where to begin ...

insomnia ... is a bugger. sleep was an elusion no amount of béhé counting could assuage. instead trolling facebook, i was. :-/ as it turned out, some of my friends closed out their accounts & i had not even noticed until i needed to send personal messages. bummer!

the short list. entitled a list created on twitter to sift & filter only to follow a select number of tweeters. yeah... my only complaint is not many people my age tweet. especially the natives. they're all still myspacing. yáadi lá! hahahaha...

késhmish ííbaal. christmas blew by like any other day of the year. not a scrooge or anything, i have found it hard to celebrate a holiday that is not in my diné calendar. but... because i am married to a catholic, a jack catholic actually... we sometimes get into the holiday spirit. more so when our kids are with us. this year... they were all holidaying with the other parents which of course makes for a sedate holiday season for us. the thick and thin of it, the day came & went. the stores were open & packed. theaters were packed. nothing like when we were kids and all the business establishments would be in hibernation for a day.

on the road. bá hózhó has a tournament in albuquerque ... actually, rio rancho. we are on the road again. the mileage on our 4runner, holy... i mean... whoa!! narbona iii. narbona i was an international scout from 15 years ago. narbona ii was the trooper before this 4runner. my war pony can haul. yeah!

wtf?!

my ramblings... chunks of it just disappeared. some of the shorthand in typing the blog entry did not jive with a template or something of the sort. i must be some kind of stupid as i painstakingly rewrote it 1x. grrr! same result when going to publish. now miffed, maybe with a tinge of livid, the entire blog entry has been blanked. time wasted. ugh! perhaps, it was just not meant to be... bleh!

dammit!

what a day!

it was a busy day. it was a good day. busy + good. my classmate with whom i am currently on rotation at this practice contracted laryngitis and was unable to come into the clinic today. this translated to more work for me today. some days are slow and time drags & snags along at snail pace and you wish for busy days. my wish was granted today, and it was nice going, going, going, going... patient in blue room, patient in desert room, patient in casting room, patient in blue room, patient in desert room, patient in casting room... and, writing, writing, writing, writing oodles of s.o.a.p. notes.

lots of patients coming in for dfc. there are some universal medical abbreviations, and then there are some specific to each practice. here, dfc=diabetic foot care. this usually means nail clipping and checking the neurovascular status, and in some cases sharp debridement of hyperkeratotic lesions. some patients are really nice and trusting with their feet even to pod med students. then there are others who do not even want a student in the room or touching their feet. knock on wood... so far... all nail & keratosis debridement have been without incident, meaning no blood drawn. yeah! :D "first do no harm..."

one patient was initially a tad nervous about me going near his calloused digits with a really sharp blade. well... it was not without reason. i forgot my spectacles this morning so i jokingly told him his toes were a bit blurry. hahaha... bad joke, i know... but i reassured him that it was all in jest and that my close vision was actually 20/20. midway through our visit, he asked if i am navajo. as it turned out, he had dated a navajo woman a couple years back which for one reason or another did not work out. we shared out thoughts on the differing world views and the required compromise in an interracial relationship or lack thereof which would ultimately be the demise of such a relationship.

another patient asks, "what do i need to do to make this go away? help me help myself." he is a former smoker with a history of 30 half-pack years. currently, patient admits to imbibing at least -/+ three 12 oz bottles of beer and several shots of brandy nightly to take the edge off and relax. to each his own but that is a bit on the excessive. having a diagnoses of diabetes, hypertension, hypercholesterolemia and osteoarthritis, the alcohol most likely contributes to his morning fasting blood glucose readings of 120-140, aggravating his hypertension and possibly altering the alkalinity of his joint fluids. and... oooh... he did not want to hear that! his words, "someone is already getting on my case for that... i need my drink to relax... !!" i assured him that i had not intended to offend but reminded him that he'd asked me to help him help himself to which he relented. and... i'm thinking if you are not willing to make the necessary changes to your lifestyle, why are you asking me to help you help yourself then?... fortunately, another patient was waiting so i left the room to start on the next patient and dr. pf came in to finish his visit.

