Ok, I'm gonna do ID instead.

What's ID, you ask? It's more than what I get asked for every time I want to see a rated-R movie or buy a pack of cigs (My for-real, I'm in an American Lung Association sponsored smoking cessation class quit date is Feb 3rd--wish me luck. In the interim, the woman at the corner store-- with what are apparently the early signs of dementia--asks me every single time, "What are you, in middle school?" No, ma'am. Just flat-chested and baby-faced. Moisturize, and you too could be mistaken for half your age!). It's Infectious Disease, y'all, and it's super cool.

Did you know there are more microbes in and on your body than there are cells that belong to you? So even if you're an atheist, or agnostic, or on a desert island...you're REALLY never alone. I know it's weird, but it's sort of a comforting thought. You, by yourself, are a community--an ecosphere all your own!

There are lots of microbes that live happily with you and don't cause any disease...it's called commensalism, or mutualism. Actually some bacteria even feed you--making Vitamin K in your intestines, for example. Others live on your skin and keep bad guys like MRSA (the nasty 'superbug' that's been in the news lately) from taking over...like your own little bacterial bouncer patrol.

And even bad bugs--enterococci that cause gastritis, para ejemplo--have some mechanisms of action that are truly amazing (sort of like how you hate the Bond villain in every movie but are frankly amazed at the intricacy and detail of his/her evil schemes): E. coli can actually get INTO your bladder cells and chill out there, evading detection. You get treated for a UTI, all the 'outside' bacteria are wiped out, but then there are these little 'seeds' of e. coli lying dormant-ish, waiting, and then BAM! Even though you haven't been reinoculated (ie, you haven't gotten more bacteria into your bladder by having sex and not peeing afterwards, or wiping back-to-front, or wearing tight pants, or whatever else is on the 'not-to-do' list these days) you're reinfected. Whoa. Take that, Mr. Bond.

Also, staphylococcus aureus is named that because 'aureus' is from the (Latin?) root for gold...y'know, Au? Remember the periodic table, kids?...and when you plate them out, the colonies are a brilliant gold color that's frankly stunning. I know I'm going to earn some weird looks for this, but especially when they're plated on blood agar, the contrasting colors are spectacular. I'd put a picture of that up in my living room, with the caveat that no one be allowed to ask what it is.

PS--No, I'm still totally married to psych, but ID is definitely, undeniably enthralling.

It's the sarcasm patrol!

So this has been an awesome weekend.

Got an email from the doctor saying, yeah, we need to do an MRI. To check for--no shit!--a brain tumor.
Had a respiratory physiology take-home exam.
Couldn't start my car Saturday because it was too cold and the gas line had frozen up.
Went outside today to discover that someone had broken into my f*cking car.
And this week looks to be like a baguette--long and hard (well, maybe not AS long, since it's only 4 days).

Seriously, God. Not cool.

Breasts!

Knew that would get your attention. Anyway, it always gets mine.
But no, this is not about mammary glands, not really. Instead it's about the respiratory exam, which we learned to do today, and the delicate art of intergender examinations.
When we finally got up to our practice rooms to attempt the arts of "inspection, palpation, and auscultation" on one another (that sequence has been effectively drilled into my head now--thanks, Dr. R!) the question arose: same gender dyads to practice, or opposite, or both? As the preceptor said, "I know that for practice's sake it might be better to pair off male/female...but for comfort's sake, you'd probably rather do same-gender exams, right? Well, you've got five more years of practice ahead of you, so for now let's stick with comfort and do same-gender pairs." It's odd; everyone in the class knows what my orientation is (I think) but to date this hasn't caused any awkwardness, for which I am profoundly thankful. It's hard enough trying to learn how to percuss and listen for inspiratory splitting without worrying that your exam partner thinks you're surreptitiously trying to cop a feel. Which, it goes without saying (and for once I'm not being sarcastic) I would neeeeeever do, for approximately 573 reasons, among them professionalism, integrity, the fact that a lot of the women in my class could kick my ass if I tried such a thing, and the fact that I'm really not into the whole sexual assault business.

