warriorsavant: (Time)
I no longer worry or wonder about the road not taken. I took the one I took, it's a pretty dang good one, whatever ups-and-downs. ("Mistakes, I've made a few… but I did it myyyyy way.") However, I am lately been having some down feelings about what I didn't achieve on some of those paths.

I used to have multiple levels of "to do" lists. Sometimes in writing, sometimes just in my mind. (Yeah, I'm a little over-organized at times.), The lists were something like "do ASAP," "do this week," "do this month," and "do this lifetime." A lot of those have dropped off the list, like "go back to taking piano lessons for the first time since 3rd grade." Just not going to happen, and don't care anymore. No just that I have much higher priorities, just don't care. Some things have dropped off because I do have higher priorities, like learning multiple languages. It would be cool, it would have very some minor practicality, but just not worth the immense amount of time it would require.

I'm a bit down about some things that I would really have liked to achieve, but didn't, and simply isn't going to happen now. Some of those things I actually wouldn't want on a practical level, even if they were handed to me on a silver platter, but ego often overrides common sense. Example, I wouldn't actually want to be Derm Division Chief at McGill. It's really a lot of paperwork, meetings, and bureaucracy for minimal prestige, very little real authority, and no money. And for what? Another line on my CV or maybe my obituary? (This is ignoring the fact that I tend to tick people off and they wouldn't offer it to me anyhow. Not sour grapes, realistic appraisal.) A bigger one is that I didn't make general in the Army. I was a Colonel and a Brigade Commander, which is way further than most people get, but you always want that one more/one last step. What triggered those thoughts was looking something up about the current structure of military medicine, and seeing that 2 people I knew had moved far up in the military and civilian hierarchy. One I used to work for, and I respected. One had worked for me, and although competent in some ways, was rather a jerk. (Come to think of it, someone else I recall who had worked for me also made Brigadier General, but she was really, really good.) There are some other minor things, but these are the two glaring ones right now.

I think it's an age thing. (Getting old? Who me?) At one point I would have liked those things. Even after I'd missed my realistic shot at them, I still used to fantasize about them, but can't even do that any more. Bah.
warriorsavant: (Dr. Injecto)
No, not a reference to Pres. Combover. Was trying to teach a student (a rather small young woman) how to do a certain procedure, namely intralesional injection of Kenalog, with a 3-cc syringe. She was having trouble doing it, and I know T has some trouble especially at the beginning of each syringe. Then it clicked: my hands are bigger, so what it a comfortable grip for me, doesn't work for them. When I took the same syringe, and only loaded it to 1.5 cc, the student had no problem. (You know what they say about men with big hands… big gloves.)

That is the sort of automatic assumption about body sizes that we all make and don't realize until something like this happens. When I was in the Far East, light switches and doorknobs were always 6" lower than I was expecting. We automatically reach for them as being at about a certain height above the floor. Nom, being a tiny Asian woman (well, tiny on the outside), grew up here, so reaches for switches/doorknobs at the expected western height.
warriorsavant: (Dr. Injecto)
I was seeing a patient in Room 1, when I heard Evil Secretary yelling, "Doc, doc!" very loud and excited and anxious. Not like her. I thought someone was assaulting her. I ran out. There was a dementor hovering over the patient who had just come out of Room 2. I pulled out my wand and exclaimed, "expecto patronum!" driving it away. (From Harry Potter Does Dermatology, the about to be released 8th book in the series.)