nail fungus. no one likes having ugly dystrophic nails sometimes with subungual debri. especially women who like wearing cutesy open-toed shoes in the summers. and... winter time is the best time to treat onychomycosis because most people wear close-toed shoes. this gal was in the chair with her socks on. and she did not want me looking at her toes. but... that's what i'm there for... and, guess what?... they were not at all bad. so... i reassured her they were not bad at all and she should be grateful that the nails were not thickened, severely discolored with subungual debri. she wondered how it happened she got fungus in her nails. explained how it can happen, and also reviewed the results of her liver function tests. patient wanted to go through another round of oral antifungal medication, a pulsed dosing in combination of topical antifungal to rid her toenails of the fungus. i presented to dr. pf and we traded patients again. she finished up with fungus nails and i started on more dfc. :)

young gal on crutches. got 3 views of her r foot. did not see any fracture lines on the films. some hypodensity at the distal ends of her metatarsals so i told her to drink her milk. she hates milk! i told her that she needed to work on making sure she gets enough calcium in her diet for bone health and do it now before she turns 30. she whined again, "i haaate miiiiilk." yogurt, cottage cheese, cheese, and if not... calcium supplements. less carbonated drinks. i think it went in one ear and went out the other. i wondered if it even made it into the ear in the first place as she thought she should also have xrays of her ankle as she was sure, "t. is crazy!" i told her that dr. pf only asked for 3 views of her r foot, no ankle views were ordered. after reviewing the films with her and dad, i returned to writing, writing, writing, writing notes.

wrote up all the patients i saw by myself and those i saw with dr. pf before i looked up again, it was 1800 hrs and dark out. bleary-eyed, i got into my car, buckled up and got on the road. whew... and those were not all the patients. just a few that stood out.

a fix & such ...

ach'íí'. mexican style. tripas. tacos de tripas. albeit not mutton, the mexi ach'íí' still hit the spot. no more jonesing for mutton. the tripas were cooked to my liking. not too soft. not too crunchy. somewhere in between. not too greasy. not too salty. on warm soft corn tacos. fixings on the side with which i did not even bother. the ach'íí' tacos were soooo gooood. hwiih sélíí'...

my peeps. the pueblo grande museum auxiliary indian market at south mountain park. just getting in will cost you but a family membership will pay for unlimited access. it was well worth it. minime and i took our time looking at the wares going from booth to booth. beautiful but incredibly overpriced! partly to blame for the current price of silver. but... primarily due to the patronage. at one booth, we overheard some bilagáana ask an artisan if a geometric cloud pattern on a bracelet symbolized anything. minime and i exchanged looks and kept on walking. tell her anything that will rock her boat... is what i was thinking. hahaha... the apparel booths that captivated my attention the most were penny singer and jeanette ferrara. when i used to sew which i have not done in a long time, i always thought i would design my own natively influenced designs. now... this is an aside but what now preoccupies my mind is having the right tools so i can be efficient in surgery. i may design some surgical tools that will work in my small hands. :D a girl can dream.

my relations. someone yelled out my name. outloud, too! as it turned out... it was my niece. i had not seen her in ages! and... sadly... i did not recognize her until she told me who she is. the last time was at the memorial services for my late yáázh óshí. almost 10 years ago. this is my mom's oldest sister's oldest daughter's oldest daughter. she has a daughter who is 14 years old! she caught up on the family. i did not impart much about myself. minime was excited to meet relatives she did not know she had. and... i think she was upset with me for not doing so earlier. all i know is... while i love my extended extended family, i am not in a place to come back into the fold of the family. if i do, i know i will be expected to open my home and my bank book which is always hovering around empty at this time. truthfully... i am not sure if i feel comfortable doing so because of the expectations. as my mom shared during one of my visits home, my sister was making her rounds among the relatives back home asking for money. not little money either. something about foreclosure and $50k or some outrageous amount. there is apart of me that thinks... you want what?! from me?! and... where were you when i was strapped and struggling through med school?! as for my family... my mom... my sisters... my brothers... my dad... i could never say that to them. there is a collection of iou's with them. however, with extended extended family, most definitely! seeing relatives that felt more like mere acquaintances was a tad bittersweet. ok... a lot bittersweet. they remember this really sweet aunty who cooked the most delicious meals for them. and... i am a long way from that sweet person. jaded. perhaps that is the best way to describe what i have become. as i got into my chest thumping she-woman garble with an ex-bf, he wondered aloud... what happened to that sweet girl that i knew way back then? so... it seems there was once a sweet innocence. that apparently has jaded with bitter experience.

