in the pot and has to call a subsequent bet laid because it offers them better mathematical odds to call than to fold. Ideally, I would like to somehow apply that to the situation I am currently facing in order to better motivate myself to commute to work by bike. However, my accounting alleles handed down to me from my father have black-and-whited that and it is simply not true.

Commuting by bike saves me 15 miles a day in driving. Mutiplied by 26 days a month (which will not realistically be happening) and by 4 months a year, I'll be riding 1560 miles by the end of October, assuming I last that long. Anyway, that means, factoring in the average current price of gas and the mileage of my car, I will have saved $227 by commuting. The problem with this calculation is that my costs for outfitting my bike and myself to commute (much stronger bike light, massive U-lock, special folder for packing clothes, shoes into which to change when changing out of road bike shoes) put me over $260. Again, this all assumes I bike to my July rotation, my obstetrics rotation which starts at 6 am, my night float rotation which ends in the morning, and then my surgery rotation which, ironically, is lighter than all the others I just mentioned.

Of course I'm not factoring in the benefits that make up part of the reason I decided to take this up in the first place. I didn't want to take up commuting by bike to save money, I wanted to take it up to get into shape and be fit and healthy. Hopefully it actually works, because if I don't manage to pull this off, there will be many embarrassing and time-consuming returns to make. Being the accountant, I also perfectly stored all the tags and receipts, so I suppose returning is at least possible. Maybe if I burn them I'll be more motivated to go through with this whole thing. Nah.

My e-mail

If anyone wants to start any discussions about anything on here or with me in general, I'd be interested to hear from those all over the globe (and in North America as well) who are currently viewing my page.

Email (remove asterisks)

j*f*d*9*8*6*@*c*o*m*c*a*s*t.net

Let the hate mailing begin.

06/23/13

One week of residency officially down, and I was only mildly productive this weekend but that doesn't really matter as I'm looking to set up some lifelines and routines for the remainder of my three years.

I went out on Friday night so naturally ended up waking up late Saturday morning. Upon waking though, I immediately went to the laundromat to do a full 2-load round of laundry. After coming back and folding everything, I relaxed for a couple of hours and then went to run some errands (home depot to buy a speed lock for my future locker at work, best buy to try out different devices to see which would be my ideal one) and got back in the evening.

At best buy, I found my ideal device to be the Samsung Note 8, at least I think it is. Many purchases will be made, and reimbursements will be sought, in order to ensure I pick the right device and use it effectively.

I went to the mall, and was adamant about returning my ill-fitting Dansko Travises. Upon returning them and trying out some other supposedly ergonomic shoes, I learned that these shoes were actually supposed to fit loosely behind the heel. I had no idea I was supposed to have one or two fingers of space between the heel of my foot and the heel of the shoe, but when I took the Danskos back out of the box and tried them on, not only was the store clerk sure that I had a perfect fit on, he was instantly surprised at how good the actual shoes looked. He said he had never actually seen Dansko Travises up close because nobody who had ordered them had actually brought them into the store. Somewhat irritated at how long this whole shoe buying debacle was taking, I told the clerk I simply wanted to un-return the shoes I had brought in, and when he clarified what I wanted, I used a line from Captain America that had stuck with me. I said they are "the clear choice", in case anyone reading this actually remembers that from the movie.

I came home and hit some road blocks with this whole ACLS online course because I found it rather difficult to complete having had no experience memorizing medication dosages. I went to bed, couldn't sleep because I didn't brush my teeth or put my acne medication, and then got up, did that stuff, went BACK to the ACLS course, stayed up until 1 and worked at it until I cleared it with a 92% pass. Yes, I do feel sufficiently stupid.

This morning, I woke up and started vacuuming right after breakfast. They said I should bring one item in for show and tell on Wednesday, and I've decided well, I'm bringing the vacuum cleaner. It's a Dyson DC26, what can I say except I'm proud of it. Waking up today, I actually couldn't wait to vacuum the apartment simply because I knew I'd be using my stupid awesome vacuum cleaner to do so. Things the vacuum cleaner says about me:

1) I take great joy in mundane things
2) I place a premium on that which makes things organized and clean
3) I like buying things that I can take apart and mess with, it makes me feel smart
4) Even if it's at my expense, I will sometimes say or do things for the sole reason of putting a smile on peoples' faces. I'm always happy just to make people laugh, ideally on my terms.

I went for a ride, and noticed my bike shorts held up quite well to the ride, better than my previous ones had done so. I guess more padding is better for me. I guess the new seat is also a lot firmer than I previously thought it to be.

I'm gonna go get some cotton swabs and some healthy food, and then I'm gonna try and do an honest hour and a half of ACLS prep tonight, followed by some Harrison's reading early tomorrow morning.

First night out

We went out in Pittsburgh for the first time today, and while it was a lot of fun, it was somewhat of a rehash of classical social dynamics.

I volunteered to drive (as I don't drink) and I arrived promptly at the bar at 7 pm. Upon arrival, I found that only 2 other interns had made it out tonight, and that everyone else was staying home for various reasons (tired, had to take care of grandmother, etc). Then I watched as my intern friends became inebriated enough to require supervision of some kind while their less-inebriated friends went from one bar to another. The second bar was populated mostly by men and, being straight, I was not excited about this at all. The only other women there were senior family medicine residents and, even if they were interested in me, having relations with supervisors, subordinates or colleagues is generally a very bad idea. That doesn't necessarily mean that sort of thing never takes place.

The interns I was with and one of the seniors, who was also, to put it his way, "done" , wanted to go to a hookah bar. Since I wasn't someone who smokes either, I was not excited about this either but felt somewhat obligated to join them and "look after them" as such since they were my team but they were quite inebriated. I chilled out at the hookah place while they smoked and, around the time I ducked outside to get some fresh air, one of them pops out for air as well and starts walking all the way back toward the bar (about 8 blocks distance) with the other one. The senior comes out, continues to smoke, and doesn't know where the hell the other interns have gone. I get a call at some point from them, telling me they're at Jimmy John's getting some eats. In the meantime, we end up sitting across from a couple of radiologists and we start this long and drawn out discussion of medicine in the US versus medicine in Canada, and about family medicine versus radiology.

