Archive for July, 2010

Next up: lathering myself up with chum and free diving off the coast of the Bahamas

So, let it be stated here and now that when one goes from working an obscene number of hours each week to NOT, there’s only so much one can do to fill one’s time before one gets batshit crazy with listlessness.  Sure, there were stacks of mail to go through and an expired driver’s license in need of renewal (lest I get pulled over for my erratic, drunk-and-mad-with-glee-over-being-done-with-residency woman-driving and get handed a ticket and a lovely little misdemeanor!1) but that would be SENSIBLE.  And this was no time for sensibleness!!  Sensibleness = Boring!  THIS…this time between residency and starting The Real Job required something more distinguished, more exciting.  Like impromptu dancing in the streets!  So I did that.  But no one followed my lead and it didn’t turn out to be the local, independent Xanadu-reprisal experience I’d hoped it would be.  (And I thought San Francisco would have my back on this one!) So, next best thing:  a vacation!

This brought me to my next dilemma:  where to go!?  I wanted to go on a dive trip, because summer = diving.  So, Australia?  Thailand?  Cozumel?  Maui?  A toughy, because they all offer great diving opportunities and because I regard kangaroos, vagina ping-pong, Mexican fine dining, and getting lei’d all of equal caliber on The Enjoyment Scale.

This, as one of my friends put it, was quite The White Collar Problem.  Kind of like:  Shall I have the Black Sea Caviar or the Maine Lobster Risotto?  Shall I purchase the offensively expensive Louis Vuitton bag or settle for the absurdly priced Versace one?  I’d never had a white collar problem before but it seemed like a pretty good problem to have!  At least the vacation problem, which was a real dilemma.  As for the fictional ones, I’d go with the lobster risotto every time and I’d use the money it would cost to buy a Louis Vuitton bag to erect a small orphanage in a third world country.  And then I’d feed all the orphans lobster risotto.  I’m a foodie AND a giver, what can I say.

Because I had a few weeks at my disposal, I could literally go ANYWHERE.  At this realization, I laughed maniacally, heady with the power of it all.  And then I remembered that The Brit didn’t have any vacation time.  So if I wanted to be nice, I would choose a place that was close enough for him to meet me for the weekend.  Be nice?  Be mean?  Nice?  Mean?  Nice.  Fine, we’ll go to Maui.  Sighhhh.  The burdens of marriage, am I right ladies??

So.  We went to Maui!  I went for five days, and The Brit joined me for three of them.  And it was lovely.  Palm trees always equal happiness to me and there were plenty of them.  Our hotel was small and quaint, setting it apart from the high rises of Kahana or Wailea…and it had a small, private beach on which The Brit and I, starting on opposite ends, could run towards each other with arms outstretched, hair aglow with the light of the setting sun, in slow motion…just like in the movies.  I mean, if we’d WANTED to.  We totally would have had we not been preoccupied with the important business of eating the local pineapple and drinking all the local beer (aloha, coconut porter!) and diving with all the local fishies and turtles.

Which brings me to a couple of points I’d like to make about SCUBA diving.  Firstly, for as long as it is a sport that requires a wetsuit, the act of donning and doffing it will always result in comedy for me and those within ass-reach.  My behind is a well-described phenomenon and, let’s be frank, it just doesn’t obey the conventional laws of size and proportion.  You know how Hallmark has a special Mahogany Line of cards specifically targeted to meet the needs of the African American community?  Well, I think ScubaPro should create a similarly inspired line of wetsuits…to meet the needs of African Americans AND chicas latinas like me who are built like a sista.  Until then, I’ll just have to grease myself up like a pig at a county fair to squeeze myself into wetsuits made for the mere butt-depraved mortal.  It’s a good time.  Bring the fam.  And some popcorn. It could take a while.