20 years. it sure does pass by fast! my sister's firstborn passed on veteran's day. gut wrenchingly sad. and... i was crazy in love with the father of my children. my younger four siblings were still in school. my grandma was still with us. it was the year i never went back to cornell. it is amazing how life is affected so much by the choosing of one path. yet it feels like i would have still ended up where i am. one way or another. this always brings me to ponder this poem. hmmmm...

blips

senior moments. something i would rather happens to others. just not me! please... well... this afternoon when i began feeling snoozy and my eyes began to droop in a conscious stupor, i could not remember if i had taken my t4 pill. for that matter, i began to wonder if i had taken the med the day prior. wtf?! honestly, i have not been as consistent as i had been before much like the what i perceive as non-compliant patients. omg! get with the program!

i'm not saying you're fat! she said tongue in cheek. don't worry about it, i said all the while laughing. ... and, in the back of my mind, i thought... absolutely no filtering system. seriously... when a patient uses your girth as an example for comparison to illustrate how much weight she has lost, it is time to do something! holy fat cow! bleh! and blah, blah, blah, blah! bottom line is i just need to get my fat @$$ back out on the trail. grrr!

onion remedy. the filterless patient above related to me her korean mom's onion remedy. she apparently prepared a topical onion remedy which she wrapped around her left heel to draw out all the toxins associated with having stepped on her husband's tack-backed name tag. the puncture site well-healed definitely wreaked of onion odor. all the while... she kept assuring me that "it work. it work. it work." who am i to knock another culture's medicine? navajos mix mutton fat and piñon sap into a salve to dress an open wound and wrap with a strip of blue bird flour bag. what i will admit is, i would rather smell like the pinon salve than onions. :)

generic. in the grand scheme of things, i realize we each are a simple specks in the universe, galaxy, etc. however, on an earthly level, i have the audacity to wonder sometimes how i am perceived. i mean... what do others, especially other med students and preceptors, see first when they meet me? the woman? the native american -- navajo? just another pod med student? and... exactly how do i want to be perceived? i am certain some people have this figured out long before the 40s. i certainly thought i did. after ~10 years off rez, i am beginning to feel homogenized. and... it nags but i also do not want to be pigeonholed. :/

manic monday

it definitely felt manic, though it was most likely not as chaotic as it felt to me. for starters, i was on the road much later than normal and it was a mistake. ugh! everyone appeared to be in slo mo on the west/south bound 101 traffic. not remembering whether the speed cams are still working along the 101, and since i did not see any flashing as i zipped on by... the gas pedal was as close to the floor as it could get as i was not about to show up late. bleh! made it! since i was supposed to observe a surgical procedure for removal of hardware, i kept one eye on my watch as we began taking patients back. just as the day was going... i got stuck in a room with a patient that i had worked up, and did not get out until 1020 hrs, and i was suppose to be at the surgery center at 1000 hrs. after finishing the soap note, assuming dr. pf started without me as i would if any student of mine was running late, i took in another patient. as i was presenting to dr. ro on the next patient, one of the front office gals came back and informed that dr. pf was waiting for the student observer. i looked at my watch and it was 1100 hrs. crud! to add to the panic, i was supposed to bring films on the patient. oh crap! with xrays tucked in my arm, i ran to my car and drove like a mad woman in the rain to the surgery center. parked and ran in. drenched and all soggy, i ran the films to the nearest nurse i saw. she took the films back and came back and informed me that dr. pf said it was up to me if i wanted to come in to observe. are you kidding? of course! changed into scrubs and pulled on one of those ugly hair covers and foot covers, masked up and entered the o-r. as it turned out, the films were to determine hardware placement and incision planning. the heads of the screws could not be visualized and dr. pf could not justify removing them as the locus of the pain experienced by the patient was more proximal than the screw heads. the plate and screws were removed from the lateral fibula. the voids left by the removal of the screws were filled using a calcium phosphate cement paste. sutures to close up. the most superficial suture is a running stitch which is anchored on the inside of the epidermis, more of a cosmetic stitch, to minimize scarring. by this time, it was lunch time. excused to go back to clinic, i rushed back and famished i took out my sandwich and bit into it. the nanny sitting in the other chair to me tells me to put my food away because pizza and salad was ordered in for lo's birthday luncheon. oops! a dry gulp and the food bolus slowly descended my esophagus. salad was awesome. pizza was huge. as last bite descended esophagus, i wished i had stopped at the salad. burp! the afternoon was a blur! patient after patient after patient after patient ... any "free" moment is spent writing soap notes and looking up stuff we were asked about which we could not recollect on the spot. it was dark out by the time i got on the road home. the rain was pelting & i just wanted to get home. picked up my daughter and dropped her off to the school for a drama club activity & finally went home. kicked shoes off and decompressed in catatonic state in supine on the bed. ate leftovers and talked with my hubby, sharing our day. i have had a day. dose off a tad in warm embrace of hubby. aaaahhh... abrupt rrrrriiiinnnngggg! picked up the munchkin and made a side trip to wally world. home... now... i can fall off to sleep. g'night.