Uh, yeah, okay, not quite. I'll get my fantasy life in check. What actually happened was that I had seen a patient in Room 2, and removed a small growth. We usually can tell when a patient is feeling faint or dizzy, and get them lying or sitting down quickly (such as the next patient who was in Room 2). This makes only twice in, uh, never mind how many years, that someone slipped past our guards. Anyhow, he seemed fine, said thank you & goodbye, and went to the front desk while I went into Room 1. Apparently he suddenly went from 'fine' to starting to fall over. Evil Secretary grabbed him, but she was on the other side of the reception desk. When I came out in response to her shout, she was leaning across the desk, holding him under the arms. Couldn't let go or he'd fall, but had no way to get around the desk either. I got him under the arms, and laid him down with something soft under his head and a stool to raise his feet. Turned out he hadn't eaten all day. Those are always the ones who get dizzy, combination of low blood sugar and anxiety. Frankly, if I don't have a nibble mid-morning, I get light-headed by the end of the morning (just the blood sugar, no anxiety), and this was the early afternoon when the gentlemen saw me and had his episode. We got him some juice (we keep some juice boxes in the fridge), and half of E.S.'s granola bar. After a while, he felt better, sat in a chair for a while, and when felt even better, took a taxi home. I think we're going to lay in a supply of not-very-good chocolate (because if it's good chocolate, well, I have no will power and would eat it all). Raises the blood sugar, and besides, everyone knows that's what you need after a dementor attack.
warriorsavant: (Default)
Had a power outage in the building today. Apparently they were doing work, and didn't warn me this was going to happen (some people seem to have gotten the word). Since I had a visual specialty, that made things rather interesting to say the least. Fortunately large windows (with discrete shear curtains). Also fortunately wasn't needing to cauterize any bleeding, so managed. (BTW, can't wait for Revenue Canada challenging my writing off dry cleaning bills. "Now, doctor, do you really claim dry cleaning as a deduction?" "Yes, it was to get blood off my shirt.")
warriorsavant: (Composite)
Often detested in his own land, but often correct.
There is a condition called Actinic Keratosis, which has a very low (<1%) chance of becoming cancerous. They also have a 30% chance of just going away on their own, so I don't get too excited about them, but do treat them when I see them. If there are just a few, then they can be destroyed individually, but when there are dozens-to-hundreds, it is better to use "field treatment" that will destroy them wholesale. The advantage of these creams is that they get all of them, including ones too small to see. The disadvantage, is they all get irritated - very irritated - at once. I usually warn patients that they will hate me for 2 weeks, therefore come back in 6 months when I'll be their best friend.

Had one patient came back today, had only used the cream for 1 week instead of the 2 prescribed. He explained that "After a week, I had enough of detesting you (i.e. it was too much for him to tolerate for 2 weeks), so I stopped, and now I'm back to liking you."

"Routine"

Oct. 18th, 2018 08:38 pm
warriorsavant: (Chimerae)
Busy day at the office, but I'm feeling dissatisfied. Things felt too routine. Yeah, first world problems. I should count my blessing; most of everything that everyone does is routine, and at a far less interesting level than I do. That is true, but also irrelevant.

Cancer is a scary word, but there are cancers, then there are cancers. The most common form of cancer of any organ system is the basal cell carcinoma (BCC) of the skin. It is also the least serious, and barely qualifies as a cancer. Put it this way, if you could put cancers on a scale of 1 to 100, this is a 1. It grows slowly, and almost never metastasizes. In short, it would take years, if ever, to kill you. That having been said, an oozing ulcer 6-inches/15-cm across is unsightly and unpleasant. *understatement* Still, when they are small, it's fairly routine to destroy them, maybe 5 minutes.

Squamous cells carcinoma (SCC) is a notch up. However, the first stage, "in-situ," also called Bowen's disease, can sit at a completely superficial level for 20 years before invading. And that having been said, nobody could say if a given one will sit for 20 years, or invade tomorrow, so certainly worth treating, but again, fairly routine to destroy, maybe 5 minutes.

Actinic Keratosis (AK) is considered "precancerous," but that too is an exaggeration. Maybe 1:1000 per year will turn into an SCC, but probably 300:1000 will just resolve spontaneously. Again, the catch is not knowing which one will convert. Still, having that risk, Medicare will pay to treat them, but scarcely exciting.

Benign lesions are no longer covered by Medicare, as part of the changes they abruptly initiated Jan 2017. (I don't disagree with dis-insuring them, it was the abrupt and chaotic way they did it.) Since not insured, I can charge the patient for it, and I never object to getting money, but again, completely not exciting.

Short attention span and easily bored. My kids must be rubbing off on me. Okay, I've always been that way. Not sure how I made it this far. That most be why I'm constantly doing other things at the same time: teaching, military, now trying to get into research. Can't really complain even if all I did was sit in my office: it's more interesting and pays better than most gigs, but today just felt totally unsatisfactory.
warriorsavant: (Dr. Injecto)
My father was a locksmith, a Mr. Fixit of the old school; from him I got my mechanical skills. My mother was at various times a pre-school teacher, homemaker, and assistant locksmith, but an artist at heart (I have one of her few paintings); from her I get my artistic eye. Both I find useful in Dermatology.

