Appetizer: cheese, crackers, and olives
First course: Mushroom soup (yum!)
Main course: Prime rib, with sauteed spicy broccoli and asiago cheese potatoes
Dessert: summer berry gratin
Sunday, March 31, 2013
Pelagano art colony in Gabane
Today was a huge adventure! Lisa and I wanted to go to Gabane to see the art colony there and maybe buy some stuff, but we didn’t really know how to get there. We got the general directions that we had to take a combi to the combi station, walk over to the bus station and take a bus to Gabane. The combis are an experience in themselves! It’s Gaborone
So first we get on the combi going the wrong way. We have to get off, cross the street, and flag down a combi going the opposite direction. Oh no, another 40 cents. :) Good thing for us, the combi stop is the last stop – and there are rows and rows of combis. It’s a pretty amazing site. Good thing we met this guy Reuben on the combi because he then took us to the bus/train station, which is across this big foot bridge – we would never have found it on our own. Or at least, it would have taken us a lot longer! And there are about 200 lines of different buses waiting to go to different towns and cities. They all say the name of where they’re going on the front of the bus, which is helpful, but he led us to the right one for Gabane. And these buses aren’t really buses – they’re really just combis, maybe a little bigger. And we squish in, and once it’s full, we were off for Gabane! Again, we rode it to the last stop, which took about 30 minutes, but we definitely did not see any art colony. So we had to ask around – good thing there are at least a few people who speak English and almost everyone is very willing to help out lost tourists. A guy basically told us that we had to walk 2 or 2.5 km down this dirt road to get to the art colony at the base of a hill, and that it was called Pelagano.
It’s not as desolate as it sounded though – there were cars that went down the road from time to time and people walking down it along with us. Every once in a while a car would honk at us and look, I think expecting us to hitch hike. We almost did it a few times, but it wasn’t that far to walk. It was pretty interesting too - there are domestic animals (donkeys, sheep, cows, etc) wandering everywhere, and we got to see what type of places normal Motswana (that's the term for someone from Botswana) live in. Most of them live in these cement s
quare rooms, with an outhouse in the back. Some of them have thatched roofs. But they look tiny, and I'm sure a whole family lives in there, with a small stove and everything all squished in. The picture I took was of a really nice one with a store attached to it at the back. These guys kept coming up to us and chatting us up too. Most asked if we were single and things like that, but there was one guy who kept asking us if we wanted to buy his property! Pretty funny.
When we got to Pelagano, it seemed pretty deserted. But we wandered into one of the open doors, and met this artist Elijah. He was surrounded by all these large, nearly-life-size sculptures, and was working on this huge clay scorpion on the floor. We found out that most of those huge sculptures were made of fiberglass from molds that he designed – he also designed the outside entrance to the art colony. He seemed really talented! He had beautiful works in clay, fiberglass, metal, and watercolor, and we prob
ably only saw a small portion of his work! And apparently he had a twin brother who did a lot of art as well – I think mostly glass-blowing. But we didn’t meet him. Anyways, after talking to him a bit, we wandered around. It was pretty empty, but he told us that it was much busier on the weekdays, when the colony was more open. It didn’t really matter though, people would see us walking by and invite us in. And the glass-blowing and pottery shops were also both open. It was very impressive stuff – if I didn’t think some of it would break on the trip back, I might get some of it. And it was not nearly as expensive as in the states, although it was probably expensive by
Friday, March 29, 2013
The Main Mall
Lisa and I went to the main mall, a 10-minute walk from the hospital during lunch hour because I had to change money and Lisa had to buy a cell phone. I ate from the ladies with food in pots on the sidewalk - it was really good food for only P12! It was similar to the stuff in the cafeteria, but even cheaper. The meat on the bone, which they barbecued on the spot, was really tough though. I think from now on I’ll just eat stewed meat, because otherwise it’s been too tough for me. There were also a lot of vendors selling really really cool touristy type stuff. I’ll probably buy some of it eventually. I think there may be a Chinese grocery store there too! Lisa got this phone that was really cute and the buttons looked way easier to use for the same price – it was a Nokia phone, whereas my phone is sorta just generic. Plus, her American electric plug for her American Nokia phone also works with this phone, so she could use it in the states too! I was a little jealous, but oh well, I’m only using this phone for 10 weeks or so. It’ll do.
