A Brief Note…

Beware the post call euphoria of “I’M RELEASED FROM MY BONDAGE TEMPORARILY” that causes a 2nd wind (or maybe its actually your 6th), making you think you can have a productive day.


Eat breakfast.

Pass out.

Night night.

Too bad its nice out today. I’ll see it this afternoon.

24 hr coffee tally: It is hard to know…

Operating Is Tiring

When you are tired, drink water.

I was in the OR most of the day today — from about 9 am to 4 pm. For people who are curious what the “work day” is like, we rounded at 6:10 am and I left the hospital at 6:30 pm. Leaving at that hour on the rotation I am on is “good.”

Operating is very tiring. In fact, it can be exhausting.

It can also leave you very thirsty.

This is a giant problem.

You see, in medicine you generally cannot eat/drink/pee at your own leisure, especially if you’re a surgeon. You cannot drink too much so as not to have to pee. But, you also have to live and, given that the body is a vast majority of water, you have to drink something.

Coffee is also an issue. A little known fact is that about 30% of a residents plasma volume (the “water” component of blood, so to speak) is caffeine (joking). You have to drink enough of your requisite caffeine requirement to be alert and oriented, but you cannot drink too much given its diuretic effect (caffeine inhibits the receptor of anti-diuretic hormone if you really wanted to know…if I remember correctly).

You have know idea how much I think about when I can drink something and when I can pee. I am also very thankful for attendings who understand the necessity to pee before a case. It makes a huge difference.e

I’m surprised anyone reads this blog — all I talk about is vaginas and urine, apparently.

Anyways, I was so tired after the OR that I thought I would definitely not be able to run with my co-resident due to fatigue, dehydration, and overall resident lethargy.

Then, I drank a seltzer.

This can cure many problems, including overall resident lethargy.

I also housed a bag of Skinny Pop and pistachios. Does it sometimes occur to me that my hand was a few minutes ago in someone’s abdomen and now I’m using it to feed myself? Yes.

Fortunately, I haven’t died or contracted any weird illnesses, yet. I do break out into gnarly rashes frequently though…

(Differential Diagnosis: contact dermatitis, eczema, poison ivy if I ever saw the outdoors…)

We ran 6-ish miles. It was lovely. It was hot and humid; perfect for those of us who love summer running.

I am now drinking another seltzer.

When am I getting a endorsement deal with La Croix?

I learned a lot in the OR today, but I am too tired to tell you about it.

This means I probably need another seltzer.

Or to go to sleep.

Night night…

Until next time..

Daily Coffee Tally: 2

Pen to Paper: Notes From The OR

I think the only way I can really learn anything is to put pen to paper.

In college, I used to rewrite notes over and over and over again.

I went through a lot of paper. And a lot of ink.

But, recycled it, so…

Anyways, today I felt like I learned a lot in the OR. So, I came home and wrote everything down, to the best of my memory, so I wouldn’t forget it.

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You may think I’m very serious after reading this.

Just remember, this notebook is covered with unicorns.

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Until next time…

Daily coffee tally: 1.5 (no time to drink anything! in the OR!)

Not A Lot

My arms are sore from boxing.

I hope this doesn’t affect my retraction skills tomorrow. We have an open case.

Actually, I hope I get to do the hyst/BSO. After that, I’m ok retracting.

It is, after all, one of the best isometric exercises you can ever do.

I’m going to start a new workout class.

I’m going to give everyone two Briesky retractors and make them hold them for 2 hours straight.

The catch will be that you also have to curve your body in a weird position so as to not get in the way of the primary and assistant surgeons.

Yes, I will name this class “Arms by Vag Hyst.”

That is, it is a recreation of the arm workout you get when retracting in a vaginal hysterectomy.

It both callouses the mind and body. You learn your arms can tolerate a very long time in one position. You also realize that your arms can, at points, go numb.

But, enough about retracting.

I think someone in New York should invent a screaming class.

Get a sound proof room and give everyone Bose headphones and then they can scream their hearts out.

Its like yoga for the type A, Wall street type.

Red eyes will be served after.

Speaking of yoga, raise your hand if you breathe out loud when they tell you to. Or ohm.

I cannot do these things. The thought gives me hives. But, I’m work on it.

Speaking of hives, I have become the most atopic individual on the planet. I get contact dermatitis just looking at something.

Case in point, I think the rash on my arms is from boxing gloves.

Damn you, exercise. First, I get contact dermatitis on my feet. Now my arms.