Recently my my mechanical side came into play. A seven-year old girl had had her ears pierced, and the pin-backs pulled inside and the skin closed over them. Not sure how it happened, probably tightened too much, got swelling and a little infection, and the metal of the studs wasn't going to stretch. I saw her and arranged a time to do a small surgery to extract them, a time after her father could heavily coat the site with topical anesthesia. Such takes an hour to work, and even then not completely, still had to inject some local anesthesia. She didn't feel the first side, but definitely hurt putting in the local anesthesia on the second side. She sat in her father's lap, while he talked to her constantly ("talkesthesia"), both of which helped. Once frozen, I tried to work it out gently, but no go. The skin really had sealed over it. Then I slit the skin, reached in with a toothed forceps, and basically wrenched the backings out. She was trooper about it except for the few seconds during the second injection. I'm proud of having done it, but a good mechanic - or locksmith - could have done the same. Thanks, dad.
warriorsavant: (Chimerae)
This was my second-to-last day doing consults at SAH, the former (and still partial) veterans hospital. As mentionned before, will be ceasing to do my monthly clinic there soon, partly because don't want to do the drive anymore, and partly because fewer and fewer veterans still there. I'd recruited a replacement for myself, but the administration hasn't followed through to bring her on board. I can only do so much; am tired of doing other people's jobs for them. Regardless, next month is my last day. It will be sad, but only a little. In my mind, I'm already detached, so it's hard to keep motivated today. Basic professionalism kept me going on the straight and narrow, but my heart not in it. I told the nurse for the clinic that if possible, I don't want any new patients for next month, just finish taking care of/disposing of the existing ones.
warriorsavant: (Composite)
Dunno what brought this to mind, but about 12 years ago, I mobilized to back-fill Walter Reed, the Army's premier medical center.*

Some key background:

- "Patch testing" is used to test for allergic contact dermatitis (eg allergy to something that touches the skin, not food or animals, unless you are rubbing the kitty cat on your face). The antigens (test agents that you might be allergic to) are usually organized into "trays" by functional area. There is a Standard Tray that everyone gets tested to, then specialized trays such as Hair Dressers, Dental, etc.

- Dermatopathologists examine biopsy specimens from skin. Contrary to what you might have "learned" from TV, Pathologists spend very little time on autopsies, and very much time trying to diagnose disease from biopsy specimens. About 25-30% of biopsies are from skin (much easier to biopsy than, say, brain). In bigger hospitals, Pathologists are subspecialized by type of tissue/organ system. Some of these are officially-recognized subspecialties, some are de facto. Derm Path is the oldest such subspecialty, and in the US, you can come to it either from being a Dermatologist or a Pathologist, but you have to spend half your fellowship (eg subspecialty training) in whatever field you did notcome from (eg a Pathologist has to spend half his time on Dermatology, and half on Derm Path).

While I was there, the Derm Path trainee who was doing his rotations on Dermatology was someone I had known from being deployed to Iraqi Freedom 2-3 years earlier. He had already been a Pathologist, who was then deployed with the Theater Medical Lab (I forget the official bureaucratic Army-speak name). Very nice guy, very sharp.

It came up that his patient had to be patch tested for hand eczema. I told him to organize it, to use the Standard Tray, and also the Glove Tray.

- He gave me a "what the heck are you talking about?" look.

- I gave him the "why the heck are you giving me the what the heck am I talking about?" look.

- Then he asked in a puzzled tone, genuinely confused, "the LoveTray?"

After we sorted out the miscommunication, and got over laughing, we spent some time figuring out what should go on a hypothetical Love Tray: latex and lambskin, lubricants, spermicidal agents like nonoxynol-9, massage oils, leather and PVC, etc.


*Now combined with Bethesda, the Navy's premier medical center, to form the Walter Reed National Medical Center at Bethesda - no one wanted to give up any part of their names. The Air Force didn't play well with others so they're not there, but all military hospitals take care of all military as needed, with some political nonsense sometimes interferring.

warriorsavant: (Default)
Or, I could have just titled this "various: mostly about family."

A small boast. The other day I had to do an excision on a 7-year old. I usually defer these until teen years when the child is ready and wants it, but the lesion was physically hurting her and mom talked her into doing it. I managed to do the local anesthesia (eg by injection) without her so much as saying "ouch" or otherwise seeming to be uncomfortable even once. Pinch the skin, keep talking to the patient ("talkesthesia" - which is not easy for me), and inject very, very, very slowly.

I don't know how I'd handle one of my kids going in for major surgery or other serious medical issue. For doctor's visits, Nom is the designated parent; I usually go too, but not always. For minor, but more-than-doctor's-office stuff, I'm the designated parent, and Nom sometimes goes also, but not always. Hedgefund, for all her fussiness has been fairly good with blood draws, ultrasounds, and other other more-than-doctor's-office stuff. Some of that credit goes to the staff at Montreal Children's Hospital, some she picks up from my attitude that medical things are normal, and some is she just has different things that do and don't bother her.

When Wallstreet describes / refers to something as "big," he always makes his voice BIG when he says it (eg "that big truck"). I don't mean louder, but he purses his lips, deepens his voice slightly, and makes the word resonate.

