Another proud moment

Owen and I went to the library this evening. While we were browsing, he grabbed the Ramones first album and slipped it into my stack of stuff. I didn't even notice it until the librarian checked it out.

Editor's note: I do have non-musical reasons for being proud of Owen. It's just that these seem to be easiest to blog about.

Motivation

Owen is not the most goal-oriented walker. On trips longer than the kitchen to the front window, he tends to lose focus. For example, he and I don't walk out to get the mail together. It would take all night, and we might not make it back. And that's fine and understandable, as there are a lot of interesting things to observe and explore along the way.

So I was a bit surprised on Sunday when, at the neighborhood park, I asked Owen if he was ready to go home and have some lunch. He immediately started marching off for home, saying, "Lunch, lunch, lunch". (OK, more "luch, luch, luch", but the intent was clear.) It was a couple of minutes before he stopped saying "lunch", and a couple of blocks before he even broke stride.

Yippee!

I'm done with the boards! They have impressive security for these tests - they definitely wanted to make sure that I'm the person taking the test. But yippee! Now I can resume normal life. Or start working on a research abstract that's due next Monday. What kind of people put a deadline right after Thanksgiving weekend?

Disgusting Medical Factoids of the Day

The studying continues.
Sunday was anal disorders and irritable bowel syndrome. Monday was inflammatory bowel disease. Today is all about infectious diarrhea.

Things I know:
How long a tapeworm can you get from sushi? A very long one (feet) –diphyllobatrum latum.
What happens if you eat a bad chitterling? You get yersinia diarrhea.
How many individual Norwalk virus (cruise ship gastroenteritis) particles does it take to cause diarrhea? 10
What is a common method of transmission of Norwalk virus? Aerosolized vomit (eeewww)
What bacterial infection can you get from a pet turtle? Salmonella
How many E Coli bacteria does it take to make you sick as stink? 10
How many E Coli outbreaks have been attributed to leafy green vegetables since 1993? 26
What does 30% of raw chicken juice have in it (the liquid around the chicken in the styrofoam tray)? Campylobacter jejuni, which causes diarrea

I’m going to go wash my hands now.

And one last fact: How long is the ‘appointment’ for taking the GI board exam? 630 minutes

Language

There’s all kinds of talking going on at our house, and some of O’s is understandable. He’ll point at something, look at me, and very earnestly babble something completely unintelligible. So I guess. He’s also picking up new words which include some 2 syllable ones like ‘apple’ and ‘bubble’. He also is saying words that begin with ‘L’ more, but he adds a ‘g’ sound to the beginning. So Owen’s current fave photo to look at (and carry around the house) is one of his cousin Lili when she was a baby. He alternates saying ‘baby’ and ‘gLili’ when he sees the pic. He also has discovered the ‘sh’ sound, but can’t always determine when ‘s’ vs ‘sh’ should be used. Hence, he proudly climbs into a chair in the kitchen and says ‘shit!’ Sometimes it’s ‘sit’, but most of the time there’s an ‘H’ inserted there. It’s hard not to laugh when he says it.

Studying

I’ve been studying for the gastroenterology board exam. It covers everything GI-related and all the stuff I learned as a fellow. So even though I know a lot of GI, the test is expensive enough (>$1k) that I feel obligated to study (alot) until I actually take it.

Medicine is full of standardized tests, which is good, because you want doctors to know stuff about medicine. But bad, because they're irritating, expensive, often the information tested isn't practical, and good test scores don't guarantee a good doctor.

The standardized testing started prior to med school, with the MCAT (medical college admissions test). I studied a lot for this one. Then in med school, there was USMLE (United States Medical Licensing Exam) steps 1 and 2. Step 1 was all about memorizing biochemical pathways and which viruses were double-stranded DNA viruses vs single-stranded RNA viruses – clearly very practical. Step 2 was a bit better, asking questions about diseases. USMLE step 3 came right after my intern year and was all medicine, which was great for me as an internist because there was very little on the test that didn’t apply to the general adult patient. The internal medicine boards came next, which I took during my first year of GI fellowship. They rocked because it was a day off of work and all my work friends were taking the test at the same place. That test was in a country club ballroom complete with chandeliers, which made it an extra-classy testing experience.

So now I’m to the GI boards and have spent the afternoon reviewing the different anorectal manometry patterns that can be seen in fecal incontinence and the plethora of diseases that can cause diarrhea. Now is probably not a good time to invite me to dinner. Or if you do, don't ask me what I've been up to.

With each level of testing, the price goes up, I think mainly because there’s no one to say ‘stop, there’s no reason this test should cost so much’. I’ve also been a party to the advent of computer-based testing. Step 1 and the medicine boards were paper. Step 2, 3 and the GI boards are computerized. Hopefully the computer test will go better this time than with steps 2 and 3. The computer at the testing center crashed for both my steps 2 and 3, ending my test early and requiring a reboot. During step 2 (which is two 8 hour days of testing), most of the people around me were taking an HVAC test, real estate licensing, or the GRE and they would all finish in a few hours. For step 3, the whole test center crashed, so they made all of us go sit in the hall, but weren’t allowed to speak. I’m sure they’ve worked out the kinks by now, right?

A-P-P-L-E

We’ve had to start spelling a few things. Well actually, one thing, which would be O’s new favorite food. He prefers a whole apple, to be eaten while wandering around with bits of apple and peel stuck to his shirt, the floor, and a bit in his hair. He uses his 8 teeth to knaw bits off the apple and will eat the whole thing, skin, stem, and core, unless watched closely. Peeling them makes the eating process a little easier, mainly since he doesn’t have any molars. I’ve also figured out how to get the core out without breaking the apple so he can still eat it ‘whole’. And just in case you’re wondering – Macintosh apples are his favorites, as there a little softer than other apples. In addition to spelling the a-fruit, we’ve also had to rearrange the kitchen, moving the a’s up and farther out of reach. We also had to move the onions, not because he keeps eating them (he only tried biting into one once), but because he peels them, and then proceeds to drool on them.

The surprising thing about the election

This just occurred to me this morning. The surprising thing is not that Obama won. He ran a great campaign, and the macroeconomic/political deck was stacked against McCain (who ran a disappointing campaign). Rather, I'm surprised at the Democratic gains in the House and Senate. The polls say that a big majority of voters think the country's "on the wrong track", they're all concerned about the economy (domestic policy), so you reward the party that has controlled Congress for the last two years? Yes, I know, it's only been two years, but given the time horizon of most voters, that's forever. If nothing else, shouldn't there have been some ambivalence about the ability of the party to get anything done in two years? (Certainly that's what the Congress's abysmal approval ratings are said to reflect.) But I guess this is what riding coattails is all about.