FAIL

at 5am this morning, i dreamed i was nauseated. i awoke sweat-drenched to find that it was true. a brief spate of vomiting followed this revelation (as well as a brief stint of vomit's less appealing cousin - diarrhea). sorry for the graphics. i went back to bed and managed to sleep for another couple hours. i woke up, prepared for my interview, felt like i looked exceptionally good this morning - except my hair - which badly needed a root job and a general freshener (color and cut-wise).

the 2 hour drive to my interview turned out to be excruciating. maybe due to my early morning trip to the porcelain god...or for some other inexplicable reason - but i was absolutely zombified. i kept nodding off to sleep. it was a terrible drive (although lovely - especially with spring everywhere).

i finally arrived at my destination. i was greeted somewhat indifferently by the receptionist and told to wait in the lobby. i waited. and waited. in reality, it was about 15 minutes before the office manager came out to see me (i arrived about 15 minutes early, as prescribed by all job hunting recommendations). she gave me a small smile, said hi, and turned around to go back into her office. no handshake, no introduction, no nothing. we sit down - still no introduction. finally, i offer my hand and tell her my name. she looks startled and doesn't offer her name. the handshake is limp and not even half-hearted. more like quarter-hearted - if that.

there is no polite chitchat, no questions about my life, family. she immediately whips out a paper and asks me, point blank, "what is your weakness as a doctor?"
i am - naturally, i think - somewhat taken aback by the relative hostility i sense. still, i maintain composure and give my stock answer (hard-headedness, if you're intersted). she scribbles on her paper. this goes on for a few minutes. no friendly chat, no interest in me as a person, my interests, hobbies, nothing. just questions she reads from a paper.

then it's my turn.

i lob out a couple of soft opener questions, "how many appts/dr/day?" type questions. i ask about anesthetic protocols and segue nicely into : "do all surgeries receive IV catheters?" the answer is no. i ask if this is protocol or up to personal doctor discretion. she tells me that if a catheter and fluids are administered, it must be included in the estimate, and this will raise the price. speaking of prices, i ask if they have a fee schedule (this is a VERY standard vet interview question). she says yes. i ask if i may see it. she gives me a blank stare, and then in a very defensive voice says, "why do you want that? what do you want that for?" i'm speechless momentarily but recover my poise and explain the large cost of living difference between her area and my current area, as well as explain that i do not know what normal pricing in the area is.

i feel more and more uncomfortable. i try to turn the conversation in a different direction. i ask if they are paperless, predominantly paperless, 50/50. she stares at me and then launches into a tirade against the use of computers! she explains that good record keeping can't be done on computer, that hand-written records are the only way to go. she explains that she has been with the clinic for 15 years, and the clinic tried to go paperless, but she fought it. i have to struggle to keep my jaw clamped shut so that it doesn't hit the floor. need i explain the absolute IDIOCY of this position? handwritten records are laden with mistakes, impossible to read, and a proven HORRIBLE way to keep records - especially when dealing with either the best interest of the patient OR liability OR both. many pharmacy errors can be traced directly back to sloppy doctor handwriting!

i change tack again and ask about in-house diagnostics - can they do clotting panels? she stares at me with the same blank look i keep getting. she doesn't know the answer.

the interview finally ends. she halfheartedly offers me a tour of the clinic. during the tour, she comes across 2 of the doctors - neither of which introduce themselves to me or even GREET me. one glares at me in what i can only describe as a hostile way - but WHY IN GOD'S NAME WOULD SOMEONE I'VE NEVER MET HAVE HOSTILITY TOWARDS ME?? she doesn't introduce me to any technicians.

we end up back in her office where she asks me if i will take a meyers-brigg personality test. i acquiesce, although at this point, i already know there is NO WAY IN HELL that i will ever set foot in this unprofessional, hostile environment again.

the interview ends with my asking her how many current applicants they have. she smugly shows me a pile of resumes almost 2 inches thick. when i try to broach the subject of job-hunting in a friendly tone, she becomes condescending, telling me how very many applicants they have, it's the largest pool she's seen in her 15 years, yada yada.

i leave realizing that this small petty woman probably didn't like me because i'm attractive, i'm young, and i'm a doctor.

i drove 4 hours round trip for that - for the polar opposite of my 1st interview. i haven't talked about it, but in brief: i was greeted warmly by everyone, introduced to everyone, treated as a professional, they bought lunch for me, answered my questions, included me in appointments, and in general, acted like i was a doctor. they DID NOT act like i was a 17 year old girl fresh out of high school applying for a vet assistant position. that's what i felt like this morning.

what a waste of gas, laundry detergent, and make-up!

ps: i did get 3 good things out of the day: my new ariat barn boots arrived so that i can stop traipsing around in the mud around the barn in tennis shoes, i went and had my hair colored (dark, walnut brown with intense red undertones again) and cut, and i had dinner with my always better half.

recipe by request:: penne pasta in a cream sauce with gorgonzola, prosciutto, ham, and peas

Serves about 4 - best if TOSSED with noodles instead of ladled over (VERY RICH!)

