Beef and Birds

Clients

2011-12-14T14:35:00.001-05:00

I forgot how much I enjoy clients.

They were my favorite part of clinics, often teaching me more than the endless rounds (which seemed to be frequently geared to residents' display of wit/brains to clinicians and the endless competition for most obscure knowledge-nugget (with citations!)). Basics were more important, reviewed between appointments, frantically drilled at night before sleep, repeated mantras while reviewing blood work, rads, and muttered while walking into appointments. Endlessly a struggle - there's a lot of knowledge to master!

Once in the appointment - a relief! A partner, in the quest for answers, asking reasonable questions - basics: Why, what can I do, is my pet in pain, should we continue? Wanting what's best, lacking endless funds, shining through with appreciation for their pet. Reasonable and less fun questions: what does this cost, can I afford it, what happens if I don't or can't?

Busy clinic, joy of finding flow in quick appointments, spot-on interactions, and quick wit of co-workers, support staff and clients.

How much I'd forgotten!

Pix.

Writing for fun (not quite profit)

2011-12-05T17:17:00.001-05:00

I just entered Hanne Blank's Commie Pinko writing contest, and I'd like to encourage everyone else to ~~suffer~~ enjoy along with me. Check out the link and sign up!

Pix (join the crowd!).

Study, abroad

2011-11-03T00:13:00.001-04:00

If you know things primarily about people close to you, then having
archaic and limited views of the world may relate to (but not necessarily
cause) the (lack of) diversity of the people who surround you.

I don't think more memorization of geography will help. However,
travel diaries, travelogues, and personal description can grip,
thrill, and make relevant geographic details of little previous
interest.

I'm currently reading about Malaysian state responses to a swine virus
outbreak. I didn't know that the country was organized into states.

I'm not sure it was relevant information prior to now, however, the
pervasive lack of geographic knowledge contributes to feelings of
being a "dumb American".

I wonder to what degree grade-school geographic knowledge-retention is
influenced by travel and diversity of friend group.

Pix (outskirts of Ulaanbaatar, Mongolia's cosmopolitan capital city, wandering far from downtown in a neighborhood few tourists have ever seen).

Those that can't do... teach?

2011-11-01T18:29:00.000-04:00

And those that are directionless - inspire?

I'm reading Feynman, and I love the outstanding dedication he puts into teaching. For me, the description of the care with which he crafted his introductory freshman lectures describes the culmination of his career and the pinnacle of achievement. In further reading, this dedication comes through even in his description of his lectures. While winning a Nobel prize for a lifetime of brilliant physics research is beyond my understanding, I find myself uninterested in the specifics of his work.

What I'd claim is his legacy and my takeaway from reading these books is the humility and dedication that he put into his work and the willingness he
has to see beyond it into things we don't understand, but are awe-inspiring just the same. It takes balls to step outside of a rigid world of abstractions-on-paper and claim that there's things you don't understand but believe are true anyway.

It takes balls to point to nature, and be slack-jawed and ranting ... about beauty! That's doubly true if what you're known for is tiny mincing, endlessly logical steps.

It's inspiring.

Pix (Mongolian horse, a h/t to the necessity Feynman found for travel)

Ill-prepared to enter the wilderness: Why we should implement competency based training

2011-10-15T21:20:00.000-04:00

This reminds me of what they're trying (and failing!) to implement in veterinary schools in the US.

The intention is good - the goal is to release rockstar veterinary associates into the 'wilds' of practice -- unfortunately, they're still also doing exactly the "Notice what they're not doing..." stuff, below, meaning that over 4 years, only one partial year is spent in the clinic!

So we graduate, scramble for a job (if we're confident or foolhardy or simply sick of school), and bemoan our lack of experience... and our practice owners berate us for our lack of skills, lack of confidence, and slow speed. In the end, we learn, but how much better off would we be if we were in clinics sooner, longer, and more frequently?

Competency-based training (CBT) means that you only teach people what they need to be able to do. Nothing extra. You don’t graduate them from the training until they can do it properly, in the context they need to do it in the future.

For a physician, then, if you are training on IUD insertion, you teach as much anatomy information as they need to do an IUD insertion. You then train them to do the insertion on life-like medical models and then you train them to do it on actual female volunteers. Finally, you observe them while they do insertions in patients in a clinical setting.

Notice what they are not doing: reading about IUD insertion or taking tests on their knowledge of female anatomy. Instead, they watch insertions being done, and they do them. Your physician officially completes the training and gets her certificate when she can insert an IUD correctly on her own in a clinical context.

From Blood and Milk.

Pix.

Michael Jackson

2011-10-08T13:44:00.002-04:00

What _is_ the deal with Michael Jackson?

I thought I understood: I'm a child of the 80s, an American from Michigan, the original 70s home of motown (and my mom loved the Jackson 5).

I grew up listening to the Beat It single on endless repeat, dancing madly with my siblings in our living room. I remember trying to spin on our heads listening to the song (narrowly avoiding breaking our heads open on the furniture, the motherly refrain to our attempts) but that was as far as any of our breakdancing careers ever progressed.

We had a record player and a very limited selection of records. I don't remember being allowed to change records without supervision but I do remember moving the needle oh-so-carefully back to the beginning of the song when it was over.
There was a lot of skipping when our dancing got extremely energetic and that was always a marker of parental intervention (I suspect after song skipping comes damage to furniture, limbs, and probably each other.)

I remember my older (cool, impossibly worldly) cousin spending the night when Thriller was released and played late at night on MTV or VH1, back when they were video request channels and not economic and social media creation engines. This was before someone dreamed up the title 'VJ', and the announcers were little more than young glorified news anchors.

I remember watching the video entranced - and in a near-rictus of fear. I was young and our TV watching was controlled closely, unlike most of my friends, and my 5-years-older cousin. In retrospect I'm not sure why I was so scared - the video was dark and some of the dancing called up images of zombies, but ultimately I knew the dancers were human, despite my vivid imagination and limited pop culture experience. I don't remember if I had nightmares that night but it wouldn't surprise me.

Later, I remember interviews with both Michael and Janet on TV - everything from tabloid-style interview highlights to longer in-depth, 60-minute-type journalistic explorations of personal topics: the Jackson childhood experience, endless discussion of plastic surgeries, whatever the newest one was, discussions of Neverland, details about impossible indoor zoos, private shows, and Michael's obsession with childhood. Later of course, strident denials of child molestation, bizarre relationships, and strange behavior - the mask, odder than the glove or other clothing affections, I remember quite a few interviewers asking Why?.

I don't remember the answer.

All this is a very long way of saying that I thought I 'got' Michael Jackson. I thought I understood the media appeal, the scandalous public cycles, and the media always willing to report the latest scandalous soundbyte or grainy video image.

He defined superstardom.

That being said, you wouldn't catch me listening to his music. And if a radio station I was listening to played his music I'd likely laugh my head off as I changed the channel.

This is in direct contrast to China, where apparently his legacy lives on, free of irony or pop culture scorn. I've heard Michael Jackson played in swanky restaurants, bars, over loudspeakers at public events, and most-recently on a cab ride to the train station. In all of these cases, the Chinese response was no-response - the lack of ironic recognition of the impossibly dated and overwrought pop ballad was missing completely.

In China, Michael Jackson is a good singer, a highly respected superstar, and an unironic American pop culture export.

Pix.

Why do I like feedlot med, anyway?

2011-09-27T07:21:00.001-04:00

Feedlot med is like managing an airport (I know less about managing airports than beef...). The question is always "Where can we improve?"
Optimization, efficiency, constant tweaking of tiny variables for small improvements. If its changing a feed ratio to increase gain by X% or getting planes off the ground one minute faster, the details are similar.

It's a swirling mass of complex data with unquantified but meaningful relationships and causation between elements. Big factors like weather are completly uncontrolable, while other factors like market prices, input costs and fluctuating vagaries of conferences, travel costs and vacation days are understood but far from predictable.

I'm awful with details, numbers, and precisely measured relationships - but with exposure, learn the intuitive pattern of relationships that comprise the whole. It brings me joy to grasp that pattern and correctly predict the reaction of the complex system (I picture amorphous tangled yarn) to small changes - my own version of the mythical butterfly flapping it's wings over the ocean, causing a typhoon on the other side of the world.

It's endlessly fascinating, and there's never any shortage of variables to gently juggle towards an optimal state.

Pix.

Journey

2011-09-23T17:43:00.003-04:00

I'm in the Mongolian north-country, sleeping in a ger, departing tomorrow for a 10d trip on horseback around a lake and through the mountains.

The stars blow my mind as does the smell of woodsmoke and the breeze from the lake.

Dogs bark constantly at night here, I'm not sure why.

Getting here has been painful, miserable, uncomfortable - but not without tiny moments of joy. Yesterday we took a 16 hour minibus, packed with adults, and then filled with children who do not count towards the limit... 4 benches, 4 to 5 adults per bench - and stuff. The roads are best thought of as nonexistent as they are infrequently more than 2 rut dirt or grass tracks with ginormous potholes, rocks, falloffs, and sudden turns around obstacles or soft spots.

If prepared for the pain, it's bearable (and the hours of waiting that accompany it), but if unprepared, the experience can be breaking.

Mongolia is a place that drives home, harshly and completely (but without scorn) that it's the journey not the destination that is important. It's a fierce lesson.

Pix.

You don't rub underwear on your head in the shower?

2011-08-22T05:29:00.001-04:00

I just realized that normal well-socialized adults don't do this --
they don't rub dirty underwear on their heads while they're in the
shower.

There's an explanation, and it's perfectly logical:
Say you've been traveling for a few weeks - at least 3, as I would
assume you'd have run out of clean underwear by now - so what do you
do?

Laundromat would be a logical choice in the US and some places in
Europe. Let's say you aren't one of those places - _then_ what do you
do?

Maybe there's a service - either at your hotel or nearby? If you're
traveling in Asia, laundry service is cheap and widely available, so
you're in luck -- but they don't do underwear.

So you're left with a pile of underwear and no desire to scrub them in
the sink with your fingernails (and water is scarce besides)... so you
shower and clean them at the same time, and it turns out your hair is
a good way to get them uniformly sudsy without wasting shampoo.
And one day, after you've been doing this for a few weeks (because
you've learned its much easier to do this whenever you shower rather
than all at once, whenever you run out of underwear), you realize how
bizarre this behavior would seem to anyone back home.

Pix.

Bits of Mongolia

2011-08-01T04:35:00.000-04:00

Ulaanbaatar is under construction, growing rapidly, and moving ever upward.

Much like Mongolian ladies' footwear.

There's an obsession with stiletto heels here, chunky heels, wedge heels, the kind with wide straps and the kind held on with thread and hope.

Accompanying these heels can be western-style skirts, dresses, pants (from jeans to dress pants), or capri pants or tights.

Fanny packs are a common necessity here, on both men and women as are bag-style purses, mostly carried by ladies but a few particularly fashion-conscious men have sported them as well. Backpacks are the province of tourists from any country. Business-style messenger bags are sometimes sported by serious and well-off young men.

Pleasantly, hand and arm-holding are the norm, similar to China, and male friends are not restricted in showing their affection for each other, even among middle-aged laboring men. My personal favorite is the old ladies tottering along with younger friends or family members in tow. I walked down the street an hour ago behind a very fashionable young man, arm gripped loosely by a smartly-dressed older woman likely his grandmother. There was nothing self-conscious or planned in their slow movement down the sidewalk, and their affection for each other was familiar.

An import I'd guess from Chinese tourists is the umbrella-as-sunshade -- necessary in this bright sun, close cloudless sky, and constant breeze, and likely to assist in achieving the paler less sun-baked skin popularized by advertising.

Hair here is simple - ladies wear it shoulder-length or longer + or - very basic bangs -- it's straight, black, and frequently pulled back in a ponytail. Men's hair is equally simple - either buzzed or more rarely in a basic 'man cut'. Kids, both boys and girls, get buzzed until they deal with it themselves and grow it long. I'm particularly fond of the buzzcut on little girls - sundresses are very common and mean great mobility and ease as they run around freely. Little boys frequently wear brightly colored pants and unmatched but brightly colored zip jackets.