I was surprised, but the guys actually seemed more uptight about the idea of examining women than we did about the prospect of being palpated by gentlemen (and in fact all the men in my practice group are what I would call gentlemen). "I mean, how do you do the exam...with women?" one of the guys asked. To which our preceptor--a funny guy who I am 99.9% positive is gay, and whom I thus had no qualms about allowing to demonstrate part of the exam on me--said, "Well, the breasts are always going to be there." We all laughed at that, but it's true; I've never really been conscious of it, because I'd only ever been on the receiving end of physical exams before, and with my 32AAs there isn't much concern about impeding the progress of a physical (though there was the nurse who took an EKG and left my gown wide open until I yanked it closed...I was not pleased), but breasts can be cumbersome when you're trying to do a cardiac or respiratory exam. You may have to ask a woman to lift or move her breast, or if she can't, gently do it yourself. We're just learning about all this, so we still get awkward and blushy and worry that someone's going to be pissed at us. By third year, apparently, mammaries will be mammaries will be mammaries. It's all in the approach, I guess, in how the body is constructed and understood from a cultural perspective (and medicine--medical school especially--is definitely its own culture).

Learning to laugh at my own stupidity--and Microbes!

So I slept essentially...not at all last night (ok, 5 hours) and that was from 4:30 to 9:30. That may not seem like much of a shortcoming to you late-night IMers and Conan O'Brien watchers (yes, I realize I just sounded like a geriatric patient, and secretly I am a 87 year old woman--you kids quit playing grabass on the lawn!), but I've got me some bipolar disorder, and I need my damn sleep. So I was not running on all however-many cylinders today, as became immediately (or, unfortunately, not-so-immediately) apparent when I went to pick up some essentials at the grocery store today. Never mind that the grocery store is kind of a fraught place for me, or that I have a rough time actually picking things up and putting them in the cart, or that I always feel like I'm in 15 different people's way...beyond all that intrinsic neurosis, I got to the check-out counter FINALLY, and when all was said and done...I didn't have my credit card with me. Got it out of my wallet to do God-knows-what with it and never put it back in, and had all of $7 in cash with me. So I did the whole stammering/turning red/sweating/sympathetic nervous system in overdrive thing, y'know, where you wish the earth would open up and swallow you down to the bowels of hell where at least you could hang out and drink absinthe with Oscar Wilde. So I muttered an apology and all but ran out the front door, my face a color somewhere between "rose" and "carmine" in the Martha Stewart interior decorating palette. Once I was home and finishing the last of a bottle of merlot I could look back at it and laugh, because it is sort of a ridiculous situation for a person who's obsessed with doing everything perfectly and never incoveniencing anyone to find herself in. Maybe I'm learning, little by little, to laugh at my shortcomings--at least those that don't kill anyone (please, please, universe, don't let there be any of the other kind!).
Also, had Microbes today for the first time, and it was so utterly kewl. We got a pack of these Microbe Cards to augment our learning process...like Pokemon or sports trading cards, with images of the infectious fungi, bacteria, viruses, or parasites in question on one side and information (from epidemiology to diagnosis to treatment) on the opposite side. I'm really looking forward to getting together a microbe card playing league..."I play N. gonorrhea!" "I play Cipro!" or "I play Hepatitis C!" "I play interferon!" Gonna be a +3 infectious disease specialist by the end (Note: I have never actually participated in an RPG and thus have no idea what I'm talking about...except for the microbes. I kind of know what I'm talking about there, but only to such an extent that I can sound reasonably intelligent at cocktail parties and probably be very dangerous to actual patients, which is why I'm not yet allowed in the same room with them without an M.D. chaperone).

No fumare

No smoking in...Italian, maybe?
Did you know nicotine is more addictive than heroin by most objective measures?
I did. And I'm trying to quit despite that knowledge. I went cold turkey once before, in college, and didn't smoke for 6 months...then stupidly, oh-so-stupidly, started again.
So right now, as I'm quitting (not trying to quit--quitting) I could kill someone--maybe myself, maybe an innocent bystander--with a spoon.
And so I was actually on the edge of breaking down and going to the corner store to get some nic sticks/coffin nails/ciggies/fags/whatever you call them, only to find (yeah, ha ha ha, Universe, really hilarious) that my ID is temporarily MIA. So no dice. This, to me, is a coincidence--but it's also an example of the Goddess saying, "You promised you were going to quit. Now sit your ass down and do some deep breathing." What a lesson in surrender.
Mysterious ways, indeed. I can't shake the feeling that Divinity has pinched my driver's license. Luckily I walk to school.