1/4th pound penne pasta
¼ cup olive oil
1/8th cup chopped green onion
¼ cup chopped fresh parsley
¼ cup crumbled gorgonzola
¼ cup cream
1 tbsp minced garlic
¼ lb prosciutto
+/- diced ham
+/- peas (fresh or frozen)

Dice prosciutto. Add to bowl with green onion, parsley, ham, peas, lightly salt with garlic salt (or add minced garlic). Heat oil (medium heat). Cook until sizzling (about 5 mins), stir frequently. Add cream and bring to boil. Cook 10 minutes or until thickened. Add gorgonzola, turn heat to low, simmer 5 mins or until cheese melted. Toss with penne pasta or serve over penne pasta. Can toss with parmesan and black pepper if desired.

Modification: I don't think that the garlic is much needed. The sauce is very flavorful. I didn't have minced or fresh garlic, so I used garlic salt (lightly).

Nothing ...

i have nothing interesting to say right now - hence the hiatus from blogging.

work is...work. i spent the previous week on internal medicine. monday and tuesday were very, very busy. wednesday through friday was very, very slow. so slow that i actually left and went to the gym on friday afternoon.

i won't know about the dream job until the 3rd week of april. i spoke to the office manager on wednesday. she said that they had so many applicants that they still weren't finished interviewing. the conversation did not leave me hopeful.

another interview tomorrow - in antioch, tennessee. i have no reason to move there. it's farther away from family and friends, and i know no one in nashville. the following monday, i have an interview in waynesville, NC - which is about 25 minutes outside of asheville. i haven't been doing it long, and i already hate job hunting.

friday night, my 2 best friends came to spend the weekend. i cooked prolifically.

saturday night, i tried something totally new and it was FABULOUS: penne pasta in a cream gorgonzola sauce with prosciutto, ham, and green peas. it was a rip-off of a dish i had when i was in NYC last time - and it came out amazing. it was also very easy to make.

today, we went to brunch/lunch at our local greasy spoon. the best friends have now vacated (post lunch), leaving me to my own devices for the rest of the day. that will consist of: 1) the gym at some point 2) reheating the enormous amount of leftovers we have from the weekend (pasta, as well as meatloaf and mashed potatoes) 3) reading some of 'brave new world' and 4) washing, ironing, and preparing clothes for interview tomorrow.

what else, what else? oh yes. jim and i officially have savings now. we finished paying off the credit card, and then we made a decision to make a CONCERTED effort to stop eating out. we eat out ALL the time. it's largely a function of our lifestyle - jim traveling back and forth to school and being gone 3 days a week sometimes, me working 120 hour weeks sometimes, exhaustion, too many pets to care for, etc. unfortunately, when reviewing our finances, i realized how much money went toward eating out. so, for the past month - we've worked VERY hard to stop eating out - and we've improved massively. i think in 3 weeks or so, we've eaten out maybe 4-5 times. that sounds like a lot to some, i'm sure - but we were eating out every other day and sometimes every day. and we have a SAVINGS account - with actual money in it. that's a rather new development.

i know. my life is the stuff of tabloid journalism.

blargedy blarg blarg. dammit.

sorry for the cursing in the title, i generally try to refrain from cursing and keep this blog PG to PG13...every now and then, i think i slip into the R category.

ANYHOO.

our flight this morning was utterly uneventful, but i was anxious the whole time. it always correlates to me sleeping poorly. it was ridiculous. i was clammy the whole flight!! none of my normal deep-breathing techniques or thinking about flying logically would help me calm the frick down. it sucked, because we had a sweet flight. i was initially annoyed to see that we were seated in row 29. that's right next to the engines and is always loud. as it turned out, we were flying on an MD83. row 29, seats A and C are awesome. they have (literally) twice the leg room of any of the other seats. i'm not sure why - perhaps because they are located in front of the back galley. it was downright luxurious. we also got the 2 seat row instead of the 3, so it was just me and jimbo, stretched out. it was downright decadent. even jim had ample leg room (at 6"0 - that's saying a lot).