The language, described by some as fighting spitting coughing cats, reminds me far more of Swedish, particularly when spoken quietly between girls or guys rather than yelled in argument between homeless drunks (when the harsh unpleasant edge is quite notable). Since people here are very quiet, polite, reserved, and clean, the former is more often the comparison I'd make.

People are petite but strong, men and women alike, something I was reminded of just now as I watched ginormous sturdy likely German tourists walk by. Some laboring men are huge and squat - with wide bull-shoulders and solid legs - but short, and relatively nimble for their bulk. Few particularly young and fashionable young women are taller and willowy and despite their Mongolian facial features (high, marked cheekbones) I always wonder if they're tourists.

Sometimes subtly, sometimes not, cars have the right-of-way here, despite lots and lots of pedestrians. The difference is most marked when crossing the street - it is the responsibility of the pedestrian to move if a car comes out of nowhere, and cars do not slow even marginally, even for old ladies crossing the road.

There are shockingly few motorbikes in this city - land rovers and small new cars are the majority, though there are few VW-type mini-buses, traditional city buses, a few sports-cars, and occasional new cargo box trucks. Overall, vehicles are new, sidewalks are hastily constructed irregular stepping stones, and curbs and roads are old or non-existent (anywhere outside of Ulaan-Baatar).

Pix.

Beijing airport to hotel

2011-07-30T04:09:00.000-04:00

There's a freedom to reimagine when traveling where you don't speak or read the language. Most things you can guess the function or nature of - roads, tableware, houses.

However, some of the more ambiguous items or places hold more mystery. For example, in heading for downtown Beijing from the *enormous* airport, there are green grassy and tree filled spaces that resemble an odd kind of high density car camping setup. The misunderstanding of this place's function leads to ideas for innovations elsewhere.

How cool would it be to arrive at your destination but need a few hours to recharge, acclamate, make phone calls while enjoying nature? A car park would be a civilly vibrant answer to that possible use, and a beautiful way to fill the traditional wasteland surrounding most airports.

Pix: traffic management in downtown Beijing central business district is high-tech

Mongolia, we made it!

2011-07-30T03:52:00.001-04:00

We are, contrary to expectation, in Mongolia. We'd hoped to arrive
sometime next week via train tickets we could only 'reserve' with our
names and well wishes rather than payment with guaranteed seat
assignments. Waiting for a maybe in Beijing for a week seemed annoying
and unfun.

After talking, questions, more questions and enough indistinct hopes
for a 12yo girl with a crush - we actually arrived at the Chinese
border town early this morning (after a highly memorable but no-damage
sleeper bus ride).

At that point negotiations, questions, and yet more questions were the
order of the morning. After several short taxi rides and exorbitant
fees, our new French friends joined Anthony and I in the Mongolian
border town for an all-day wait in the dead town for our train
departing this evening for the more hospitable capitol of Mongolia,
Ulaanbaatar.

While this has been an outrageously inefficient method of getting from
A (Beijing) to B (Ulaanbaatar), its been an amazing, fascinating, and
highly entertaining journey.

Pix: delicious food before we left Beijing

Sculpting with people

2011-07-30T00:16:00.001-04:00

I think Beijing is the first place I've been where architecture really
has a visceral and demonstrated effect on people's lives. While this
is no doubt true in other contexts, the impact has remained more
cerebral in other places.

Pix: Great Wall, as we sped by

Behind the curtain

2011-07-18T02:46:00.000-04:00

I'm impressed by how normal and approachable people are at conferences - I'm reassured that our thought leaders are a little rumpled, a little hesitant of speech, and are as occasionally unsure of themselves as I am.

Far from being alienating, I'm thankful for this conference for being humanizing.

I feel lonely but supported, which is not a bad place to be. The void between achievement and starting out feels smaller tonight. I am thankful to be given this opportunity to glance behind the curtain.

Pix.

Thanks

2011-07-18T00:52:00.000-04:00

I've been sending out unsolicited resumes with cover letters to members of a professional organization I'm part of and whose members I respect (and consequently would like to learn more from!).

I've never thought of veterinarians as a cohesive group - we're practicing in vastly different practice types, working on different animals, facing incomprehensibly different practice pressures. Some of us are calculating dosages for guinea pigs and others of us are calculating dosages for market-weight beef cattle. How much could we have in common after a few years of practicing such vastly different medicine?

I've been awed and honored by the warm and encouraging reception I've received across the board from veterinarians. I've had offers of housing while I job search, a phone call from a retired-for-13-years practitioner, complements and encouragement, referrals to practices I haven't contacted but who might be interested, and offers of related employment (small animal and cow-calf).

I am honored and deeply thankful to be joining your ranks, veterinarians. I hope I'm able to live up to the high standards that you've established.

Pix.

Reflection in job searching

2011-07-17T23:49:00.001-04:00

It's probably good to have a long and painful job search. If you're not at risk of becoming homeless (in which case, this does not apply), it's useful to have time to reflect. If success is not immediate in your search, there is time to question goals, suitability, motivations, and alternative plans.

Maybe you remain true to your original course, maybe you deviate, and perhaps you scrap the plan entirely and start over. In any event, progress will be with renewed resolve and clearer sight.

Buck up, comrades, we can do this.

Pix.

Trash

2011-06-23T17:12:00.000-04:00

My trash is in stacks, smashed, combined, organized. My favorite bread, high in the gluten my insides hate, is the wonderfully dense and toothsome Tuscan-style. Cake - my favorite is densely carrot-packed, pineapple, banana, raisin, and pecan-filled and barely rises because it's so goody-filled.

My best friend is light, ethereal as the blue smoke that trails towards the ceiling from his cigarette. Back when he had a car and drove for hours each day for work, I have vivid memories of getting into his car and marveling at the lightness of the trash that he generated. Lidded coffee cups, empty and baked dry by Chicago summer heat, filled the passenger seat and wheel-well and spilled onto the pavement whenever the door was opened. The sound and feel of climbing into that seat, making room among the quiet rustle reminded me of amusement park ball pits of my childhood.

The feeling wasn't unpleasant - lightly coffee-scented and dry - a nostalgic ball pit for urban commuters.

Pix.

NYC: Smell of presence

2011-06-23T16:36:00.000-04:00

New York city stinks.

Its not the stink of well-used Swedish bathrooms: shit, unadorned with fake scents, fancy deoderizers, or cloying disinfectant stench.

Its not the stench of new Orleans on a July morning: vomit, warm urine, stale alcohol.

Nor is it the hazy heavily sticky scent of Kampala's burning garbage and strangely acidic tang of bird shit from the huge scavenger storks that accompany refuse throughout the city.

Its not nauseatingly perfumed body odor, wafting from the body next to you on a August afternoon bus, nor the stench of urine and excrement clinging to a subway platform late at night.

It's not sewer gas, up through the drain, though this might be the closest scent so far. Its presence is hailed by my burning eyes and raspy throat, more mechanical and industrial than organically unpleasant.

Of the industrial odors, its not tar, hot pavement, or the dusty metal of cement. Its not quite as strong as refinement of oil, a process so far from refined as to be laughable. Its close to this, but cut with airy ozone-compounds that might seem to dillite the stink initially but simply make it more difficult to pull this air into your lungs.

Smog, I'd never realized that you had a taste, and that only minutes in your presence would coat my lips for hours.

New York, I expected to dislike your crammed together mass of humanity - but it hasn't caused me grief (yet), it's your smell that surprises me.

Pix.

SFDVM seeks open-minded, creative, progressive employer. Passion for excellence required. Salary negotiable.

2011-06-23T14:13:00.000-04:00

I'm looking for a relationship.

I guess this is typical for a woman of my age, however, I'm not looking for a date. I'm just coming to the realization that job searching is more about good fit, similar outlook, and shared perspectives. In that respect it's very similar to looking for potential dates.

However, unlike dating, I have no expectations that this will be the perfect fit forever, or that I'll buy into the first practice I join. I'm exploring my options, looking for something that fits both professionally and personally. I want to do work I find fascinating, exciting, interesting, and fun (at least some of the time).

More important though is the work environment - I'm looking for the "right fit" - and *that*, more than anything, feels like dating.

Pix.

Accidentally found

2011-06-12T16:56:00.001-04:00

Every once in a while I find what I'm looking for. (Frequently whenever and wherever I least expect it.)

Today that was this guy - a lazy suzan, neurolinguistics, a poisonous caterpillar, and stand-up comedy.

The more detailed the memory, the longer the moment seems to last. “This explains why we think that time speeds up when we grow older,” Eagleman said—why childhood summers seem to go on forever, while old age slips by while we’re dozing. The more familiar the world becomes, the less information your brain writes down, and the more quickly time seems to pass.

Thank you internets for curating awesome, providing interesting ideas, and news.

Hoping your day is full of inspiration,
C

Pix.

Five rotations

2011-05-14T15:32:00.010-04:00

Clinics went like this:

1) Client skills, history taking, compassion, directed open-ended conversation, note-taking, physical exam, orthopedic exam, reading radiographs, professional interactions with co-workers, staff, pressures of speed, perfection, sterility: Orthopedics.

2) Drugs, generally everything goes OK, miracle of putting an animal to sleep and waking em up again, serenity through boredom and crisis, advanced social skills: Anesthesia.

3) Spay, neuter, comfortable excitement of surgery, physical proficiency, speed, intuitive assessment: Shelter.

Two I’d like to forget: wrenching failure, hopeless repeated wrongs, insufficiency: Equine, excitement, exhaustion, grinding small not-good-enough, no recovery, grey bleakness: Emergency.
Pix.

Progress

2011-04-18T14:32:00.003-04:00

Welcome to clinics.

Its not about what you know, but how well you learn to search and copy a set of discharge instructions. Discharge instructions are clinician and resident specific - it took me almost 12 months to learn to ignore wording, detail, and instruction preference. Its a painful thing to watch a resident shred the document you frantically composed according to the preferences of the resident you worked with the day or week prior.

Sundays take on new significance (see Spastic Colon Sundays) when you're in clinics - every monday means an extra-early morning as you frantically order paperwork, write SOAPs and add discharge notes to cases that you turn over to your classmates just starting the rotation. You then scurry off to your next rotation, hoping your cross-departmental-contamination (smelling of horses or cows when on neurology or internal medicine) isn't noticed. In addition, you're unclear on what to expect, where to meet, or what you should have prepared the night before. (Check online, then facebook for classmates who have completed the rotation). Order the extra-large coffee from the lady under the stairs.

Monday night isn't great - don't judge a roation by how you feel that night, as it's likely to be exhausted, overwhelmed, and strung out. You'll end the day with a promise to yourself that tomorrow will be better, that you'll spend two hours reading, and that you'll remember what the resident wanted the discharge to say, and that you'll at least google for the basics of whatever disease you saw that day. For the first few months, you'll try - and you'll fall asleep over your internal medicine book or coursenotes. This is the best time to learn the material (assuming you're not so exhausted that you're a hazard to other drivers on the way home -- and you will be) before you start cramming for boards.

The takeaway: it always sucks - until it gets better. This is "growing a thicker skin", one of the most-important but never discussed goals of clinics. The technicians seem to view it with relief, the clinicians with tired disgust and perhaps a small measure of pride in our "growing up", and your family may either consider you an insufferable egomaniac or "finally a doctor", depending on your starting personality and their perspective of the process.

Your friends won't love it - by necessity I think you become self-involved. I've lost humility, a wonder at possibility, and awe at the practice of medicine. But I can say "I don't know but I'll look it up" without self-disgust.

Pix.

2011-04-18T13:30:00.003-04:00

I don't love what I've become in the last year - there's lots of "in" (as in inbox reading) but very little action (replies, movement, creation). This year of intense learning has turned my attention inward, rigid, shallow.