We have a Vietnamese landscape painting that belonged to Nom's paternal grandfather. Her father, who is a bit of a pack rat, had it at home and gave it to us when we moved to the new house. He had also tried to unload a bunch of other art on us which we declined. However this piece is a bit of family history. The grandfather had been in the Vietnamese Army, rising up to Colonel. He was initially in the Army under the French and a prisoner during the Japanese occupation, then when the country was divided in 1954, was in the Army of the Republic of Vietnam (South Vietnam). The painting was a gift from his junior officers when he was promoted to Colonel, out of their personal respect for him. I love history, and family history, and so am interested to know about this piece. Last night, I sat with FIL and asked him about the painting and about his father, which I think pleased him. BIL, other than having some self-identity as VN, doesn't care at all about VN history, culture, family history, etc (which is why we got that painting, not him). Nom cares, but not in an organized way. I am going to do a small write-up about the piece. I've done that for several items I've picked up over the years that are either antique, or have a personal/family story, or are otherwise unusual. I am doing this part for myself, but more so some day I'll be able to tell the kids about their great-great grandfather.

Nailed it!

May. 7th, 2018 01:42 pm
warriorsavant: (McGill)
One of my colleagues has started organizing guess speakers for our division at our hospital (JGH). He's very modest and gives all of the credit to our division chief, but he is actually the one doing most of the work, with the chief and I in a support role. Doesn't matter, it's not about getting credit, it's about education. The format we did this time, which seems to have worked really well, is that on Saturday, the visiting fireman expert lectures, then on Sunday we have giant clinic. The university division overall has its Rounds on Thursday, and it would make more sense to have the lectures at Rounds Thursday morning, and the special clinic supersede all regular clinics on Friday, but that would require cooperation of the university division chief (who is also chief of the MUHC), who has a hate-on for our hospital and won't cooperate. We are not going to let the education suffer but not having our program, so this is the compromise plan. We'd like to do this every 2-3 months.

This past weekend we were graced with Dr. Bertrand Richert from Belgium, who is the greatest expert on nails in the world. (Yes, there is such a thing.) He is also the greatest teacher we've ever had visit, both as a lecturer and as a clinical mentor. He did 3 hours of lectures on Saturday which have got to be the best done lectures I've attended for many-a-year, and probably ever. They were clear, to the point, organized, giving useful and precise information, at exactly the right level. In the clinic (we had over 70 patients), he was equally good as a clinical mentor. On Saturday, anyone could attend, and we had most of the residents and a handful of staff. On Sunday, we deliberately limited it to half-dozen residents (those rotating at our hospital or having a special interest in the field), and again a handful of staff. All who troubled to attend got a lot out of it.
warriorsavant: (McGill)
We had a retirement dinner for one of our senior colleagues, Bill Gerstein. Properly speaking, he is only retiring from the hospital/university practice, and will still be going 2-3 days/week to an outside clinic. We had a show of hands when different groups of his trainees - some themselves retired now - graduated residency: 2010's, 2000's, 1990's, 1980's, 1970's, and even 1960's. Yes, he'd been on staff for over half a century. He knew something was in the wind - his daughters and their children had come in from Toronto Canada and London UK - but didn't actually know there was going to be a testimonial dinner with dozens of people in attendance. He was (isn't) a super cutting edge practitioner, but as a human-oriented physician, decent person, and old school gentleman, he was the best. Oddly enough, he was a wiz with taking pictures on his iPhone. He had been chief at Montreal General for years, and when the McGill hospitals (except JGH) merged into the super-hospital, and he stepped down as a chief, no one did anything for him, which was sad. Partly things were too chaotic, and partly the chief of the combined institution (our current embarrassment of a division chief) never gave him the respect he deserved because he wasn't part of her clique. (I'm pretty sure she wanted to be in the popular clique in HS and wasn't, and so is trying to make herself head of the popular clique now.) He was really, really touched at the having so many people at his dinner. There is also going to be a portrait made of him, but that is still in the works. Most people don't stay in practice as long as he did, but since I have two current pre-kindergarteners to get through medical school, I'm planning on beating his record.
warriorsavant: (Signpost Ft. Benning)
I suppose the title should be more, "local geography and it's impact on a dermatology practice," or maybe even, "look sucker, it's only 10 minutes away, stop whining."

