What's your personality?

A topic that I've found a renewed interest in recently is differences in personalities. It started with talking to someone recently about the Myers-Briggs Personality Type Indicator, which basically puts people into one of 16 personality categories. You're supposed to take the "official" test, which you can learn how to do here. There are also a few fake online ones floating around out there. (For what it's worth, I've taken both with the same result.) Basically, there are 16 Myers-Briggs types, because there are two "preferences" for each of the four categories they measure personality with. The four categories are favorite world (introversion or extraversion), how you get information (sensing or intuiting), how you make decisions (thinking or feeling), and how you deal with the outside world (judging or perceiving). For example, your personality could be ENTP, for extraversion, intuiting, thinking, and perceiving. (My personality is, to no surprise to anyone who knows me, INTJ.) I sort of like this kind of qualitative measure of personality, because it's quite non-judgmental, and forgives us for being different (for example, I can't feel guilty about not wanting to socialize for hours at parties; now I can think that it's not a character flaw, being introverted is hard-wired into my personality). I also think that we are pretty much born with our personality, and it changes very little. (Which might explain why I was such a terror as a child, sorry mom and dad.) There are a couple websites where you can read about the different personality types, and from the people I know, the descriptions seem pretty accurate.
The second reason I was thinking about personality differences is because I am doing a psychiatry rotation, and I feel like there's often a very fuzzy line between personality and pathology; i.e. what some clinicians want label psychiatric disorders or personality disorders I sometimes have a hard time viewing as little more than differences in personality. I mean, where does the line between high-energy and hypomanic lie? There are, of course, real, quantifiable criteria for diagnosing, say, depression or generalized anxiety disorder, but people who fall on one side or the other of the diagnosis aren't radically different. I think we're all lying along a spectrum somewhere, and the idea of where personality differences end and pathology begins is an interesting one.
I highly recommend looking into the Myers-Briggs stuff, if you never have. It's very interesting, and might tell you something about yourself or how you interact with others that you never knew before. When I read about my personality for the first time, it definitely taught me something (and, alas, not all of the information was good ;) ).

More pictures...

In Zarzal, near a clinic we went to

Local wildlife (just kidding...we went to the zoo)

Lake Atitlan

Dinner

GST (Guatemalan Standard Time)

One of the starkest differences between life in the US and life here is the liberal interpretation of time frames, and the lack of a hurried feeling to do anything. It only took a few days to figure out that "I'll pick you up at 8 am" actually means anytime between 8 and 10. And even if it turns into 10, that's no reason to not stop and have a cup of coffee before heading out the door. The sense that there is no rush to do anything pretty much pervades every aspect of life. For example, there is no such thing as dropping someone off, in the sense that we think of it - you pull up at the curb, the person gets out, and you drive off (or, at the most, you go to the door or inside for a few minutes). Here, dropping someone off can turn into hours of sitting and eating and talking. Going along for a ride to bring someone home can mean I'll be sitting having coffee and bread (or sometimes lunch or dinner) for hours in someone else's home. What's particularly interesting is that even if a carload of people arrive unannounced at a home, there's always (always) enough lunch/dinner to feed everyone. I don't know of anyone in the US who makes enough of a meal to feed a potential family of 5 that might drop by without warning. Certainly there is a certain amount of efficiency that is lost when an entire country functions in such an unpressured way. However, what's so wrong with that? People are probably having fewer heart attacks here than in the US. Another example of not feeling pressured to function at a fast pace: at the hospital, there are several doctors who spend good amount of the day lying in the doctors lounge, watching tv. This occurs whether or not there are patients waiting at their desks. Also doctors (a rather hurried group in the US, I think we all agree) spend a good amount of time just sitting around and chatting with other people, or drinking sodas at the little cafe outside the hospital, or stopping to chat in the hall for 30 minutes while they're clearly on their way somewhere. It's quite a difference from the blur of white coats that I'm used to seeing at UMass. And yesterday, we were going to work in a clinic in a rural area, and we decided to leave at "8." I woke up at 8 (ok, let's be honest, someone woke me up at 8...I guess this culture is rubbing off a little...and lord knows I love my sleep....especially after late nights with rum....but I digress), and, figuring I didn't have time to take a shower and whatnot, just pulled on clothes and came out to the kitchen, apologizing, and ran into the other people (we were the entire staff of the clinic for the day...so it's not like it was up and running without us), in their pajamas, just making coffee. Then we sat around drinking coffee and eating eggs and beans, until one person decided it was time to go shower, and one by one they got ready. We left at 10. I asked my first patient what time she arrived at the clinic to wait, and she said 7 am. And yet...no one appeared particularly annoyed, either at waiting or keeping people waiting. My American self is still having trouble wrapping my brain around this. Like (last example...I could go on for pages) at the mall, there's one area where all the banks are, and some nights you go and the lines are snaking around the mall, and you have to wait for an hour just to get inside. Again, no one appears annoyed...they just wait, like it's totally normal, and that's just what you have to do to make a transaction at the bank. Normally I am a total type B personality, and don't get annoyed waiting for stuff for a while, but being down here makes me feel like a typical type-A American.

Medical pictures

Since I did, after all, come down here to particiate in some medically-related activities, I decided to post some pictures of that part. Central American trips can't be all about tortillas and rum, after all (or can they??). The first four pictures are from the Hospital Nacional de Amatitlan, and the last one is outside a health center in a small town a couple hours north of here (the city).

pre-op and post-op area outside the OR (yup, those are patients on stretchers in the hall)

the ER

EKG

Weekend pictures

Cows on the farm (the one on the left was scratching his neck on some cement)

Sunset from the hotel Casa de Santa Dominga, Antigua

A marimba and its players, Antigua

When in Rome?....

