happy new year!

here in the emergency department, it's about 2 hours until 2011, and i'm sipping on some delicious hamakua coast coffee trying to stay awake. (thanks, buzz and michelle!) i'm sure that after folks begin ringing in the new year at the local bars, we'll get a little busier.

we got back from a magical trip to california five days ago, and i've been working most days since then. liv did a great job summarizing the trip, so i won't go into extreme detail about it.

it goes without saying that the best part of our little adventure was a very special hike in the marin headlands with livvie.

other highlights of the trip include: christmas with john and katrina, our yuba river hike, running with liv around the presidio,  walking around japantown and soaking in the kabuki baths.

so happy 2011 everyone! cards will be sent out starting next week. i used to be so good about writing letters to folks. it's exciting to reconnect with folks who i haven't seen in a long time, especially now that we have some good news to share. 

lunch at milltown

our holiday card: better late than never

goodbye san francisco

christmas with john, katrina & zosia mae, oakland

lunch at small shed flatbreads, mill valley, calif.

breakfast with july

big thanks to rebecca and ian for opening up their home to us!

i asked. she said, "yes!"

christmas eve, san francisco

yuba river gorge hike

breakfast at the ashram

door to our cabin at the sivananda yoga farm

yuba state park warnings

thoughts of bringing my kayak to the yuba

livvie at the yuba river

japantown, san francisco

our spot

sushi ran, sausalito, calif.

tennessee beach

lunch at joe's taco lounge. mill valley, calif.

peek-a-boo

breakfast with zosia mae

if you're going . . .

on our way to san francisco, blogging at 34k ft (courtesy of delta airlines). we can't wait to see john, katrina, zosia mae, and nelson.

working like crazy this past week, but more than ever before, i'm having fun doing my job.

oh, and i found out that i am graduating in december, 2 years from now, which is 6 months early. this will give liv and i six months of quality time together before she graduates and i start a new job. life doesn't get much better.

stay tuned. i hope to post regular updates while we're in california.

overheard in the ED

my posting as of late has gotten spotty, to say the least. i've been busy, and when time is at a premium, it seems like i have more important things to do than detailing my life for everyone to read on the internet. this blog has been a great tool for reflection and for keeping my writing skills sharp (outside of documenting the medical encounter, which i do daily).

i also have enjoyed knowing that my widely scattered friends and family can get a little gimpse into my daily doings, as it seems like my capacity for phone or written communication isn't what it used to be. so thanks for reading. posting should be more frequent in the coming weeks.

one reason for the lack of posts: in preparation for going away for the holidays, i've been working a string of 12-hour night shifts the past week. here, on my 4th of 5 night shifts, i feel like i'm getting into a nice rythym. work / sleep / putter around the house and eat breakfast / run / work.

there are some enormous snowflakes falling outside my window, which reminds me that it's time to run so i can get to work on time this evening. hope everyone is having a lovely holiday season!

overheard last night in the ED:

"i'm going to eat real fast, then i'm going to disimpact this dude."

getting cold

it's cold outside, which means that the ED is pretty quiet (and i finally have some time to blog).
starting a long string of nights for the next 5 days before our california vacation. we'll be going to hanging out in the city, going for a hike in the marin headlands, and checking out  japan town (with a visit to kabuki springs planned). after a few days in the city, we're going to hit the yoga farm for a little yoga retreat.

in medical news, this website has rocked my world. it presents the data for several common medical interventions in a straightforward fashion. as a friend of mine and i have been saying for years, we should be smarter about what therapies we use. it might save us a few lives as well as money.

in health policy news the ACA was challenged successfully in federal district court in VA. the justice dept has already said that it will appeal this decision. so what does this mean?

the recent court decision wasn't a ruling on the entire ACA. rather, it specifically addressed the question of the individual mandate to purchase health insurance. the problem is that repealing the individual mandate spells disaster for many of the big (moneyed) players in healthcare, when you consider that insurance companies now are forbidden from excluding individuals with pre-existing conditions or  dropping subscribers when they get sick. trying to muck with these provisions of the ACA would be politically disasterous. if insurers aren't happy about the idea of having to cover sick folks while healthy people aren't required to purchase insurance.

for this reason, it seems as if the individual mandate is here to stay.

in other ridiculousness, try out this toilet. one of our hospitalists has one in his house. as you approach the toilet, the seat rises, anticipating your arrival. upon sitting upon this thrown, you are greeted by a pre-warmed cushion, pre-programmed by remote control, to your exact temperature specification. as you take care of business, a fan propels air aftward, bypassing your nose and keeping the room air fresh. (ordinary fans direct air upward, which causes foul air to pass by one's nose) after your mission is complete, an oscilator comes out spraying you with cleansing water applied in either a direct or oscilating fashion, followed by blow dry. lastly, the lid closes automatically after you stand up.

polar bear cookie

apparently, our hospital has the largest starbucks in the world. (it really isn't that big, but the patio is enormous, which apparently counts in the calculation of size)

go home WBC

westboro baptist church is coming to pay north carolina a visit. they will be protesting at elizabeth edwards' funeral.

nova scotia

this was taken at liz's wedding last summer. they have a baby on the way that i can't wait to meet.

remembering

our thoughts are with the family of elizabeth edwards.

good night

we had a great applicant dinner for the residency tonight. i feel hopeful about who might end up at our program next year.

winter

after a beautiful snowfall last weekend, it finally feels like winter here in NC. i just got back from an awesome run with ulysses in the cold night air. wow, he's like a different dog now! this summer, he could barely make it two miles with me. in tonight's sub 32-degree weather, we were doing under 7-minute miles x six miles without any difficulty.

i had an discouraging meeting with my program director today regarding the possibility of me getting that extra six months of credit towards completing my residency. it looks like the board is going to deny me (and everyone else that started last year) those 6 months off. of course, before all this happened, i overjoyed at completing my training in 2.5 years instead of 3. so i guess it's all a matter of perspective.

the meeting also gave me a chance to talk about how frustrating it can be sometimes to not get the respect that i used to enjoy as an attending. this won't be the first time i've mentioned this, but it's way harder than i had imagined it would be. it has been a lesson in humility if nothing else.

returning

it seemed like i've been busy for the last week, although objectively, i didn't do much. this week marks my first week back in the ED after two fairly easy months. i haven't acutely felt any kind of stress at going back, but obviously, a few things (like blog posting) have fallen by the wayside.

one interesting little piece of news that has kept me preoccupied: the american board of emergency medicine just changed its standards for people training in emergency medicine that have previously trained in other specialties (ie, me). whereas before, they had granted six months of credit, now they are saying that folks like me can have one entire year of credit toward emergency medicine residency training. this means, in effect, that i could finish my residency in two years instead of three.

at this point, there's no word on whether this will apply to me, as the policy is written oddly. they say they won't grant "retroactive" credit. what does that mean? in any case, i'm working with my program director to see if i can take advantage of the new rules. stay tuned for more information.

we got a tree two days ago, and the house is filled with holiday cheer. this pic was taken with the hipstamatic app for the iphone. it's got myriad funky lenses and settings that make taking photos way more interesting.

i ran an easy six miles yesterday. i ran my marathon two weeks ago, but somehow now i'm feeling a little slow. i don't think i could be still recovering from the race, and i don't think that in two weeks would have had time to get out of shape. maybe i was just having a lazy day.

more tomorrow on the calm of the radiology suite.