day off

plans for quartzsite got scratched as the day began winding down late yesterday because there were not enough patients confirmed for the field podiatry clinic. this meant i had a day off! yeah! with my ambitious list of to-do's and my hubby's busy schedule, we set out for the hills due north. we pulled into flagstaff with 13 miles of gas left to go. heh! traffic is a monster on fridays, and i do not like to drive in it. grrr... after delivering my hub to the city court, i went straight to napa auto parts to get a low beam bulb and pulled into jiffy lube. perfect timing! after i sat down in the waiting room, more customers scurried in from the cold. done with some time to spare. set out to find an eye clinic that took my insurance and a walk-in exam spot available. the only one that took the insurance had no appointments. bummed out, i rushed back downtown to pick up my hub and get into the traffic towards the juvenile court. stopped for coffee at new frontiers. made it to court with time to spare & hubby jumped off. i set out for jay's art supply store which to my surprise has been thunderbird supplies for the last 3+ years! an eclectically dressed japanese woman offered to help me. as it turned out, her husband is a sushi chef at hiro's, my favorite sushi restaurant in all of arizona. seriously! animated conversation going from japan to l.a. to flagstaff to foot ailments to cultural similarities/differences and on and on... after picking up supplies, i got back on the road to a gas station. just as i headed towards downtown, a call from my hub. luckily i was close and got there with time to spare. then... finally... downtown bound. parked in front of my hub's office. he dreaded having to work while i was thoroughly enjoying my day off. like a child not wanting to go to school to play in the snow, i coaxed him into the office and gave him a peck on the cheek and set off for downtown. 1st stop was at sagebrush trading co. & fell in love with a nice big black purse. no way i was walking without it. 2nd stop at winter sun trading company. now... this is a store from which i rarely leave empty handed. they sell mimosa blossom dream cream. i loooove that stuff. i wish it came in an even bigger jar! and... let's not forget the jewelry! omg... they have the prettiest turquoise earrings. i just cannot get enough. :) it was close to the time my hub said his meeting was across the railroad tracks. as it turned out, the client was running late. he needed to run errands requiring transport so off we went. my mission was to get my eyes checked and get a new 'script for glasses & contacts. it took me 30 minutes tops from the time i stepped into sam's club to have my eyes examined to picking out frames & lenses and paying the ticket. there are some things about which i am not picky. specs are one of those things i rate comfort & function over fashion, much like shoes. another stop at the county jail. finally... to meeting with client at beaver street brewery. yummmm.... late afternoon meeting finally wrapped up around 1620 hrs and we had to go back across the tracks to another client waiting for my hub at the office. he grumbled as he walked in. i agreed to wait for him in the waiting room playing on my phone. the meeting wrapped up an hour later, and we got going only to find out once we got outside that we locked the keys in the car! my stressed out hub was $#!&*%@ x100 as he stumped back into the office. got on the phone to the insurance only to learn we did not have roadside service and even if we added it on, it would not offer same day activation thereby extending us same day service. triple a saved the day. we reinstated our membership and waited for the locksmith. interestingly, he had about 10 lock-outs throughout the day which he noted was more than usual. it must be the hustle & bustle of the holiday frenzy. so... we finally get going close to 1900 hrs. my hub was agitated so i offered to take him to a watering hole and load him up before getting him on the road. hahahaha... chili's is right off the road. no availability in the bar. darn! 25 minutes of waiting?! are you kidding me?! onto olive garden. the same story. crap! dejected, we got on the road. traffic was busy coming down i-17. ugh! pit stop in verde valley. 6-pack on board. hubby noticeably more relaxed by 2nd can. i am thankful. zoom, zoom, zoom... i love going up that hill out of verde valley... passing slow chidiis. :D the 2nd hour went by fast. just past the city limits, i called minime. i woke her. poor kid. she agreed to go with us to late, late dinner at rock bottom. yay! i gave her the car keys and ordered the flight -- sampler of all their brews. i was reminded just how much i love the taste of dark beer. yummmm... licked off the froth from my upper lips. their ipa was the only one that had too much of a bite on my taste buds which my hub finished for me. the food was gooood. satiated & more relaxed, we went home ... happily. :)