So at work, I missed my first LP today – the patient was a super skinny guy and I went way too deep. The MO Maggie who was helping me took over, and she says she thought I’d had it at some point because she saw CSF in the needle, but I probably went past it. When she finally got the needle in, it wasn’t very deep at all! We also discharged a lot of patients just in time for a really difficult week. My team is on call Saturday (but I don’t have to go in), so I pick up a ton of patients on Monday. Then we’re also on call Wednesday and Friday.
Tonight I made fried rice and this really good cheese and onion-stuffed bread I bought for P6 (~$1) at the supermarket the night before. When Mike, Kristy and Kiona came back from call, they took the bread and some of the fried rice, so that was good. Lisa came over and we made plans to go to this relatively close by town that specializes in pottery. Or is it weaving, I can’t remember. I think we’re the only two going – everyone else is sick or busy. So for tomorrow, we’re going to have to take the combi to the train station, and then the bus over to this town… it’s going to be an adventure!
So at work, I missed my first LP today – the patient was a super skinny guy and I went way too deep. The MO Maggie who was helping me took over, and she says she thought I’d had it at some point because she saw CSF in the needle, but I probably went past it. When she finally got the needle in, it wasn’t very deep at all! We also discharged a lot of patients just in time for a really difficult week. My team is on call Saturday (but I don’t have to go in), so I pick up a ton of patients on Monday. Then we’re also on call Wednesday and Friday.
Tonight I made fried rice and this really good cheese and onion-stuffed bread I bought for P6 (~$1) at the supermarket the night before. When Mike, Kristy and Kiona came back from call, they took the bread and some of the fried rice, so that was good. Lisa came over and we made plans to go to this relatively close by town that specializes in pottery. Or is it weaving, I can’t remember. I think we’re the only two going – everyone else is sick or busy. So for tomorrow, we’re going to have to take the combi to the train station, and then the bus over to this town… it’s going to be an adventure!
Thursday, March 28, 2013
Doctor Shortage
People have been reporting about this for quite a while, but a friend just recently forwarded me this NY Times article about how there will be a severe shortage in doctors in the future, especially in the primary care field. It seems many people, including the current Obama administration are becoming increasingly worried about this problem. While some steps are being taken to try and delay this crisis, there are many many roadblocks.
Of the ideas that have been proposed or already instituted to try and solve this problem, one includes increasing the sizes and numbers of medical schools. Medical schools may have to admit more students that don't have science backgrounds - while some worry that this may decrease the quality of medical students and eventual doctors, I don't think this is a problem and may even be of benefit. Medical schools already admit plenty of students with non-scientific backgrounds and as long as they can build up a significant fund of knowledge either in medical school or in a year of study before entering, I think it's not a problem. In fact, it may even build diversity and bring new ideas and perspectives to the table, which is definitely a good thing.
Another idea is to increase the use of non-MD sources of health care, including nurses and other health care professionals, which I think is a great idea. However, there is also a nation-wide shortage of nurses, so this avenue may be limited as well. Finally, it has been suggested that we use more minority as well as international doctors as there are many MDs from other countries who would like to practice in the U.S. Obviously this presents many problems as training in other countries can be vastly different than training in the U.S. and currently, depending on the country they come from, international doctors often have to retake licensing exams, as well as complete full residencies (after having already completed residencies or full training programs in another country) in the U.S. This is a huge deterrent for MDs coming from other countries to try and become MDs in the U.S. - I don't know how many international MDs I know who have instead become lab technicians or Ph.D. students or post doctoral students because the requirements for them to practice medicine in the U.S. are so overwhelming. However, I don't have a great solution for this as I do believe the training is different from country to country and that international MDs should practice in the custom of U.S. training, for legal purposes as well as medical.