The discussion comes to an abrupt end when the senior decides hookah time is over, and it's time to find them. We find them and then we try to backtrack to find an internal medicine senior who was hanging out with the initial group of people from whom we broke off. Finding him in another club, and unwilling to go home, we formulate the soon-to-fail plan of going to the casino. The plan was doomed because we decided to first drive back to one guy's house and then drive to the casino. In the ensuing drive to that guy's house, everybody cooled off and lost the energy to go to the casino. Except me of course, I wasn't drinking so I was therefore not nearly as fatigued or dehydrated as these other guys. I went back home and showered, and here I am now, thinking restlessly about how much I will be able to get done tomorrow.

It was a nice night. It probably would have been nicer if I had met more women, but there's tons of time for that. Also, it's not like a bar or club is the absolute best place to land a career woman who's looking to settle down. We did talk to a few women there, but they were all in college and, quite honestly, seemed somewhat ditzy. I don't do ditzy anymore, it sickens me. I really do sound like an old man sometimes.

Orientation day 3

Today I found out a lot more about my residency, lots of valuable info was passed down to me from one of my seniors. Here are the highlights:

My patient maximum when on inpatient medicine is 5. I have previously had to round and write finished notes on 8 patients before 6 30 am. Granted it was surgery and there was barely anything to report on, but here I have to only SEE the patients before 7 30 am. Notes begin after rounds and must all be completed by 12 pm, or else they get mad at me. I don't want to sound overconfident, but I think I should be able to clear those notes. If not, then my four years of medical school will have been for naught.

My senior has learned everything he's needed to know (he won the "intern of the year" award) from online databases to which we all have access. He's not had to reference any textual material. This is a good thing and a bad thing I believe so anyway. I believe it's good to read Harrison's Principles of Internal Medicine, but it's nice to know that the standard of care can still be provided without having to constantly check up on it (or obviously on it's online version, I'm not carrying a 2700-page book with me through the hospital)

My residency pays me more than the average annual salary AND they give me meal tickets. $100 a month in meal tickets. There's no tax on clothes here either, which is a welcome change to the regular 13% sales tax I would suffer in Canada. If I shrink down 20 pounds to my ideal weight (I think it's 130 or so) then I could buy all the clothes I'd need for the rest of my life (no I couldn't) and never pay tax on clothing again, or buy clothes ever again (yeah right).

There are good seniors and bad seniors here. Some will help you with admissions, some will not. You are expected, always, to at least pull your own weight. You will apparently be routinely tired. There will be times where, if you do not finish your notes, you do not get to eat in the afternoon. I take the bad with the good, and the good is all the stuff I mentioned in this post. The great is that I actually managed to match, despite having only 5 interviews. I'll never let go of that.

The crying woman and her child

Day 2 started on a lighter note than Day 1. There was a nice big breakfast, I felt more of the "family" aspect of the hospital, and there was a lot of joking throughout the morning. There were a few dry presentations, but not everyone can take a topic and turn it into something enthralling.

I learned more about my fellow residents ; some of them are a bit charismatic, some of them not so much but then again you can't really know a person after one morning watching lectures with them, and quite a few of them are married. I didn't really know what to make of that, hopefully they're older than I am.

I ate lunch and got re-certified at Basic Life Support, then left promptly with just enough time to obtain my parking sticker, which is now good for a year. Apparently this area of town actually does have parking enforcement officers (two of them). Maybe I should start putting quarters in the meter when I go to the laundromat. Nah.

I received my second set of shoes from amazon and, once again, disappointingly, found them to be oversized. Then I found out amazon didn't wanna play ball on a second exchange, instead my only option was to return the shoes. I then found out the same shoes were available for much less money from the Walking Company, so I called them and rushed down there to order from them and return the amazon-bought shoes at a UPS store, post haste. I'm getting quite proficient at making amazon returns. However, the traffic on the road at the time did slow this whole escapade down and it ended up taking me an hour to actually get to the UPS store.

At the mall, I decided to tool around a bit since I did not want to be continually fighting traffic, so I ate after ordering the shoes, and then I walked into an electronics store to find a blue-tooth keyboard for my soon-to-be-bought tablet. 5 x 10 1/8 inches were the dimensions of the keyboard which I deemed would be sufficiently big to allow my fingers to throw down words at the blistering speeds I demand of them.

On the way to the exit, I went to the bathroom and, upon exiting the bathroom, heard a woman crying. I turned the corner and found a Hispanic woman with an infant in her arms, both alive and well for all intents and purposes. She was crying, and I immediately asked if she and her child were alright, if there was anything I could do, if she needed to go anywhere or needed to call anyone. All responses indicated she did not need my help, so at first I did what my parents trained me to do, which was to walk away. I got about 12 meters away when I realized I simply couldn't turn my back on this woman, but hesitated because I wasn't sure what, if anything, I was qualified or equipped to do. The least I could do, I figured, was obtain more information and listen to her. I am trained to listen at the very least. In an effort to negotiate more trust and information out of her, I went to the nearest food stall I could find and grabbed some napkins so that I could offer them to her so she could wipe her tears. I went back in the direction of the bathroom and turned the corner.

She was gone. No door movement, no sounds down the hallway, gone. The universe had vaporized this woman and her child, and I knew I would most likely never find out why she was crying, what was going on, nothing. A security guard came by and I asked if someone had alerted him about the woman. He said yes and then asked me for information on her appearance. Hopefully, he found her and something somehow was resolved, but I'll never really know. I don't know what I should have done, or whether it would have made a difference if I had stayed or simply made her more uncomfortable. What would you have done?