Don't get me wrong, I'm a pretty firm believer in "When in Rome, do as the Romans do," but I'm also a firm believer in, and there's no quote for this, not apologizing for who you are (or the country that raised you) when you are elsewhere. For example, I spend quite a bit of time down here with a man who always attempts to take my hand as I get out of his car. Granted, it's a small two-door, and it would be difficult for anyone to get out of the back gracefully, but I have never actually needed help. Honestly, if I did need to grab something/someone, the open door would be a more stable choice. For a while, I said gracias and took his hand, but after a while that got really annoying (if either of us should be helping the other one get up, it should be me helping him), so I just said thanksbutnothanks and didn't take his hand. Apparently he found this quite rude, and thought I was being unappreciative and uncourtious. When the subject came up last night, we had an hour-long argument about it (I'm not normally so pugnacious...especially in another language...must have been the rum talking...). I (ever-practical), tried to tell him that I just didn't need help, but this argument totally didn't fly. (For better or worse, I am of the school of thought that if you want or need something, accept it, if you don't want or need something, don't accept it. If I'm not thirsty, is it really being rude to the host to turn down a glass of water? Maybe I'm just not very good at picking up on how people expect me to behave in certain situations. Whatever.) Anyway, he insisted that taking his hand was the courtious thing to do, and not taking it was rude. Now, if he offered his hand to everyone squeezing themselves out of the backseat of his two-door, that would be another issue. But it only gets offered to girls. Even girls who clearly don't need help, and, in fact, could probably break him in two with one swift roundhouse kick. Then, as the argument continued, the hand-offering was framed in the setting of "Latin culture," along with door-holding, etc. Hence, I was advised to do as the Romans do (ok, they don't reference the Romans in the expression in Spanish, but the message is the same). However, being the practical, independent, American female that I am, I took offense at the idea that because (and only because) I was female, I was a fragile flower (literally, those words were used). I mean, I'm not trying to be rude, and I appreciate gestures of hospitality and help, but where is the line drawn between adapting to local culture and compromising your beliefs and values to silently accept something you find offensive? Granted, it wouldn't kill me to take his hand, but having this argument with him (and kind of with another man, who piped in from time to time) really irked me. Am I being unreasonable? Should I just defer to the whole women-are-fragile-flowers-and-need-men's-help position? Am I being a rude gringa by sticking to my American guns? (and decidedly un-girly guns, at that.) Argh.

picture

Song of the Week

I've been listening to (and watching on DVD, and learning to play songs by) the Beatles a lot recently, so...here's a Beatles song. It's a nice one (not that all aren't).

My First Earthquake

Put that way, it sounds like a children's book. But a scary one! No, just kidding, it wasn't scary. It was just weird, having never before experienced the sensation of the earth shaking. What was weirder, though, is that no one around me (I was sitting with 3-4 people) acknowledged what was going on, they all just kept on chatting like everything was normal (I wanted to shout, "PEOPLE, EVERYTHING'S SHAKING!" but I kept my cool, a.u.). Then after a minute (or maybe after one of them saw my face), one person said, "it's an earthquake," and I said, "huh." (Interestingly, in Spanish a small earthquake is called a temblor, and a large one a terremoto. I tried to explain that English has just one word, and it didn't depend on the magnitude of the shaking. They were perplexed by this.) It lasted for what felt like a while, but was maybe only a minute or so. According to reuters (so it must be true) it was a magnitude 6.1 quake off the Pacific coast. The fun never stops down here...

Happy Columbus Day!

Or, as my dad put it, have a "very happy Columbus Day, with all the joys, responsibilities, fun and solemnities thereto appertaining." I'm celebrating by watching 'La ley y el orden: UVE' (not dubbed, thank goodness) and wasting time online. Not that I had the day off (they don't exactly celebrate Columbus down here). I hope everyone had a good day off! (If you were lucky enough to).

Pics from the weekend

Lake AtitlanSantiago de Atitlan

Lake Atitlan

updates, pics, and whatnot

Hi friends & family,
Hope everyone is doing well up in the chilly(?) northeast. Just wanted to post to check in. No particularly new or exciting things have been happening here. I have a surprise day off, since we were supposed to go away for three days, but something happened with the car (information relayed over the phone in Spanish...never a recipe for thorough understanding) so we're not leaving till tomorrow. So I find myself lounging around the house, playing the guitar, reading the nytimes.com....essentially exactly what I would be doing if I were home. With the exception of going out somewhere, cause I live in a locked, gated community and there's nowhere to go except around the small neighborhood. Which I did (pics included).
Other than that, not too much happening. I've been enjoying the hospital (it's called the Hospital Nacional de Amatitlan), and have been amusing myself by comparing it to American hospitals I've been in. 1, at home you don't have to bring your own toilet paper. 2, our sterile scrubs aren't see-though (literally and seriously). 3, men and women have separate OR changing areas. 4, patients in the ER have some semblance of privacy, and don't have, you know, foleys placed in front of a dozen other people. One similarity: there are drug reps (complete with expensive suits and trinkets to give out).
I've also been keeping up on politics (the debates are shown here in English, and it's in the paper every day) and fighting people about why Obama is better than McCain (somewhat difficult in Spanish). I live in a house of Democrats, but the extended family is Republican (two people actually high-fived about McCain the other night at dinner...and a piece of my soul died), partly because they seem to all be evangelical Christians. Which is a somewhat, uh, interesting situation to find myself in. I was actually in the backseat of the car the other night, and we stopped short, and a Bible came flying off the back shelf and hit me. Maybe God is trying to talk to me.
Take care everyone, and step on some crunchy leaves for me. :)

My street
The world outside the walls

Pictures

Pictures of the beautiful Antigua, Guatemala, a city about 30 min from here.

Day 1 in la emergencia

Ok this has been quite an interesting day. I was supposed to spend part of the day in surgery, but I never ran into a surgeon (nothing is too pre-planned here), so I just spent the day in the emergency room. By 10 am I had seen an arma blanca wound to the buttocks (side note: it was not explained to me what an arma blanca is. It was just stated to me as the mechanism of injury, as if I was supposed to know what it was. I was foiled in googling it because it´s also the name of a Spanish rap group. I finally had to inquire around the house, and it turns out it´s a long piercing knife-like thing. I guess everyone in the ER knows what this is, and people come in with these wounds all the time, like everyone in the UMass ED knows what a switchblade is.), a cockroach-from-the-ear extraction, and two amputated fingers (on the same person). And I seriously got to put my rusty suturing skills to good use today. And every time I sutured I was surrounded by 3-8 students, who I gather were the Guatemalan equivalent of pre-med (they said they were in high school but were wearing matching uniforms...they were probably 17 years old). At one point the (only) doctor said, "I´m going to a meeting. You can finish suturing this cut then sew up that head wound over there?", and before I could process the fact that she had just annouced she was leaving, I was on my own. (HELLO?!? Imagine leaving a fourth-year in charge of the UMass ED. Disaster couldn´t be far behind.) At the time I felt ok, I could definitely suture these people up in a vaguely competent fashion. But of course in short order there were trauma victims coming in, and paramedics (we´ll call them that...I mean the people that bring patients in on stretchers) were telling me about car and motorcycle accidents, and nurses were coming up to me saying, "Doctora, (something in Spanish I barely understood and even if I understood the question I didn´t know the answer)." One of the nurses located the doctor´s stamp, which she had left behind (with her name; it´s what you need to write orders), so I could write xray orders (hey, it takes hardly any Spanish to elicit C-spine tenderness). And of course, everywhere I went there was a gaggle of white-uniformed students following me, who may or may not have been under the impression that I had any idea what was going on. FUN TIMES. Everyone lived though, and everyone eventually stopped bleeding. (i.e. no harm came to anyone, in case there´s some liability lawyer or med school administrator that´s eventually going to read this.) More later. I took some pretty (I hope, I haven´t seen them yet) pictures yesterday that I want to upload. Besos a todos. :)

