"The Best Laid Plans of Mice and Men.."

"...often go awry." I'd only had one thing planned for today - I'm trying out this new (to me) workout system of thrice weekly total body workouts with varying numbers of reps, and today was supposed to be 15 rep day (my least favorite thus far). The idea is that muscles only grow for about 48 hours, so those once-a-week, dedicated chest days I used to do really weren't that sensible. As far as varying the reps, moderate weight-low reps increases muscle blood flow and size, whereas high weight - low reps increases strength; varying the reps gets the best of both worlds. Anyway, that was all I'd planned for the day (the lectures were planned for me, so they don't count), but they're shampooing the gym carpet, disinfecting the machines, and fixing what's broken. It's not the greatest gym; there aren't any heavy weights - no bench, no squat cage - but I'm making do, especially with this new regimen (and I figure I'll use it since I'm already paying rent here). Since I can't do that, I guess I'll update this running commentary/complaint, while Flo Rida's Right Round plays on loop.

All of last week was spent riding the Metro down to the Hyatt for class. Strangely enough, some of my classmates prefer to drive - I have no idea why. If you don't know anything about Miami traffic, it can be an absolute beast. Add to that a 10$ parking fee, and you get a hassle that I just don't want to deal with - the Metro cost 2$ one way, and the stop is just a moment's walk from where I live. You really can't get around without a car in this city, and the arrival of summer also heralds spiking gas prices so, as much as possible, I'm going to try to limit myself to stores and businesses that are either within walking distance or clustered along the metro line, like ancient villages along a river.

I got my first taste of serious Miami traffic yesterday. Apparently, it's always worse the first work day after a long weekend. Anyway, Nicole and I were assigned to go write up HPIs (histories and physicals - "History of the Present Illness) at an assisted living facility (ALF). On Monday, we'd driven down to the place, comparing Ross' directions with those from Google Maps. Needless to say, Google Maps got us hopelessly lost in an area that most closely resembled Mexico. We backtracked and found the place from Ross' direction. Thinking we'd build ourselves a nice, fat time-cushion, we left the next morning around 8ish for our 9am arrival -I even brought a book for what I was sure would be a long, boring wait. Then, the traffic descended upon us.

I've never lived in a huge city, so when folks have said traffic moved at a crawl, the only frame of reference I can conjure up is tied to memories of accidents on I-95, which slowed everything for a while, but eventually returned to normal flow. This was an entirely different matter - we inched forward. The previous day, we'd flown down US-1. Distances came to mean something entirely different, though, when I realized that we were at 42nd Ave and had to get to 17th, and then had to get from something like SW42nd street to northwest 22nd street. We moved like molasses for forty minutes before Nicole started to panic. I called the Ross office and spoke with my favorite receptionist who relayed my call to some of the junior faculty waiting at the ALF. I also called the facility itself, and spoke with one of the receptionists. Ironically enough, right when we turned off US-1, traffic really seemed to pick up - as if we were an embolus interrupting laminar flow. By the time we got there, it was 9:01, and I jumped out of our rented Dodge Calibre (which sounds like it has CHF), threw on my white coat, and ran to join the other med students. One of our clinical professors - who'd previously spent 11 years as a narcotics officer before becoming a doctor - was explaining things to the short white coats (they identify us as folks who don't know anything yet - only doctors and such get the long ones). One of the junior faculty came over to me and said in serious, hushed tones that I could never be late again - he wasn't being an ass about it; it sounded more like "you don't know how lucky you are he hasn't noticed you". I told him Nicole was parking the car, and, after checking her name as present, he suggested that I text her and tell her to hide for a few minutes, because if our clinical professor saw her, he'd send her home. I did and she came in a bit later, running into the same junior faculty who waved her on by, but that's exactly what happened to [at least] four of my classmates. I watched through the windows of the ALF's cafeteria as they hastily parallel parked and spilled out of their little blue car - but they never joined us. Nicole came in, followed by the junior faculty who, moments later told us that folks had already been sent home, and that if we knew of anyone who wasn't there yet, to call them and tell them to not even bother showing up.

Nice, right? By the skin of our teeth! That's kind of how I do things - I oughta prepare better, I know - and I thought we did - an hour seemed enough. Anyway, we split up into several groups to go interview patients. Turns out, the one of the junior faculty members was a nurse practitioner who frequently worked this ALF, and so he knew everyone. Nicole and I were assigned to this one guy who'd said he wanted to talk to us, so we went in and introduced ourselves. He changed his mind, though, telling us (1) that he was watching his show - Judge Joe Brown - and (2) that he'd really like to help us out, but the day he was transferred in, he'd missed a dental appointment, and that after his show, he had to call and straighten things out. Nicole went out to tell the junior faculty, and I stayed behind, subtly needling him for information in case he decided to humor us. I briefly considered attempting to convince him to let us do the interview, but decided against it. In hindsight, that probably wasn't the best decision.

We followed the junior faculty around for a few more minutes while they assigned more pairs to patients, and finally, came to a patient we were told we could work with. The middle-aged-to-elderly gentleman was obviously rather large, lying propped up in a bed in a small room, listening to Barry White on the radio. Nicole and I introduced ourselves again, and got to work. He was paralyzed, although where exactly, I couldn't tell - he had feeling above his knees, but really didn't move anything above his neck, and his speech was slowed and slurred. We dug through his history, finding out that he'd had a stroke and fallen. We did our best to work through his halting answers, but he was incredibly agreeable - he told us it was a good day.