When I was a resident, one of my teachers said, "my patients are so loyal they'd stay with me no matter what… unless someone else opened up 10 feet closer to them." Sort of how I'm feeling right now. I've moved all of 10 minutes away from my old office, and some of the patients are whining that it is too far, or just started looking around for someone else. This is counter-balanced emotionally by those who find it much easier to get to and are happy, but they were already coming, so it's a net loss of patients. Evil Secretary is filling in as much as possible with new patients, but winter is always the slow season for us.

Montreal area is interesting in that people can be very parochial about their little municipality. In the US, people are far less concerned about driving somewhere, including to see their doctor. Frankly, I loathe communiting, and prefer everything within a short walk, whether or not I actually walk. That's the urbanite in me. Also, I logically consider transportation time to be dead time. I'm neither at work, nor at home, nor getting things done. Montreal goes beyond that. Like many cities, it was agglomerated out of smaller municipalities. Some wanted to join up, some were shotgun marriages by the province. (Too much history to blog about here.) Even saying "Montreal" is not precise, because it could refer to Montreal City proper, or the Island of Montreal (which has an over-government/counsel for certain functions). And yes, Montreal actually is an island in the middle of the St. Lawrence River, the largest of a number of grouped islands, which I suppose technically makes it an archipelago, but I digress.

So, anyhow, some of the municipalities actually are separate cities, and some are "arondissments" in Montreal City, and some are former cities which emotionally keep their identities. Maybe it's the Canadian conferation-ist mentality, but people often are resistent to going to "another municipality," even if it's only 10 minutes travel time. I think overall that feeling is less than when I first got here, but it's still there. Years back, the big divide was St. Lawrence Blvd, which officially divided East and West on the island and city. (That is, civic numbers on the longer east-west streets were something like 1234 Avenue ABC East/West, like 5th Avenue divides Manhattan in NYC.) Overall more English west, and French east, with maps in each langauge showing blank space labelled "here be monsters" (or "voici des monstres"). A secondary divide was the Decarie Expressway dividing out the WestIsland from DownTown (for a West Islander, crossing the Decarie really did imply a risk of being eaten by monsters).

When I'd moved to my old office from where I'd worked for/with another Derm, a percent of the patients didn't follow me because it was "so far away." Which is to say, 10 minutes by car, maybe 20 by metro. Now, same thing has happened. I mean I don't claim to be much, but I think I'm worth an extra 10-minute drive. I'm not really annoyed (although Evil Secretary is), more faintly amused by the whole thing. I'm not suffering from lack of patients, and we'll see how fast they can get an appointment with another Derm.
warriorsavant: (Dr. Injecto)
Just got my 25 year membership certificate and pin from the American Academy of Dermatology. Gosh, I'm all teary-eyed. (Do I need to hold up the "sarcasm" sign, Gentle Readers?)

On Call

Feb. 11th, 2018 03:23 am
warriorsavant: (Dr. Injecto)
Am on call this weekend. Before you mock the idea of Dermatology on call ("What? Emergency Botox for an elopement?"), look up autoimmune blistering diseases, severe drug reactions, rapidly progressing infections, and erythroderma. For the squeamish, don't look at the pictures. (Have actually been on call for the past week and a half, but actually went in from home yesterday.) Don't usually have to go in, since have Residents taking first call. Usually just discuss with them by phone if there is anything from Emerg. However, this weekend, the Resident, although very sharp, is very junior. We had a bad call from Emerg (patient with known Pemphigus having a flare-up), and three very sick in-patients. They're stable, but hadn't actually laid eyes on them for a few days, and wanted to make sure they were okay over the weekend.

There's an odd quiet pleasure in being there on the weekend, like being on watch at night. It's quieter, and calmer, and there's a sense of camaraderie, and of purpose. Also had some intelligent discussion with the Resident, Attending Staff from another service, and looped in one of the Residents by email, which is stimulating. No doubt it would lose some of its charm if it were every night and more hectic, but I enjoyed it.
warriorsavant: (Warriordaddy)
Friday was my 2nd day at the new office. (Thursday I was at St. Anne's which was fairly light. Just as well as I wasn't in the mood.) Patients overwhelmingly like the décor, which is very, very gratifying.