I just read a review of the last month I spent on clinics. Interestingly, there was one clinician I got to see in two very different contexts. Her comment in the less social enviroment had to do with my technical skills: improvement noted, confidence gained, success. Her later review of my interactions in the more social of the contexts sounded surprised - complementary, love from the clients, amusement at my enjoyment of client interactions.

It was a good reminder about the effects of context on evaluation. It seems obvious to me that I enjoy client interaction, even if I'm an introvert. However, someone evaluating me in opposite scenerios would be likely to miss one or the other of those two very important qualities.

Either way, the review made me smile - and considering that the last month of clinics wasn't full of joy, I thought it worth mentioning. (I also sent a thank you note to this person - she was a joy to work with - relaxed, calm, encouraging, unflappable.)

Tomorrow: more hiking, hoping to turn attention outward, with movement.

Pix (Em, kindly helping with a different kind of creation).

AT in GA

2011-04-15T00:13:00.003-04:00

Thank god for family that understands your quirks, geeks out on your departures from normalcy, and laughs gently as they support you.

Pix.

Dataset: Life

2011-04-03T21:10:00.002-04:00

I don't know how this man doesn't explode from the sheer awesomeness of his work (and I mean that in both senses) and from the magnitude of data that he's collected.

I also love that he gets a little rough-voiced at the end when he's talking about his son learning to walk.

Link.

2011-03-21T11:16:00.004-04:00

I had a dream last night that I was walking someone through the method of hemostasis used on the hide of cattle getting cut for a csection or displaced abomasums.

I was somehow bleeding from the back of my neck and needed an unknown someone to grasp the bleeding artery or vein and yank -- causing vasoconstriction and arteriolespasm, resulting in hemostasis. They were horrified by this method -- one that I like -- it relies on the body's own mechanisms, doesn't involve a foreign material being put into your incision (ligating is the alternative), and is quick, shortening surgical time and risk to your patient. To say that it's painless is a given - I'm a fan of anesthesia, local blocks, and systemic pain control - and in that, it's no different than ligating.

The person couldn't wrap their brain around yanking. They thought it was barbaric. I was arguing that it's not difficult to do and they should just grasp the thing and pull hard and that my body would take care of the spasmed contracted end as I healed.

I woke up thinking about clinics, and how so much of what we do is experiential and just needs to be done. Things like how hard to yank can't be taught in a classroom (we learned the basics of hemostasis and details of the clotting cascade as a theoretical exercise three years before).

How hard to press when incising a cat abdomen vs a full-grown cow abdomen, how hard you can pull on different types and sizes of suture, and how tight is too tight when tying suture are things you can only learn by cutting too deeply, not deeply enough, or by breaking suture and tying loose knots.

Clinics is about the experience you had before vet school - did you work for a small animal vet who let you spay and neuter with supervision? Did you spend a summer riding with a large animal vet who let you fix DAs and pull calves? Did you spend weekends spotting equine lamenesses and doing nerve blocks in your sleep, passing tubes, and injecting sedation in bucking thrashing foals?

If someone asks, the right answer is always "I don't know, but I'll look it up". And then do, and come back with an answer, even if it's "I looked in XYZ and VXY and checked VIN and there doesn't seem to be a consensus answer."

That's what I learned from clinics: show up, have a good attitude, and learn to look things up. Some things you'll never know the answer to - those things you just do, because they aren't memorizeable. There's a reason this profession used to be by apprenticeship, and should be again, if you ask me.

What I already knew: patient care and client communication are way more important than tidbits of specialty knowledge you can't recall in rounds.

Pix .

Wild food

2011-03-12T21:53:00.008-05:00

Met a man this afternoon who wanted to be an organic farmer. He likes plants, likes people, but in a tertiary way. He never had the capitol for a purchase of land. He's an older gentleman now, adherent to the ideals of his generation's youth.

He takes kids on nature walks, talks to youth groups, adults, those interested in eating nature. He's an outdoorsman, self-taught, learned from books and tastings of plants he's found. He's foraged up to 50% of his food at a time, though that's unusual for him and takes an intense commitment even in a favorable season (early spring is a hard season in the midwest).

He's not into hunting, though it seems like a subject he'd considered and rejected, but held no ill feelings for. We had a short conversation about my interest in learning the practice though I don't come from a family with a history of doing such things. I didn't mention that a large part of my comfort with hunting comes from comfort with the idea and reality of death and the process of harvesting food (meat) from a (dead) animal. Had I, I don't think he'd have been shocked.

It was an enjoyable few hours, though one I wished had covered a larger distance (we walked less than a quarter of a mile, tops), simply because it was a beautiful day.

Like gardening, foraging is a habit that involves being in nature, eating, and observing and respecting seasons. As far as ways to spend an afternoon, I could do worse.

Pix. Chickweed, an omnipresent ground cover in open areas, lettuce-like, mild and pleasant, and one of my favorite discoveries today.

2011-03-05T09:05:00.002-05:00

Already I was beginning to realize that a spectacle has no meaning except it be seen through the glass of a culture, a civilization, a craft. Mountaineers too know the sea of clouds, yet it does not seem to them the fabulous curtain it is to me.

When I left that room I was filled with a childish pride. Now it was my turn to take on at dawn the responsibility... But at the same time I felt very meek. I felt myself ill-prepared for this responsibility. Staring at the aridity of my maps, I could see no help in them; and so, with a heart full of shyness and pride, I fled to spend this night of vigil with my friend. ... "We'll drink to it. Don't worry. It's easier than you think." ...

"You'll be bothered from time to time by storms, fog, snow. When you are, think of those who went through it before you, and say to yourself, 'What they could do, I can do.'"

-- Wind, sand and stars; Saint-Exupery

Pix.

Audacious!

2011-03-04T20:58:00.001-05:00

2011-02-23T15:54:00.005-05:00

A traveling friend writes:

"I am in XXX and internet connections here are minimal and slow! the ground has stayed stable, but while on a jungle trek had a near run in with what our guide said, from the sound, was either a honey bear or tiger. I am done with jungle trekking! will be back soon ... see you on skype."

I have a little more sympathy with my friends and family who read my travel updates and cringe. When traveling this sort of thing seems normal, routine - a funny story to be shared with friends and laughed about over a drink.

From the steady routine of a stable work week, this seems insane, terrifying, crazy.

It's all in the POV.

Pix.

2011-02-06T10:52:00.002-05:00

I pray at the church of coffee.

Thank you for this small moment of silence, quiet, contemplation, and warm nourishment. 5 minutes of closing my eyes, relaxing my jaw and inhaling the scent of peace and contentment. Mentally ordering my to-do list, checking in, asking if this is what I need to be doing. Thinking. Being present. And thankful.

Thank you.

Thank you, thank you, thank you.

If I am empty, these few moments go a distance towards filling me up.

Pix.

2011-01-23T22:34:00.002-05:00

His grandmother really is a superhero, I just think mine is.

Link (pix is not mine).

2011-01-23T14:29:00.004-05:00

Quick, quick, slow.

Where is that from? (EDIT: oh) It's stuck in my head this morning - description of dance, rhythm, and life.

Looks like the homestretch - is this quick or slow?

I think this year, this month, this coming 12 months are going to be about finding a way to preserve who I am, my sanity, identity, without loosing the thread of day-to-day routine _work_. Boundaries. Or maybe that's the wrong way around, I'm not sure.

Brainstorming about ways to preserve space, bubble of silence, mental isolation, recharging, well upon which to draw, and some way to refill it surrounded by thousands of screaming people. Burning man in august. I'm an introvert.

New relationship, also, friends, and impending job search (I'm late already, haven't started). Internships too, tryouts, tourist explorations of the western states, new labs (familiar, they fulfill the same function), new contacts (the kind that won't pay off for several years, enjoyable, casual, expanding professional circle).

Maybe I should be concentrating on my classmates, peers, those already geographically adjacent. I'm lazy - they know me, have worked with me in clinics, watched me or ignored me in class for three years, and they know my friends - they're passive contacts. I have the few close friends I always have - and they're aggressively friends, not contacts, and that's the way I like it. They're unlikely to help me get a job - but they'll be the people I discuss my contracts with, and who talk me through those dark few months on the job (you've got the Dr. but your tech knows more about the work than you do -- the reality of this wildly diverse field is "training by reality").

I hope for kind clients and generous co-workers and a scrap of personality left behind after the first year. I don't even know who I am anymore - I hope I can figure that out when work becomes more routine and every action doesn't need to be scrutinized. Maybe I won't ever remember, and maybe enjoyable travels, good friends, good food, and good drinks are all it's ever about.

Pix, the one I can't look away from, I'm getting a large version printed and framed for my room.

2011-01-05T19:25:00.002-05:00

How long *could* I stay on a train?

Really. And what if I changed trains?

Pix.

2010-12-09T12:30:00.002-05:00

I just love this lady, really. She's funny about chairs - and pretty much everything else. Not ha-ha funny, but the smile-and-quiet-joy 'isn't life funny?' kind of funny.

Pix.

2010-11-29T01:08:00.003-05:00

Chinese Junk: The roster of ingredients includes dried lotus leaves for snails, noodles for the wood floor, physalis lanterns, and the obscure wild green yamakurage for the rope.

h/t Brainpickings for pointing me to illustration of my half-remembered dreams.

2010-11-07T19:37:00.001-05:00

h/t moominmuppet via darkroastedblend.com

2010-11-05T22:49:00.003-04:00

There's a professor I'm particularly enamored of, much to my surprise - he's a surgeon. I'm so far from interested in surgery that I don't have words for it. The precision of excision, the brutal hammering of living bone, and the wrenching of blobs of soft tissue for the purposes of healing are best left to those with a gift for anatomy, garment construction, and a love of power tools, tinker toys, and a misguided engineer's love for details of assembly.

This guy is what I am not - formal, precise, methodical, with a grasp of anatomic subtlety that borders on artistic.

I only present this as background for my awestruck regard for his passion for teaching, dedication for the task, and single minded focus. (I'm still talking about the teaching.)

The thing that strikes me, beyond the immediate surprise, is the wholly nontraditional approach. I suspect it's so classic that its new again, but not having previously encountered such a dedicated adherent to the didactic approach, I'm not sure what to compare it to.

Unlike most instruction, PowerPoint based, reducible to outlines, lists and precise definitions - this is a story, a series of stories, reliant on a store of reference knowledge, but quickly and seamlessly tying that material into a storied summation of knowledge.

Taking notes isn't the point, and the material needs to be previously mastered for the refresher sketch to make sense.

Its an elegant, spare, and coherent conveyance of visual nuggets, well-suited to rounds style teaching - minimal materials, short format, case-based.

Its a personally - consistent expression of material, and though the shape is formal and the personality is not mine, I'd like to know how he manages it. Where did it come from, where did it evolve from, what changes have been made along the way?

Most importantly, how does he maintain that passion through exhaustion (years of a 'clinics caseload', 6 days a week, 12-14h a day, without the time off that is the due of clinicians)?

And how does such a personal expression of passion, seemingly unrelated to trends in educational theory, inspire years of students, residents, and clinicians?

Pix.

Fun is reason enough

2010-10-24T19:20:00.006-04:00

In response to this, and in noodling about next year (first year as a practicing vet), I keep revisiting an idea I had a year ago about a self-designed internship.

Due primarily to lack of experience during our clinical year, graduated veterinarians are electing to spend an additional year in training, largely in an internship program, either academic, or private. Other motivations are better job opportunities and the requirement for an internship for most residency programs. Residency and boarding (and PhD) programs are driven by a variety of factors, in large part financial.

Graduating with the astronomical debt of medical school and 1/3 to 1/6th the starting salary tends to push people into specializations such as surgery, anesthesia, internal medicine, and pathology. If that isn't motivation enough, some jobs (government, higher education, less commonly private corporations) require the additional degree or boarding, so there's a strong push among those who would like to work in a particular area (international development, college or university professor, diagnostic lab) to pursue the additional 5 years for a doctorate on top of their doctorate.

