Hmm, so I can't seem to leave comments on posts that don't already have comments, using firefox or IE.

So, since I don't feel like working, I'll post.

My comment to imk-

Yeah, how COULD that boyfriend-husband of yours let you get "so far gone"?! Parking tickets! You lawbreaker you!

Speaking of non-existent husbands, I was on the phone with my bank once, about my student loans or something, and the guy was nice and almost flirty, sympathizing about loans, and he said something like 'well, don't worry... someday when you marry that rich doctor it will all be ok.' And maybe I shouldn't have said anything, but I couldn't help it, and I said 'actually... umm... i am a doctor' And the poor guy was so embarrassed. So when my credit card expired and the new one came in the mail, I noticed that it says "Dr. Jenks MD" Not just Dr, or MD, but BOTH. They must have put big red flags all over my account. hehe. It's embarrassing though, b/c people think I'm that asshole that requested to have Dr emblazoned all over my card. Twice.

I am off to kick a patient out of the hospital. I get a surprising amount of satisfaction out of it. I am sick of people who think the hospital is a hotel. I mean it's one thing if you're sick and need to be in the hospital. But this guy has been ready to go since Friday. We tried to send him home friday, but he said he 'wasn't ready' and begged to stay through the weekend. We said ok. Monday- "no way I'm still in pain you can't kick me out". FINE, one more day. Tues "well I know I said I'll go, but I had a little bit of a bloody nose. I have to stay one more day. I PROMISE I'll go tomorrow." This morning "no I can't go b/c my son's car broke down and he can't pick me up." "well, we can arrange transportation for you." "Nope, I won't leave with anyone but my son."

Ugh. So much of this is a stupid political game. This guy has no medical reason to be in the hospital, and every day he is here costs taxpayers money. But you can't make patients feel like you're kicking them out. They have to feel like it's their idea to go home, or they get upset. And there are several games you can play. One is the "well the food is better at home and your bed is more comfortable and you don't have to wear a gown and have your ass hanging out all the time and have people walk in on you peeing". Next is "well I'm not going to kick you out, I'm just afraid you might get pneumonia or something if you stick around too long! Hospitals are for sick people! You're all better!" If that doesn't work, sometimes the 'well, I'm not going to kick you out- *I* love you and as far as I'm concerned you can stay forever, but you just need to know that your insurance might make you pay for the extra days'. That usually works. (But you can't play the insurance card with veterans.) When they say 'i don't care, i'll pay for it', a last resort is to stop all pain medicine, give them a low-fat, bland diet, and order daily suppositories and twice-a-day blood draws. That will often remind them how nice their own house is. But once in a while they just persist, and threaten to call the "patient advocate" and tell on us, saying the big mean doctors aren't being nice. And since we are so lawyer-phobic, we give in.

Seriously, I've had patients stay in the hospital an extra WEEK b/c "my girlfriend has to work and can't pick me up." Um, I hate to say this but your carlessness is not my problem. (But even though it's not our problem, we have social workers etc who can get them all set up with taxi vouchers, even ambulance rides home.) I always want to just write 'discharge patient to home'. That's is a 'doctor's order'. The nurses theoretically HAVE to carry it out, and I think the patient has 23hr to leave after that's written in the chart. But often they won't. So you think the patient will have left, since technically he had to, and then you come in the next day only to find he's still here. I've never understood how this works.

But apparently I am a mean inconsiderate bitch b/c I don't want my tax money to pay for this guy to spend an extra unneeded week at Spa VA.

But so today enough is enough and we called the nursing administrator, who for once, is on our side. She said 'he has to go, I don't care. We need the bed, and he has no reason to be here. Send him home.' So we just document that carefully, and write out all the things we will do for the patient to not make him feel abandoned (home visits by nurses and physical therapy, pain meds, follow-up appointments, etc etc), and then kick his ass out of here.

Also, I might feel differently about it if the guy was not a mean, nasty little old man. If he was NICE, I might be a little nicer back.

Wow, that was a really long, boring, work story!
haha.
Sorry 'bout that...

I promise it will be more interesting when I get some answers about my international man of mystery.

-J

Do not get on (e:imk2) 's bad side.

(LMFAO)

"I wish s/he would get gang raped by fucking gorillas and then get fed shit through his/her ears. i wish someone would skin him/her alive and fry his/her slimy skin into a crisp and make him/her eat it. god, god, god, why why why are people like this dumb idiot alive???"

Wow, some of these are awesome.

When graphic artists get bored:

Ok, so I know I always talk about my life being full of crazy drama. Which it is, to an extent, but yes, I also exaggerate.

But this time (right when I need to be studying and can not afford to be distracted) I have some real life international mystery/deception going on.

I am totally bewildered and confused at the thought of it all. How/why could/would anyone possibly do this? And why me? It's totally insane.

Hopefully I'm just being nuts and there's a totally logical explanation for it all- but I'm starting to think there isn't.

I wish I were a cool undercover detective or something who had access to all the secret info and could figure out what the hell is going on for real. I feel like I NEED to figure this out- but I'm not sure I ever will. I'm afraid it will just nag me forever.

I'm going to wait til I have the whole story before I tell it, but man...

It's nuts, I say! Nuts!!