First day of orientation

We all arrived promptly at 6 15 am as we were told for orientation, and the first thing we all had to do was stand in two separate lines to take ID badge photos. We all got our pictures taken by 6 50 or so and, at this point, everyone had trickled over to the breakfast table on the third floor of the Hall of Soldiers and Sailors museum. Silence of the Lambs was filmed in the auditorium where we had our orientation. At around 7 10 am, after having eaten two breakfast plates and having listened to every bank's mortgage pitch and after having collected every free pen and key chain and other nonsense that would later end up in the garbage, I found out that the orientation presentations REALLY start at 8 am. Wow, I thought. Demanding that we all arrive at 6 15 am so that the first orientation presentation could take place at 8. I slept through half the first presentation, and then slept through the 15 minute break in between. After being fully rested, I was much more ready to take in the boring remainder of the morning, which included a somewhat entertaining yet still horribly mundane human resources presentation. Like many orientations before it, I think these orientations could have easily been done with a well-written series of e-mails. There was no celebration or festivity whatsoever (apparently that is still to come, as the psychologist for our specific UPMC site has a scavenger hunt planned for us).

Then they usher us all downstairs to stand in two separate lines to wait for our ID badges to arrive. We wait for about 35 minutes and, when they finally do arrive, they aren't all there. I stood in line for 40 minutes for absolutely no reason whatsoever, only to find that my ID badge was going to be handed to my program coordinator the next day. Why didn't they just do that for all of them? It appears as though, no matter how far out I go from high school, administrative bodies will always be significantly inefficient in some way, shape or form.

We went to our family medicine center and I found everyone else already there filling out paperwork. I too started filling out paperwork, and this was around the time we received several books on resuscitation and Life Support courses. I have 3 nights to start and finish the neonatal resuscitation manual, which is about 250 or so pages long. Hopefully there are a lot of pictures. I scanned and uploaded to my laptop every other seemingly important piece of paper, and have yet to start on any of the various online activities mandated by the generic UPMC orientation committee because I haven't yet received my employee ID or social security card. I imagine all things will befall me in due time.

All for now, more later as I have to catch up on sleep and yet still wake up at 5 and ride tomorrow. I figure if I'm going to be hitting the hospital eventually at 6 30 am, may as well get into the habit of waking up at 5 even though tomorrow starts at 7 30 am.

The Last Day

Nothing much happened in the past two days. My nagging shoulder tendonitis came back so I started taking the strong anti-inflammatories and the muscle relaxants again. I went shopping and bought some new clothes because I managed to shrink down to the size I was in 3rd year of medical school, thereabouts anyway. I thought a lot about the past year, because someone recently reminded me that all 4th year medical students who are to enter the 2014 match will have their applications open on the 1st of July. I also realized I will soon have my own students to teach and to guide, to help open doors for, and to learn from as well. Students teach residents a fair bit since all they are to do while present on rotation is read and learn. That is, at least, what their only duties should be, aside from gaining useful hospital experience.

I ran some last minute errands and tried to get some last-minute reading done, but something or the other kept coming up and eventually I just gave up. I watched an old episode of one of my favorite sci-fi shows on netflix, ate a few vegetarian corn dogs, and now I'm about to go iron a couple of shirts and see if I can't procrastinate until 10 pm, which is my deadline for sleeping since I have to be up at 5 am tomorrow.

I had a conversation with another physician today who was disappointed that a colleague who was not quite as far long in their career was not taking his advice, even on a matter that would seriously affect their academic advancement. I have seen my advice fall on deaf ears very often and had previously assumed that, having achieved the position I just did, others would now become much more receptive to that which I had to say. I suppose that is not entirely the case, and I guess there will always be those who shall remain unreceptive to my advice. I have been giving a lot less of it lately, and eventually I hope to come to a point where I will only give advice to those who ask. Ideally it should be to the point where I will only give a small amount to those who blindly ask for advice because I am a doctor, and then give more detailed, specific advice to those who persist because they respect what I have done and understand that I have knowledge that may help them succeed. Too many personal improvement projects, I feel like an old man. Maybe that's not always a bad thing.

Today is my last day before I start work as a physician. When I was 5 years old, there was a journal entry that everyone had to do in class (thank goodness half of it was drawing) where we had to draw who we wanted to be and then write on one line "when I grow up, I want to be _____" and everyone else picked lawyer, businessman, cook.... I drew a man with a cape, hat and an eye mask and I said "When I grow up, I want to be Zorro". Around the same time, my parents ordered me a set of books called "Young Scientist" (They're not available that widely for sale anymore, I think Amazon is selling a few copies of them, World Book at least doesn't make them anymore) http://www.librarything.com/series/World+Book+Childcraft+Young+Scientist

So I started reading these books (there was no internet, one English TV channel in the UAE and my parents refused to buy me a gaming console, what choice did I have) and I found that I kept reading one book in particular over and over again. Volume 8, the Human Machine. I know the list on the website says Volume 7 and the Human Body, but if you look closely at the last picture that you're able to zoom in on after clicking it, you'll notice it's really volume 8, and trust me it's the Human Machine. I got sick at some point (something viral, nothing noteworthy) and my parents, being the opportunists that they were and still are, saw this as a chance to tell the doctor I was interested in the human body. So the doctor takes out this black and white sheet of plastic, I have no idea what it is or what I'm looking at, and he says "Can you tell me what this is?" and I shake my head. Then he says "I'll give you a hint. It goes---" and then he made a sound and I immediately said "The heart?!?" I couldn't believe I was looking inside myself. I think I was 7, but maybe 8. Let's say 8. Then he had a clay model of the heart that he opened in front of me in order to show all the different pathways for blood (coincidentally, I'm not sure if drug companies can hand those clay models out for free anymore). Then my eyes went straight from there to his wall. I couldn't see his wall, though. All I could see was Thank You letters written by his patients. Christmas cards, Birthday cards, and above all "Thank You doctor for fixing my cold" "Thank You doctor for help with my foot" "Thank You Doctor....". I zeroed in on this many years later and realized that was why I told everyone I wanted to be a doctor. In fact, I told everyone I wanted to be a heart surgeon. Stupid clay model, steering me away from family medicine.

I start official work as a resident on the first of July, but I receive my badge during my orientation week, which starts tomorrow. For all intents and purposes, the badge is the unofficial confirmatory item for all new residents that they have begun their employment and, though many post theirs on facebook and other social networking sites, I shall spare everyone the brandishing of security documents because I find it a bit much to post something like that online. I know a few people who've been asking for it though, and a few who will send me theirs, so someone or the other will see it. Today is the last day I have before I start work as a physician. I guess 8 year old Jeremy wasn't as dumb as I thought he was. Good thing I listened to him.