I want to work before deciding (?pathology residency, one of the few residency programs that doesn't require an internship year first). I want to find out if I want to spend my days inside, in an office, reading slides or if I'll be entertained enough spending my days outside, freezing or frying, in the beef feedlot environment.

Unlike most of my classmates (most of whom are pursuing internships because they want a residency), I'm considering how I can pursue the learning aspects of an internship while making real money and gaining a valid appreciation for the day-in-day-out of practicing for a living.

Months ago, I idly wondered if I could convince large beef feedlot practitioners to take me on as a temporary employee so I could "sample" more practices, more ideologies, more 'best practices' without compromising my ability to practice at the next practice (temporary employee, noncompete agreement, confidentiality agreements, financial compensation). A custom internship, if you will - in the original spirit of the form.

I wrote off the idea - impossible to set up, never done before, too presumptuous of a desire to teach (and the benefit they could gain from my experience is minimal - in feedlot, unlike small animal practice, private practice informs education, not the other way around), and unsure what financial inducement I could offer from my temporary status and the additional hassle of crafting unique legal and social agreements.

So what would I do? I'd aim for the 3 biggest feedlot practices, buy an RV, and do 3 months at each of them, learn as much as I could before moving on, with the remaining month spent abroad (I dream of Vietnam, though I have a friend in China) or at an avian exclusive practice. I'd expect to know if I wanted to pursue a permanent position or enter a residency at about this time next year and I'd do that at that time. (Or put that question off for another year of learning - diagnostic lab, government, llamas in the mountains, or international work.)

Why? Solid networking contacts, 'best in field' knowledge, clinical experience, experimenting with living in different locations, and because I think it would be fun. Isn't that enough?

Pix.

I was a first year

2010-10-18T22:48:00.002-04:00

The phrase "I was a first year", with the attendant anxiety, hope, and utter lack of preparation for the onslaught to come - has some validity now. I made it far enough from that point that I can see the similarities and the differences. simultaneously

To the people currently in that condition all that is evident is the differences. Today was book buying day. The relentless categorizations and social ranking was evident even at a glance.

At this point in the year it's recruiting for a team to shore up an ego - and for the followers, a bid for the highest favored runner, a winner, a hopeful. A shore, a rock, and some meaning in the chaos. There isn't even friendship yet. The fear is too high to overcome the barrier of someone else's perceived awesomeness.

It's naked social climbing, motivated by fear - of being different, not being outstanding enough, of being alone.

It'll become about other things later - real friendships, hours spent studying, the disbelief that physical skills don't come from hours of study and the attendant ego flaying that skill development through endless strings of mistakes (clinics) requires (and the friends to talk you into trying again). There are mornings of 'just one more' (hit of caffeine) followed by nights spent forgetting with 'just one more' drink among friends.

They aren't there yet. I pity them having to establish those friendships, rather than being able to rely on them for sustenance, joy, and the mundane aspects of companionship (letting you know you spilled coffee on your white coat or dragged a leash through vomit).

I wonder where I'll get to reflect from next.

Pix.

Observer effect

2010-10-18T22:33:00.003-04:00

I can't believe the silence.

Its a luxurious indulgence I can barely afford, but love.

I'm horrified by all the people living in cities, suburbs, and in towns along major highways. We are all reliant, complacent, entrenched. Though I write this, of my love for desolation, infrequent birdcry, and wind, crickets, and a far off roar in the distance (water, not traffic) - I don't know how to make peace with it either.

Lack of cell phone reception (I'm alone and reliant on a call for help if all does not go with luck and according to plan), reliance on technology and searching for that most basic of needs - fresh water, transport (out), warmth and protection from the weather - that most fickle of abusive lovers, food - carried in and out but pursued by the wildlife I'm here to share space with (and yet another source of possible death).

I think we need a sanctuary, a protection of more space than just the national forests (though I love them) - silence is a resource we can't afford to loose.

(I'm fairly certain its not possible - but what a travesty to not allow our grandchildren to experience). (I don't know how it would be controlled, protected, or funded, and I know its rarity would ruin it -- silence after all can't be shared.)

Pix.

Getting dirty, and being clean

2010-09-11T00:39:00.003-04:00

There's a visceral joy that comes from being clean when you're traveling. Its a simple thing, but travel is generally dirty, crowded, and sweaty.

For me it usually involves public transport rather than the familiar sanctum of my personal vehicle at home.

Generally there's nature or hours wandering city streets, frequently carrying heavy bags. And importantly, if it rains or is miserably hot and humid - there's no retreat - just continually moving forward, taking life on its terms rather than the routine of home.

So its a simple thing, but the uncomplicated joy at being clean, dry, and tired when you're living out of a backpack, moving every night and cringing at the bathrooms you're about to get naked in - is one part of travel I both love and hate.

Maybe its the contrast, the movement from feet so dirty that I don't want to touch them to clean them to amazement at the improvement.

Pix.

2010-09-11T00:29:00.002-04:00

Maybe I've come to a realization about this process:

Here, now; that's all I've got to learn on.

Despite cranky clinicians, inexplicable waits, and the frantic 'go home' writing that occurs while six people stand behind you and loudly reenact the last episode of 'Glee' or sordid details of their weekends -- that's it, there isn't any other time for learning.

Its now or never, and you either embrace it and own responsibility for the process or you shuffle through, getting good grades but never having enough confidence to say 'I don't understand'... and you graduate in a year but are so petrified of practice that you pursue an internship or take the job with your hometown vet simply because he liked you as a gangly awkward kid of 16. (Maybe he'll forgive your 3 hour spay, misdiagnosed ear cytology, and botched lipoma removal.)

This is it. I don't know - but I care enough to learn.

Pix.

Old, but relevant

2010-09-10T22:41:00.005-04:00

I'm in Transylvania, in a national forest. I'm alone, it's raining, and I'm trying to sleep in my hammock. I have an unopened tent pulled over my head sheet-like, as I try to protect myself from the ceaseless drizzle. I'm worried about creeps and bears.

There's a huge sign as you drive into the forest: no cell phone reception. They aren't kidding - it was 45min of driving past that point to get here (off the trail, car hidden, stream nearby). I arrived after midnight, making navigation that much more fun.

I jerk to groggy alertness the handful of times headlights graze the trees around me.

I started the day in hilton head island among the monied retired and wannabe plains state vacationers. The former were sporting camel and casual Italian loafers. The latter were an unflattering combo of overweight and basic cottons in this seasons' walmart special.

After that start to my day, I passed through Savannah, and an unexpected detour involved touring through the abjectly poor rural countryside.

A gentleman standing in the door of a condemned trailer, shredded sheet blocking the view, gave a jaunty wave as I pulled onto a rutted dirt path, past cattle skulls leaning against a post, and a neglected no trespassing sign.

I bottomed out my economy rental car several times before giving up and turning around.

The gentleman waved as I went by again.

I waved back, always happiest when things are going just slightly pie shaped.

Pix.

2010-09-10T22:16:00.003-04:00

I can't believe that this is it - these are our techniques - and in a year I'll hopefully have a job lined up.

It seems impossible. But around me, girls are getting married, husbands are making job and career decisions contingent upon wives's graduations, children are being deferred, and everyone is counting down to "just one more year".

Being a professional still makes me want to roll my eyes (I look forward to working, but the professional part is questionable), and the idea of buying a house is flatly impossible (somehow the expectation is that house-buying goes with professional-job-having and staying-in-one-place-for-a-good-long-time).

I don't really have the expectation that I'll have more time for hobbies as some of my classmates do. I'm pretty sure this is all the time I'm ever going to have and I'm probably spending proportionally more time on things of outside interest rather than direct practical applicability now than I'll get to while I'm working. On the other hand I suspect that there's a fixed balance and I don't actually have
any control over the 'outside interests' - they just fit differently into a work day.

I look forward to getting paid rather than racking up more debit (the "mortgage on my skull"). I look forward to the immersive experience of narrowed professional focus, enough repetition and breadth of experience that I'm comfortable that I know the answer without worrying that I can't remember the mechanism.

I'm probably as social as I always am (or could be). I hope I find people I like, but I always do, so theoretically I shouldn't feel the need to stress out about it - but as always, I will.

I'll miss where I've been, long for wherever I've traveled recently, miss old friends, and wonder about the possibly-maybes of nontraditional carer moves.

I'm probably as confident as I'm ever going to get - which is not very, on the inside, but inclined to wing it (and I'm right often enough that it works out). That scares me, but it feels consistent with my lived experience so far.

While I want to wish upon the far off day of "when-i-graduate", I don't have any reason to believe that that day is any different from today.

Pix.

Anxiety

2010-09-05T00:43:00.005-04:00

How must it be to live as a chipmunk?

They're tiny cute happy meals on perfectly-sized-for-snacking-legs.

So anxious, they twitch when the wind blows, jump at a bluejay hopping in branches above their heads and freeze in watchful fright every second or two.

How is it that they ever relax enough to care for their young? (imagine searching for a safe place, impending birth relentlessly pushing you towards safety - hormones saying now, brain saying not yet, I can find somewhere better).

Or what about reproduction? Joyless anxious act undertaken when the shrill scream of hormones finally overtakes the manic fear of wind, movement, and your natural environment?

Or don't they know? Unaware, life lived as a series of "nows" (terror, delight at a bite of fresh cherry, terror again at the wind, torn between the two endlessly).

Can we learn something from the chipmunk that may explain our actions? Lead to greater insight on a topic we're all intimately acquainted with? How do they do it?

Pix.

A case from emergency

2010-09-05T00:28:00.003-04:00

My feet hurt, centering on a burning radiation at the pads of my big
toes and extending across my foot and up my legs. I'm tired,
exhausted, and worn out. I'm demoralized enough to feel that despite
the exhausting work I did, that it was badly done, and that I
short-changed myself and every patient I saw today.

We had a dog in today who I'd probably like, in other circumstances
(he's my type - square-jawed, scruffy hair, wide stance).

I can't tell if the dog is mentally appropriate, in pain, or reacting
in a consistent way to stimuli. The first two are the weirdest - the
dog is either nuts (my vote) or the most bizarrely stubborn and angry
dog I've ever met. He's on pain drugs, because it seems likely that
he's in pain, but I haven't gotten a definitive answer from anyone.

If you touch the dog he tries to bite you. Not every time, but
frequently, and when he lunges, he's serious. He's so aggressive that
I don't know how they got the dog in the building - or why - or who
the owners convinced that he's not a legal (and literal) bloodbath
waiting to happen.

I fed him this afternoon; from a syringe, dribbling concentrated food
into his mouth through his muzzle, from arm's reach away. He would
snap at the syringe and I would wrench it out of his clenched jaws and
continue to feed him.

Intermittently he screams. It's a horrible, bizarre, miserable
scream. It sounds crazy, frustrated, not even dog-like. And he
thrashes and rips at anything he can reach through his muzzle (his
front dewclaws are bloody from where he tried to remove them). He
breathes quickly and shallowly, like he's been running and panting.

Sometimes he seems better if you leave him alone, sometimes he seems
better if you talk to him. Someone else tonight thought he was
throwing temper tantrums like a frustrated and whiny child. It's
possible, but I think he's just nuts (brain tumor, fungus, or abscess
- something eating or putting pressure on his brain). I heard there's
something adhered to his spinal cord, and I know he's got a high WBC,
but I haven't heard more than that (he's in ICU and I know there's at
least two departments working his case). I'm curious what they find,
but I hope it's fast. It seems cruel to keep him alive (but
warranted, if it's infectious/treatable).

And I don't think I can do another 10 hours of screaming as the
soundtrack to my day.

Pix.

Work makes the need

2010-09-05T00:13:00.003-04:00

If you're a carpenter, you see hammers and nails in need of fixing.

If you're a parent, you see babies needing guidance and care.