we got home, and i went through the mail. the usual bills and whatnot. i set aside my financial aid statements. they usually go in a pile that i'll peruse once every 6 weeks or so to make sure everything is in order. i'm in total forebearance right now. i don't have to pay anything on my student loans because i'm a pathetically poor intern. as i was sorting through the mail, i realized i had several months of edfinancial statements, none opened. the most recent (received while we were gone) was labeled URGENT. yeah. you see what's coming? my forebearance period has ended - whether by accident or not, i'm not sure - but we were supposed to start making student loan payments in december. so we're now 4 months behind on student loan payments! i about had a heart attack. i'm SUPPOSED to be in forebearance until my internship ends. hopefully this will not be a nightmare to sort out, but we shall see. i've never previously had much trouble with financial aid.

i napped...i went to the gym and ran, as well as did some machines, then i went out and rode the fat belgian cross. it was an utterly gorgeous early spring, southeastern day. mid-70s and lovely. while riding, i came into one of the large back pastures, and a red fox ran across my path. so as not to disturb him (her?), i headed back the way i'd come, took a circuitous route, and wound up in the other, higher pasture. all this only to see the same red fox in the woods, watching me. it felt like a special moment - all for me.

that's about all.

back to work tomorrow. my last surgery before leaving (the 4th surgery that week!) was interesting. i got to take a chronic torsed spleen out of a bulldog. it was quite cool and a fun surgery, fairly simple surgery. the spleen's blood vessels had been twisted off for some time, so they were well-clotted. i barely had to tie any sutures. i basically just cut the stalk of twisted fat and blood vessels and popped the spleen out.

i know...riveting, eh?

home tomorrow

i love allegiant air. it's cheap, it flies to within an hour of my grandparents' house, the flights generally run on time, and you can get them most days. on the other hand, the flights are either in the early morning or evening. ours leaves at 7:40 tomorrow morning necessitating waking at 5:15am. bleh. it's ok, i really can't complain. i'm partaking in the miracle of human flight for so cheap (my flight was $70 round trip).

our vacation was relaxing. i spent a great deal of time sleeping and being utterly lazy. i read a book. i started another. i went to the beach, spent time with friends and their new baby, ate a lot (and probably gained 5 lbs), and just generally relaxed. it was very nice and much needed.

back to work on monday - internal medicine for 5 days. i'm happy about that. then i have the weekend off, and my best friend and husband are coming to stay with us. on the last monday of march, i have a job interview. after that, i work for almost 2 weeks straight.

april is a month that brings much excitement: i have tickets to see the avett brothers, i'll be going to see the stand-up comedian louis CK in the hometown, my niece will be having her 1st birthday, and lots of other fun stuff.

p.s.

i've heard nothing from the job interview 2 weeks ago. i'm trying to let it go and not worry about it, but i fear i will not get the job. in fact, some part of me KNOWS i'm not going to get the job.

pmdd and frank lloyd wright

so, i think that i might actually suffer premenstrual dysphoric disorder. if such a thing even exists (and the drug companies would have us believe that it does). i'm on vacation in florida with my family. last night, i went to bed around 12:30, and then i slept until almost 1pm today. i was groggy and EXTREMELY ill-tempered when i woke up. it took several hours for the generalized rage to subside. i was so mad that i didn't know what to do with myself - for no discernible reason. FURIOUS. the rage was amorphous and undirected. i could barely speak. that - coupled with the presence of a zit smack in the middle of my forehead, as well as one along my jawline on both sides, was all the evidence i needed. these zits wouldn't be noticeable to anyone else, but i know they are there, and i know what they signify. i finally feel like i'm on SORT of a level keel at this moment. hopefully the hormonal tide is subsiding. we're going fishing/canoeing tomorrow.

i just finished reading a book called 'loving frank' - it's "historical" fiction about mamah borthwick - the woman for whom frank lloyd wright left his wife. i didn't know much about FLW's history, although i've always been interested in him. he designed the campus of florida southern - the college which i attended during freshman and sophomore year, before transferring away. my grandfather taught there the majority of his teaching career. the campus is called 'child of the sun' and is quite beautiful. at any rate, the book was about mamah borthwick. i didn't know what happened to her - i didn't even know she existed. if you're at all interested in the book, don't read anything about FLW - or you'll come across what happened to mamah.

the book itself was interesting reading, although i found the main character to be self-indulgent and self-interested. the book's author wanted to tout her as a woman true to herself - true to womanhood above mother and wife-hood. i didn't identify with her much - despite some similarities. frank lloyd wright came across as a total and complete egomaniac. i couldn't muster the slightest iota of liking for him. from the stories my grandfather has told me of his visits to campus, i think the book nailed him perfectly.

at any rate, i'm going to watch a movie with the family. i'm tired, the hormones are at low ebb, but who knows when they will flow again??

p.s.

i'm scared to talk about my job interview. it is THE DREAM JOB. if i sat down and wrote out everything i could possibly EVER want as a veterinarian, this job would meet every criteria. i want it SO bad that i'm afraid to talk about it. i will later.