No shortage of good things

I kinda tore into UPS the other day when I described their wasting my time and a driver being impolite to me. However, the very next day, they decided to play ball with me. I needed a driver's license which, unfortunately, a Canadian cannot acquire unless he presents his most-renewed driver's license. It got one-day shipped to me by 10 30 am, problem is it came earlier than then and I wasn't awake. I called UPS and explained how crucial it was that I have that package, and told them I was ready to track down the driver if need be and just needed to know where he'd be by such and such time. They called the driver and then called me back, and said that the driver was coming BACK to my house to deliver the package. I was astounded, really, that after yesterday's shenanigans they'd actually do me the honor of returning to my home with the package I so desperately needed; my Canadian driver's license.

I went to the DMV and expected the standard long wait, but much to my amazement, when I took my number out of the ticket dispenser (262), I read 261 off the digital sign and realized I was NEXT in line. I ran, like straight up ran, back to my car which was luckily parked right outside the door, grabbed my folder with all my important documents in it, and ran back inside just as my number was being called. They took their own sweet time to get my license made, but it got done nonetheless, and now I could finally go and buy that car. I went to the bank and ended up taking a cashier's check, which I then drove over to the Honda dealership to buy my '07 Camry, 87000 miles on it so for 11,5 I think I made out alright.

As soon as I got the Camry the first thing I did was go back to the UPS office to collect my packages. I didn't make a big stink there because they helped me out in the morning today, and sure enough, there were my packages from Amazon, and they handed them straight to me.

After coming home I ran a bunch of errands one after the other in quick succession; make money orders for work, buy a juicer, buy a shoe horn, put together remaining IKEA furniture, bang bang bang there was no stopping me. The only thing I haven't done yet is clean the house.

When I was at the grocery store, there was some amusement there, mostly me acting like an idiot I suppose. I asked for "help" in the produce section and this guy comes out of the back, and I stand in front of the oranges and ask him "So which oranges are the sweetest?" And he hems and haws for a bit and then tells me their 58-cent navel oranges are probably as sweet as they get. Then he falters quite a bit and tells me about how the firm oranges are better because they're probably further away from "going" and then the texture doesn't really matter (I was questioning him about all of this of course) and so I ended up buying some oranges under his guidance. Whether it was expert or not I'm not sure, the juice tasted well but there was very little of it to be had. 5 oranges for 300 ml of juice. Of course, that isn't going to stop me from trying again today.

So today I wake up fashionably late (I NEVER wake up fashionably late, and it was mostly because I was up until 1 last night putting furniture together and clearing my e-mail hard drive) and I go for a ride. I met this 68 year old guy on the ride who was riding almost as fast as I was. It was my easy day, but I was nonetheless still impressed with this guy on his bike that he put together from spare parts. Then I found out while riding with him that he was an engineer and a triathlete. Luckily for me he was never an Ironman, otherwise I would've been totally unable to keep up. He said he's had multiple injuries and multiple surgeries, and I observed that the only sports he still does (or can still do, rather) at his age are swimming and cycling. Cycling just seems like a solid longevity sport to me, something that can be done comfortably at any age (assuming no cycling-related injuries anyway), low-impact but still difficult, builds strength and cardiovascular ability. The only real problem with cycling is that it doesn't involve the upper body. Swimming has been touted as the ideal form of exercise because it blends almost 50-50 what a cardiologist or sports scientist would call "isometric" and "isodynamic" muscular activity. Any sports scientist is free to berate me on here if I got it wrong, but that's what I can remember from my days on cardiology rotation.

I rode back with him and then went for a $9 buffet, which for me ended up being $11 after tax and tip, I tip heavy for anything under $10. I found out I can't really eat my way to the bottom of a buffet like I used to in the past, which honestly isn't necessarily a bad thing. So now I'm back home and I'm gonna vacuum the entire place, iron my shirts, and go out and buy a few more so that I have 8 or so ready to wear. I'll give the social security office a quick call, but I already paid my dues going there earlier this week, so they should already have started processing my application since the ECFMG cleared my J1 paperwork the day after I visited them.

Sometimes, when people wrong you (in this case they just barely wronged me), if you give them time (which I rarely ever do), I guess they can surprise you.

No shortage of problems

Today was a problematic day.

I thought I was going to get my license because the paperwork nonsense I had resolved with the ECFMG cleared my immigration form at the DMV guy's computer, but then he tells me I have to get my new renewed license (and not my old, still un-expired license) for the license transfer to occur. He couldn't have told me this a week ago, this had to happen today, 4 days before my residency is supposed to begin.

Then UPS tells me I can pick up the package that I didn't sign for (while I was at the DMV) and tells me that I have a very short window in which to pick it up. I go to the street and I see a truck there. I ask him if he's going to the UPS office and he says yes, and I say "Well I guess I should just meet you---" he cuts me off and yells "Well you better hurry up because I don't have time!" So I jump back into the car and I follow him to the office.

When I get there, the door won't open because it's 8:05 and I knock and nobody will open it. I peer through the reflective glass at an angle and I notice that there's clearly someone there and they're clearly throwing their hands up like "what?" So fuck them.

Then I called UPS to complain, and while the customer service agent put me on hold, she hung up on me.

I think this is one of those times where I just have to sit back and realize that life is too short to get angry about bullshit nonsense things like this, but for some reason I'm still mad. Also, these people are drivers and customer service agents at UPS. As far as I'm concerned, they're basically already in hell. Then again, if I told them what I did, being the unambitious lot that they are, they'd probably think my job was hell. Okay I'm done complaining. I'm gonna go iron my shirts and tune my bike, maybe I can actually make it to bed early today.

The wrong salt

Yesterday I woke up shamefully late as usual, and decided against cycling in the morning because I wanted to "get some things done" during the day. What things, exactly, I didn't know. I just knew that , for some reason, I had to be productive in some way that day. I guess I was referring to pre-reading for residency, but I can't be sure. I started doing a bit of reading, then I went to Target, then I came back, and I realized at some point that there's a very real possibility I may not be able to do this whole "commute by bike to work" thing that I planned on doing, and I may need to simply work out, shower and then head to work in the morning. What happens when "the morning" is "be in the hospital by 6 30 am" ? I would have to wake up at 4 30 to work out and then get ready and drive to the hospital.