I'm not sure where half-student-half-clinician leaves me. My sympathy lies generally with the technicians, with those who do the work once the decisions are made. More frequently though I find myself sympathetic to the interns, incompetent and unsure as they may be.

I see things as a pathologist, imagine lesions as possible causes of death. Internal medicine is only an interest so long as it produces a lesion in the organ. I'm really uncomfortable with pain, though I'm unbothered by death.

Maybe that responsibility weighs more heavily on me than do treatment decisions, but by that acceptance, I guess I am becoming a doctor.

Pix.

Flowers, food, and homesteading

2010-09-04T23:57:00.004-04:00

I'm curious about drinking flowers - liquors, teas, ice water with a floral nose.

I think I'd like to keep around some sort of naturalist - I have frequent questions about trees, edible plants, and rocks (geology, not gems).

I'm hearing in my little insular community about growing things, canning, brewing, and wine making. There seems to be a growing acceptance of home culinary creations.

Maybe its a refinement of my friend group, a willful ignorance of where other people are, culturally and personally, but I think I see a small amount of hope for this much lauded food revolution.

Pix: Vietnam, where food is fresher, and herbs accompany almost all food.

2010-08-24T22:59:00.003-04:00

If imitation is the sincerest form of flattery, then the beef vets of the world should be flattered.

Things I'm learning to do:

Stand tall. Beef vets have uniformly phenomenal posture.

Walk slowly, with the locomotive equivalent of a drawl. You'll get there. Those that have an eye will notice that you've arrived.

Be visually calm. Cattle don't like to be spooked, and neither do people.

Keep your voice pitched low. Its soothing, and lends weight to your words.

I still stick out, and it still bugs me, but I'm becoming more comfortable with the idea that it's not the end of the world.

I've talked to a few outstanding women vets recently and they've told me my clients will care less than I expect them to about my differences.

A good vet is a good vet. Now I just need to make sure I'm a good vet.

Pix.

Being amazing

2010-08-24T22:15:00.003-04:00

So it's about being crazy. Being balls-out-insane, and doing 'your thing', whatever it might be - with passion, dedication, and single-minded focus.

That's what it's about.

For better or worse.

I watched all 6m of this video with my jaw on the floor - I didn't even know you could do that - let alone be really really good at it. Thanks to KL for the link.

Tales, even lies, have value; they tell what might be possible, 'if only'

2010-08-08T21:25:00.002-04:00

Sometimes you need a place for an impulse to go, some shape for a goal to take.

Going next, following in footsteps, adopting someone else's dream: useful, not unsatisfactory, but less scary than being first, pursuing some amorphous half-formed confusion in the hope that you can somehow make it work in the end.

Whether a surprise paper or a career path, there's the fear of following the unknown. And what may seem obvious and logical in hindsight will be sleepless nights and nauseatingly rolling stomach before the decision is made.

Pix.

How To Be Alone

2010-08-08T21:20:00.001-04:00

2010-08-01T21:48:00.004-04:00

Looking at pictures of old friends - I'm struck by how frail we are, to carry the broken bits of ourselves around and show them to each other.

These are people I know well, and have enjoyed their presence intermittently - a visit here, a stay here in that city, a year or two, then one of us moved on. Pictures snapped in unremarkable moments of togetherness, comfort, and joy.

I'm struck by the other things in the photos. The space, and arrangement of limbs, bodies, and other friends. They speak of other times, other relationships, current entanglements, solid engagements.

I reflect on the choices that have brought us here - to this current collection of simple snaps of moments with friends. Nothing special - dinner, last night, ice cream, last week, moments at work, cute pets.

Feeling the enormity of choices - little ones and big ones, mistaken ones, and unimportant ones - little contributing choices to big decisions. Branches of friendship grow to fruit and flower.

Choosing is continual.

Pix.

Chopsticks

2010-08-01T21:38:00.002-04:00

I was talking to some friends this weekend and we were discussing chopsticks.

I learned to use em from my younger sister, sometime after the age of 20. My friend is self-taught. The last person learned at some point during childhood - it was a non-event, an environmental norm.

The self taught friend has been living in China for the last year, though he's from about as nondescript background that you could invent. Midwest, tiny outer-ring suburb/small farming town - "Chinese" was only the blandest and most deep fried of the americanized cuisine we know by that name.

We were talking about comfort with chopsticks and he described his everyday usage as 'being able to look at something and know how to manipulate it'.

I realized this was an excellent metaphor for surgery.

Its not particularly difficult, once you've mastered the physical skills, but until then, it's awkward, magical, and the simplest goals are impossibility difficult.

If you're chopstick-savvy, try eating with your non-dominant hand.

Pass the love onto your surgeon.

Pix.

2010-07-20T20:06:00.004-04:00

Random assvice for clinics:

Take emergency early (not first or second but relatively early). It's good prep and confidence for _everything_ else - and you'll know how to write ICU orders for lots of different services. You'll be exhausted - be gentle to yourself this month and try to enjoy what you can of the sunshine - being 'off' during the day is a novelty. Eat ice cream and sleep as much as you can. Friends and family should baby you and bring you food, love you when you're around, and understand when you're wired, wide-eyed and exhausted. Your grade won't correlate to the amount of effort you put into the rotation. Be sad, if you must, but move on, appreciating what you got to do, what you learned, and what practical experience you obtained.

Take anesthesia after emergency, but also early. You could take this before surgery, if you want a preview of what happens in the OR. It's a good way to learn the drugs - the ONLY way to learn the drugs. Be prepared for the environment - mildly hostile, tech-centric, chaotic but molasses slow. You learn a lot - bother to kiss ass (the drs are OK, you need to kiss tech ass). Relax - nothing in anesthesia is ever an emergency. Cultivate a sense of humor and you'll be popular.

Neuro is a good gentle one - I was on while we were crazy busy and it was great. Your clinician will determine if you get out early or not (hint: one week you will, one week you won't - there are plusses and minuses to both).

Round about june or july (or when your mood-altering drugs kick in) you'll be getting used to starting over feeling like a moron every two weeks. Relax and learn as much as you can. Studying for boards starts soon.

Dance, drink, and catch up on life when you can.

Pix.

2010-06-02T08:00:00.004-04:00

Driving home in morning rush hour, bone-tired but satisfied, eyes red-rimmed, dry and unblinking - watching everyone in their cars, not fresh, but starting their day. It's surreal, remote, cotton-wrapped. I feel compassion for them, wet hair and coffee, focused and anticipatory, running late, counting seconds at the traffic light, wishing they'd gotten up 10 minutes earlier.

I don't want to work the overnight shift, but I appreciate the skewed worldview that living out of step brings.

Pix.

2010-05-26T13:23:00.004-04:00

It's hard not to lie in bed and feel sorry for myself. It's tempting, well justified, and socially encouraged. (I worked 18h on monday without even a chance for dinner. Last night was a short 13h but I only managed to stay asleep for 5h this afternoon - I'm now exhausted and can't get rid of a headache - and I haven't even started my shift).

On the other hand, this is the first time since I've started clinics where I've felt less than completely incompetent. I don't know how to do most of the procedures that happen in an ER but I've seen some of them before. The types of cases that present on emergency are familiar (lacerations, seizures, bloats, blocked cats, vomiting dogs), and I can use that experience to attempt a care plan and differential list (unlike for example: horses).

The 'criticalists' (emergency and critical care specialists) would have my head for saying this, but the attention to detail is less - getting it done is more important than getting it done perfectly. They, of course, do both - but for us they're relatively tolerant of that most-hated and most-used phrase in my vocabulary: "I don't know but I'll look it up".

Stabilization of a crashing and shocky patient is a dance - artwork of blood pressure, fluid management, drugs, and transfusions - but it's a formula, a routine, or a recipe with several addendums: Start with fluids, do BP, EKG, monitoring and palpation, progress as you learn more. If all else fails, do XYZ (CPR, atropine, open-chest cardiac massage) - it rarely works but you loose nothing by trying.

For that "just do it" attitude, I am immensely thankful. For the opportunity to do something with my hands, make an obvious difference (even if relief from suffering is pink juice and a cardboard box), I am even more thankful.

Lets hope I make it through the sleep deprivation.

Pix.

Free-floating advice for clinics

2010-05-23T20:30:00.004-04:00

Be nice to the pharmacy folks - they notice when you're rude - and word spreads.
Keep your intern/resident happy - if they think you don't care, you'll start getting the shitty cases.
Be nice to the techs - if they don't like you, they'll make your life living hell.
If you've managed to piss any of the above off, bake cookies, apologize profusely and try to do better next time. Realize that it's likely you won't change their opinion of you, but that you'll at least (sort of) get a chance to start over in another 2w, and may get to explain where you were coming from.
Ask questions, but not mindless ones. (It makes you look interested, like you're thinking, and may convince clinicians or residents that you care and are trying to learn, and it demonstrates a good attitude.)

Pix.

2010-05-23T20:24:00.003-04:00

I'm surprised that clinics are so hard. I didn't expect it to be all puppies and kitties and rainbows and I came in expecting to dislike the experience overall (based on it being 90% small animal with 2m of equine, little beef, no exotics, and only 2w of pathology).

The things I expected to hate were the year of long hours (no weekends, no vacation, no sick days, and no time off), the bureaucracy, the paperwork, the frustrating slowness of every aspect of the hospital - and having to explain those things to the clients.

So far, those things have been frustrating (and I've been sick since I started clinics, despite my rigorous 9p bedtime, responsibilities permitting). The clients have been more understanding than I expected (and to some degree they're prepared for the wait). The paperwork stinks and is overwhelming (and contributes to the glacial pace of diagnostics and considerable client wait time), but it's learnable, and it gets faster your 2nd week on a rotation.

What does suck, unexpectedly, is constantly feeling weird, out of place, and socially inept.

I'm an odd bird. I accept that I'm an odd bird, and it's mostly not something I think about except occasionally when I'm meeting new people and realize (yet again) that I'm weird, and I'd forgotten. It's not usually an issue.

I'm still not sure why it's suddenly an issue - I'm with classmates I've been with for 3 years. They're not new people, I mostly like them, and I'm not new to them.

However, up until now all of our interactions have been about the ways in which we're the same (school). Now suddenly we're spending 12h a day together for 2 weeks and our backgrounds are clashing (not in a way that causes conflict, but in a way that causes me internal angst and surprise).

It adds the stress of social discomfort to a situation already primed for pain (pretending we're doctors, being inept, constantly learning new techniques/information/drugs/mechanisms, not to mention the more mundane: new paperwork/names/clients/residents/interns, and locations of new departments/supplies/procedures).

I don't have an answer for it. It's a surprise - a friend described it as being in high school all over again, except maybe without the knowledge that it's high school, and that to some degree, feeling weird is normal.

It's grating and contributes more than I expected to my exhaustion.

Pix.

2010-05-16T13:28:00.003-04:00

There was a moment in Kampala (in Uganda) when we entered a temple. It was at the top of one of the hills that the city is built on, and you could see the pattern of the city spread across the other hills as you looked out.

The temple was surrounded by gardens (and a small army of silent gardeners) and flat green grass without mororbikes, cooking, garbage burning, or the huge carrion-eating cranes with the peculiar smell that haunted most other similar spaces w/in the city. There were people, but they were few, and they brought picnic lunches and arrived mostly on foot or parked in the lot. Unlike most of the other places we went within Kampala, there wasn't foot traffic.

This was a place you got to only intentionally, when you were looking for peace, gardens, and, most shockingly to me, silence.

I didn't realize how powerful it was, the silence, until I had a seat in the silent temple, carved with holy words of major religions, lacking a centralized pulpit, music, or a central focusing image (beyond the decorative carvings of holy phrases that lined spires up to the baby-blue central dome). As I sat there, silence barely punctuated by bird chirping and remote city sounds, I felt tears running down my face.

I still don't know what I was crying about, or for. I'm not sure there was anything specifically. It was relief maybe, from sound, the pressure to communicate, interact, and navigate. Maybe it was a response to the place, to the message of unity and peace and solace within a busy chaotic city far from home. It may have been all of those.

