A Haiku from 2 days ago.  And a Dog Picture.

It's raining all day.
Sky dull, gray, low and clouded.
Sun unseen still shines

A new life form has joined our family.  He is blind, with no eyes.  Makes sense, as I would never spell 'dog' with any I's, anyway.  Aside from the occasional bark at the noise or when I come in from work he's fairly acceptable.  Daughter number one belongs to him and dotes on the poor thing.  I am glad she is home.  She is loving and lovable and has matured very nicely, we are grateful to have her home with us.  She is looking for a job but her prospects are slim, these days.  Something will come along eventually.  In any case will plan on going to grad school in a year or year and a half.  She wants Ph.D. in art history, emphasis in Asian Studies, eventually.

Work was long today with two difficult cases.  They got done and well, I think. 

I am glad to have a job, in this time.  There are very, very many people who have lost their jobs or been downsized in income.  Even at my work people have been cut hours involuntarily.  All due to the pandemic.  It seems to be slowing, I think, though I believe some parts of the country will go through their own phase of increased infection and hospitalizations, intubations and deaths.  Bomi herself still works, too, the magic of being a medical trainee, like myself.

The government stimulus came in today, along with some military money.  All in time.  The Toyota overheated this AM and it will need repairing or replacing. 

Sunday Mornings

I like to get up early because the house is quiet.  It is quite nice.  Don't get me wrong, I love my family and I like being around my family (or them around me) but I also like to have time that is quiet.

This morning I signed into Twitter again, for the first time in like, 3 years, I think.  Updated some profile stuff.  Tweeted.   https://twitter.com/cleverjarhead

Today we will have a family meeting by Zoom, with all of our extended family that belongs to Grandpa and Grandma Davis, so my brothers and sister.

79 days until I gradumutate.  6,882,525 seconds, and counting.

Picture of the day:

Haiku of the day:

Cool but not cold now

Warming, and day will warm more

Warm and breezy soon

A job!

Hello All,

I have signed a contract with a health care company to provide vascular surgery service to one of their hospitals in Western Arizona.  I should start in the August 2020 time frame.

A lot of people have been involved in my journey in surgery and I am hopeful that I can remember all the good things that I learned from them, including my attendings, seniors, colleagues, junior, but most of all my patients.

Today when I got a message from a recruitment agency I responded with this haiku:

Thank you for the note.
I have a signed contract now.
No more emails, please.

Happiness

Today's Haiku:

Only three patients.

A small list is a blessing

Rounds are fun when short

Bullet Journaling

I have been trying to improve my mental health.  I am sure that if you examine your own life, or relationships, or what you know of some of your close friends, family or associates, you would find that mental illness is all around us, or sometimes within.  I believe it deserves more attention.

In the effort to help regulate my own emotional state I feel that it is important to work on priorities and tasks and planning.  After all, if I know what I need to do (tasks), and why I am doing it (priorities) and when I need to do it (planning), then I can hope to manage events and circumstances that might impact my emotions, for good or bad.  Missing deadlines = bad emotions, getting stuff done on time for the right reasons = good emotions.  This is a little like eudaimonism, "a moral philosophy that defines right action as that which leads to the 'well-being' of the individual."1 (a quote I ran across as a quote in The Bullet Journal Method.)

For a long time when I was a lot younger I was a hot and cold devotee of the Franklin planner system.  But it always fell by the wayside and I can tell you that when I had a year of that ordered, I never, ever used it the entire year.  Never.  It may have worked better if I had stuck with my desk job but I didn't and such a huge system is not really too useful in the white coat and scrubs world of surgery.  Plus, it is really pretty rigid.  Obviously with tabs and blank/ruled paper you can do whatever the heck you want with it but then you could just buy a binder with paper in it for a lot, lot less.

Several years ago I stumbled on something called the bullet journal method and started adapting some of the lighter elements of its philosophy.  Then one day a couple of months ago I went ahead and got the book that covers the system in depth, called The Bullet Journal Method by Ryder Carroll.  I am glad I did.  It is extraordinarily flexible (because it is based on a bound notebook of empty, dot-grid paper) and seems more meaningful to me than any system I have tried in the past.  Plus, and this is really important - if I don't use if for a day, no big deal!!!  I don't have to stare at the blank pre-printed pages of the days I skipped and feel bad about spending $40-50/year for paper blanks, of which I might only use 20%. 