Wait, am I allergic to exercise?!

No, it can’t be. The thought is too tragic.

Anyways, that is all for now.

I am tired.

Night night.

Until next time…

Daily Coffee Tally: 3

Track Workouts and A New Marketing Plan for the IUD

So, last night we went over the pelvic exam and how the vagina is not a potential space and is, indeed, finite.

Look, no one really looks forward to the pelvic exam. But, should you see your gynecologist yearly, yes?


Well, first of all, gynecologist are fundamentally awesome people. Like myself.

Second, you need an exam to make sure nothing is wrong and you need birth control, unless you have a religious, moral, or other objection to it.

BIrth control is something I deal with every day. As I mentioned before, my favorite website to refer people to is bedsider.org for information on all things contraception.

Unintended pregnancy is something I see a lot, as well. Which is why I mention birth control method with every single patient.

In my counseling sessions, when I mention the IUD, I get a lot of “oh no not something inside me thats so weird!” or “my moms friends had those and they got all messed up” or “I’m not gonna have sex anymore.”

I want to walk around with a button that says “NOT YOUR MOM’S IUD.”

Whoever is marketing the IUD, needs a new scheme. We need to really repair the image of the IUD. Why? Because IUDs are awesome. It is like having gold in your uterus. Yes, I tell that to the patients. “I’m putting gold in your uterus right now.” But, seriously, IUDs are like $700 so it is sort of like gold.

If it could, the IUD would really need to go on Dancing With The Stars to rid itself of its image from the Daikon Shield days. Prove to everyone its lovable, friendly, and safe.

Maybe we could make IUD sound trendy and cool. “The IUD – its electric! Boogie woogie woogie.”

Or maybe we should walk around with buttons that say “Ask me about my IUD!” Its true- something like 80% of gynecologist using birth control use an IUD. Or some impressive number like that.

Anyways, IUD marketers – let’s be friends? Start a twitter feed? Let’s repair the image of the IUD.

Moving on to something far less exciting, running.

The love affair continues. Running and I eloped to Tahiti tonight. It was beautiful.

I decided that I want to try to do one track workout/tempo and one long run per week until a half marathon I’m running in October. Obviously, this is energy and time permitting.

Last week, I did the 10 min tempo, 6×1 min on/1off, 10 min tempo, which added up to about 3 miles worth of “work.” So, I thought I’d keep the volume the same but change it up a bit and do 3 x 1 mile. I also like doing this workout as the mile sort of serves as a benchmark for me, giving me a small indication of what kind of shape I’m in.

I ended up feeling really great. I did the first three in 7:15, 7:14, 7:11. I felt so good and oddly motivated. A little voice inside of me said “you can do one more, just go for it, its only 7 more minutes of your life.” I then spiked an imaginary football in my head and was like, “let’s do this, track!”

So, I did. 7:11.

I neglected the fact that I still had to run home after this. A mile seemed really far then (I live about a mile from a track).

So, that was my night.

Which is now ending. Dream land is calling.

Night night.

Until next time.

Daily Coffee Tally: 3

PS – Every time the coffee man said “just milk, no sugar,” I really wanted to say “Nope, I’m already sweet enough!” I refrained. Maybe tomorrow.

Whirling Dervish

I sit here in my bed in my running clothes.

I came home with every intention to run. And then I sat down. And then I felt really tired. And then all I wanted to do was just prep the stuff for tomorrow (Colpo article) and Friday (MFM article). And to add more people to my master checkbox spreadsheet. And then go to bed.

Usually, I’m really good about being disciplined. You don’t get through med school without being disciplined.

And, usually, I love exercising. Its the best part of my day.

So, for me to feel like I want to do something other than exercise when I have the time to do it is really odd. This usually sends me into “am I suffering a life crisis?” mode. I do the whole SIG-E-CAPS (acronym for questions to ask about depression), but when I start with “do you have problems sleeping” I realize its a moot point as residency has made me essentially a narcoleptic. Yes, I have problems sleeping – I don’t get enough of it and, therefore, can sleep on any chair, sofa, loveseat, or even standing between two cabinets.

Every so often I actually listen to what I’m feeling and decide not to be super disciplined and actually *gasp* REST! Its weird, I know. And, my quality of resting isn’t great as I spend it….updating spreadsheets.

But, anyways…why am I so tired?

Because sometimes being a resident is like being a whirling dervish.

Wait, let me google whirling dervish to make sure that’s a correct statement.

OK, yes – rapid, spinning object? That’s me.