I then decided I would have to get my workout going in the evenings, so I decided to do a "trial run" of evening workout yesterday. I don't really know how I thought yesterday's minimal-doing day would lend itself to simulating me after a full day's work in residency, but I went ahead and went for a ride anyway. Strictly from a workout standpoint it was a really good idea to go for a ride, and I managed to get to the hospital in 33 minutes, easy-riding most of the way. I easy-rode back and made it home in 39 minutes. Tomorrow I'm going to wake up as early as I possibly can (going to really try for 5 30 am) and I'm going to ride as hard as possible all the way to the hospital and will see how long it takes me to get there. Then I'll add five minutes for carrying a backpack that has a lunch bag and a cereal container in it, and we'll see how quickly I estimate I'll end up getting there.

The whole plan also depends largely on whether or not I'll be able to store clothes and towels at work. If not, then loading all that into a backpack may make things "interesting" to the point of it being way too cumbersome to ride to work, but we shall see.

Yesterday I went to target to buy, among other things, salt. I bought the only salt container they had, and I returned home eager to pour the salt into my salt grinder. I realized, upon seeing the salt spill out the bottom, that I bought the salt powder when I should have bought the salt granules. This means I have to make a trip to the grocery store today to buy granulated salt just to be able to put it into my salt grinder. I sincerely hope all my problems in residency are of this nature, but I sincerely doubt my life will remain as such.

Today I finally woke up at a semi-early time considering my record late wake ups last week (7 30 am, then back to sleep, then 8 am). I should be able to wake up earlier tomorrow. I haven't mentioned this on the blog so far, at least I don't think so, but I am traditionally a morning person. I think that puts me in the overwhelming minority of the population.

06/09/2013

Today I started bright and early (at 10 30) and set out to find this supposed magnificent bike trail that so many (just the psychologist at my program) bragged about. I hit it and instantly ran headfirst into thousands (about fifty or so) of dog walkers. Apparently today was "the dog walk" or at least that's all the detail the locals would give me, so I hopped off the trail and joined it 3 minutes further down the way. The trail really was everything they said it would be, at least the 7.7 mile stretch leading to the hospital was impressive anyway. I'll go further tomorrow if my body is up to it, everyone who has exercised knows the perils of starting an exercise program after several months of rest.

This old man passed me on the trail. I was biking along in my lycra shorts and he was wearing regular shorts and a t-shirt, on his mountain bike. He had a camelbak on his back, and he was wearing regular shoes, and he was at least 58 years old, and he passed me. I couldn't keep up with him, at some point he took a breather after an uphill and I picked up the lead ... for about two minutes. Then I had to give it up again. He had calf muscles within his calf muscles. I aspire to one day be as fast or faster than him when I'm his age, certainly a lot thinner (yeah he wasn't skinny either, must have been mostly muscle).

I came home and ate my wholesome breakfast of pizza ---just kidding, special K and soy milk with blueberries. Then, in order to delay having to buy groceries and cook, I set to work replacing the broken screen on my tablet PC. I had planned to use it during rotations and during residency when I bought it (before entering medical school), but then the attending physicians I shadowed kept telling me I needed to have both hands free, and so I would use the tablet as a backup PC, eventually having the LCD unit crack on me during the move to Chicago.

I finally researched and purchased the necessary replacement part, and took it with me to Pittsburgh. Today, I opened up a previously-downloaded youtube video of how to repair a tablet PC of the make and model I own, and all was going well until I realized the person in the video did not show how to remove the screen. Furthermore, the tablet I bought was wacom-enabled, meaning a wacom digitizer (without which the pen wouldn't work) was soldered onto the LCD circuit-board. Stumped, I removed the old screen with the digitizer (obviously I didn't want to just rip the thing off the old screen, there may yet be a way to save it though I do not know how) and then, at the point where I removed the old screen, began a guessing game of biblical proportions. The installation of the new screen and the putting back together of the tablet with all the right screws in the right places, was an epic farce of which songs shall be sung long after I have left this Earth.

I got it to work, but the pen doesn't work. Oh well, I'll plug in a mouse and a keyboard and give it to my parents, they need a new computer anyway.

I went to buy groceries, and ended up buying a shocking amount of "back up" groceries. I define back up groceries as high-calorie high-taste frozen food (mostly pizza) to be eaten either in the advent of surprise guests or the advent of insufficient time to buy and cook food. If it weren't for the emergency food, my grocery bill would have been about $70 lower, but that's a very rough estimate, as I haven't the energy to walk to the receipts drawer and read the receipt.

I set my slow-cook marrakesh chicken on low and I did all the dishes that have been painfully neglected this past move-in week. I think I'll get started on the fish dish now. All in all, not a bad day. Tomorrow will have to start earlier though, 10 30 is just embarrassing.

Start-up in Pittsburgh

I drove 6 hours to get here, and as soon as I got here I hurriedly unpacked all my boxes and drove straight to ikea to grab all the furniture I wanted. The next day, I ran into problem after problem with banking, car buying, license obtaining, etc. and this has led to me having to rent a car for the entire first month here, possibly longer if the government decides to slow-roll my social security card.

I've managed to set up a few things, a few others are still in the wind. Building all the damn furniture took forever. If anyone reading this ever wants to buy ikea furniture, the first thing they should buy is an electric screwdriver. I didn't know the wood components of ikea's pieces have un-recessed holes and require the use of wood screws to fasten them together. Wood screws are not the easiest thing in the world to work with and they can be quite tiresome when almost every piece of furniture one has is from ikea.

I was very upset with my bike shop for not properly tuning my bike because I thought it'd take forever to me to do it myself. It took 4 minutes. I don't understand how it took so long in the past, possibly because I was also doing other things to the bike as well and it therefore took longer at a time for me to work on the bike.