So much for one major religion, then.

Examine your prejudices.

So I guess I can't be Catholic. The Vatican recently released "On the Dignity of Persons"--in Latin, of course, to make it sound cooler--in which Cardinal Ratzinger (he'll always be Cardinal Ratzinger to me, because it sounds so much more appropriate than Pope Benedict...which just sounds like a sacreligious breakfast dish) decried stem cell research and the morning-after pill as the harbingers of the end times. Well, not exactly, but he called them both mortal sins, ie Very Bad Things.

Here's the thing. The morning after pill prevents implantation of the (potential) embryo, which at that point is (if anything) a collection of several cells--like, literally less than 100. (See, Dr. C, I paid attention during your embryology lectures!) It doesn't kill it. It keeps it from glomming onto the uterus, which is what happens more than 50% of the time anyway. It isn't abortion (which I'm also not saying is wrong...but that's a whole 'nother kettle of fish), so even if you're opposed to abortion, you don't have to be against the morning-after pill.

I honestly think every woman who's begun to menstruate should have the morning-after pill, or a prescription for it, in her medicine cabinet (well, actually in her dresser drawer, since the temperature fluctuations and humidity in the bathroom could screw with the drug). Am I saying everyone should be out not using contraception? C'mon now, don't you know me better than that? Sometimes contraceptive methods fail. Sometimes the condom breaks. Sometimes you realize the next morning that, yeah, you were both really drunk and didn't use one, and after saying a few mea culpas and vowing never to be that irresponsible again, you need something else to do. In short, life happens, ergo shit happens.

But (hold on while I get out my soapbox...) EVEN IF you're one of those who thinks heathen young women having sex out of wedlock should have to "face the consequences" of their actions (yes, person purportedly so concerned about an unborn child's wellbeing, let's think of the kid as a 'consequence' rather than a person--do you not see the intrinsic cognitive dissonance there? And let's not even get me started about the heathen young men who get off scot-free, morally speaking, because boys will be boys...) those aren't the only people who use the morning after pill. Here I will insert a

**Self-disclosure alert**

I have used the morning-after pill. If I were ever in the same situation again, I would use it again without hesitation, even knowing the side effects (it made me so nauseous I had to go get another prescription to replace the one I'd urped up, as well as a few hits of promethazine--ie Phenergan, an antiemetic that had the nice fringe benefit of making me tired enough not to care if I was feeling vomitous). I was raped my freshman year of college. September of my freshman year of college. The only thing that could have made it a more fantastic start to my academic career? If I had gotten pregnant. I realize most people dismiss this as The Extreme Example, but honestly it's not as rare as you'd think; 25% of college-age women experience rape or attempted rape at some point during their schooling.

If my God/Divinity/Ultimate Reality required a young woman to carry her rapist's baby, I would look for another one. Or maybe I'd talk to Her directly and see what She had to say, rather than getting it secondhand from a lifelong-celibate male (ahem).

Fears and Vindication

Finals are upon us. A time of trepidation, of fear, but also of vindication.
The holidays are also upon us; likewise, a time of mingled despair and delight.

What am I afraid of? Unreasonably afraid of?
I am afraid of failure, but more than that I am afraid of mediocrity.
Less existentially, I am afraid of food poisoning--I've only had it once, but it left a lasting impression. Salmonella and e. coli especially.
I am afraid of never finding "the One"--the person to spend the rest of my life with.
I am afraid of flying.
Spiders.
Failing medical school and having to live in a box under a bridge.
That I will never be truly happy, because I'll never really know what that even looks like.
That everyone else knows what they're doing, and I somehow missed picking up the secret instruction book that the rest of the world is reading from.
Cancer.

What am I proud of, vindicated about?
That two of my finals are over, and I passed them.
That I've survived this long in one piece (it's been a bigger task than you might think).
That I'm blogging again.
That for the most part I manage to prevent myself from indulging in sophomoric navel-gazing like this.

What about you?