Just before we began our physical, one of the workers kicked us out so she could clean him up. Nicole and I were out in the hall, talking to another one of the junior faculty members, when the worker called me over and asked me for help. Not one to shy from helping folks out, I put on my best bright-eyed, bushy-tailed grin and told her that of course I'd help. She handed me a pair of gloves - she was bathing him. She had me help her roll him onto his side so that she could change his sheets. Pardon the analogy, but what helped me move this large gentleman around was my experience moving around corpses in the gross anatomy lab. This was probably the most humanizing patient experience I've ever had, because, remember - he was paralyzed, meaning that he was incontinent. Washing him meant changing his diaper.

This all sank in as I watched her wipe him down and spread clean bedding beneath his bulk. We rolled him from side to side, straightening out the sheets, and I was struck by the absurd notion that he must be terribly embarrassed. I say it was absurd, because he'd been there for years - it was something he was used to. I've just never before directly participated in such intimate care of someone who, though mentally lucid, was so dependent upon others.

Nicole and I continued with what we could of the physical exam. There was so much we were supposed to do, but due to his physical limitations, our list was amended and abridged - we simply couldn't have gotten him up to listen to the posterior lung fields, and his casted arm had been held against his chest for so long that I couldn't unfold it enough to listen to his heart without causing him pain. We did what we could, and Nicole went to the nurse's station to record his meds from his chart while I continued with the Folstein mini-mental status exam. He was less lucid than I'd initially thought, but all I could think was that he was such a sweet guy - his windowsill was lined with pictures of his family and, at one point, he used what little motor control he could muster to point to the birds outside.

A few minutes later, Nicole and I learned from the junior faculty that his stories changed subtlely over time, but that they were consistent from day to day - we also learned that today saw a decline in his mental status, making our work doubly hard. I'd love to tell you more, but I don't think I can - today's HIPAA lecture's got me all paranoid; I've probably said too much already.
So that was my first clinical experience of 5th semester. I'd gone in there with it in my head that I was going to write the most pristine and beautifully logical H&P they'd ever seen - that I would make them weep for the beauty and coherence of the medical history I would weave. Well, you know what they say about the best laid plans. I'm sure the write-up will be interesting.

After that, Nicole and went to thank the receptionist for relaying our call to the higher-ups, and then we went to see Angels and Demons. I'd read the book years ago - if I recall correctly, I read it before The Da Vinci Code hit it big. Anyway, my primary reason for going to see it was to listen to the music of Hans Zimmer - one of my favorite composers (right up there with Shigeru Umebayashi, who penned the theme to Zhou Yu's Train), the composer for the latter two Pirates of the Caribbean movies. It was ok, I suppose; it feels more like the book's skeleton than anything else - the basic plot was there, but the feel was different. The sinews and flesh of the story were lost to the time constraints, as is inevitably the case - the book leads you to believe that the Illuminati is actually revealing themselves after centuries to plot their vengeance, but the movie makes you feel like it's just one guy; a very small plot. Nicole has a slight headcold, so we made a stop for gelatto.

Later that night, I finally managed to finish the second book in R.Scott Bakker's Prince of Nothing Trilogy - The Warrior Prophet, and I think I'll continue on second book club book The Soul Thief - I'm loving this time I have! All too soon, I'll be back to 6-8 hour study days. Today was painfully long - we hopped the metro down to the Hyatt to listen to lectures on HIPAA, prescription-writing, and tons of endcrinology. The first medical Spanish class was also supposed to begin today, but the teacher was sick, so it was cancelled. As the days go by, it suddenly looks like I'll have less time to myself than I actually thought - peering through the hazy, confusing dust of our ramshackle schedules, it almost looks like we might have something 7 days a week. All I've got to say is "bring it on".

That is....after I get my laptop fixed. You see, I bought this tablet PC a few years ago as a factory refurb from HP. Knowing that it had already gone though major surgery, I wisely shelled out for the super-extended-three-year warranty. I say "wisely", because, just after I got to Dominica, the most maddening thing began to occur. You see, with tablets, the screen automatically flips around when you go from laptop mode (typing) to tablet mode (writing on the screen with a stylus). First, this stopped happening, such that I had to manually enter the commands. Then, the screen started flipping of its own volition in mad little spurts Nicole eloquently likens to seizures. I've noticed that this only occurs when it's plugged in, but this problem is compounded by the fact that my battery life is now nonexistent. So, I e-mailed back and forth with tech support, and they told me just to disable the screen rotation and download some nonsense or other. Sounds great, right? Sure, except for the fact that when my little laptop tries to have its screen-flipping fits but can't, I get assaulted by ravening hordes of error messages. I call them hordes because one pops up every time the screen tries to flip, and it never happens just once - there are usually only 5 or 6, but they get up into the thirties. On top of that, my little white guide-arrow has its own little tonic-clonic seizures in the bottom right corner of my screen, randomly clicking on whatever's down there. And I get a keyboard pop-up that I want nothing to do with - all of this has driven me to heights of profanity I didn't think myself capable of before now. Thankfully, my warranty is still good - HP has sent me a laptop box, and they'll take care of it.

So that's my life, and that's what's going on right now. Oh, and I have to stop buying new clothes - I'm cutting myself off. I signed up for a Macy's credit card (which I never intend to use) because it gave me an additional 15% off of their Memorial Day sale, and I'd already fallen in love with a few ties. I really have to stop now.