Life is good

Alright! I have figured out a way to update this blog. I have to type the entry into word on my computer, then transfer it via USB drive to the house computer and upload it when the internet works. Thus far, the internet has stayed working long enough to let me check one email account. (addendum: this post took more than 24 hours between writing and uploading due to the vagaries of the internet connection. So...I guess they´ll be a little like snail-mail in the sense that 'today' isn´t actually today (or the posted date).)
But life is good. I wish I had very exciting things to report, but I don’t. I don’t actually start working in the hospital until tomorrow. But for now, some observations for you:
1. It’s wet. Very wet. Only after 2 pm though. How is it sunny all morning, then every day at 2 pm for 6 months it pours? Mother nature is a mysterious lady. I belive “winter” (what the rainy season is called) ends at the end of October.
2. Mayan (or whatever you want to call them) women stash cell phones in small pockets sewn into the inside of the neck of their (traditional) shirts.
3. Mayan/indigenous women wear traditional dress consisting of a high-waisted extremely colorful skirt that goes to mid-calf, and a tucked-in blouse. And, often, heels. The men for some reason wear regular old western clothing. Why is this.
4. Guatemala is nowhere near as poor as Nicaragua is. I kind of expected it to be similar (being the only other central American country I’ve been to). Wrong. We went to a shopping mall the other night that was bigger and fancier than most malls I’ve been to in the US. The cars here are all pretty nice and new (whereas the cars in Nicaragua looked like if they went over a big enough pothole they would collapse into a heap of parts). Homes have computers! And cable TV! (Confession: I watched ‘Gossip Girl’ last night. I know, I know, that’s hardly advancing my Spanish or medical knowledge. But lord was it enjoyable.) And washing machines! Obviously there is still exteme poverty here. But there was extreme poverty in Nicaragua, without the obvious displays of wealth right alongside.
I have been lucky enough to land in the middle of an extended family of musicians. The father in my house is trying to teach me how to play American songs on the guitar, which are apparently “classics” but because I was raised on a diet of Mozart and Gilbert & Sullivan (thanks, dad!), I have never heard any of them before (or my strongest recognition is “hmm this part sounds sort of familiar”). I’m amused that he’s teaching me songs from my own culture. And the doctor who’s organizing my entire trip (I’m living with his sister’s family) is a good guitar player and singer, but mostly plays the marimba. Heaven.
Um, so if someone could please locate some information on the Mayans and what exactly happened to them, that would be great. It hurts my eyes to read this computer screen too long, and the bookstores only carry books in Spanish or something. But I’m curious, so if someone could find out a little history there and get back to me, that would be great. Thanks, Nat. :)

Hope everyone’s good! Thanks for reading. :) If you’ve just skipped to the end, well, thanks for visiting anyways.

p.s. Dear Dad,
I have not been trapped beneath a mudslide, fallen into a volcano, had my car hijacked, been kidnapped by rebels, or contracted Dengue fever. I am in fact alive and well, and for the most part feel pretty much like I’m in the US, except for the cold showers and the volcanos.
Love,
Your daughter

Pictures!
This is my new best friend, Chispa. I tried to take her picture sitting upright looking at the camera, but every time I tried to get her attention by calling her name or touching her, she flopped over pathetically on her back.

This is a tree. Um, I forget what it’s called, but it’s the national tree of Guatemala. And…they look cool. (I´m pretty sure I´m going to be able to parlay this eloquent blog into a lucrative book deal.)
This is one building of the main public university in Guatemala; it’s in Guatemala City, and it’s called the Universidad de Juan Carlos. I enjoyed the placement of a centuries-old Mayan sculpture in front of a university named after the leader of the people that invaded and decimated the indigenous culture.

I´m alive

in case you were worrying. :)

I arrived in Guatemala city this afternoon, after almost missing my connection in Miami (but making it!). I am staying with a v. nice family with two girls living here (and a son living elsewhere). I have my own room, and, most importantly, the house comes equipped with a very small white fluffy dog that likes to have its stomach rubbed and 3 (three!) beautiful guitars in the corner of the living room. I have met my soulmate, Guatemalan-houses-wise. Since I am lucky enough to have internet in this house, I really have no excuses for not updating this regularly. So...feel free to harass me for a post if I seem to be slacking. :)

I just...love this picture

I love how Republicans are talking about how they're going to be a "change" in Washington. Give me a break. I guess they think voters are actually dumb enough to forget that they have been the ones tanking this country for the last eight years. Well, a picture is worth a thousand words. It beautifully and clearly displays how the current Republican candidate feels about W and his s*****y policies.

Thank god, only 115 days left

(or, however many...see widget below) (I tried to find one that fit in a more streamlined way into the layout of this blog, but I couldn't. So...it's big and bulky but it's ok, it does its job.)

So I was having dinner with an old friend the other night, who's very level-headed (well, like most of my friends...but her in particular) (Caroline I'm talking to you), and we were discussing the inane stupidity of the current administration. And how mad they make us. Thinking about George Bush is actually one of the only things on earth that makes me mad. Like, heart-rate-up mad. So rather than sit here with steam coming out of my ears, I'm gonna channel the anger into enjoying some lovely music, courtesy of everyone's favorite folk singer, Antje Duvekot. It's a new song called Christian Boys. And it's the new Song of the Week! (See the little mp3 player to the right.) Lyrics below:
How does a poor man on a bench become a criminal
While the rich man on the hill hails to the thieves?
How does revenge equate to pride until the flag becomes a gun
How will the sun go down after the war is won?
How come the wise man is so quiet
While the killer speaks so loud?
He is hollering from out of my TV
And he is claiming that he knows me
He is taking little bows
But he is drinking from the silver palms of greed

And Mama, aren't you proud
Oh, he plays with such big toys
And he thinks it's all a game
Your little virtuous Christian boys

So you're playing by the rules
But every time it is your turn
He moves the net a little higher up
And you think it must be fair
'Cause that is what you've learned
But he scores every time
And you score none

And Mama, aren't you proud
Oh, he plays with such big toys
And he thinks it's all a game
Your little virtuous Christian boys

Oh but this is an impressionist painting
And we are standing way too close
We are sitting in the circus tent
Just waiting for the show
While the cannibal elite
Eats from their sacrificial plate
And they are lying through their teeth
Making a mockery of faith
And your dollar lets you buy
Yet another empty cup
And that is how they fund their lies
And they hope we don't wake up
And they are feeding us this fear
They are feeding us the news
And they know we're biting off
Less than we could chew

And Mama, aren't you proud
Oh, he plays with such big toys
And he thinks it's all a game
Your little virtuous Christian boys

It's here! It's finally here!