Pix.

2010-04-07T17:41:00.005-04:00

Started clinics. They're terrifying, but I won't bore you with the demons in my head.

Trying to see things from the perspective of the client, I'm struck by what a pageant we put on, and how part of what they're paying for is the experience of coming to visit us. (Us being a large teaching hospital, with long waits, obscure paperwork, bizarre and regimented procedures, far more inconvenience than their usual vet, less space, and certainly less privacy.)

Many specialized referral hospitals do what we do, and have the boarded specialists and sweet electronics to pull it off. Yet people still opt for the obscenely long waits (clients can wait for 8 hours, _easy_ on the day their appointment is scheduled, before we admit their pet to the hospital and tell them what might be going on and what we're considering doing about it). I'm not sure the cost savings over the private referral hospital justifies the frustration and inconvenience.

The thing we have going for us is the perception of quality: "Teaching hospital", flocks of flapping white coats, and a bewildering array of DVMs who never introduce themselves properly, marching through the waiting room in an endless stream, give the impression of competence. Meticulous care and personalized attention are the markers and stanchions of that competence. I don't think a private institution can provide the same excess of personnel (students are paying to be here, unlike even the most frugal private practitioner, relying on an army of minimum wage assistants to spread their billable procedures further).

Our patients have at minimum one student per case, usually more. That student provides medical assessment, treatments, assists on surgeries, diagnostics, etc, and consults with multiple departments and many other doctors on the case (for better or worse, this is, I think, a large part of the excessive wait time). We have the luxury that private practice doesn't have, in that we have "enough time" to review the medical literature (at the very least a stack of august books) and reference many of the people who wrote the reference books and research papers, by asking them questions directly.

So back to client perception - they don't have a way to measure our medical expertise directly. They're stuck relying on their judgment of our knot-tying skills to evaluate surgical knowledge, expertise, and precision. The circus we present, the inconvenience of waiting, of high costs and intense diagnostics, is, at least in part, the reason they're there.

Pix.

Another world, parallel to this one

2010-03-26T20:43:00.005-04:00

Spent this spring break all over the place, but finding myself thinking a lot about wealth and signaling as I watched the top fraction of a percent of the country socialize with each other. The Spirit Level may have some influence, also.

I watched a gentleman on the beach with a boxer. He was a talker. He was retired to FL from KS. He was scruffy, well spoken but indefinably rich. He stood near my chair and had a chat with another boxer-owning gentleman, better dressed, but no less crazy. If you took a military man, made him a golfer, then made him retire and asked him to pose for a magazine ad, you'd get this guy. He was doing a very formal casual thing, sweater over the shoulders and stiff pressed khaki shorts, with a military buzz cut.

The next day, a few hours away, I had lunch at a cheep Mexican joint. The clientèle was interesting in the way that zoo animals are interesting, beautiful but strange, incomprehensible. Camel: gorgeous, silky, lofty but dense, with casual Italian flats(!). The outfits (there was a group of 5, dressed similarly) were obviously casual (yoga-pants-level-casual), retired, but so edgy that it was obvious someone else did the shopping and choosing.

They were retired but the social climbing never stops.

Pix.

2010-03-11T14:19:00.004-05:00

How soon until we start using the cars parked out in front of our houses as extra bedrooms, extra living rooms, for privacy and silence, and as refuges from our increasingly overcrowded and stressed family dwellings?

How far are we from that future?

Pix.

PS: Kids already live there. The front yard, the backyard, the tree out front, and the drivers seat of a parked car are their refuges from the prying eyes of adults. How long before they're pushed out and looking for the next best option?

2010-03-07T18:01:00.003-05:00

The people who'd made the system thus were jealous, not of money and not of power but of story. If there employees came home at day's end with interesting stories to tell, it meant that something had gone wrong: a blackout, a strike, a spree killing. The Powers That Be would not suffer others to be in stories of their own unless they were fake stories that had been made up to motivate them. People who couldn't live without story had been driven into the concents or into jobs like Yul's. All others had to look somewhere outside of work for a feeling that thy were part of a story, which I guessed was why Saeculars were so concerned with sports, and with religion. How else could you see yourself as part of an adventure? Something with a beginning, middle, and end in which you played a significant part?

Neal Stephenson: Anathem

Pix.

Stillness in movement

2010-03-07T17:29:00.002-05:00

Being in flow is the small matter of playing games with your brain.

I've lived with two people obsessed with driving less.

One girl always volunteered to drive (she didn't drink, which was helpful), though she'd almost never drive when she was alone. It was a point of pride though, that she pick up every member of the party as well as taking the shortest route to our destination as well as entertaining the various requests and desires of the people crammed into her car (Person X was in a hurry to get home, Person Y wasn't in a hurry but lived out of the way, etc). She found enjoyment in planing and strategizing and optimizing the route we took depending on time of day, traffic, and the quirks of passengers.

I enjoy driving for different reasons. I enjoy driving fast, in getting to the front of a pack, away from people whose driving I don't like, and in being cautious but speedy. If you need to get to the airport in a hurry, I'm your girl. Many lanes of traffic, lots of merging, and high speeds don't bother me. However, I need a navigator (or GPS) because I get lost at the drop of a hat. I prefer to optimize for speed and the flow of moving quickly with traffic and I swear there's an internal rhythm of the road when everyone moves in a choreographed manner.

Another girl I lived with optimized trips around town, planning several days in advance (dog park + specialty grocery store, bonus if this trip was organized around picking up someone from the airport). She didn't go the grocery store without also dropping off the recycling and she didn't come home with an empty tank of gas if she passed a gas station and could knock off that task from her mental todo list.

All different games to play with your brain while driving. Similar, simple ways to find flow in your daily life are all around you.

Pix.

Ionophores

2010-03-01T23:37:00.002-05:00

We learn about ionophores as a treatment, I've seen em given in the field, and I've heard complaints about em by animal rights people. I know what ionophores are, but I don't know exactly how they work.

Ionophores are commonly used feed additives in production medicine and they protect against one of the most devastating illnesses I saw in late/heavy animals on a beef feedlot - the dreaded "bloat", also known as rumen acidosis. (We'd find em dead with little to no signs of illness - they marked a huge loss for the producer, and I imagine death by upset stomach toxins or respiratory compression is painful. Everyone involved wanted to prevent those deaths.) They're used in small ruminants and camelids (and for the same reason, though the disease isn't called bloat, it's called acidosis).

They're also a current topic in the press and I've heard several lectures at veterinary conferences recently that bring them up as a hot topic in both the area of antibiotic resistance and animal rights (and the laws, constitutional amendments, propositions, and policy discussions that are the outgrowth of this discussion).

I believe that they help. They work to prevent a devastating and painful disease from occurring at the high levels that it might otherwise, and the animals on them are healthier and don't walk around with persistently upset stomachs. In my opinion this is a good thing. I don't like to see animals in pain under any circumstances and I appreciate that we can give em something to modify their rumen bacterial function. Producers and consumers appreciate that the side benefit of their use is increased average daily gain and greater feed conversion/efficiency. Also, I appreciate that there's no question that they work. It's easier for me if there's a direct linear relationship between use of ionophores and decreased disease - being able to prevent disease is the ideal situation and this is, thankfully, one of those cases.

So what I found was these two papers, one published and one by a student, and both answer my question:

Ionophores reduce protein degradation in the rumen thus aiding in post ruminal digestion (Horton, 1992). Ionophores also increase production of the VFA propionate by modifying the microbial fermentation in the rumen (Gates et al, 1989). from http://animalscience.tamu.edu/ansc/beef/ANSC406/Prince,S.pdf

So ionophores (which are in the antibiotic family, though not in the way that we give antibiotics for most diseases) somehow protect protein that is made by the rumen bacteria and protozoa from being broken down by different rumen bact/protozoa (allowing the animal to then "eat" this protein rather than loosing it), and then they increase volatile fatty acid propionate production by altering fermentation (these VFAs are what the animals are "eating" after their food has been fermented by bacteria and protozoa and proprionate is the best one for conversion to glucose, the body's preferred food source). That's an OK answer, but I'd like pathogenesis (which we may not know).

The basic affect of ionophores is to alter the flow of cations across cell membranes (Kirk et al., 1989). This leads to a reduction in gram-positive bacteria (Oheme and Pickrell, 1999). Gram-positive bacteria are known as the cause of bloat and other digestive problems associated with high carbohydrate diets.

Ah-ha! This is what I was looking for. So ionophores preferentially kill off G+ bacteria, which are the problem in acidosis. They have other effects (decreasing methane and ammonia losses, both desirable in my understanding).

The second paper is published but including quotes would require re-typing those segments. It's conclusions are very similar to above, with more detail, with antibiotic resistance defense, and in more academic language. It is available and highly recommended, here: http://www.horizonpress.com/ciim/v/v4/05.pdf

I won't address here the complaint about their use, period. I feel that given our production system as it stands, they're necessary and not using them would be painful and cruel for those animals. However, complaints about our current production systems are warranted, though the rebuttal is by now standard.

I don't know of a way to decrease the use of high-concentrate diets except through governmental regulation and increased food prices for the consumer. While this is a fine solution in my mind (I lived in Sweden for 6mo and appreciated their high food prices directly!), there's no way to raise prices while remaining competitive and not-bankrupt without doing it across the whole agricultural industry.

That's a huge undertaking.

Pix.

Purpose

2010-02-28T00:54:00.005-05:00

This weekend, I took a small roadtrip with friends. During this trip we spent a lot of time listening to the radio.

Much of what we were listening to was pop and dance music with occasional forays into oldies, 80s, classic rock and one country song.

The pop/dance radio reminded me of the time I spent in Canada this summer (I drove a lot and listened to the same five songs on endless repeat). I had a great time, met wonderful people, learned a ton, and I'd go back tomorrow if I could.

Thing is, when I was there, it wasn't fun all the time. I mostly worked. Early (5a early), on something I didn't always find fascinating, and late, on stuff I found interesting but hard (and I got lost a lot). In between then I looked things up, went over cases, wrote up findings, and enjoyed as much coffee as I could stand.

I didn't talk to my friends. I didn't email anyone. I didn't log onto facebook for the whole time I was there. For the first two weeks I didn't even write - all I did was work and sleep.

On no planet does that sound like a good time. But I liked the environment, the people, and the challenge.

I miss it.

Pix.

2010-02-28T00:25:00.002-05:00

Reading about border disease in lambs (lambs infected in-utero are born weak, shaking, and with hair rather than wool and do not recognize the border disease virus as non-self).

It has similar pathogenesis and antigenicity to BVD in cattle. The is transmitted in-utero to calves if their dam was infected at a specific stage of their development (it's 45-80d in sheep). Those calves are born sickly, weak, and immunotolerant of this virus. They're walking virus factories and serve to contaminate the environment and other cattle until they run into a different strain of the BVD virus, which kills them. It's a horrible way to go and an impossible way to live.

I saw a lecture on friday about BVD virus in deer. Specifically, the lecture was about the discovery of two wild deer found infected with a cattle strain of BVD. Interestingly, the virus isolated from one of the deer was very highly related to the BVD vaccine strain given to cattle. No one has any idea how the deer were infected (the virus is called Bovine Viral Diarrhea - it usually affects only cattle). No one is sure if it's significant that these deer were found in the wild, affected with a cattle disease, or if it's an infrequent-enough occurrence to be insignificant.

I don't have an answer. However, I found the connection among these three diseases interesting, in that they're all one related virus, different hosts, and with similar but not identical disease expression.

My feeling is that we'll be seeing more cross-species viral transfers or jumps in the coming years (this is just my personal feeling not a scientific opinion). Changing environmental pressures, changed vector populations, differing weather patterns, and susceptible populations of densely-packed stressed domestic animals housed in overlapping habitats with wild animals, pressured by habitat encroachment and monoculture growth.

Pix.

2010-02-25T18:27:00.001-05:00

I picked a guy up today.