Several "firsts" at the new office (nothing earthshaking, but firsts for there).
First student. I like having students. At the hospital, since it's a teaching institution, the patient is basically stuck putting up with students and residents. I rarely have students in my private office, but sometimes, and the patient certain has the option to say "no," although few do. I had a student, which in this case was Evil Secretary's daughter. She had to do a project for High School, some part of which required shadowing someone at an interesting job. I almost calling her a medical student then catching myself just in time. "Mr/Mrs Patient, do you mind if our med… uh student joins us." I think Daughter of ES got something out of it.
First biopsy. Since skin is very accessible, skin bx are no big deal, unlike, say, a brain bx, or any other of those fiddly little internal organs. Reminds me of when I was a resident, and one of our patients needed a liver bx (was on methotrexate, and still did a lot of liver bx in those days for patients on MTX). Paged the Surgery resident to do it, and when he arrived, I asked if I could do it with his coaching me through it. He scoffed openly. A mere derm resident thinking he could do such a thing. That required the skilled hands of a Surgeon! Stand back, mortal, I shall do this wondrous thing!! Yeah. Then the bx came back as "normal lung tissue." Mr. "I'm a Surgeon" managed to miss the largest internal organ in the body. I still don't actually do liver bx (especially in my office, but I'm far less impressed by those who do.
First cosmetics. Got a peel, a botox (actually 2), and a filler. For me, the trifecta of cosmetic procedures. I have no intention of being a glorified cosmetician, but I do want to have all of Friday afternoons be my cosmetics time. I'm slowly working toward that. I hope having 4 procedures in one day is a harbinger of getting there, but probably just stacked up from my being away.
First toes. The advantages of now having my own kids, I'm better at dealing the kids-as-patients. This one, as so many, didn't like, and was frightened of, doctors. Which is often because the parents are frightened, and the kid picks up on it. Regardless, there are some tricks that help: take off the white coat, get down to their eye level, make faces. And, when all else fails, bite their toes. My Peds Derm colleagues scolded me today for having done that, but really, it worked. I was transformed from Frightening Monster to New Best Playmate.
warriorsavant: (Cafe)
First day at the new office.
It is gorgeous. Everyone from Evil Secretary to my grumpier patients to my cheerier patients commented. ES had seen it in past week while we were unpacking and contractors still working on last details, so it was beautiful in her eyes to see it as the patients see it. Still a few details have to be finished, plus things needing to be sorted out and put away, plus inevitable changes later. All that having been said, I love it. Probably cost me a month's worth of patients to give it that elegant and slightly magical look (pix eventually), but worth it to me to not be working in what looks like a 2nd hand bus terminal, which is what half the doctors' offices around here look like. Although not as full-on magical-looking as I'd like, there is still an air of Hogwarts School of Dermatology and Witchcraft.
Of course, couldn't start off entirely smoothly, what with the ice storm yesterday and the walkway not properly salted. No one broke anything, which is a good thing. Booked fairly lightly until we get the hang of things. It's all the little things that feel wrong: where did I put this? Why is this 2 steps further away than I'm used to? (Doesn't sound like much, but 20+ years of muscle-memory makes things like that fell just slightly off.)


First day back at the hospital in a bit. Have been on-and-off between the Christmas Holidays and the move, but ramped up full time. First patient was easy: rectal melanoma. You read that correctly. What is usually a skin cancer, highly correlated to UV exposure, manifesting inside someone's rectum. Super rare. Had already been diagnosed and half-worked up, but she landed on my doorstep because she'd been shuffled around, didn't really know who to trust, or where to go. I told her frankly that I was not the person who would be able to treat her condition, but I would take charge of getting her to the best place and quickly.
A couple of other patients had odd cases of "who has been treating your case of xxx as yyy for how long?" Not grossly wrong, but the sort of thing that sometimes gets passed down as diagnosis xxx from one doctor to another, made sense initially, but nobody rechecked the facts when it didn't seem to be behaving as it should. Sometimes all I do is get people routed to the correct place. That can be a big thing by itself.


Came home, salted the walkway in front of the house, then had kids climb all over me (that's what is referred to as rearing children). Very tired, but life is good.
warriorsavant: (Composite)
Getting back to a few more serious posts that were sketched out, but not cleaned up.

Was talking a few months ago with a colleague. He is newly on staff at McGill. Already had a PhD when he got to us, finished our residency program few years ago, was faculty elsewhere for a bit, and now is back on staff with us. He is interested in research, very hard-working, and also very astute politically/socially, so he'll go far. We had dinner to talk about his taking over some of my administrative teaching duties, and also talking about projects we could work on in common.

Years ago, when I was even more neurotically obsessional than I am now, I had not only a "to do" list, but several of them: (A) to do top priority, (B) to do soon-ish, (C) to do sometime this year, and (D) to do sometime this lifetime. I still keep to do list(s), because you can't be this busy and get stuff done without tracking things, but I'm not that bad. I suppose the 'to do this lifetime" list still exists, but only in the back of my mind. There are things that have already dropped off of it, for example, I'm not really going to go back and take music lessons again (last time was grade school). Still had several things that I was going to do, some starting when this current time crunch (the one that started before Hedgefund was born, and will end when house and office properly set up).