Despite these efforts, I see a lot of hurdles for which there are no easy answers or solutions. One is that even though medical schools may be increasing their enrollment, there are a limited number of residency training spots available. These are being increased as well, but they cannot be increased as easily or at the same rate as medical school spots. Residencies are much more complex to set up, and must go through a thorough accreditation process every couple of years, which is not only cumbersome, but can be difficult to arrange and maintain.
Moreover, there is heavy competition for competent people by other professions, the major competitors being business and law. Now, with the economy being the way it is, business has been less attractive the last few years, and perhaps the medical pathway is getting a boost from the decrease in business school applicants or business jobs. However, law and business careers can be much more attractive than medical careers - the training is much shorter. School takes half as long, and after school you start earning a relatively good salary right away whereas in medical school, it can take 4-6 years, with 3-5 year of low-paying residency afterwards, sometimes followed by 1-2 years of low-paying fellowship. Once you finally get out of all this training, doctors (especially primary care) often still make lower salaries than lawyers and businessmen, and have to contend with other headaches and costs associated with malpractice insurance, insurance paperwork and red tape, etc. Until there is good health care reform, or salaries become more equalized (either doctors' salaries have to come up or other salaries should be lowered - probably the latter is better for various reasons), there's not much that can be done about this problem.
Finally, even with the increase in medical school admissions and residency spots, many people are still attracted to practicing in medical specialties rather than primary care, in which the doctor shortage is the most severe. Again, this likely is due to a salary differential as primary care doctors make much less than doctors in medical specialties. As with competition with business and law degress, not much can be done about this problem until the salaries equalize - in this case, I think primary care doctors should be valued more highly and their salaries increased.
Of the ideas that have been proposed or already instituted to try and solve this problem, one includes increasing the sizes and numbers of medical schools. Medical schools may have to admit more students that don't have science backgrounds - while some worry that this may decrease the quality of medical students and eventual doctors, I don't think this is a problem and may even be of benefit. Medical schools already admit plenty of students with non-scientific backgrounds and as long as they can build up a significant fund of knowledge either in medical school or in a year of study before entering, I think it's not a problem. In fact, it may even build diversity and bring new ideas and perspectives to the table, which is definitely a good thing.
Another idea is to increase the use of non-MD sources of health care, including nurses and other health care professionals, which I think is a great idea. However, there is also a nation-wide shortage of nurses, so this avenue may be limited as well. Finally, it has been suggested that we use more minority as well as international doctors as there are many MDs from other countries who would like to practice in the U.S. Obviously this presents many problems as training in other countries can be vastly different than training in the U.S. and currently, depending on the country they come from, international doctors often have to retake licensing exams, as well as complete full residencies (after having already completed residencies or full training programs in another country) in the U.S. This is a huge deterrent for MDs coming from other countries to try and become MDs in the U.S. - I don't know how many international MDs I know who have instead become lab technicians or Ph.D. students or post doctoral students because the requirements for them to practice medicine in the U.S. are so overwhelming. However, I don't have a great solution for this as I do believe the training is different from country to country and that international MDs should practice in the custom of U.S. training, for legal purposes as well as medical.
Despite these efforts, I see a lot of hurdles for which there are no easy answers or solutions. One is that even though medical schools may be increasing their enrollment, there are a limited number of residency training spots available. These are being increased as well, but they cannot be increased as easily or at the same rate as medical school spots. Residencies are much more complex to set up, and must go through a thorough accreditation process every couple of years, which is not only cumbersome, but can be difficult to arrange and maintain.