Secondly, I’ve discovered that I’m way less of a scaredy cat that I was when I first started diving.  Astute readers and real-life friends will recall a certain perforating of a certain tympanic membrane which resulted a certain degree of anxiety about ever getting back in the water again.  The Brit’s solution to helping me overcome my fear of ear explosions?  Taking me to French Polynesia and throwing me in with the sharks.  Like, I’m not even kidding.  Fucking sharks.  Check it:

The dive master in FP told me that if you want sharks to maintain a distance from you then there were two things you could do:  continue blowing lots of bubbles (because REAL fish don’t blow bubbles and sharks prefer real fish to human ones with self-contained underwater breathing apparatuses (apparati?) for dorsal fins) and refrain from wearing bright colors.  Like yellow fucking flippers.  Sweet.   As far as I was concerned, folding myself up into a C-shape to blow bubbles AT my yellow flippers only served to cancel the benefit of one out with the disadvantage of the other, leaving me vulnerable to a life-threatening shark attack.  I was most certainly going to die. Fuck my ear drums!

Now, admittedly, what we saw in FP were only reef sharks.  Compared to the Tiger or Bull shark, the Reef shark is practically a vegetarian.  He eats like grass and plankton and shit.  And by shit I mean fish that are much smaller than my ass.  (And he probably really doesn’t eat grass or plankton.)  But still.  Fucking shark, nonetheless.

We saw sharks on every single dive we did in French Polynesia.  Every. Single. Dive.  I survived the ordeal with but a few flesh wounds (mostly from being attacked by the inanimate coral which quite rudely, on occasion, got in my way), an intact pair of ear drums, and a sense of pride that only the battle weary possess.  I may have shit my wetsuit2 but I made it out of, like, The Vietnam of shark encounters and lived to tell the story.  Ok, maybe it wasn’t Vietnam, but it was at least The Gulf Conflict.

So, when we were in Maui and we came across this little 3 foot long fella:

Other divers were like:  OMG, it’s a fucking shark!  I knew this, even underwater, because they were putting their hand up to their forehead to simulate a shark fin while opening their eyeballs really wide in abject fear; universal underwater sign for “OMG, it’s a fucking shark!”   While they were all busy soiling themselves, I was like:  Pssh!  Pfft!  Whatevs.  You don’t even KNOW what I’ve lived through.

1.Did you know it’s a misdemeanor to drive with an expired license?  I was recently quite surprised to find that mine expired in 09.  OH NINE.  WTF?
2. Ok, so I didn’t shit in it.  But I did pee in it.

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I’m still holding out for the impromptu dancing in the streets though

Finishing residency is a lot like having a birthday.  You expect to feel different…older, more mature, accomplished.  But, really, you just feel like you did the day before:  tired and a little gassy.1

Last Thursday was my final day of residency.  And after seven PLUS2 years of bustin’ my balls, I kind of expected a parade, a speech, a couple mojitos, and possibly even some impromptu dancing in the streets.  Sure, there was a formal graduation dinner a few weeks ago at a country club wherein us graduates and our friends and family were gathered (including my recently widowed Mamacusa and my remarried, recently babied3 father & his wife, none of whom had been in each other’s presence since my wedding…Hello, Awkward, we haven’t had enough of you this year, have a seat right here between my divorced biological parents!) and fed mediocre food while some attendings said a smattering of vaguely nice things about all of us before handing us diplomas…but that was boring.  I’d rather have the parade with the mojitos.

Imagine my disappointment when I exited the hospital on Thursday afternoon and there was no fucking marching band.  Boo.  Don’t get me wrong, I was ecstatic…I just wanted a witness!  Can a girl surgeon no longer in need of attending supervision get a witness up in here?

I got a witness.  I had celebratory frozen yogurt with a favorite Ho of mine (Ho Fro-Yo?) on the way home and then, later that night, had beer and sushi with The Brit and some homies.  It’s a well-known fact that, if you can’t have a parade, the second best way to commemorate finishing seven years of surgical training is to eat dairy and then, later, eat salmon eggs over rice all wrapped up in seaweed.  Word.

Friday was my first official day of Not Being A Resident and the only two things I had on my agenda after waking up and questioning the prior night’s diet choices were: 1) tackle the laundry pile and 2) make mojito mix for mass consumption.  There was to be a party in my honor at a bar in our barrio the following day and the bartender informed us in advance that mojitos were too labor intensive to make.  Sorry, but the one thing La Cubana Gringa needs at a party in her honor at a bar is mojitos.  Luckily, I have a DNA-imbedded blueprint on my Cuban chromosome for the best mojito mix ever and it makes mass-mojito making easy and fun!