-J

I am having some major motivation problems lately. I have a major test on 1/27, and a research project due 4d later. And because I HAVE to do better on the test this year, I arranged my schedule to have this week off to study. But I am still having trouble getting much done before noon. Since I am technically on vacation, I refuse to set an alarm. But I am still getting up around 8. I'm just not sure where the hours from 8-11 go. So I really should be going now, but I was thinking in the shower and felt like posting, instead. (that's probably where the hours from 8-11 go. ;) )

Yesterday I did some work on my project in the afternoon, then after the office closed went to spot. I love spot. Haven't been in ages. And first I saw (e:joshua), which was a pleasant surprise as I had just been thinking about how I hadn't seen him in ages, so it was nice to catch up. Then I saw a guy that graduated from my program a year or two ago, and he invited me out with 'the boys' tonight. Odd. Then I went across the street for a nice sushi dinner. Good stuff.

But to my point....

So, as some of you may or may not know, I have pretty big boobs. Not freakishly huge, but big enough that my size bras are always hidden away in the stores, and I usually can't wear the cute little sexy, trendy tops. But, I'm not a tiny person, so I think I'm more or less in proportion, and I'm ok with it. Most of the time. But I have been told a few times that I'm TOO big. (Who the hell tells a girl that?!) So there have been times when I've wondered if I'd benefit from a breast reduction. Or even just a lift.

So now I'm doing this research project... I'm studying breast reductions and complication rates, with the hypothesis being that the bigger the reduction (i.e. the more tissue removed), the higher the chance of wound-healing problems. Seems kind of intuitive, but somehow it doesn't seem to have been published before.

So I've been spending this week in a local plastic surgeon's office, going through the charts of all the breast reductions he's done over the last 5 years. I go through each chart and collect data, like height, weight, pre-op measurements, then amount of tissue removed in the OR, and then if they had any problems post-op.

And on the one hand, it's a little reassuring. These women NEEDED surgery. They make me feel downright perky. But after charting measurement after measurement after measurement- it started getting to me.

And when I got home last night, I couldn't help it and I measured myself. And I must say, was relieved to find that I don't think I'd qualify for surgery. And was pleasantly surprised to learn that I'm not even 'saggy' (ptotic) at all. Phew!**

But then it just got me thinking about society and culture and plastic surgery and expectations of women and physical ideals and all that good stuff...

I really enjoy plastic surgery. I think it's fascinating. But it's gotten to the point that if people ask what I want to do, I say "reconstructive surgery" (which is under the umbrella of plastics), because I am sick of people's reactions. If I say reconstruction, they all nod appreciatively like that's a good, noble thing for me to do. But if I say "plastics", there is inevitably a bit of a look-down-the-nose-in-judgment and a snarky comment about the money. (or a request for a boob job.) Sure, the money is great, or rather, will be great, I hope- but that's not my main motivator. I just LIKE what plastic surgeons do. It has its downsides- largely that you have to deal with a lot of crazy, vain women. And then the nasty stuff that no one realizes plastic surgeons do- a lot of wound care for complex ulcers, stinky necrotic bedsores, etc. But I like the cases. I think it's fascinating. And I like the people. I keep finding, over and over, that when I go into the OR with plastic surgeons- it's FUN. People laugh and joke and play music, as opposed to sour dour stressful "what artery is this? what nerve is that a branch of?" in a lot of the other fields. And a plastic surgeon I worked with at Roswell recently broke it down pretty well. He said in general surgery you learn operations. You do each procedure more or less the same way every time. But in plastics you learn techniques. A toolbox. And you have to figure out which ones to use where, and there's a little more problem solving and decision making involved, which I think is awesome. There are other aspects too, but I'll stop there.

The typical dichotomy in plastics is that cosmetic pays better, and reconstructive is more rewarding. Most people create their own balance depending on their own priorities.

Yes, cosmetic surgery is sort of fluffy and I don't know how I (will) feel about supporting my children by living off women's insecurities, or men's, I suppose- but at the same time, I think of the poor kid who has had stick out ears or a big honking nose for his/her whole life, and is miserable and the butt of jokes etc etc. If you can fix that for him/her, and improve his/her quality of life that much- is that not a valuable service, even though it is "only cosmetic"?

And the other thing I find interesting is that over the years 'standards' have been developed. I mean what is beauty? Can we define it and spell it out? Well apparently, yes. There are textbooks on the 'ideal' facial features, etc. What angle of the nose, etc, is "attractive", blah blah. Which I think is kind of amazing. That you can break it down in to parts and make a science out of it. And it's not just like one egotistical guy decided what was beautiful and said that's the definition. It's been studied. Kind of neat.

Ok, off to filter through more charts and collect more measurements...

-J

• In case I've made any of you girls out there insecure about your own breasts now, well first of all, I apologize, but here are some rule of thumb "golden rules" if you want to reassure yourself. The main measurement to consider is the sternal notch to nipple distance. Take a tape measure or a piece of string and measure from your sternal notch (that little V at the top of your breastbone) to your nipple, while standing up. A little difference between the two sides is pretty common. And a quick and dirty rule is that an equilateral triangle of 20cm per side from notch to nipple to nipple to notch is "ideal". I doubt too many people meet that. Depending on height/weight, once you start getting closer to 30 reduction MIGHT start to be reasonable. Some of the women whose charts I'm going through were 40+.

And as far as ptosis (sagginess)- put the tape measure under your breasts, right at the inframammary fold (the crease where the breasts come off the chest wall). Nipples 'should' be above that line. Then ptosis is graded based on how far below the line they fall, with the worst (grade III) being when the nipples are on the bottom of the breast, aka snoopy-nose breasts.