The area around me looks poor, but everyone has assured me it is safe, and I have a security system in my house, so I guess it's all good. I hope nothing bad happens, but I'm going to be sensible about things nonetheless; don't flash cash, don't leave doors or windows open, keep blinds drawn, etc etc etc.

I placed pieces of cardboard on top of my bedroom windows and duct taped them to the window frame, so now there's minimal light shining through in the morning. I'm gonna optimize that in the coming months with more cardboard. I'm gonna go fold my laundry, shave for the first time in five days, and sleep early. Tomorrow I will ride in the morning, and then I'll cook for the week and start an early-rise healthy-eating exercising routine for the first time in months. Everyone was asking how excited I was to move and to start here, and I kept telling them that moving was this and unpacking was that and work, work, work etc etc etc. Just now, though, just as I wrote that .... I felt a bit excited. It's nice to look forward to things.

Graduation commencement trip part 2

I arrived in NYC sometime in the afternoon, and I thought I was doing quite well for time. Little did I know I was about to get violently ill and spend the next three hours with diarrhea in my friend's apartment. Thankfully for him he was busy being a resident while I was paying for eating three bowls of cereal the previous day (I think I'm lactose intolerant, and I'm almost sure cow's milk is what set me off).

After my penance was paid, my friend came home to find his room re-organized and cleared. I did this a little at a time between my trips to the bathroom to pass the time. Him and I went out for dinner later, and then two of my friends from medical school called and convinced me to go into Manhattan and stay with them. I ended up meeting them at a club, and we hung out until 4 am. I, however, did not enjoy myself. I felt the music was too loud, the club was too crowded, and the women seemed quite ... plastic, if I could find a word to describe the vibe they gave off. I think I may be done with clubs.

I parked the car on the street and, as soon as I got out, my friends jumped into a cab to take us back to the hotel. We slept a total of three hours (an overestimate) and promptly headed to graduation the next morning. I met a friend of mine in line and was surprised when he volunteered that he did not match this year. I quickly pulled my two friends aside to warn them not to ask anyone where they matched, and explained to them that some people had actually come to graduation despite not having matched. I have no idea how these people worked up the courage to come, if I had not matched then I certainly would not have appeared for the ceremony. I was nodding off through my president's speech, it was very long-winded. The best overall student from our cycle, though, definitely managed to make light of the situation by throwing in a 5-minute speech that included several funny quotes and anecdotes.

Several people from the office were mentioned by one speaker during the ceremony, and as he ran through the list of people we hated, the clapping was mediocre, a word I use generously. Then two or three people who actually do work at the school were mentioned, and we all erupted in praise and applause and obnoxious shout-outs. One of the people we disliked at the office actually had the nerve to walk up to me afterward and ask why I had initially not wanted to come to graduation. I shrugged and made a bunch of monosyllabic sounds because, at least for the next three years until I need some transcripts or licensing papers processed, I'm done with the school. Eventually, the people we don't like at the school will be dead, and it won't matter anymore. Realistically, eventually I and everyone who reads this blog will be dead, and it won't matter. I'm not trying to sound depressed or to freak anyone out, I've just gained some much-needed perspective on things after medical school ended. I feel like my graduation (my real graduation, in September) allowed me to stick my head up out of the water for air. My family thoroughly enjoyed the ceremony.

Then we got back to the hotel, and I couldn't find the car. I searched again with a cab driver, who was very reluctant to drive around and help me find the car. Then I tried the transportation department, the cops, and the local police precinct said that, unless I was sure of where I parked the car, they didn't have the man-power to send a squad car out looking for the thing. I was so angry and frustrated and stressed about the whole situation that I got a separate room in the city just so that I could get an uninterrupted, full-night's sleep without being disturbed by my friends walking into the hotel room. I don't handle these types of situations well.

The next morning, I set out after my full night's sleep to search for the car. It was still missing. And it was a rental, so I had no idea what I was supposed to do. My resolution at the time was to wait until it got towed, and pay the $400 required to pull it out of the impound lot, and then drive home. I then arrived at my friend's apartment in Queen's, and he told me to go back to the precinct and make the cops help me. He said something about the cops not wanting to do actual community service unless they are absolutely pressed to do so, and so I went back there and told them that I remembered the exact sign at which I parked the car, and that it was only found at such and such intersection. I was right about the sign, but I was wrong about it being the only one in midtown. There were a few of those types of signs in midtown, as we soon discovered when the cops agreed, upon realization that they had to either file a police report or play ball, to drive me around in a squad car and canvas the area to search for the car. After various interesting conversations with New York's finest, we found the stupid rental car. It was parked (with a $95 ticket on the windshield) one street south of the last street I had walked looking for it.

To celebrate my finding of the car, my friend and I stuffed ourselves with sushi and we talked at length about residency. He had recently found a 2nd year internal medicine position (he was previously in a preliminary match meaning he had to re-apply in his second year) so he was very happy, and I was just starting myself and worried about ending up tired and destroyed and surviving entirely on meal bars like him. He said not to worry, for he was in internal medicine, and I will be in family medicine.

The next glorious day, I drove all the way home to Toronto. The day after that, I rented a U-Haul and headed to Pittsburgh.

Graduation commencement trip part 1

I packed light for my trip to New York city. The night before, though, I couldn't sleep. I wish it were from excitement. I have a chronic shoulder problem, calcific tendonitis, earned from a mixture of bad genes and overuse. When aggravated, this problem affects my rotator cuff tendons, different ones each time, and on the Monday before graduation weekend, I decided I was going to play a little squash. The Wednesday night before I left for graduation, I deeply regretted that athletic excursion.

The pain was so bad that I had considered waiting in the emergency room. I got the name of the "quick" emergency room in Toronto (i.e. the one where someone would likely wait less than 4 hours) from a friend, and then I fell asleep while trying to figure out how to explain to my parents how much pain I was in. When I awoke, I thought the pain had subsided but, upon moving my shoulder, I realized that nothing could be further from the truth. I was first in line at the local walk-in clinic (my family doctor is a joke) and this was no easy feat. The clinic officially opens at 9 am but, unofficially, it opens whenever the medical assistant arrives. In my case, 8 26 was early enough to stay ahead of two others who took up line behind me, and when the medical assistant arrived at 8 40 we all put our health cards into the "Card rack" in a very orderly manner (I have to acquire one of those for my practice, it's a major organizational tool). By 9 am, there were 9 cards in the rack, including one of a young man who had walked in with one of those extraordinarily attractive blonde women who you see in a bikini on the set of "Burn Notice" or in the background of a travel brochure. Then I found out HE was a resident as well! He was starting in Internal Medicine in Philadelphia, what a small world.