So, I spent Friday in my jammies, loading the washer, squeezing limes, rinsing mint, testing the mojito mix, and repeating.  This may explain why the laundry was fortified with citrus-minty freshness and the mojito mix might have had a sock in it.

Saturday, we partied with lots of amigos.  The theme:  SEVEN!!! FUCKING!! YEARS! CAN I GET A WITNESS?  It’s what I put on the Evite that I sent out to everyone…I figured that finishing general surgery residency was grounds for liberal usage of F-bombs, exclamation points!!! & CAPITAL FUCKING LETTERS!  Little did I know that The Brit would take that theme and emblaze it on custom made coasters, napkins, and specialty drink menus.  Also, he’d renamed the specialty drinks…a Mojito became a “Whipple” and a Moscow Mule became a “Colonoscopy.”  It’s a good thing it was an open bar, because otherwise, my friends might have been cognizant of the fact that they were asking the bartender to probe their colon or surgically excise their pancreas.  Yeah, you’re going to want some sedation for that.

All in all, I had a great time and this weekend was a great ending to seven long years.  I have a thoughtful husband and crazy, amazing (Cramazing!) friends and THAT is worth more than any parade.

1. Having two helpings of eggplant lasagna the night before was ill-advised and should be avoided at all costs in the future.
2. Remember, I had to work 3 weeks past graduation!
3. WTF?  Yeah, that’s what I said when my dad & his wife adopted a baby last August.

And I STILL got a letter of recommendation out of that guy!

Days left in residency:  7 (if you count today), 4 (if you don’t count today or the weekend), (but who’s counting?)

SCENES FROM AN OPERATING ROOM

7:43 PM, Operating Room 3

It’s been one of those days.  The surgeons should be done with their cases for the day but, for reasons that don’t just border but full-on straddle the ridiculous, they are only just starting their second, a laparascopic partial colectomy.  Who starts a lap colon at 8 PM?

La Cubana Gringa, a well-seasoned resident, busies herself with positioning the anesthetized patient and getting things going.  She knows Dr. X is on his last nerve.

Dr. X enters, visibly frustrated.  He’s totally pitted out.  This confuses La Cubana Gringa.

La Cubana Gringa voiceover: WTF?  Did he just do a quick Insanity plyometrics cardio uber-abs work out DVD in between the last case and now?*

Dr. X:  What?

LCG:  What?

Dr. X:  You’re looking at me funny.

LCG:  Sorry.  You just look…frustrated.

Dr. X:  I am.  This is bullshit.  Who starts a lap colon at 8 PM?

He exits the room to go scrub before LCG can come up with an obnoxious comment that lives up to her high personal standards.

Twenty-six minutes later, the ports are in and the case is started.  Dr. X mans the camera.  LCG is dissecting out the vascular pedicle like it’s her job.  Well, it is her job…she just happens to be mind-blowingly good at it.*

Dr. X:  You are mind-blowingly good at this.*

LCG ligates the pedicle and proceeds to dissect posterior to the upper part of the rectum.

LCG (playfully brown-nosing): Well, you know… when you have a good teacher!

Dr. X:  Ass kisser.

LCG:  Ass doctor.

Dr. X is, in fact, a colorectal surgeon.  The two surgeons laugh heartily at the well-timed pun.  The mood lifts somewhat.  Perhaps the glands in Dr. X’s axillae have even slowed production.  The case proceeds along smoothly and conversation drifts to more lighthearted topics.

LCG (while operating):  Ok.  So, what’s the grossest thing you’ve ever had squirted in your eye?

Dr. X:  Hmm. Give me a second to think about it.  How about you?

LCG:  I once had the contents of a sebaceous cyst splatter into my left eye.

LCG recalls the incident as if it were permanently squirted onto her left cornea.  The sebaceous cyst was the largest she’d ever seen, at least 4 CM, on the upper back of an emergency room patient several years back.  She was just sterilizing the overlying skin when the tender, almost transparent flesh that separated her from the cheesy, sebaceous matter inside the cyst ruptured.  She was simultaneously dazzled and flabbergasted by the kinetic energy with which the cyst contents exploded onto her hair, face, and left eye.  It smelled not unlike vomited blue cheese.  It was disgusting.  She should have worn eye protection.