He was walking in my neighborhood and I'd seen him before, walking in the same direction I do on my way to class. I was running late so I was driving three blocks closer (it means I'll be on time even if I'm running late; lame, but those three blocks are slushy and muddy).

So I stopped, rolled my window down and invited him to join me. After a moment of surprise, he did. I asked his major and his name and talked about the stupidity of driving three blocks closer just to skip the slush and mud and gain 5min to avoid being late. We talked about our respective majors (his is actuarial science), the weather, and the need for a sidewalk to connect our neighborhood to the well-traveled path to school.

It was pleasant.

Pix.

2010-02-24T23:04:00.002-05:00

I hate the phone and almost never use it for talking (texting OTOH is a useful way to make plans with someone I'm seeing soon). An exception to that rule, however is talking to my father (and less frequently, my sister).

That connection is a reliable and valued reminder of family, to lives different from my own, to perspectives on work, dating and socialization that don't fit with my chosen social circle's norms.

I'm thankful for their warm, friendly, and easy ability to "catch up" for my 10m walk to school or the library. It's a warming way to spend a very cold winter walk.

Pix.

Today

2010-02-23T21:34:00.001-05:00

Really, this is it.

I've been feeling busy and scattered lately, always behind. I realized that today is it - there are ebbs and flows of work and outside requirements, but it all comes down to this being normal. There's never going to be another point in my life when I have more time (thank god I don't have children!).

If I'm itching to start doing something, barring some truly seasonal work heavy periods (ag is a seasonal beast), there's always going to be long days, sleep deprivation, and "never enough done". Mind you, this isn't a new realization, and far from original material, but it was an epiphany of sorts today.

There's nothing to be done but getting to it (whatever "it" is).

Pix.

2010-02-22T00:17:00.006-05:00

Random inquiries:

Food

Do you forage? Tell me about it! (What? When? Where are you? How do you cook it?)
What do you eat most frequently? What can't you live without? (I'm currently obsessed by grapefruit).
Do you garden? What? Where? How?
Have you ever made sausage/ground meat? Advice?
I'm corn and gluten reactive. Do you have any fav recipes or advice?

Music suggestions, given this list?

Kassaban, *16 Horsepower, *Explosions in the Sky, *Andrew Bird, *Zoe Keating, Fatboy Slim, Ludacris, POS, Atmosphere, *K'naan, Kayne West, Jr Sr, Matt + Kim, Mondo Generator, Porcupine Tree, Action Action, *Klezmer (various), Calexico, Desert Sessions, *Eagles of Death Metal, Experimental Dental School, Fall out Boy, *God is an Astronaut, James Hyman, John Cage, Madeline Peyroux, *Madrugada, Movits, *Queens of the Stoneage, *Ray LaMontagne, Satie, Riceboy Sleeps, Sam Philips, Sharon Jones and dap kings, *Black Keys, Cat Empire, *Killers, Magnetic Fields, Weezer, *William Elliot Whitmore.
While I love blogs for everything, I only read one music blog: aurgasm, and can't rec it highly enough.

Sleep: Obsessed. Occasional insomniac. If I had to complete "Health=____", I'd say sleep. You?

Need a hairstyle, motivation and most immediately: more sleep.

Pix.

2010-02-21T22:00:00.001-05:00

Protecting human health via protecting animals sounds like a self-congratulatory inflation of veterinary medicine's importance.

However, it's a direct relationship in places where dead livestock mean lack of food, where unhealthy animals spread disease either directly (zoonotically) or indirectly (via food contamination) and where livestock are a living breathing 'bank' - cash held in reserve, available to pay for a sick family member's treatment, school fees, or produce at the market if the harvest is bad.

We hear a lot about the important role veterinarians play in public health, but it's a non-intuitive role, and the importance wasn't clear to me until I considered that last role of livestock.

It's one we grapple with indirectly in this country - the importance is economic and the families are no less devastated, but there's fewer of them providing food for more of us. The difference is one of scale but the impact is no less dilute for it being invisible to the consumer.

Pix.

2010-02-20T17:18:00.000-05:00

Today: not moving, but contemplating movement. Does that count as progress?

I've added a bunch of yoga to my RSS feed, and a few tri bloggers (most are too far along in the process/too tech-focused/numbers-based for me to enjoy, but if you have pointers or reccs, I'd love em!) and runners (my complaint about advanced competitors in both sports stands).

If enjoyment of life is based on making enough money to be able to have hobbies and vacations and visits to family and friends in far-flung locales then part of that enjoyment is in being fit enough to enjoy the hard physical work that can accompany adventures.

Pix.

Ambient knowledge

2010-02-19T22:52:00.001-05:00

Thinking about background, unrelated-to-vetmed useful or ambient knowledge:

pumps and electric motors
electricity
plumbing
construction
water sanitation
growing seasons/crops
pest control/hunting

There are more, but I was attempting to brainstorm 'incidental' knowledge that could be useful in a beef production scenario.

Since much of farming is about machines, mechanical knowledge is always useful. Machines always break and if you can add value by making a suggestion, you're ahead.

Many of these skills are transferable to a travel or developing country model of veterinary medicine. If you can fix the water pump, you're impacting more than animal health - it's a chance for direct impact on human health.

Pix.

2010-02-19T00:31:00.002-05:00

Vegas is a weird place, full of funny connections, random encounters, and surreal stumbling in a half-lit netherland.

Beyond the obvious (it could be day or night and you wouldn't know the difference, flashing, blinking lights and naked girls decorate most surfaces, signs are hard to find and frequently unclear, gambling, drinking, and girls are ubiquitous), it's also full of security, housekeeping staff, a vast support and communication network, most of it invisible, hushed, imported, and difficult to see without concerted effort).

I wonder if (when) it will become unsustainable and collapse. Will we see Dubai in this country?

Pix.

Fat Tuesday

2010-02-16T15:02:00.001-05:00

Though I don't celebrate this particular religious holiday, I enjoy the tradition anyway.

May you find wealth and plenty in this season of cold.

Pix (from a warmer place, and also because the glasses + hyena ultrasound makes me laugh)

Creating space

2010-02-15T19:49:00.002-05:00

The connection today was about being hurried, not having faith, and needlessly forcing events to conform to my internal schedule.

It's unnecessary, stifles creativity of those around me, and leads to a state similar to flow, but anxiety-fueled and far from effortless. It feels unpleasant, and I don't like the impatient, terse, unsmiling person that stares back at me from the mirror.

I don't have an answer, just this reminder to myself that what needs to happen, will.

Pix.

2010-02-12T05:49:00.002-05:00

It's a connection I hate, but the link between procrastination and anxiety is one I find personally problematic.

I care, deeply, about externships, gaining experience in a field I love, doing "really amazing" stuff and making full use of every free moment I have available. However, the process of setting those up terrifies me. It involves scheduling, details, spending money on travel (more than I'm comfortable with, and not even for any enjoyment) and asking people for help. Sometimes even asking those very same helpful and kind people, _for money_.

Intellectually I know that they've all been in this position, that they're generous and abnormally helpful and don't resent the questions that I ask, the drain on their time, and my inability to perform as a full member of a professional team (I'm still learning!). But my little lizard brain, governed by fear, sits on my shoulder (it should be wearing a red cape and carrying a pitchfork!) and whispers that I'm pushing too far, asking too much, and shouldn't be doing any of this. I should play it safe.

If you know me in real life you know I'm fairly unconventional and more than a little odd. Perhaps you wouldn't guess that I struggle to remain that way, that the small demon on my shoulder pushes hard for conformity, conventionality, and the always impossible task of fitting in.

Pix.

2010-02-11T23:31:00.002-05:00

Loss, grief, and lust all read similarly to me. They taste metallic, sweet, and fat on the back of my tongue - the finish on a rich fruity wine. Both cloying and bitter, the edge of nauseating.

In the nineteen-seventies, Colin Murray Parkes, a British psychiatrist and a pioneer in bereavement research, argued that the dominant element of grief was a restless “searching.” ... A 2007 study by Paul Maciejewski found that the feeling that predominated in the bereaved subjects was not depression or disbelief or anger but yearning.

From the New Yorker, h/t Frontal Cortex.

Searching is a useful frame. But I don't know what it reveals.

Pix.

2010-02-10T11:10:00.003-05:00

Yesterday was a little rough in my head. Not any particular reason, just struggling to live up to my self-expectations (I failed miserably but no one seemed to notice, leading me to believe I'm perfectly average in that respect.)

Today is off to a better start - there's music and coffee and I've got an hour, followed by strenuous ass-kicking in the snow (xc skiing!).

Sometimes you have an off day, feel like shit about yourself, and can't believe you made the mistake(s) you made. But chances are good that all hope isn't lost. Give yourself a break, have a quiet evening in, reconnect with yourself and your motivations, and get on the ball tomorrow.

Today is that tomorrow.

Pix.

2010-02-09T20:19:00.001-05:00

I don't have much for you today - so I leave you with a picture.

Is this lack of content the result of too many snow days? I think so!

Too much snow

2010-02-08T17:55:00.002-05:00

GET OUTSIDE!

The connection between mood and nature and movement is well documented.

And it's fun!

Pix (first cross country skiing experience this weekend, today a crunchy hike through the snow).

Networks and early career experience innovation

2010-02-07T14:54:00.005-05:00

Can I graduate and organize my own self-funded internship?

Is it possible to spend a month (or 3) at places of interest, working in diagnostic labs, on feedlots, and with feedlot practitioners, asking them to cover my expenses and not much else?

I'd get out of that year the experience that interns want but rarely get (a huge variety of hands on experience!), I'd get to meet potential employers in a radically long-form-interview format, by working side by side with them for weeks at a time (thus ensuring a mutually rewarding employment fit, later, if desired). In addition, the expanded time of professional contact (beyond the 2w I have available currently) would result in a focused network of potential collaborators later in my career.

What's the most rewarding statement you can hear from someone you're asking for a letter of recommendation? "Oh, I went to school with him - he's a great guy!" You're guaranteed extra consideration if the interviewer reciprocates in their high estimation of your recommender. It's how job searching has always worked. But can I pursue that network directly?

I'd walk away with a map of current industry nidi and the rolodex of personal contacts that make the professional networking of work life successful and interesting. Not one of us exists in a vacuum - enriching our own work is exposure to new ideas. The 'employers' in this instance have lost almost nothing financially or in commitments to future employment, and have enriched their networks and exposed themselves to successful ideas from other industry leaders.

Pix.

Seeing with love

2010-02-06T14:24:00.003-05:00

Seeing people, deeply, for who they are, and recognizing in them, our own humanity - is world-changingly powerful.

One of our deepest human desires is to be understood, seen, and acknowledged.

It's hard to be present enough to appreciate another person, warts and all, without wanting anything from them.

But rewarding. And it takes less than two seconds.

Pix. (I'm missing Vietnam, lately.)

2010-02-06T13:20:00.003-05:00

"People who don't wear shoes when they run have an astonishingly different strike," says Daniel E. Lieberman, professor of human evolutionary biology at Harvard University and co-author of a paper appearing this week in the journal Nature. "By landing on the middle or front of the foot, barefoot runners have almost no impact collision, much less than most shod runners generate when they heel-strike.

From Science Daily.

This reminded me of the girl pictured above. She was incredible.

Our rusty, wheezing bus was winding through the bush, traversing miles of deeply rutted mud roads, on the way to a Heifer International farm.

We passed many people and almost all of them waved. A few children followed us for a few seconds but most were content to remain stationary on the side of the road.

Not this girl. She was coming home from school (the purple uniform identifies her local school district) and she chased our bus, on foot, as we accelerated, for far longer than I'd have ever guessed was possible.

As she ran, she flipped off her flip flops and tossed her books into the woods. Her friend abandoned the jackfruit she'd been eating. She sprinted full out for what seemed like 20min on this dusty rutted road, barefoot. Her run looked joyful, intent, springy and fun (and she soon left her friends in the dust).