What we've all been waiting for for the past 364 days...International Talk Like a Pirate Day! Before you think I'm totally crazy, this day is bona fide: it was in the New York Times crossword puzzle today (8 down: "Well I'll be" as might be said on Sept 19. Answer: Shiver me timbers). And no holiday can be solely in the counterculture if it makes it into the crossword puzzle. So why have TLAP day? Why not! According to the website, the whole point of TLAP day is that there is no point. So have a great day! And remember, today's the one day of the year you can't make too many harrrrrible pirate jokes. :)

p.s. whoops, somehow I neglected to actually post this one. okay, it's now a week after TLAP day. well...close enough. :)

New feature! New feature! Read all about it!

I decided to embed an mp3 player into this site, at the advice of a friend. It's taken me several attempts, and several hours at each attempt, sadly, to figure out, but it's finally up and working. I think I'm going to change the song every week or so (or maybe longer, if I forget about it). So the inaugural song is Beethoven's Heilige Dankgesang. At times other than 2am I could extoll its virtues and tell you why I love it so much. But not now. I'm too tired. Sorry it's so long, but have a listen, it's really nice. If you're interested, you can read a bit about the piece here (it's a little verbose though).

Some pictures from last weekend

View from the 38th floor of East 42nd Street.

Sunflowers on the farm, Tarrytown, NY

Brooklyn Bridge, the waterfall, Manhattan Bridge

Lerner Hall, Columbia University

Sheep's Meadow, Central Park

Waiting for the train at Bleecker Street

Freakin' social conservatives

What is wrong with you people?? Sorry to have a random post about politics and bat-shit-insane Republicans, but I need to get this out of my system. How is it possible that gay couples, some of whom have been partners for 40 years, are ruining the "sanctity of marriage" by getting married, and yet when 17-year-olds get pregnant, the right moral thing to do is to get married? How are shotgun weddings preserving the institution of marriage, yet marriages of long-term couples eroding it?? Argh! Crazy Evangelicals and their moral high ground. Thanks for letting me vent, I feel a little better.
p.s. Dear Conservative America,
Please teach your children about birth control. When they decide abstinence-only isn't cool anymore, they will need it. Thank you.
Fondly,
Liz

Finally!

Third shift's a charm: I finally got up in the LifeFlight Helicopter today. There was a lot of waiting around for things to happen, but I had (had) to get up there before I graduated.

photo:umasslifeflight.com

You can't make this stuff up...

Patient (looking at me intently): You look like Amy.
Me: Who's Amy?
Patient: My cat.

A night out in Worcester

So as part of my Emergency Medicine rotation, I have to do two ride-alongs with Worcester EMS. I had kind of a crazy and interesting night, which I feel like sharing parts of semi-publicly. We had quite a few calls tonight, which usually came in right as we were nearing a coffee shop (did the dispatcher know what we were doing and where we were going? perhaps). There were a couple non-interesting calls, so I'll leave those out. But even amid the mundane, the two paramedics I was with were quite a duo. They were hilarious and inappropriate, and just as I was on the brink of rolling my eyes at their adolescent humor, they quickly and smoothly sedated and intubated an old woman in respiratory distress. I mean, I had barely opened the bag with the equipment and I looked up and the tube was in her mouth (paramedic: "When you look in and see their teeth come out, you know you're golden"). Preceding her florid respiratory failure, she had just been having some difficulty breathing. Her rapid decline (this was the most serious gasping for breath I have ever witnessed) while we were on our way to the hospital forced me to poke my head up toward the driver and ask, in a polite and high-pitched voice, "um, excuse me? could you please pull over?" and as soon as we stopped she was intubated and we were on our way again. And the medics were nothing but patient with me as I fumbled with IV tubing and squirted saline on them (and on me) (Medical Students: Always Cool Under Pressure). Actually the scene wasn't as frantic as I would have imagined an emergency intubation on the side of the road to be. (End result: we brought her to the hospital, and I have no idea what eventually happened to her.) (Unsatisfying, I know.) What's also interesting about this lady is that she kept saying over and over she didn't want a breathing tube (known in medicalspeak as being DNI: Do Not Intubate), but then when she actually started gasping for breath and frothing at the mouth, she said she wanted the tube. This is not the first time I have seen this happen, where people swear up and down they want no "heroic" measures, then when it comes down to it, they want everything. I guess your feelings are different when you're thinking about what may potentially happen in the future and experiencing what is actually happening. I can't imagine the terror of knowing you're about to die, even if you're very old and very sick and have thought about it a lot. But this is a discussion for a whole other post.
Anyways, we had this other call which was to a "man down" in downtown Worcester. He ended up being a drunk guy with new and old cuts, scrapes, and bruises all over him, and large switchblade hanging out of his back pocket (which, upon noticing it, the paramedic and police officer quickly took). At first I was thinking, this guy's totally drunk, he was stumbling around and fell and hit his head, he's refusing to go to the hospital, why are we here? Then I got more of an idea of what was going on, and it turned out he was well-known to all parties on the scene, he's a sometimes-resident of the PIP shelter, he's pretty skinny and pathetic and gets jumped all the time, and had been beaten up today because he had $20 that someone else wanted. He carries the blade for protection. The officer told him he understood it was for protection, because there were some dangerous characters out there (I'm cleaning up his language in paraphrasing here), and then told him, after seeing a bottle of gatorade in his bag, to "pound that shit." I was kind of surprised (and then felt guilty that I was surprised) at how patient and respectful and just plain nice everyone was being to him. The man eventually decided to come to the hospital, and as we were getting out, the medic reminded him to please be polite and treat people with respect, and that's how he would get treated by the doctors and nurses. I'd like to think that's true, but I'm not sure the bleeding drunks sleeping in hall stretchers get treated the same as other patients. I know if there were a choice of two patients to go see, I probably wouldn't choose the drunk man in the hall. (I wish that wasn't true and I didn't think like that, but I'm being totally honest). But it was nice to see this man from a different angle; fine, he's an alcoholic (who am I to judge), but he's also just trying to survive (and has probably had a pretty bad life so far), and ends up bleeding on the sidewalk every couple of weeks because Worcester's Finest want to mug him for his $3.50 bottle of vodka. Life's a bitch for some people...so who am I to judge them and not treat them with respect??
[Side note: talking about this man brought up one of UMass' family physicians who works at the PIP shelter, Worcester's only (I think) wet shelter, and an all-around rough place. We quickly concluded that this particular doctor is a bald, male version of Mother Theresa, in that he is compassionate and respectful and patiently treats everyone, even if they walk out the door and start shooting heroin into their eyeballs; then they come back the next day and he treats them again. We are certain that he has an express, speed-of-light ticket to heaven. He's the kind of doctor that before medical school we all wanted to be like, treating everyone, being kind, being non-judgmental. Now most of us are just in awe that someone like that exists, and we mull over his saintliness as we elbow each other out of the way for the few open derm slots.]
And just when I thought I'd seen enough for one night, we got a "FDGB" (fall down go boom) call. We walked into the house, and it was (I'm not making this up) a family of deaf people. Most people that know me know that I love sign language and that learning it has been a hobby since college. It's not really a handy life skill (even though ASL is the third most common language in the country, after English and Spanish), and I don't think I've ever been called upon to actually use it. Needless to say, the paramedics were kind of stunned that I could communicate with this family and figure out what happened, and then talk to the patient on the way to the hospital. I ended up waiting there until the interpreter got there, leaving my ambulance to go out and take more calls, cause I felt bad leaving this poor person in a cervical collar strapped to a backboard staring at the ceiling and unable to communicate with anyone. I'd imagine that would be a pretty scary situation for a deaf person, only able to look up, not really able to move at all. At the end of the night I was pretty pleased that I hadn't totally forgotten all my ASL, though certainly it could use some work.
I feel like I packed a bunch of crazy experiences into one short shift. Thanks for reading this very long post (if you even did...and didn't skip right to the last sentence...I have a short attention span too, I know how it works). I don't think my next ride-along will be quite as adventure-packed, but we'll see... :)