Dr. X:  That’s disgusting.  You totally should have worn eye protection.

LCG:  Yeah, well, you know what they say about hindsight.  Your turn.

Dr. X:  Oh, I don’t know…I vaguely remember something gynecologic ending up in my eyes during med school.  Too long ago though.

LCG:  “Something gyneocologic” ends up in your eye at ANY point in your life and you forget it??  Boo.  You’re boring.

Dr. X:  I know.

Unbeknownst to the surgeons, outside, a thick, foreboding cloud cover rolls in.*  Almost like something ironic and bad is going to happen later.

9:23 PM, Emergency Department

While his chief resident, La Cubana Gringa, is the the OR with Dr. X, the surgical consult resident on call evaluates a patient in the emergency department who he thinks might have a peri-anal abscess.

Surgical Consult Resident (eagerly, proud of his diagnostic prowess):  This guy needs a rectal exam under anesthesia and surgical drainage!

He scuttles up to the OR to schedule the case and wonders, passively, if he remembered to wash his hands.  He sniffs his index finger and seems satisfied with the result.*

11:49 PM, OR 3

The colon case is finished and the peri-anal abscess patient is now on the OR table in the lithotomy position.  It’s a commonly used position; completely utilitarian, albeit comically so.  Though, top points for Most Comedic Position, in La Cubana Gringa’s book, still goes to face down with the butt cheeks taped to the side of the bed so that they are spread open.  It’s a good thing patients are asleep before they get put in these positions or they’d feel violated.  Or aroused, depending on the patient.   LCG ponders this as she raises the OR table to level that’s comfortable for her to proceed.

Dr. X walks in and finds himself eye to eye with the anus in question.

Dr. X (tired):  I should have been a florist.

LCG:  Who needs to smell flowers when you have 24-hour access to the human perineum?

Dr. X chuckles.

LCG dons her gown and gloves, positions herself between the patient’s legs and, with a little lube, does a quick rectal exam.

LCG:  Hmm, I don’t feel an abscess in there.

Dr. X hadn’t expected to have to get involved.  He sighs heavily as he pulls on a gown and gloves and gets in between the patient’s legs to LCG’s right.  Four is a bit of a crowd (what with LCG, Dr. X, the patient’s right testicle, and the patient’s left testicle), but LCG stays where she is.  Dr. X does a rectal exam.  Pauses.  Then sticks a speculum in and looks around.

Dr. X:  I agree.  I don’t feel anything either.  But the patient was in excruciating pain.  So he probably has an intersphincteric abscess. In which case you should just make a small incision with a scalpel right here.

He points to a spot in the patient’s anal canal.  LCG feels the spot with her finger and appreciates the space between the internal and external anal sphincters.  She grabs an 11-blade and makes a small incision.  LCG is instantaneously startled by the feeling of something warm and wet splattering onto her forehead just above her right eyebrow.  She instinctively squeezes her right eye shut; she’s wearing her glasses so she doesn’t think anything got into her eye but one can’t be too sure when butt puss is amongst list of possible projectile liquids.

LCG turns her head to the right to look over at Dr. X, her right eye still clenched shut.  Simultaneously, he turns his head to the left to face her, his left eye clenched shut.  They are mirror images of each other.  Dr. X has butt puss showered fancifully along the left side of his face and all over his left eyelid.  It smells of poo mixed with curdled milk and toe jam.

LCG:  So, back to my question from earlier.  What’s the grossest thing you’ve ever had squirted in your eye?

Dr. X:  I hate you.

LCG:  You totally should have worn eye protection.

* These items may be exaggerated and/or somewhat completely fictional.

Screw it, we might as well peel potatoes in the shower now

Never does one truly appreciate how convenient a working drain is more than the point at which the drain ceases to actually drain. Seriously, write that shit down.