The doctor (who arrived fashionably an hour and a half late and received no complaints from the staff for doing so) prescribed me some next-level anti-inflammatories and a muscle relaxant, both of which I am still taking religiously. I left and packed the remainder of my luggage in a hurry. I took a few minutes to scan and email an info sheet to that resident regarding the J1 visa when I happened upon an administrative email saying that my score for the Step 3 is available. I'll spare everyone the tedium of medical board examination scoring and simply happily say that I passed, with a bit of wiggle room no less.

Content but still in pain, albeit less than the night before, I headed out to New York city. I had to stop at Syracuse on the way to pick up my graduation attire. Upon approaching the border, however, I realized this would be a much better and sooner opportunity to quickly obtain my J1 visa. I waited 2-2.5 hours at the US customs office, but it was worthwhile, because I obtained my visa and did so easily. The customs official even asked if I had interviewed for one in the past, because he was impressed at how smooth I was during the interview with the answering of questions and the handing out of documents. I may have been a half-decent immigration lawyer. Too bad I'll never find out since I have emotions and I care about people. To the one lawyer who may eventually read this; it's called humor, and it's been around a while.

I showed up very happy indeed to Syracuse, but I did some quick math and found myself unwilling to complete the journey to NYC that day. I was exhausted, in pain, and would only end up arriving to NYC at 1 am if I pressed on. Tired but content at my progress thus far, I decided to rest at my friend's house in Syracuse. While there, I decided to be productive with some of my evening and head to the nearest AT&T store to activate my flip phone. That's right ladies and gentlemen, for at least the first month of residency I shall function with a flip phone. I'm also buying a tablet, possibly a google nexus, so that I can actually do work, but hey...flip phone. What people reading this are minimalist enough to say they get along just fine with a flip phone and only a flip phone? I'm not talking about the "business and personal" phones, or the "this one is for my girlfriend and this one is for the miscellaneous women" phones, I'm talking every day all day work and play flip phone. $50 a month plus tax for my phone plan, and that includes unlimited calling and text messaging. I threw in another 10 bucks a month for this month so that I could call Canada for 250 minutes, but I realized my parents can call me any time they want so I may just cancel that extra feature next month. If I want to cancel everything altogether, guess what? I can do that to, because I didn't go on any kind of contract. The flip phone cost $50, but I bought it 3 years ago to use in Maine when I was at school there for a pre-clinical and board exam review semester at my school, and the damn thing still works perfectly to this day. Battery life on this thing is amazing, I'm charging it right now just for the hell of it, just because I'm worried my charger is going to rust or accumulate grit or something if I don't. Those reasons are both made up, but I don't care, because I'm using a fucking flip phone. I'm the happiest man on this street right now. That night in Syracuse, though, I was not the happiest man at all. I woke up at 2 am in excruciating pain, the worst I had suffered so far since the pain began to manifest the day before. My friend, the lifelong humanitarian activist and champion trap shooter (hey it's my blog, if I wanna make shit up I will) graciously switched sleeping arrangements with me so that I could sleep on the firm mattress upstairs, leaving him to sleep on the soft couch which I believed exacerbated my shoulder pain. This was not before I finished an entire bowl of cereal and took an extra anti-inflammatory, a practice to which I was not accustomed at all.

The next day, I started out somewhat early (10? Let's say 10) and I headed for New York City.

Things I liked about Europe

I would elaborate on these, but I have a lot of ikea furniture to assemble.

- Fresh-pressed orange juice
- Tapas of serrano, fresh mozarella, some salami, and bread
- Nougat
- Tax is already added on to every purchase
- The highways I took were pristine. They were expensive, but every euro was valued with fresh asphalt and bright lines.
- I realized i need to learn another language (spanish would be most practical)
- When on my own, I was able to navigate without a map without stopping for very long or needing to speak the local language
- The average size and shape of most people. My fat ass needs to start eating right and exercising, and I need to stop wearing clothes that simply do not look good. Having said that, "look good" is a very relative term and buying new clothes is only something I'd do after I cut down to size. So we'll put a pin in that lofty goal.
- Cafe a la crema di caffe
- Electric towel warmers
 

Too bad everything else about the vacation was abhorrent. 

Picking your battles part 2

I picked up the phone and didn't expect to hear what I heard. Rajeev (or George, as he called himself) from "Bell Canada Promotions Department" wanted to know if I was interested in some bullshit he had to pander to me. I asked him for his full name and Badge ID number and, surprise surprise, the "Promotions Department" of Bell Canada doesn't give out IDs. So I swore at him and then I put down the phone, and then I thought to myself ; what did Bell Canada promise me the last time I called to complain about this?

Bell Canada promised that, if I got a call from their promotions department after May 11th, I would be eligible to receive a letter of apology. I thought for a few seconds about obtaining this letter from them the other day, but then I thought, how long would it take for me to actually get someone to set one up for me? How genuine is this letter? Does Bell really care and are they really sorry that their promotions department in Pakistan called me ? (Thanks to an amateur, I have the street address of the promotions department, in case I wanted to egg the place. Either that or the guy is a pro and he fake-addressed me to Pakistan on a wild buffalo chase [there are no geese in Pakistan]). The answer to both the aforementioned questions is no. So why should I bother?

Second battle I decided not to fight was marginally less interesting, so it's not even worth mentioning. In all honesty, I can't even remember what it was about anymore. That's how fleeting life is. You get all red-faced about something one week and then a week later a bunch of hopefully-important things happen that eclipse all the petty stuff you endured poorly. Maybe I shouldn't be getting so red-faced in the first place.