Pittsfield happenings

This is getting blogged about, per request...
There was one hell of a fire the other day at an apartment building across the street from the hospital. Of course being voyeuristic like we are we rushed out to watch (and take pictures). And mingle with Pittsfield's Finest. I'm not sure what time the fire actually got put out, but it was after 11pm (and it started around 8). From what I read in the newspaper, no one got hurt, and the fire started on someone's stove. It was pretty impressive. And HOT (I know, I know, you think that'd be obvious, but it still surprised me). Plus I was watching the firefighter on top of the giant ladder hanging over the burning building, thinking, we must be made of different stuff, or have different neural connections (see?? I'm tying this into my neuro exam tomorrow, so it's totally like I'm studying) than me, cause WHAT would possess someone to do something like that?? I mean, this was a giant ladder and a big fire (see above image). Now, alas, the building is very sad and burnt-out looking. But it's still there, and at least the fire didn't jump onto the house next door (it was close - you can kind of see the roof next to the bottom of the ladder in that pic).

New post - I am alive

Sorry for the month-long delay in blog-posting. Life got in the way. You know how it is. :)
So, I wanted to write about an awesome music festival I went to yesterday, on my last (oh, the horror!) weekend in the Berkshires. It's the Falcon Ridge Folk Festival, and it's a four-day festival held on a farm in Hillsdale, NY (just across the MA line near Great Barrington). And let's just say the crowd was, um, unique. We were actually keeping a tally of the number of men we saw wearing skirts (and I don't mean kilts). Bras appeared to be optional. There was a woman wearing a flowing skirt, bikini top, and butterfly wings (like from a halloween costume or something), playing with devil sticks all day. There were multiple canoodling same-sex couples (which shouldn't make me, a super-liberal from the most liberal state in the nation, even really notice, but somehow it still did). There was (when the sun when down) a giant peace sign made out of tiny lights hung way high up in a tree casting a nice glow over the audience. I mean, there were adults hula-hooping. Needless to say, it was some of the best people-watching I have ever had the privilege to enjoy. There was also (and this was the main, draw, really), some awesome music. We saw (in one day!): Dar Williams, John Gorka, The Nields, and many other singers who were also great, but who I've never heard of before and I'm now too lazy to look up their names. At one point, Dar Williams sang with John Gorka, and I thought I would die of happiness. (And it goes without saying that she's a pirate's favorite folk singer, right, Hoyt?) And the weather was beautiful, except for about 20 minutes of rain (but it was a serious rain). Normally my days are filled with old sick people and bad cafeteria food, but yesterday it was chock-full of acoustic guitars and peace signs and organic smoothies. I wish I could bottle up that feeling of zen-happiness and unleash just a little bit every day. :)

Aaaaaand we're done!

With this year, that is. Perhaps most importantly, we (we're employing the collective "we" here) are DONE with our medicine rotation. We weren't entirely sure we'd make it emotionally, physically, and cognitively intact. It was touch and go for a while there. So, sorry for the lack of posts...and this is just gonna be a brief one to let you know I'm alive. I hope everyone has a lovely weekend! And J&E, have an excellent birthday! :)

An Ode to Inpatient Medicine

This morning, I decided to channel my energy away from thoughts of strangling my attending (or at least re-doing her hair) and into more creative places. Hence, a poem for you:

O inpatient medicine, please listen to me
I can't take too much more of ACS and PE
Of blows to my ego, of sickness, of death
Of five-to-five admits, and of course M.Ed.'s

O inpatient medicine, send me a sign
You take over my life, and up all my free time
I used to have friends, and hobbies, and fun
Now my guitar gathers dust, and I can't hold my wine

O inpatient medicine, what can I do?
Your lights are fluorescent, your halls smell like poo
I'm ensnared by your monster, caught in its grasp
It will haunt me forever, till I'm old and sick too

O inpatient medicine, do you see those blue skies?
While I'm locked in this labyrinth, a part of me dies
I'm dreaming of summer, of drinks with umbrellas
But you're immune to my pain, and deaf to my cries

O inpatient medicine, I'm doing my best
Help me through these last days, through third year's last tests
Give me strength to come in, and motivation to learn
And - oh, fuck it, I've got just two weeks left

Picture time

Some pictures from when I was home over Memorial Day weekend, cause this blog needs some color:

Happy Saturday!!

I hope everyone is having a fantastic day. If you're even up. So...it's 8am. I've been at the hospital for almost an hour. I'm just thankful there are no windows anywhere around this fluorescent labyrinth so I can't see the blazing beauty of the sunlight dancing off the lake. I'd like to say I'm saving lives, but in reality I'm nursing a giant coffee, reading the nytimes online, and half-heartedly looking for my senior resident. Occasionally I'm working on a discharge summary for my patient who was admitted a whopping 6 days ago, and I'm utterly unable to remember what he presented with when he came in or what his problems were before yesterday. I could go get his chart, but that would require more energy than I can muster at this particular moment. Anyway, I hope you all have a v. good day! Go to the beach. Or sit inside in the air conditioning, if that's more your style. To friends whose emails/calls I've been ignoring: it's not you, it's inpatient medicine. I'll resurface soon. I really do love and miss you all. :)