Now, I'm not so sure. One thing that already had faded into the background was intense French lessons (and possible even other languages). I can get by, but nowhere near as good as I'd like. Had always been planning on improving it "when I had time." However, since I am, and have been, good enough, I always had higher priority things to do. At this point, and not going to take weeks-months off for French immersion somewhere, or even devote xxx hours/week to it. (Although reading childrens books to HF & WS might be helping a bit.) I had definitely been thinking that would like to get more involved in teaching and/or research. In fact, am already as involved in teaching as I'm going to get. Research? Right now, it feels like just opening another can of worms, and I've spent so much time the past few years (decades?) herding enough worms. Do I really want to bother? Not sure. Some part of me still does, but after listening to my colleague bubbling with plans, energy, and enthusiasm, I'm thinking going to work, then coming home and biting toes seems about all I want to do. Admittedly, soon enough they'll be too old for toe-biting, but there will be other things. We'll see. There are lots of political games and paperwork involved in research also, and I've had enough of the latter, and was never very good at the former. Right now I'm tired, and thinking that the roads not yet taken will just have to be traveled by other people, not me.
warriorsavant: (Dr. Injecto)
Yup, I'm now officially a whore to Big Pharma. Actually, have been for a while. Could say don't do it very often, but like being pregnant, it's an all or nothing. Actually, I don't believe that (about being a whore, not about being pregnant); things are conditional and relative. Also, I'm digressing.

Just got back from a consultancy panel on a certain drug for resistant hand dermatitis. I've used this drug, it is great when nothing else works. Like all Derms, I mostly prefer topical treatments (eg creams) to systemic (eg pills and injections), but I'm slowly using more systemic treatments. It's something I'm growing into. Yes, even after all these years, I continue to grow professionally. This is good, as one either grows or shrinks and dies in everything; there is no static. (BTW, apparently 20-30% of Derms in Quebec never use systemic treatments!) The purpose of this panel was to share experiences on using the medication, looking for better ways to use it, and different things to use it for. For the company, that translates to more opportunities to sell it, but if it is useful, why not? There is also a certain amount their stroking us, as we'd be considered "opinion leaders," but that only gets them so far. If I don't like the product, I don't use it, and don't teach using it - in fact, teach not using it.

So why do I do it? (Besides the money, but really not much more than spending a half day in my office.) A large number of reasons. Partly getting new and different and advanced information on a drug. It's biased info, but everything is biased to some extent, and at least their bias is out in the open. Partly I get to meet colleagues and chat with them. I'm not the most social person, but that's importantly. Following what is principally an out-patient specialty, I'm mostly in my own office. Even my days at JGH, I'm not really chatting with colleagues, we're busy seeing patients. Also, the doctors at these panels are frequently not the same ones I work with. Today I was the only McGill doctor there, and 1 of only 2 from the Anglophone community. Yes, the whole thing was in French, which was also good practice for me. Partly, I do pick up tips and suggestions from the other doctors there. Sometimes that just reinforces what I do anyhow (but good to have validation), sometimes it gives me new ideas and approaches and warnings of pitfalls.

If I wanted, I could go to something at least once/week, probably more (treated to dinner with a speaker of just to exchange ideas). The actual paid panels are less frequent, but could happen often enough. I just don't want to be away from home that much, and as stated, not that sociable. Still, it's part of keeping my place in my professional community, and adds aspects to my professional practice, so I so like to do some.
warriorsavant: (Staten Island Ferry)
As mentioned, recently got back from a trip to NYC. I officially went for the AAD (American Academy of Dermatology) summer session. It's much smaller (low 1000's as opposed to 10000+ attendees) than the annual (winter) session. I prefer it. The winter session is too big, too chaotic, and really, they fill it out by the same or similar courses being given multiple times throughout the week. The summer session has many fewer courses, but just as many as I actually want to go to. After doing Dermatology for this long, if I get 1-2 tips out of each session, then it's a success for me. Now that I'm back, I'm doing what I always promised myself I'd do after a conference (and have rarely done), namely review the notes. In modern life, most of the lecturers post their handouts on-line. I've downloaded them, and am systematically going thru them and integrating into my learning program. (I have app called Anki, sort of digital flashcards, that I've found has really improved my learning, even at this late stage in my career.)

Had wanted to go down to NYC earlier, when [personal profile] ravensron  was visiting, but as mentioned, the MIL was ill for months (all better now, thanks), and I was neither going to go alone (I've become a total homebody, in case that wasn't obvious by now), nor were Nom & I going to wrangle 2 tiny ones down to, and around, NYC w/o backup. In the end, 6 people across 3 generations went. With all the spending on renovations and such, had enough travel miles for almost everyone (Wallstreet is a lap child, so almost no cost, and I paid for my ticket but is tax-deductible.)