Like being a mom and having 3 children to divide your attention between, you have to divide your attention between certain tasks as a resident, but do them all at the same time. AND MAKE IT LOOK GOOD. (Jk on that last part).

Its like having three different pans on the stove and managing them all. I mean, I think. I don’t cook. But, it seems like an ok analogy here.

For example, today I was in high risk OB clinic. So, I’m seeing those patients, but also have to move around some of the surgery dates for the patients I’ve booked so I have to figure out where exactly I move them to, call the surgical coordinating center, then fax the form to the surgical coordinating center (thank you to our PA for doing this!) and then go check PICIS that is on one computer available to us GYN residents to make sure that SCC got the fax, made the appropriate change, and the patient is in the system correctly. You’re trying to teach the med student at the same time about the high risk patient you’re about to see while sending a few texts/calling/faxing/writing.

See what I mean?

So, my head is still spinning, I’m tired, and I think I’m just going to eat a peanut butter sandwich and pass out.

I’m just going to sleep in these running clothes and hopefully go tomorrow morning. If not, tomorrow afternoon. By some point tomorrow I will have run.

Finally, for a little GYN fun, let’s review the difference between the pap smear and a pelvic exam.

The pelvic exam has two parts.

The first is everyone’s favorite – the speculum exam. This is when we use a metal or plastic contraption to push open the walls of the vagina to look at it and the cervix. Little known fact that even some doctors (ER, I see you) forget – the vagina is not a never ending space. There is an end to it. And, unfortunately, we can make everything really tiny these days — put a computer into a watch, essentially — but there seems to be no better solution for looking at the vagina/cervix than the speculum. Sorry, ladies, myself included.

The second is the bimanual exam in which one hand goes in the vagina and the other on the abdomen to palpate the pelvic organs (uterus/ovaries).

The pap smear is performed during the speculum part. Its where we take a brush to get cells from the cervix to send to the pathologist to look at to tell us if they look weird or not. Its a screening test for cervical cancer, which is caused by HPV. We test for “high risk” HPV, too (there are like a billion types of HPV and certain strains – 16 and 18 – have been shown to cause cervical cancer).

Another fun fact – yes, HPV is sexually transmitted, but, no, its not like chlamydia or gonorrhea. If you have it, it just means you have had sex in your life. HPV is like the Kardashians – its ubiquitous and annoying (jk I sort of like watching the show, truth be told…).

Alright I need to go read about rescue doses of antenatal corticosteroids or update a spreadsheet or something. And feel guilty about not running (guilt — one of the 3 main driving factors in life, remember?)

Until next time…

Coffee Tally: 2.5 (NOT ENOUGH)

I’m Having An Affair With Running

With running.

Dear Exercise Classes,

I love you. You are wonderful. You mean a lot to me. However, running means a lot of me, too. And, running and I are having an affair right now. Its not you, its me.



You’re probably tired of hearing my whine about the endless check boxes that you drown in being the “booking resident,” right?

Suffice it to say I have three sets of lists:

  1. Giant spreadsheet of all the patients and workup/clearance. This is the master list.
  2. The list of people recently booked to add to the master list.
  3. The running list of day to day things to do to make sure the master list is pristine and all the patients have no issues come the day of surgery.

This is somewhat my dream and night mare.

Check boxes make me feel needed. Give me purpose.

But, Bellevue, I’m sick of using fax machines, which is a lot of my to do list.

Speaking of check lists, I really I have a very specific way of making my lists.

I separate them based on “section” of my life — residency admin, residency research, personal, so on and so forth.

That’s usually my overall list and then I make a separate list of things that need to get done today or this week.

Do you do that? Or organize your to do list based on timing i.e. “to do now” versus “to do later.”


I spend an inordinate amount of time thinking of how to be more organized.

I spend a lot of inordinate amount of time thinking about a lot of things I shouldn’t.

Things like guilt, fear of failure, and fear of missing out. I think those are some of the 3 greatest driving factors in my life, especially the first two.

The fear of failure is strong, guys.

How do you think I passed step 1 of the boards?!

Finally, popcorn is a gateway drug.

Whatever you do, do not buy this popcorn: LesserEvil Avocado Oil Popcorn.

The promise of that and coffee are what get me up in the morning.

That is literally my ramblings for the night. There was no filter, editing, or even too much brain power put into this post.

I hope you enjoyed.

Until next time..

Dally coffee tally: 1.5 (WEAK)

Daily check box tally: 16000000,00000