Moreover, there is heavy competition for competent people by other professions, the major competitors being business and law. Now, with the economy being the way it is, business has been less attractive the last few years, and perhaps the medical pathway is getting a boost from the decrease in business school applicants or business jobs. However, law and business careers can be much more attractive than medical careers - the training is much shorter. School takes half as long, and after school you start earning a relatively good salary right away whereas in medical school, it can take 4-6 years, with 3-5 year of low-paying residency afterwards, sometimes followed by 1-2 years of low-paying fellowship. Once you finally get out of all this training, doctors (especially primary care) often still make lower salaries than lawyers and businessmen, and have to contend with other headaches and costs associated with malpractice insurance, insurance paperwork and red tape, etc. Until there is good health care reform, or salaries become more equalized (either doctors' salaries have to come up or other salaries should be lowered - probably the latter is better for various reasons), there's not much that can be done about this problem.
Finally, even with the increase in medical school admissions and residency spots, many people are still attracted to practicing in medical specialties rather than primary care, in which the doctor shortage is the most severe. Again, this likely is due to a salary differential as primary care doctors make much less than doctors in medical specialties. As with competition with business and law degress, not much can be done about this problem until the salaries equalize - in this case, I think primary care doctors should be valued more highly and their salaries increased.
Wednesday, March 27, 2013
Korean food in Philly
We've been really getting into the Korean food lately. There's an asian grocery store called H-Mart near the 69th street station, and on the second floor, there's a Korean fast food court. It's great. There's Korean food, Japanese food (with a Korean accent), Chinese food (with a Korean accent), a Korean bakery, and even a place that sells fried chicken (with a Korean accent). We always go to the Korean fast food counter - it's soooo good. They have all sorts of barbecued meats, soups, fish, tofu, you name it. Some of it's not spicy at all, but some of it is pretty spicy (one or two peppers on the menu). I think my favorite is the marinated beef short ribs. TASTY. And it's so cool - all the dishes come with rice (or noodles depending on whether you get a rice dish or a soup dish), maybe soup, and about 3 or 4 other small side dishes. They always give you kimchee, and the other 2 or 3 might be things like pickled vegetables, broccoli, bean sprouts, tofu, whatever. Even better, they recently put up pictures with their entrees, so now I'm not stuck wondering if that's what I got last time, or if that's something I'd like to try. I had been thinking of starting to take pictures with my cell phone and labeling them with the menu order number. Not a bad idea huh?
So for Pete's birthday yesterday, we went to a new Korean place, in the same general vicinity. However, this was an actual sit-down place where you order and they take it to you at your table, and you get tea and water and everything. It's called Moo Jin Jang. I didn't even realize it had my name in it until I got the receipt. I think it was a good omen. It's not a fancy place - there's no alcohol, they serve the tea in big plastic pitchers (not even a teapot), and the menu is this laminated card on every table that lists about 20 choices. The one waitress was the only one that spoke English, and I think she translated for her mom and dad. But everything still looked good. I only recognized maybe half of the menu - all the other items listed things I had never heard of before. I was tempted to try one, but I stayed with tried and true. I ordered the barbecued pork (spicy) and Pete got the beef short ribs. DELICIOUS!! And unlike the little fast food counter, this meal came with about 8 different little side dishes - it was great. We got fish, broccoli, bean sprouts, kimchee, pickled vegetables, hot pickled vegetables, little meatballs (which I think were marinated hot dogs), pickled potatoes, I can't remember them all. It was a lot of food, and of course I took it home. I'm pretty sure we'll go back at some point.
So for Pete's birthday yesterday, we went to a new Korean place, in the same general vicinity. However, this was an actual sit-down place where you order and they take it to you at your table, and you get tea and water and everything. It's called Moo Jin Jang. I didn't even realize it had my name in it until I got the receipt. I think it was a good omen. It's not a fancy place - there's no alcohol, they serve the tea in big plastic pitchers (not even a teapot), and the menu is this laminated card on every table that lists about 20 choices. The one waitress was the only one that spoke English, and I think she translated for her mom and dad. But everything still looked good. I only recognized maybe half of the menu - all the other items listed things I had never heard of before. I was tempted to try one, but I stayed with tried and true. I ordered the barbecued pork (spicy) and Pete got the beef short ribs. DELICIOUS!! And unlike the little fast food counter, this meal came with about 8 different little side dishes - it was great. We got fish, broccoli, bean sprouts, kimchee, pickled vegetables, hot pickled vegetables, little meatballs (which I think were marinated hot dogs), pickled potatoes, I can't remember them all. It was a lot of food, and of course I took it home. I'm pretty sure we'll go back at some point.