W-O-W.

every now and then i have one of those cases where i'm left slack-jawed with amazement at what transpires. last night was one such case.

the patient was a beautiful, sweet-natured intact female pit bull. her owner said that at 1pm, she'd been totally normal. she'd gone from that to lethargic, depressed, and dehydrated. he had fed her a giant ham bone with a TON of ham left on the bone itself. while with my technician, she vomited a massive amount of frothy fluid filled with ham.

my physical exam revealed a small amount of bloody feces with bony fragments, fairly significant dehydration, a mildly subnormal temperature (98.8), and screaming abdominal pain. when i tried to palpate her belly, she yelped and tried to bite.

i discussed my concerns with the owner: pancreatitis, foreign body obstruction with the bone, etc. i recommended bloodwork and xrays, which he agreed to do. bloodwork was absolutely normal other than evidence of dehydration (elevated PCV). xrays were more interesting. all of the intestines were shoved into the cranial abdomen, being displaced by a large, soft tissue density object taking up the mid and caudal abdomen. gas opacities were contained within this mass.

i sent the rads to the radiologist for review, and then whisked the dog to ultrasound. i was disturbed to find 2 things i could not explain: MASSIVELY (golf ball sized) dilated intestinal loops and free fluid in the abdomen. it wasn't a ton, but it was definitely there and worrying me.

in the meantime, my xray report had come back - and the radiologist called it a pyometra. this set off warning bells. pyometras are infections of the uterus (the uterus fills up with pus). it starts about 3 weeks after the end of a heat cycle usually. it didn't fit for my pit bull. she'd only been out of heat for a week, she was only 2 (usually a disease of older dogs), she didn't have vulvar discharge, and a host of other things!

i went to the owner with the recommendation that we go to surgery immediately to find out exactly what was going on in that nasty looking abdomen. he agreed reluctantly and to surgery we went.

as i made my nick through the linea alba into the abdomen, a smell came wafting out. it was the smell of rotting. NEVER a good sign. as i enlarged my abdominal incision, i saw something purple-black pushing up out of the abdomen. as i opened it up, i realized what i was seeing. dead intestines. lots and lots and lots and lots of dead intestine. i carefully packed off the abdomen and then pulled the GI tract out. to my amazement, i was looked at a mesenteric rent and small intestinal torsion. that means that for some odd reason, there was a hole in the fat that surrounds and cushions the intestines. the intestines themselves had moved through this hole. once through, they had squeezed and peristalsed and become completely 360 degrees rotated - cutting them off from their blood supply. as a result, they had died.

this was no "cut out an inch of dead intestine and attach the ends of the healthy stuff." greater than 3/4ths of the small intestine was completely dead. there was no fixing it. sure, i could have cut it out - leaving the dog with less than 1/4th of normal small intestinal absorption space...but she would have suffered from short bowel syndrome (inability to absorb nutrients and water from the intestines), she likely would have become septic (or already was), and all other kinds of complications. i gave her owners a prognosis of <10% for survival and quality of life, as well as several more days in the hospital, and an estimate of $3000-5000 for her care.

i euthanized her on the table.

her owners were distraught, obviously - and kept asking me was it something that they had done. explaining to them that the cause couldn't be elucidated was difficult. it was a very sad, very random case. a perfectly healthy happy dog, playing with her ball only 12 hours ago...

i think i'm going to try and write this up as a case report - that's how weird it was.

no news is good news?

i have another job interview set up for the end of this month in antioch, tennessee.

the weekend shift wasn't bad. i did 2 surgeries yesterday - one on a dog with 30+ bladder stones and 1 urethral stone making urination very difficult for him and one on a dog with a dead and rotting fetus in her uterus. i've been worrying about both of them ever since i woke up this morning. otherwise, we were busy - but it was entirely, pleasantly manageable.

my job interview is tomorrow. i'm not nervous. yet.

remember the boxer from my long ago post with lymphoma(?) maybe?

http://returnofthederelict.blogspot.com/2008/12/bleh.html

he was euthanized for progressive worsening of his disease after about 1.5 months. the lymphoma was never confirmed via biopsy...but there aren't many other conclusions to which we can come.