We've taken to getting to the airport well-early (like 2+ hours before), and with 6 people holding 5 seats on 3 different bookings, I don't even pretend to use their silly kiosks, I go straight to the "I need help" counter regardless of their regulations. Oddly enough, the kids, fussy as they are, are fine on airplanes. They're practically seasoned travelers at this point. In fact, we were essentially free of travel-kerfuffles as such. The only real negatives was the MIL was just recovering from a cold, and Hedgefund seemed to have caught it, and the kids were a little feeling "why am I not at home," so everyone was restless and didn't sleep well. Had fun, but a fair amount of illness and tiredness, with commensurate lack of energy.

Got into the hotel (stayed at the conference hotel in midtown) too late to do anything except bed down. Each morning I got up early, went to the conference while everyone else breakfasted and relaxed and strolled around, then I joined them for lunch.

It was Restaurant Week in NYC, and we'd booked some good lunches, but didn't always follow through in the end. For good restaurants, we ate at Capital Grill and Ruth's Chris. Both are chains (steakhouses as it happens), but high end chains, and their NY outlets are especially lovely and very good food. Although the in-laws don't always have the most elevated tastes, they do appreciate when we take them some place with standard food done very well, and with lovely decore. At their age, after all they've been thru in life, I'm glad they are getting some enjoyment.

Did a few "NY things" of course. However, for the kids, the highlight was WWC bringing two kittens up to the hotel room for them to play with. HF always liked cats (since WWC introduced her to same), but she especially loved kittens, what with their being tiny. She use to be afraid of animals, especially dogs, but after enough times of my telling her, "we eat dogs, yum, yum, yum," now she usually just gives me a knowing smile when she sees a dog. It unsettles people when they hear me tell her that, but it worked, she's not scared anymore. WS has gotten a bit afraid of animals, he's so tiny yet, and also not verbally-oriented enough yet to understand about eating dogs, but I'll work on him.

Was hoping to get together with more friends and family, but didn't work out, except for one of my Army buddies who joined us for dinner, and then he & I had some drinks afterwards. Everyone else either couldn't make it, or just didn't respond when I emailed.

Have to see one show in NY. Ended up at an off-broadway piece called The Marvelous Wonderettes. Described to us as "campy fun." It was neither. It's basically a thin story of 4 girls who have formed a local singing group, woven around a review of 1950's and 1960's songs. The 1st act is their performing at their HS graduation, and the 2nd is their performing at the 10 year reunion. They were trying to be to 1950/60's pop music what Mama Mia was to Abba, but failed miserably.

For museums, went to NY Historical Society. They had several exhibits WWC & I wanted to see:
     The first was about WWI. They had historical reenactors in WWI uniforms in the lobby. It was a good exhibit. A bit grim (hard to be otherwise about WWI) and a bit preachy/politically correct at times, but worth seeing.
     There was a really nice exhibit of Tiffany lamps. They were from a private collection, someone who'd started collecting them when they first stopped being stylish (1920's) and amassed over 200. I love Tiffany's works, but I've seen so many of them by now that's it less striking to me.
     Eloise at the Plaza was featured. I hadn't realized that it had started as a comic cabaret act, and the book came later. Brief but enjoyable.
     The last exhibit was one WWC really wanted to see, called Saving Washington. It was supposed to be about the contributions of women to the US Revolutionary War and the early days of the Republic, but actually rather thin except for the parts about Dolly Madison. (Wife of 4th President James Madison, the first person to make "First Lady" a notable position, and the ultimate Hostess-who-advanced-and-agenda.)
     Overall, NYHS was worth the visit, but not as fullfilling as hoped for.

Last touristy thing we did was the Circle Line Cruise. It's a cruise/tour boat that circles Manhattan Island, while giving a commentary on what you are seeing. I'd always wanted to do it, but never had. WWC had done that in 4th grade, which is a good age to do it, or if you're from out-of-town. It's ideal then, before you've seen all the sites 100's of times and know them better than the tour guides. The bambini were too young to enjoy it, and not sure how the in-laws reacted. I'm glad I finally got to do it, even if not OMG-exciting.

That last sentence seems to sum up this trip from a vacation point-of-view. (Great from a medical conference POV.) We're glad we did it. Everyone had a good time (except for the sick and tired parts) and saw/did some new things. Not awe-inspiriing, but worth doing.

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