Tuesday, March 26, 2013
Heavy thoughts
Well, I don't know if I'm back for good, but I've been thinking about things sufficiently to write again... the world of lung cancer is not the most uplifting of worlds.
For example. I was talking to a patient that I like very much - one I empathize with, one I like personally, and one I even identify with. She's a hard worker, in a demanding career, still working through radiation we had given her previously, and chemotherapy, funny, witty, smart, had 3 children relatively late in life. We had a great conversation about how her daughter just went off the pill and was hoping she would get pregnant soon. I shared my story about how I got pregnant only a few months after stopping the pill, and the patient had the same experience. So she was hoping she would have a grandson or granddaughter soon. Her time is limited - she has metastatic lung cancer. In the world of lung cancer, her average survival would probably be about a year. And that's with chemotherapy, which, let's be honest now, will make her feel lousy half the time.
She started coughing up blood lately, and so we are going to give her radiation to her lungs at a low dose to shrink her tumor and hopefully stop her from losing blood. It's not serious. Not yet. I was doing what I do with a million other patients, I was explaining the side effects of radiation:
"You'll feel tired. But fortunately, that will pass."
"You might get a sore throat. But that will eventually go away too."
"You might develop a cough, fever, or shortness of breath, but that's not common."
ETC.
One of the last things I say is something like "Very rarely, radiation can cause a second cancer in the area we are treating you, but this doesn't happen for 5-10-20-sometimes 30 years."
She snorted and said "if I get another cancer in 10 years, I'll be very happy. Right?" And I nodded my head in understanding and made an mm-hm sound. Then she started crying. I gave her some tissue, she coughed up some blood, and I put my hand on her back. Nothing to say. She pulled herself together, and said, "okay, let's get on with this." And she thanked me for being honest with her.
Here I am, feeling horrible about mentioning a side effect that realistically, she will never ever have the chance to feel, and she thanks me for it. Maybe this is a lesson that I should stop mentioning this particular side effect to certain patients. Or maybe it's not that deep, it's just a manisfestation of a really sad situation, one that I will have to get used to.
For example. I was talking to a patient that I like very much - one I empathize with, one I like personally, and one I even identify with. She's a hard worker, in a demanding career, still working through radiation we had given her previously, and chemotherapy, funny, witty, smart, had 3 children relatively late in life. We had a great conversation about how her daughter just went off the pill and was hoping she would get pregnant soon. I shared my story about how I got pregnant only a few months after stopping the pill, and the patient had the same experience. So she was hoping she would have a grandson or granddaughter soon. Her time is limited - she has metastatic lung cancer. In the world of lung cancer, her average survival would probably be about a year. And that's with chemotherapy, which, let's be honest now, will make her feel lousy half the time.
She started coughing up blood lately, and so we are going to give her radiation to her lungs at a low dose to shrink her tumor and hopefully stop her from losing blood. It's not serious. Not yet. I was doing what I do with a million other patients, I was explaining the side effects of radiation:
"You'll feel tired. But fortunately, that will pass."
"You might get a sore throat. But that will eventually go away too."
"You might develop a cough, fever, or shortness of breath, but that's not common."
ETC.
One of the last things I say is something like "Very rarely, radiation can cause a second cancer in the area we are treating you, but this doesn't happen for 5-10-20-sometimes 30 years."
She snorted and said "if I get another cancer in 10 years, I'll be very happy. Right?" And I nodded my head in understanding and made an mm-hm sound. Then she started crying. I gave her some tissue, she coughed up some blood, and I put my hand on her back. Nothing to say. She pulled herself together, and said, "okay, let's get on with this." And she thanked me for being honest with her.