Anyway, it is super detailed if you really want to get into the details of it.  I am in fact still in the stage of figuring out which pieces I will go forward with and those I won't.  My next step is to try and re-structure my early morning schedule to do a little planning, a little meditation and praying and a small period of scripture reading.  Part of that would be going over my bullet journal and using a little more of its techniques to structure my life a little better.

What systems have you used and found useful?  Which ones not so much?

1.  https://www.philosophybasics.com/branch_eudaimonism.html

A red arc shoots forth
A brazen snip with the Metz
Should not have cut that

Today's Haiku:

Gray ropy tendrils
Suppurative and smelly
Chronic wounds are bad.

So I just told my wife and one of my daughters that I have a blog and they were so surprised.  So I had to prove it to them, which I did by pulling it up and showing them, then I generated this post.  I am amazed to realize I have had this blog for about 10 years!  I suppose it might be more useful if I posted to it a lot more often.

I don't want to be famous or even understood, I just like to write random stuff once in a while.

Things that are going on:

1.  looking for a job
2.  writing - it is NaNoWriMo, but I am so busy
3.  language - I love different languages, have been working on Norwegian for awhile now.  I think I will probably work on it until the end of the year.  Next, I'll go back to Korean.  Korean is stressful and difficult for me.  So I needed a break, so that's why I switched to Norwegian, which is easy by comparison.
4.  Army stuff - I need to do the pre-BOLC online course, but of course I can only initiate it at a .mil network.  Gotta schedule that.
5.  Daughter #2 wants to learn Krav Maga, so we are going to check out a martial arts school this week.  They teach kali arts there, too, so maybe I can pick up my escrima sticks again.
6.  Turned 49 last week, no big deal.  I still think pretty immature thoughts most of the time and at this point in my life have only learned to simply not let all of them come out of my mouth.  I suppose for most values of n, this is as mature as I am going to get.
7.  Looking forward to reading the 4 hour work week, but I am pretty sure it is going to take a lot longer than a week.
8.  Still slogging through Schneider's endovascular text - very readable, pretty up to date (this is the 2019 edition), and Understanding Ultrasound Physics.  My goal is 10 pages a day in each, at least 5 days a weeks. 
9.  My wife got me Air Pods for my birthday.  Best. Birthday. Present. Ever.

All in all most things are going mostly well, so I'll take that.

Tusen Takk!

Recently I was in an M and M, which stands for Mortality and Morbidity, and I made some notes for myself.  Now, if you have never participated in an M & M meeting, you may be interested to know what it is.

An M & M is about reviewing poor outcomes in healthcare.  There are some specific criteria regarding what cases should be included in the list for an M & M.  I won't go over those today.  I would like to offer some important points, however, to those who might be new to this sort of thing.  Usually the chief or senior resident on a given surgical service will have the responsibility of presenting these to the group.  Because I was part of the inaugural class in my surgical residency, we began presenting these cases as interns, which is a very unusual circumstance.  So most of the time, you will have already been exposed to how to do these presentations.  Your program will have its own particular rules about M & Ms.  Stick to them.

That being said, I would like to offer some of my observations, based on a recent presentation I witnessed at our program.

• Know the sequence of events.  Write them down.  Major events should be memorized, especially when they affect the eventual outcome.
• Know the case better than the attending.
• This is possible!  Read, re-read and map and re-map the data that make up the case.  
• Know how the data relate to the outcome(s).  
• If you are contradicted by the attending in the meeting, don't fight them.
• Review the expected complications for your procedure/hospital course/co-morbidities.
• Be able to compare your complication with other complications
• Somehow learn how to present without saying "uh," or "um" & the like
• Do you need to practice in front of a mirror or video camera?  DO SO!
• If the attending has to tell you that it was an avoidable morbidity or mortality during the meeting, you just made an intern mistake.  Hide your face in shame!!
• Meet with the attending before the meeting and go over the M and M in detail.  Make sure the intent and conclusions are congruent with the attending's viewpoint.
• Avoid casual vocabulary:
• GOOD: "...cautery sufficient to ensure hemostasis..."
• LESS GOOD: "...cauterized the heck out of it..."
• DO NOT CONTRADICT THE ATTENDING

M and M's are a very valuable supplement to medical education.  When a resident prepares well, it shows professional judgement and everyone benefits from such a presentation.  When a resident is poorly prepared, it makes everyone uncomfortable.  Be professional, be responsible.