Pica

A quick google search turned up that pica stands for: 1. The Portland Institute of Contemporary Art, 2. the Podiatry Insurance Company of America, and 3. the Printing Industry of the Carolinas. However, the Pica that I am endlessly fascinated with is the "persistent eating of nonnutritive substances." According to emedicine, people with pica eat substances, "including, but not limited to, clay, dirt, sand, stones, pebbles, hair, feces, lead, laundry starch, vinyl gloves, plastic, pencil erasers, ice, fingernails, paper, paint chips, coal, chalk, wood, plaster, light bulbs, needles, string, cigarette butts, wire, and burnt matches." Um, ew. Though pica has always held a morbid fascination for me, this post is inspired by a patient today (not mine, hipaa) who was found by the nurse eating baby powder, and subsequently found to have an earring in her colon on xray. And I had a patient a couple weeks ago who admitted to eating cigarette butts (seriously), but flat out denied eating coins (her exact words: "I save money! I don't eat it!"), though clearly there was a quarter in her cecum on xray. Crazy. Factoids about pica: eating ice chips can be a sign of iron deficiency; and eating clay or dirt is acceptable and a learned behavior in some cultures. Not helping Worcester's infant mortality problem: pregnant Ghanaian women eat clay (though I've heard that this problem gets more press than it's really worth in terms of actual harm to infants). Anyhoo, I got off track. Pica is weirdly cool. Except for the people that eat, you know, razorblades and whatnot.

Whither must I wander

My dad spoke at his high school's candlelight ceremony yesterday (kind of like graduation, but more introspective and less celebratory), and his speech (which was awesome, in my unbiased opinion) focused on a poem by Robert Louis Stevenson, which I really liked. I think I've been drawn to literature/songs/themes of wandering lately, as I have recently become nomadic (seriously, it takes a minute in the morning to figure out where I'm waking up). So anyway, here it is (the poem, not the speech):

Home no more home to me, whither must I wander?
Hunger my driver, I go where I must
Cold blows the winter wind over hill and heather
Thick drives the rain and my roof is in the dust.
Loved of wise men was the shade of my roof-tree
The true word of welcome was spoken in the door
Dear days of old with the faces in the firelight
Kind folks of old, you come again no more.

Home was home then, my dear, full of kindly faces
Home was home then, my dear, happy for the child.
Fire and the windows bright glittered on the moorland
Song, tuneful song, built a palace in the wild.
Now when day dawns on the brow of the moorland,
Lone stands the house, and the chimney-stone is cold.
Lone let it stand, now the friends are all departed
The kind hearts, the true hearts, that loved the place of old.

Spring shall come, come again, calling up the moorfowl
Spring shall bring the sun and the rain, bring the bees and flowers
Red shall the heather bloom over hill and valley
Soft flow the stream through the even-flowing hours.
Fair the day shine as it shone on my childhood
Fair shine the day on the house with open door
Birds come and cry there and twitter in the chimney
But I go forever and come again no more.

FAQ: glioma vs glioblastoma

Been getting a couple questions about brain tumors lately. Obviously because of Ted Kennedy (so sad) but also because of a family member recently diagnosed with glioblastoma (also very sad). Here goes:
A glioma is a tumor that arises from cells in the brain called glial cells. Basically these are all the cells in the brain that aren't neurons; they are the "glue" that holds the neurons together. Any tumor that comes from glial cells is called a glioma. But each kind of glial cell (for example astrocytes or oligodendrocytes) can have its own tumor arise from it, and each tumor has its own name. A tumor arising from astrocytes is called an astrocytoma. A tumor arising from oligodendrocytes is called an oligodendroglioma. These are types of gliomas.
Astrocytomas comprise 80% of primary brain tumors in adults. (Primary simply means that the tumor doesn't originate as cancer somewhere else in the body and metastasize to the brain.) There is a spectrum of badness for astrocytomas. Grade IV astrocytomas are the most aggressive and have a special name: glioblastoma. (I didn't come up with this naming system, people.)
Contrary to popular belief (or my interpretation of popular belief, I guess), brain tumors rarely present with headaches. This is because there are NO nerve endings in the brain, so tumors don't cause pain. Crazy, right??? (If there was some way to get inside your skull pain-free, you could undergo brain surgery without anesthesia.) They usually present in one of two ways: with seizures (a la Ted Kennedy), or with something called mass effect. Mass effect means the signs and symptoms that arise from having a mass in the brain, since the brain really doesn't like to be pushed around inside the skull. Symptoms include mostly nausea and vomiting, though a classic sign is vomiting without nausea. One more time: headaches rarely mean brain tumor.
Hmmmm....any other burning questions about brain tumors?....

Why didn't I become an I banker??

I'm pretty sure that inpatient internal medicine is going to get the best of me. I am 2 (two) weeks in out of 7 (seven!!!) and I'm already ready to throw in the towel. I'm not entirely sure how/why anyone actually goes into internal medicine, and ends up alive with cognitive and emotional function intact at the end. As my resident put it (he's only a PGY-2), "When I was in medical school I wanted to save the world. Now I just want to make it through each day alive." This is seriously the most draining rotation I've done this year. Thoughts about that? Other opinions on the most exhausting one? I'm not even sure the hours in surgery were worse, given that you had post-call days off q4. As an example of my morning: We worked up a new patient (obviously I'm not revealing/changing the details...I know you're reading this, HIPAA) for new-onset weakness, and she ended up having f***ing mets all over her brain from an as-yet-unknown-but-probably-lung cancer. That was real fun. And my patient from last week with ten zillion medical problems that we managed to stabilize was just discharged back to her nursing home. She's 45 years old. How can people do this day after day?? Maybe one day it'll make me so numb that it won't depress me anymore. But then that in itself might depress me. Oy. I leave you with the eternal wisdom of Scrubs:

Dr. Cox: You see Dr. Wen in there? He's explaining to that family that something went wrong, and that patient died. He's gonna tell them what happened, he's gonna say he's sorry - and then he's going back to work. Do you think anybody else in that room's going back to work today? That is why we distance ourselves; that's why we make jokes. We don't do it because it's fun. We do it so we can get by. And... sometimes because it's fun. But mostly it's the getting by thing.