Here I am, feeling horrible about mentioning a side effect that realistically, she will never ever have the chance to feel, and she thanks me for it. Maybe this is a lesson that I should stop mentioning this particular side effect to certain patients. Or maybe it's not that deep, it's just a manisfestation of a really sad situation, one that I will have to get used to.
Monday, March 25, 2013
Medical Time Suck
I cannot believe the time I spend doing non-medical things for my medical patients. Some of course are necessary, for example - speaking to patient's families. In a way, you can consider that part of a patient's health, especially if they partially or completely depend on their family for assistance at home or for their medical care. However, I would bet that the majority of my time is spent doing non-medical tasks. Let me give an example.
Today I had a patient who was admitted several days ago from a shelter for fainting and having chest pain. At first it sounds serious, but it turns out he probably is an alcoholic and "passed out" after drinking too much, and his chest pain looked clinically like a mild rotator cuff injury. Moreover, he had no idea what his medications were, which shelter he lived in, what kind of past medical history he had (cardiac or otherwise). For this patient, not only did I spend hours on his medical care, but I also spent hours calling 4 or 5 different shelters trying to find out where he lived and what medications he took. I called his health center many many times trying to get a hold of his doctor, and when I finally reached her, she didn't know anything about him. I spent time talking to the medical records department of another hospital, getting the patient's authorization for medical record release on paper, faxing it to the medical records department, and then waiting for them to fax me the studies he had when he was admitted there. Then finally, it took quite a while to get him discharged as we had to involve social work so that he could get sent to a shelter using a cab voucher and could get medical follow-up (which he probably will not do) with our cardiology department.
These are all very frustrating things, and unfortunately it's the poorest and neediest patients who often need all this extra attention. Sometimes they come in to the hospital partially to find a warm, dry place to sleep, a place to clean themselves, and 3 meals a day in addition to medical care. I think a lot of doctors and nurses often take a look at these patients and brush them off since they don't have a good medical reason to be in the hospital or sometimes are actively lying and trying to deceive us in order to stay in the hospital. However, I see it like this - if you spend the time on them now, then hopefully they will have good medical follow-up afterwards and won't get to a state where they have to be admitted to the hospital again, thereby decreasing the amount of our work. Of course, some patients are just hopeless - they're well known to the Emergency Department and the medical staff, and I guess that's just something we all have to accept.
Today I had a patient who was admitted several days ago from a shelter for fainting and having chest pain. At first it sounds serious, but it turns out he probably is an alcoholic and "passed out" after drinking too much, and his chest pain looked clinically like a mild rotator cuff injury. Moreover, he had no idea what his medications were, which shelter he lived in, what kind of past medical history he had (cardiac or otherwise). For this patient, not only did I spend hours on his medical care, but I also spent hours calling 4 or 5 different shelters trying to find out where he lived and what medications he took. I called his health center many many times trying to get a hold of his doctor, and when I finally reached her, she didn't know anything about him. I spent time talking to the medical records department of another hospital, getting the patient's authorization for medical record release on paper, faxing it to the medical records department, and then waiting for them to fax me the studies he had when he was admitted there. Then finally, it took quite a while to get him discharged as we had to involve social work so that he could get sent to a shelter using a cab voucher and could get medical follow-up (which he probably will not do) with our cardiology department.
These are all very frustrating things, and unfortunately it's the poorest and neediest patients who often need all this extra attention. Sometimes they come in to the hospital partially to find a warm, dry place to sleep, a place to clean themselves, and 3 meals a day in addition to medical care. I think a lot of doctors and nurses often take a look at these patients and brush them off since they don't have a good medical reason to be in the hospital or sometimes are actively lying and trying to deceive us in order to stay in the hospital. However, I see it like this - if you spend the time on them now, then hopefully they will have good medical follow-up afterwards and won't get to a state where they have to be admitted to the hospital again, thereby decreasing the amount of our work. Of course, some patients are just hopeless - they're well known to the Emergency Department and the medical staff, and I guess that's just something we all have to accept.
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