For the last couple of weeks, we’ve been having plumbing problems. Showers have become more of a wading experience. I’ll wade the shit out of the ocean tide but wading in the AIDS, ebola, herpes, hepatits C, e. coli, prion stew that invariably results from one of my showers after a shift at the hospital and, well…that’s just gross. This coming from a girl whose job description involves incising and draining butt puss. Daily I resist the temptation to culture our bathtub…the results, I think, would be simultaneously horrifying and provocative, and in the very least, publishable. For now, though, I just carry a crucifix with me into the shower and hope for the best. Peace be with you, MRSA!

As Lady Luck would have it, we discovered a cute little clause in our rental agreement that reads a little something like this:

Greetings imbecile future tenants who do not read fine print! As ricockulous as this may seem, ye tenants and ye alone are responsible for ALL of the pipes in this house. Even though this house was built before the gold rush! Crazy but true! So good luck with that! Suckers!

Yeah, so…because of that little clause, we’ve been trying to take care of the plumbing matters ourselves. And by “we” and “ourselves” I mean, “The Brit” and “The Brit”. I don’t plumb. So, the other day, The Brit donned his saggiest pair of butt-crack exposing jeans and jammed a plumber’s snake down the bathtub drain. After some chest beating, grunting, farting and other various displays of manliness, out came a multi-lobulated amalgam of hair (you’re welcome!), toenail clippings (how’d those get there, you ask? Don’t worry, it’s coming up), and zombie balls (probably).

This brings me to one of the main topics of contention in The Brit’s – La Cubana Gringa’s Lexicon of Grievances: Is the bathtub an acceptable location for toenail clippage? I say no. He says yes. I remove the nail clipper from the bathtub. He puts it back in. I say goodbye. He says hello. It’s like The Beatles ARE THE SOUNDTRACK TO OUR LIVES!

Anyway, it chaps my disproportionately large ass that he clips his nails in the tub because hair is one thing. But hair plus toenails = Matrix of Unequivocal Obstruction.

Plumbing if I had it my way:

Approximate frequency of drain blockage: less than once a year

Plumbing if The Brit has it his way:

Approximate frequency of drain blockage: many, many times a year. MANY.

All this talk of toenail clippings and plumbing reminds me of a patient I treated a few times. There was this dude who was incarcerated for Lord Only Knows, and his idea of a ticket out of jail was to find some excuse to get taken to the hospital and then try to escape from the Emergency Department. Good plan, right? Except that his ticket to the hospital involved sticking various objects into his urethra and obstructing his urinary outflow tract. In other words, he was cramming his pee-hole with stuff. Stuff like: toenail clippings, the serrated end of a plastic cafeteria knife, screws, nails, splinters, drink straws (probably the crazy ones).

All two men who read this blog just grabbed their crotches and gagged a little. Sorry about that.

Trust me when I say that anyone who inserts sharp foreign objects into their urethra as a means to get out of jail clearly has a few screws loose. (And not just the ones they’ve shoved up their urethra! Zing!!). Anyway, that guy a) clearly hadn’t thought things through all the way b) didn’t succeed in escaping despite stuffing his penis like a Home Depot Thanksgiving Turkey on three separate occasions and c) probably wasn’t aware that toenail clippings only create a Matrix of Unequivocal Obstruction.

You know, at first I thought this digression was only going to provide a brief interlude of dubiously related and somewhat morbid entertainment, but in the end, it furnished further supporting evidence for my theory that toenail clippings have no place in pipes of any kind.

Science! It’s irrefutable.

So anyway, back to the amalgam that was delivered from our bathtub drain. Did its extraction make things better? If by “better” you mean, “it did nothing for the drainage in the bathtub and, in fact, made it so that now the kitchen and bathroom sinks don’t drain either” then yes. Things were much, much better. Which led me to conclude the following:

So, if you hear about a British/Cuban couple that die in an index case of bathtub-acquired creutzfeldt-jakob disease, don’t mourn us for too long, we totally had it coming.


Hark!

The madness featured here is mine and mine alone. It does not, in any way, reflect the madness of my employers, colleagues, patients, nutty family, or my colorful friends. The privacy of my employers, colleagues, patients, nutty family and colorful friends is sacred & deeply respected, so no names. All words Copyright © la cubana gringa, no method, just madness 2006-2010. All comments © their authors. Don't steal; it's not nice. (And my Grandfather knows people.)

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