Picking your battles

I often find myself dissatisfied with the inefficiencies of others. This is usually the case when I depend on others for a service. Phone and internet companies are the main source of my discontent, and telemarketers shortly after.

Today I encountered two situations where I had to simply let go of my irritation in order to continue on with more important things. But I'm too exhausted to actually write about them, so I'm gonna call this part 1 and write about them tomorrow. In the meantime, consider in your own life (the 3 people who read this blog) when you've actually been face to face with situations where you've had to ask yourself, should I bother?

Europe Day 13

I'm exhausted, because I've been in the car all day navigating. We left Venice at the usual late departure time (around 10 am or so, almost 45 minutes later than expected) and we expected to arrive at the hotel in  hours. I did not know where the hotel was located, someone else punches in the address. This time, the address punched in was incorrect, and we ended up driving to the wrong city of Thoiry in France. Apparently there are two Thoirys, and while the hotel specifies postal code, the GPS does not use postal code to verify direction. It ended up taking us a lot of extra time to get to the hotel, and my Dad and I were exhausted upon arrival from driving and navigating respectively. I wish my Dad would just let me do some of the driving, but that's what happens when I'm not paying for the vacation, I don't get the final say on things and, so far, 75% of the suggestions I've made throughout the vacation have been opposed.

Despite our exhaustion and our 6 pm deadline for returning the car rental in Paris tomorrow (Paris, the shithole of driving, one of the worst places in our vacation in which to operate a motorized vehicle), the 3 women in our party are still intent on going to Geneva tomorrow and seeing the place. This can only go poorly.

Today I told my Dad to go to the roundabout at a rest stop so that he could backtrack and park at the eatery, but instead he turned and went 200 metres the wrong way in a one-way lane and in the wrong direction on another roundabout back to the eatery. I told him not to do that again, and explained to him why  he should have just listened to me, and he didn't say anything after I finished talking, just put the car in gear and set off back down the road. We all started talking 10 minutes later or so, but there was no apology for not listening, for driving the wrong way in traffic, nothing. My Dad has a long history of not apologizing, and I love my parents and fully acknowledge that others' parents are far worse, but I have to try my best not to repeat their mistakes, because when they make these mistakes, it is difficult for me to just let go of them. I snapped at my mom again today because I had a 2-second window to tell my Dad not to turn somewhere and she yelled out "No, turn there" from the back seat. I wish she would just understand that she has very little experience in GPS navigation and should therefore just be sitting there quietly. My mom is the reason I remember the way I do, but her situational processing and ability to adapt is poor. She doesn't think on her feet nearly as much as I thought she did as a child, and it's quite difficult to watch my parents down shift in these areas. All I can do is ensure that my down shifting is not as dramatic for my children to experience. Either that or get all the vacations out of the way before I can't navigate by car through a foreign country on my own.

Europe Day 12

The drive day was incredibly standard, not even worth mentioning. Day 12 began with the worst breakfast so far in Europe. Bread comprised more than 90% of the actual breakfast, and most of it was pre-packaged convenience store-bought ready-to-eat junk snacks that I watched the server open out of the plastic package and empty right onto one of the breakfast buffet trays.

I told my parents I wasn't interested in the half-baked plan of going to the bike rental place and "seeing if there were any cancellations", so then my cousin came up with another half-baked plan which I went through with mostly because I knew it would cut down on my overall amount of walking time for the day, and also because I knew it would reinforce to others in the vacation party how pointless it was to go on vacation in Europe. Her plan was for me to sit at a bench at the roundabout near the hotel and wait for the cyclists to go by, and then ask them where the nearest bike rental place was. We ended up getting the address of a bike store (NOT a rental place) and when we finally got there (took an hour, driving on slow countryside roads) the store owner said he didn't have bikes for rent. The only other minute positive aspect of that trip was that my Dad finally got an accurate figure on how much my road bike at home cost ($660 and not $1200 like he thought).

We set off for Venice, and it took us about 25 minutes to walk to the San Marco square, which my mom insisted on us seeing. Since she was so insistent on seeing the square, my Dad rushed us along every time my mom, sister or cousin wanted to stop and buy something (my mom often makes plans on vacation with no time management whatsoever, and my Dad always overcompensates by constantly worrying about time, another reason why going on vacation with my parents is very stressful). After we got to the square, my mom, sister and cousin quickly stood in line (which shocked and amazed me) to see the church. I thought all the lines were over, and I straight up refused to stand in line or go inside the church. I sat outside, watching everybody go by and watching people play with the pigeons and musicians performing at the upscale restaurants etc etc etc while the rest of my family saw yet another church.

Upon completion of this endeavour, my sister, cousin and I went to find out details for the ferry to Murano, the island of Venice where all the glass factories are located. We were told it would take 10 minutes to get there, so we gathered up the rest of our party and set off for the boat. What we later realized is that the woman meant it would take 10 minutes to get from the tourist info booth to the ferry stop. It took an hour to get to the murano glass factory, and this ate into our time considerably, so much so that we later had to choose between an 80-euro gondola ride and having enough time for shopping. For me, spending 80 euros for 30 minutes on a boat would have made this a no-brainer, but my sister and cousin were extremely keen on this whole gondola thing and acted almost blind to the unconscionable gouging of tourists for money, in return for basically nothing. We went on the gondola and fast-walked back through the city to find most of the stores closed, probably for the better anyway. We did very little actual walking that day and I did almost no standing in place for a prolonged period of time, so I was not in severe pain and felt much like I did that day I ditched my family to go around Rome by myself.

At the Murano glass factory, everything was overpriced and everyone was eyeing us carefully because they didn't want us to steal or break anything. They were charging 5 euros just for us to be able to stand behind the rope and watch the glass figurines being made. Then we happened upon three guys who were making glass, and despite having closed for the day, they put some into the oven and we watched as a man turned an amorphous blob of 800-degree sand into a glass horse. For 9 euros, we bought two horses that were already made and cooled from them, basically for half the price at which we'd buy them in stores. These three men were the nicest men we have met so far in Europe, although I would have to say that, in my personal experience, they were probably edged out by the man who threw 12 cents at the cashier to pay for my shopping bag.