To this day, I am awed at how long she was able to keep up with us.

Pix (thank you pam!)

2010-02-05T16:50:00.004-05:00

For me, there's a connection between stolen time (vacation days, snow days, a few hours spent comfortably in an airport on my way to somewhere else) that encourages big picture life planning and dreaming about possibilities.

Today is one of those days.

Nothing seems too far fetched and the possibilities are exciting rather than overwhelming. I'll send a few emails, I have a (few) book(s) to look forward to, I bookmark some recipes and blow through my RSS feeds. Life is interesting and fun.

Pix. (I'd like to live on (or take a very long vacation on) one of these, someday. This one reminded me of being in Vietnam.)

2010-02-05T11:58:00.005-05:00

3 things:

I'm excited for our snowpocalypse, and pleased that it falls on a weekend. My plan is to read (Flow, Barrel Fever, and The Blank Slate) and make bitter drinks involving gin and homemade grapefruit bitters and grapefruit simple syrup.

Bitten's coconut braised beef (or lamb in my case) is delicious, even when you triple the chilis called for and use fresh. It's just hot. Perfect for this freezing, wet day.
Maybe later this weekend I'll make this deliciously warming rice dish.

Pix not up yet, it's the snow that fell during this morning's one hour class.

2010-02-04T23:49:00.001-05:00

So I had this teacher in HS, Mrs. K----. She was a bit of a nutty old bird, with thinning oddly-colored hair and a weight loss obsession (she'd lost something like 50lbs the previous year) and she'd been teaching for at least 15y.

She taught English. I think she taught regular English, though I only ever had her for honors English. Like most honors courses, it was a better class, with better teachers, and more interesting material, than the regular English class, but not impossibly hard. She took her charge seriously, and didn't let us skimp on either the vocab (abstemious is a word that rolls pleasingly around in the mouth - I picked it up as a result of her weekly vocab tests), writing, or doing very complex skits that had something to do with mythology (and probably other subjects, though being Cerberus sticks out in my mind).

She was a little crazy. She hated the word "a lot" (in any permutation) and some other very specific commonly-used word (that I can't remember, maybe contractions).

We had to write these weekly writing projects called 'gems'. She'd give us a topic and let us go and we'd have to turn in a perfectly-edited one page (there was probably a maximum word count) response to her prompt. Bonus points for creativity.

I think if I'd have thought of it and could have pulled it off, she'd have loved a song, or spoken word, or a video montage response to her prompt. However, I was stuck firmly with the written word and struggled with what to write each week. It was a big deal, socially, to put some effort into it - it wasn't a project that anyone blew off.

You got zero points for spelling errors or grammar mistakes, using one of her pet peeves (alot, and perhaps contractions) or sentence fragments.

These seem like obvious things to catch, now, but at the time, when you'd rewritten your essay, story, poem, or lucid description (or whatever you came up with that week), it was far more difficult to be objective than I always expected it to be. I'd spend hours the night before it was due, crouched in front of the computer in a perfectly dark basement room, pupils blown, foreshadowing the outside-the-fold experience of my college years.

I was blessed with a string of excellent English teachers throughout school, and I credit them with my continued love of reading and comfort with the written word. (Learning to read I credit to my mother, who spent many nights in the bathtub listening to me read books about Matt, meeting his friends, and the incredibly simple and repetitive adventures that they went on. I'm not sure how she didn't stab herself or drown me, but I'm thankful she patiently tolerated the hours of 'sounding it out' and reading 'just one more' before bed).

Today I think I'd like to thank that string of amazing teachers for contributing to where I am today. I'm enrolled in a doctoral program - next year this time I should hopefully be passing boards. I didn't get to this program in a direct fashion (I have a previous career unrelated to this one), but not a day has gone by that I haven't used the skills that those teachers worked so hard to instill.

Their instruction and my hard work allows me to connect the disparate events of my life in a linear fashion, making sense of them, and creating a cohesive, instructive whole with which to inform my world view.

Thank you.

Pix.

2010-02-03T21:14:00.004-05:00

I don't frequently think about this ex - she was a long time ago, and we only dated for a short time.

I wish her well - when one of us stopped calling (probably me), she was planning on law school or a phd and dedicating her life to fighting inequality. She was brilliant, dedicated, and had her shit together. I'm sure she's doing amazing things now and I'm curious to know what they are. I'd google, but I don't remember her name.

I haven't thought about her in years, but a blog friend asked about favorite under-appreciated authors and listed her own. The genre in question was urban fantasy with a dash of scifi.

Growing up, I knew the scifi wall at my local library so completely that I browsed by looking for books I hadn't read (this was actually an effective strategy). I never remember names (in real life or of authors) but I remembered where all my favorite books lived by location.

This girl introduced me to a few things over the course of our short relationship: On one of our dates we picked up a high-end frozen pizza, took it back to her house, and watched a movie. In the course of "pizza improvement", she added canned tomatoes to top the pizza (in addition to cheese and my inaugural experience with sliced fresh mushrooms). However, unlike my previous experiences with canned tomatoes, these tomatoes tasted fresh (or at the very least, like they'd more recently made the acquaintance of sunshine than my canned tomatoes ever did). She stored her canned diced tomatoes with a splash of orange juice, to brighten the flavor, and it worked!

She also introduced me to Melissa Scott, whose name I can never remember. However, the book she lent me was called Trouble and Her Friends. Somehow I've retained the name of the book (I don't remember anything of the story other than the main female character's comfort with her bisexuality and the casual side-issue that social mores play to the far more interesting career-driven story arc having something to do with piloting a spaceship). After that introduction, I devoured whatever the Chicago public library carried of her other books (a quick perusal of amazon says most of the stuff published in the 80s and 90s) -- and then forgot about her.

I was reminded by this blog friend's under-appreciated author query - and I find that she has a new book out.

This afternoon, accompanying a friend to the library for a search of her own, after living in this town for 3 years, I finally signed up for a library card. (To those worried about the state of my brain: I have a large stash of books from a traveling friend and most of my time and energy is taken up by reading for school or devouring the internets, so I've been far from bookless).

Next on my reading list: seeing how quickly I can work through the local library's stash of Melissa Scott's work.

May peace, health, and joy be with you, ex-from-Chicago. Thank you for the time we spent together and the things you taught me.

Pix (another world expansion, though this one through travel, rather than by a friend or lover)

2010-02-02T17:01:00.002-05:00

I've had an entirely average day, so a short list of today's connections:

Discovery of a old classmate's blog
Connection between abstruse concepts of parasite lifecycles and getting to see these guys under a 'scope today. (I didn't realize how helpful a parasite lab was going to be.)
Contact with next year's externship(s) - we're at the concrete details stage of planning and it's much like negotiating a 2nd date.
Having a drink with a friend and studying for a large test that scares us
A late lunch of fried kale, with walnuts, anchovies, garlic, 2 kinds of vinegar, and Parmesan because of this lady's writing about it months ago
Connection of lecture material to real life - the first prolapse I got to see was this summer, on a feedlot (they're a relatively common occurrence in livestock). Even though it was the first time I'd seen one, I got to sew it up (with expert instruction!). Today in small ruminant our lecture topic was rectal prolapse. The concrete experience followed by a relatively short time span allowed me to assimilate so many more of the practical details of the lecture this morning than lecture alone.

My plan for this evening is to go to bed early. The connection between enough sleep and good health is an old but much neglected one.

Pix: people making connections

2010-02-01T11:33:00.004-05:00

Today I went to court. I argued my case (self-defended). And I won.

Thing is, I'm a vet student, and I'm not all that sure I should have won.

I did, and I'm happy, because I think my argument has some merit. However, I think I won not because of my argument but because of my skin color, education, class, and because I was determined to ask for judgment and go through the terrifying process of self-defending rather than settle. It had mostly to do with privilege.

And that breaks my heart and turns my stomach that the other people in that courtroom (most of whom plead guilty, if they didn't settle for "court costs" ($100) on a payment plan, so the judge wouldn't have to waste time listening to their case) couldn't do the same.

I'm not entirely sure how to make peace with this experience. I think of this and this, and contrast my experience and my wish is for some of the people in that courtroom to gain privilege and agency of their own.

My thoughts always come back to education (after a short tangent where I run off to volunteer with a reproductive rights program). It's the part of privilege that's obtainable.

So I'm donating the ticket cost (for my minor parking violation) to my school's program to buy books for children and I will volunteer an hour this month to help a local school kid read.

It's not a lot, but it's something I can do today.

Pix.

2010-01-31T11:17:00.003-05:00

So what does correlate with success? ...practiced intensively, had studied with devoted teachers, and had been supported enthusiastically by their families throughout their developing years. Later research building on Bloom’s pioneering study revealed that the amount and quality of practice were key factors in the level of expertise people achieved. Consistently and overwhelmingly, the evidence showed that experts are always made, not born.

From HBR, h/t Brazen Careerist

Pix. (click through for a story about hard work and practice)

2010-01-31T10:07:00.003-05:00

What I wished they told us in orientation (or professional development, 1st year):

Studying, like dying, is something you're ultimately solely responsible for (and must do alone).

Independence is indispensable. Don't squander your time, effort, and energy on things that "should" help you but don't. Walk away, figure out what works for you, and spend time enjoying your friends while you're not studying, if their style isn't yours.

Pix.

2010-01-28T21:28:00.004-05:00

Unrelated snippets:

I'm under the weather. Tomorrow I look forward to using some of my stock of dried mushrooms in this miso-mushroom soup.

Chris is a rockstar and continues to publish creative and useful content on his blog while traveling, writing a book, and executing ideas like this one. Water quality is an issue we face in the states. Clean water is an issue faced outside the westernized, more developed nations. It's certainly an issue I saw faced in rural Uganda and probably other places I've traveled. However, it was invisible for me because I was a tourist and encouraged to drink bottled water (some places I did, some places I didn't).

Donate if you can. If not, spread the word. I don't expect Chris to have any problems fulfilling his goal, but why not help blow it out of the water? (After the Yarn Harlot hit 1mil for knitterly donations to MSF or Doctors w/o borders I can believe that small donations add up).

Ah, what a contrast to veterinary school. What passion, excitement, and thirst for learning! Professors competing for student enrollment, acceptance of 'dropping in' for small chunks of class, independent learning, and the pressure to teach outstanding, fascinating content in a unique way -- I'm excited about education just reading about it!

Re: this: Let me tell you about my brother.

I received an email tonight that was exactly what I needed to hear, nailed practical answers to difficult-to-answer questions and reminded me of the effect of my actions on loved ones. It was from my brother. I can't express the bounty that is the continued gift of my (crazy but beloved) siblings. Sometimes it's harassment about beer (other brother) or appreciating my crazy vet aspirations (my sister). I can't thank them enough for their nutball support or love.

Pix.

2010-01-27T22:13:00.003-05:00

I enjoyed Frank at a local event.
Posterous (where I'm doing thing-a-day.com starting Feb 1)
Twitter (for intermittent e-stalkery)

Pix.

2010-01-27T12:01:00.003-05:00

I'm trying to remember that even (and most especially) when I'm feeling unqualified, telling the people I'm trying to impress this most secret of facts isn't a disqualifying weakness. It's being honest, demonstrating self-knowledge, and allows them to help, reassure, and direct toward appropriate resources.

It's hard to remember that when I'm trying to impress people who are looking at far far more qualified candidates.

'I want to learn' doesn't feel like a very powerful statement, but it is.

Pix.

2010-01-21T18:20:00.002-05:00

Friends push us to do things we didn't think we were capable of.

And sometimes we get to return the favor.

Sometimes they kick our asses in other (much needed and sometimes more fun) ways.

Anthony, have a wonderful journey through Thailand, Lao, Vietnam and Cambodia!

Pix.

2010-01-19T16:54:00.002-05:00

Classmates are graduating. Students a year ahead of me got the notification that they passed boards today and yesterday.

They're effectively doctors.

Wow.

Pix.