Slow Medicine

This has been on my mind for a while, but I read a cool article on nytimes.com that really brought the issue forward again. Seriously, why do we treat death like it's something we can avoid??? We're all going to die. Deal with it. I am, you are, everybody is. You can't put it off forever. Why do people think that good medicine is just curing everything?? Shouldn't the goal at the end of life be maintaining a good quality of life for as long as possible, not merely delaying death?? So this article: it's about a movement at Dartmouth Medical School called Slow Medicine that emphazises comfort rather than cure at the end of life, and you can read it here. Think about it: if you were diagnosed at age 85 with cancer, would you choose surgery, chemo, and radiation, possibly ending up bedridden with DVT's and PE's and urosepsis and godknowswhat else, just for the possibility of another year or two, and not a healthy year or two at that, or would you rather say, "no thanks, I think I'd rather die on my own terms." I feel like I might go for option B (though in reality hopefully I'm quite a few years removed from a decision like that...maybe I would think differently if I were actually 85). It's certainly understandable to be afraid of death and to want to live as long as possible. I mean, life's short and pretty damn fun. But it ends for everyone eventually. When can we make the shift that the goal of good healthcare is helping people live good, quality years at the end of their life and then dying with dignity and with as little pain and suffering as possible? When will our collective mind stop treating death like something that can be avoided forever? Ok, please read that article, it's short and so interesting. And don't pay too much mind to my ramblings. Inpatient medicine is making me bitter and cynical about drastic end-of-life care, and incredibly sad about the state of some unfortunate people's lives. But that's a depressing story for another post. Please go outside and enjoy your working lungs, healthy muscles, the fact that you aren't paraplegic from a freak accident, or have crippling rheumatoid arthritis, or have had 3 strokes, or live in a nursing home at the age of 37. (This has been a fun week.)

Spring has Sprung

The grass has riz. I wonder where the birdies is?

So, it's officially spring. I think it took a little longer to arrive in the Berkshires than other places near here (like Tarrytown, NY, where that pic of flowers was taken a couple weeks ago). The trees here have pretty much blossomed, and although the temperature has taken a nose-dive over the past week, the flora have still managed to explode. We (Berkshire friends and I) are spending the day in Lenox, and it's so beautiful here. Some of the houses are crazy huge mansions. And we saw the "house" where Cider House Rules was filmed (well, the outside of it). I am trying to pack in non-medical stuff before I start inpatient medicine tomorrow. When I think about it starting I picture a large black sheet being lowered over my life. I may be fatalistic and pessimistic, but maybe this way there's no way I can be disappointed by the experience. If you expect to stay til 9 every night, when you get home by 7 you're happy, right? Well, I hope everyone is enjoying spring. Go outside and smell the flowers, like this crazy kid. :)

I sold a piece of my soul, but the wine sure was good

I finally went to my first drug company dinner last week. I really just wanted to get a free dinner at a yummy-sounding restaurant in town, as I always feel pretty guilty taking anything from drug reps (normally I don't even take pens or anything, just on principle). But the prospect of a free dinner got the better of me, and I justified it to my conscience by saying that they're selling a drug I'm never going to prescribe (it's for osteoporosis...and EM people don't really treat that chronically), and I could write about it here to sort of make up for it. (right??) It was pretty interesting, and overall pretty bizarre. The main speaker was (I think) an endocrinologist, and she told some made-up story about how her own mother was thrilled to learn about this new osteoporosis drug (which obviously I'm not naming here...I'm not doing free name-advertising for them). The whole thing made me pretty uncomfortable, what with the knowledge that drug companies spend almost 30 billion dollars (I can't even get my brain around that) a year on advertising, most of it directly to doctors (i.e. not direct-to-consumer advertising like on TV). And rising drug costs are at least partly responsible for the rising cost of health care and insurance, leading to fewer insured people, etc etc etc. But I digress. I enjoyed the dinner (it was actually pretty yummy, and had lots of free-flowing wine), but with every bite I could taste a little bit of guilt. It sucks that a for-profit industry is so entrenched in (and in a big way driving) what should be an essentially non-profit, for-the-greater-good industry and profession. If sales tactics didn't result in increased use and prescription of drugs, companies wouldn't take entire offices out to dinner or give stethoscope tags or free pens. The office where I had outpatient medicine had free lunch every single day sponsored by drug reps. One day I walked into the kitchen and the rep was holding up a big brochure and describing the effects of her new lipid-lowering medication, while trays of (literally, I am not making this up) KFC fried chicken and mac and cheese sat on the table. I guess she was trying to create future customers?? I'm going to stop here, before thoughts of the current state of health care in this country cause me to become apoplectic in public. I hope everyone is doing well!!

Adventures in the Berkshires

So to continue drinking up the Berkshires experience, last night we took a trip through the woods (literally) to the famous Dream Away Lodge in Becket, MA for some dinner and music. According to its website, it's a 200-year-old farmhouse that used to be a brothel and speakeasy. Now it's a restaurant/bar/lounge that appears to have few patrons but many children and dogs roaming about. Although the website says "reservations for dinner are very much in order," we (there were 11 of us) seemed to make up over half of the customers, though there were many other people standing around that appeared to live there (and our waitress took our order while holding her 5-week-old baby, just to give you some idea of the atmosphere). There was also some really good music by Heather Waters, and we ended up getting our own private concert while we lounged on comfy couches. The whole experience was kind of odd but very enjoyable. You seriously think you're in the middle of the woods when you come across the place. (The directions on the website say, "Turn right on Watson Road and proceed slowly for three winding miles through the forest.") I'd definitely recommend going there (but don't get the fixed price menu...the food's not good enough for the high price), and also checking out that singer, cause she was pretty good. (Where else but western MA can you get good music in an old farmhouse that used to be a speakeasy??)

Picture(s) of the day

Wow, this page needs a picture. Words can get boring. These are pics from the Berkshires, where I am currently doing my medicine rotation (fyi: 'medicine' means general adult medicine, as opposed to pediatrics or surgery). Living in the Berkshires for free during spring and summer is quite a sweet deal. Our school likes to call it "required third year clerkship at Berkshire Medical Center." We like to call it "summer camp" (but with sick people during the weekdays, alas). There is lots of fun to be had out here. I'd recommend either taking a trip out here (tanglewood! and hiking!) and/or doing a rotation out here (if you're at UMass). We all live in a giant med student frat house. Tis quite the experience. :) I feel vaguely guilty for not even knowing the Berkshires existed for nearly my entire life up until now (hey, what can you do, I'm from the total opposite end of the state, and my dad calls everything west of route 128 "the midwest"), so now I sort of feel like it's my duty to extoll its virtues to people who remain oblivious to the fact that it even exists. So please enjoy the pics!

The only thing I DO have: hypochondriasis

So as I lay in bed the other morning, awoken from sleep by back pain (am I really that old?) and sweating because of the extreme lack of temperature regulation in the house out here (which rendered the temperature in my room probably 85 degrees), all I could think about was that I would be dead of meningitis by the time the sun came up. I had pain on extension and flexion of my neck, fever and chills, and as soon as there was light there was no question I would also have photophobia. Obviously it's Sunday evening and I'm very much alive and meningitis-free. Which lead me to think of all the other horrible diseases I thought I've had at one point or another since med school started. Things like Hodgkin's lymphoma, rheumatoid arthritis, appendicitis (x5), congenital malrotation (it's not even physiologically possible for me to have this), and of course leukemia (every time I'm feeling run down...which has been a lot over the last couple years). And yet I make fun of my mother for thinking that a small lump on her lower left abdomen is pancreatic cancer (Me: "Do you know where your pancreas is?" Mom: "No, not really." Me: God, what else do you worry about? Mom: [long pause] "Well, I worry that all the gin in the world will dry up"). Though I'm not entirely sure I deserve a DSM diagnosis of hypochondriasis, because I rarely if ever actually go to the doctor. The only medical professional I go to repeatedly is my dentist (dentist: "It's not a cracked tooth. You're a hypochondriac because you're in med school") because he is rather good looking (read: totally hot). Other than that I just stew about it in my own head (hmmm...let's add 'anxiety disorder' to that list...)