i have to leave soon. i'm spending the night with the BFF and husband/brother-in-law, then driving to the interview from there.

peace out. more to come later.

ok. i have news.

i have real news. no, i'm not pregnant. i wouldn't announce that to my family on my blog. i have a job interview. a real, live job interview. and it's a really exciting opportunity.

for the last month or so, i have come to realize that my current place of work is not the long-term job for me. there are a variety of reasons that range from general quality of life to other, more complex issues that i will not choose to elaborate on here. it's become apparent to me in recent weeks that i will not be happy here. it sucks, because 1) i REALLY REALLY don't want to move again 2) there are a lot of charms to this area and 3) there are some really fabulous things about my current job. jim and i have moved 10 times in 10 years. i feel like a total nomad.

on the other hand, this job interview is in asheville, which is my 2nd favorite town in the world. jim and i already have a circle of friends there - mostly jim's kayaking buddies. they do come complete with wives that i know and like, though - so that makes me happy. on top of that, asheville has a phenomenal music scene, and i've been to many concerts there - especially at the orange peel. it's a very fun town, it's buried in the mountains of north carolina, and it's beautiful. it's also only 1.5 hours from my parents and jim's parents but also only 1.5 hours from my best friend and her husband.

the clinic itself is top notch - offering endoscopy, laparoscopic surgery, ultrasound, digital xray, harmonic scalpel, and all the other bells and whistles i could want. this part is incredibly important to me because i have to work somewhere that i can offer top quality medicine to my patients and their owners.

in short - on paper - it's PERFECT.

i go down on tues/wed of next week to meet the doctors, get taken out to lunch, and kind of do a "working interview" on wednesday (before starting back on overnights on wednesday evening).

ok. i'm not going to get too excited. there are other jobs in the world, right?

unrelated to that, i have the flu. and it sucks big time. it's only 4 months (almost to the DAY) since i was last sick (bad head cold). my immune system is very wimpy. i'm taking the new inhalant antiviral relenza to try and shorten the duration of my symptoms...but we shall see how that works...i don't know if i started it soon enough after i realized i was getting sick.

bleh.

run maggot, run!

i got off my lazy butt today and went to the gym. i joined our local YMCA. the YMCA has always had kind of a stigma attached to it in my head. this is basically due to the fact that the YMCA in my hometown is the ONLY gym in town (that might not be true anymore, i'm not sure), and it was kind of a hang-out place for high-schoolers. it was also very rundown/dilapidated when i lived in greenpatch. i'm sure it's improved some since my childhood, but i've never gotten over that impression of the YMCA.

in this town, however - the YMCA is a big deal. there are 5 of them in the metro area. the one closest to my house (downtown) has recently been remodeled, and it is very nice. it has 2 pools - 1 strictly for lap swimming and another for classes. the cardio/machine area has broad windows that face downtown and let in tons of natural light. it's a very airy, refreshing place to exercise. the people are really friendly, and since i'm under 30 *by about 4.5 months*, i only have to pay $40/month. that gets me access to any YMCA in the US of A.

so, i am now a member of the Y.

i ran/walked about 2 miles today. i also did arms on the machines. i didn't allow myself to overdo it. i have a tendency to hit the gym HARD when i go back after a long hiatus, so today i deliberately took it slow. i met one of my intern-mates, and we worked out together. it was nice, but i can't talk when i run. i have to listen to my headphones.

i felt excellent after the work-out. still do. motivated, strong, relaxed, comfortable in my body. exercise makes me feel so good. i wonder why i don't do it every day. it's like sex. sex is amazing. but i sometimes have a brief hiatus from it. and then i have sex, and i'm like WOW! why don't i do this EVERY SINGLE DAY?

i'm also feeling rather good because when i donned my work-out gear (shorts, tee-shirt), i looked in the mirror and was actually PLEASANTLY SURPRISED by my appearnce. i don't look nearly as bad as the 7lb weight gain led me to believe. sure, i need to tone up...but it's not all that bad.

on the work front - it's such a cluster at the moment, i don't even want to get into details. let's just put it this way: i'm on surgery tuesday through friday. we have NOTHING scheduled during this time except for 2 consults tomorrow morning. this means that - in all likelihood - i will be off (sort of) all week. i have to work ER this weekend, but we'll see how the rest of the week shakes out.

i need a shower. i smell gross.

i'm a published author!

i somehow forgot to mention to all of my veterinary student/vet readers that my article on radiology was published in JAVMA recently. Yay me!