Dead Horse Trampoline

So I had the pleasure of seeing Antje Duvekot (again) in concert tonight. She was, as always, completely fantastic. (Actually I've seen her a few times recently...I think I'm becoming quite a groupie and I don't want to be) (though tonight I got to meet her, which was quite cool - funny story for another post.) ANYHOODLE. She sang a hilarious song at the end called - I'm not making this up - Dead Horse Trampoline. And I with my twisted sense of humor thought it was endlessly amusing, and would so much like to share it with others. You can watch Justin Roth (who I believe wrote it) singing it on YouTube here, and you can read the lyrics here (personal favorite line: That's what he gets for being so mean, He was the victim of a dead horse trampoline). So I figured most people have likely never heard this song before (the YouTube video has had 185 views), and with the convenient medium of the blog (and all 3 readers! just kidding...I know more of you are reading than that), I decided to spread the joy. So please, enjoy. :)

Awesome names

There was a post the other day in TierneyLab, a blog of the nytimes, about the "Boy named Sue" theory: the idea that people with bad names turn out just fine, or even better off because of their bad name. [The winner of TierneyLab's bad names contest was a woman named Iona Knipl ("really? I have two!"), but this is besides the point.] In the comments section, someone posted about an OB/GYN in Fairfax, VA whose name is (and I'm not making this up, I did some googling): Harry Beaver. I mean, if that's your name, is there any profession other than obstetrics and gynecology that you could really go into?? And it made me remember reading something a while back about how people really do tend to go into professions suggested by their names, and it's actually been studied as something more than anecdotal evidence. There is a dentist in Salem named Dr. Fang, and dentists in Needham (they're in practice together) named Drs. Needleman and Yelland. Though a friend reminds me of the OB/GYN at UMass named Harrison Ball (he doesn't go by Harrison...and yet why not??) who maybe reacted against his name in choosing a specialty. In an awesome-sounding book called Bertha Venation: And Hundreds of Other Funny Names of Real People, Larry Ashmead talks about people like the environmental engineer Hugh Fish, and what happens when Ms. Gay marries Mr. Beech. (I heard about this book on NPR.) And there's some debate as to what comes first: is your name your destiny? According to the New York Times (really, where I get most of my information), people who study names (called onomastics), call it "nominitive determinism" when Dr. Fang grows up to be a dentist or Dr. Fish becomes an ichthyologist. Ashmead also wrote a chapter on funny names that arise when people marry each other, like Ms. Coffee marrying Mr. Bean, or Ms. Gay marrying Mr. Beech (she hyphenated it to Gay-Beech, according to the book, and didn't actually find it all that amusing). Luckily, Dr. Beaver's children say that they got many laughs out of their father's name (according to their posts on Dave Barry's blog, and he never makes stuff up). :)

Sleepy Sunday in Marblehead

Picture yourself lying in bed on a Sunday morning (at your parents' house, because you no longer have an apartment): the distant sounds of NPR, the smell of brewing coffee, the smell of smoke from the fireplace....the sound of smoke alarms, then the sight of lots of smoke from a fire. Then the realization: shit, there's something on fire. That something being: the chimney and fireplace. Cue the call to the fire department (from a neighbor who saw flames leaping out of the chimney), the arrival of 3 (three!) firetrucks and a police car, and an improptu gathering of neighbors on the street wearing sweatshirts and pajama pants and wondering what the heck was going on. I can't decide if it's good or bad that my second thought, after it's smoky: we should get out of here, was god it looks cold out, I wonder where my fuzzy shoes are? Then I spent a minute in the mess of boxes and open suitcases that is my bedroom attempting to locate said shoes and my down vest. Long story short: the chimney and fireplace caught fire and was put out in about an hour. Apparently, the floor of the ash pit of the fireplace was made out of wood. Hello?? I've heard stories about the insane level of cheapness of the person that built this house (an uncle of a current neighbor, I think), but I think lining an ash pit with wood is taking cheap to a new level. The fire department said we were really lucky the living room didn't catch on fire. It's a little disconcerting to go from the normal lazy Sunday of coffee and the new york times to being happy that your house is standing. Although, really, I guess we should always be happy for stuff like an intact house on normal days; though obviously no one really thinks about that sort of thing on a daily basis. It was pretty nice seeing all my neighbors, some of whom I've known for my entire life. And lord knows I enjoy watching the firemen parade around with their equipment. And I was also enjoying taking zillions of pictures with my new camera (that I love). One fireman said, "Are you from the Reporter?" and I said, "eh?" and he said, "oh, there's a new girl who works for the Reporter," and I looked down at my blue fleece pajama pants with the white snowflakes and thought, hm, she must dress casually. So aside from the fact that my parents almost got to downsize real quick and now the house smells like soot and is covered in a fine white chemical powder, this has been quite an interesting (and dare I say enjoyable?) day. And the fleet of cleanup crews arrives tomorrow.

Saludos de Puerto Rico

You may be wondering why I'm in my hotel room on my computer in San Juan instead of at the beach. I'll tell you why: it's been raining/cloudy all day. Although one of only two full days we have here is far from being a beach day (and yesterday was pretty windy and cloudy as well for parts of it), we had fun anyway. Right? Right! We walked around, browsed in fancy shops next to many sunburned white people (I shouldn't poke fun...yours truly managed to get a sunburn yesterday through a frickin blanket of clouds), and ate and drank frequently. Oh, and visited the church where Ponce de Leon is buried, just to say we took in a little history/culture. It was a bit rough getting here, as our plane took off, flew for a while, then turned around and landed at Logan again (something with the oil filter, I think? Something that probably could have been dealt with before we took off? Something for which there must have been some kind of warning light on in the cockpit while we were still on the ground?), but it's been a very relaxing few days. Back to freezing Boston tomorrow, alas. And while we're all thoroughly enjoying ourselves, it's unfortunate that we have two days of interclerkships looming over our collective heads for when we return on Monday. Oh, and three months of medicine (for me). And before you say I'm being negative for thinking about school when I'm on vacation, I have seen 8 (eight!) of my classmates since I've been in San Juan, only one of whom I actually came down with. All in all, PR seems to be quite a nice place to be. So for people in snowy, cold, work-filled places, please enjoy the pictures. :)