It’s a little ironic.  Today was our first small group session in Introduction to Clinical Medicine.  We met with a few standardized patients and practiced taking patient histories of present illness.  We experimented with ways of making sure we hit on all the major, preliminary bullet points while creating a pleasant flow in the interview and demonstrating respect and empathy.  As a novice, it’s not always intuitive.  For me, it’s hard to always listen well while going through a check-list in my head.  I’ll practice.  I’ll get better.

Immediately following, I went to get some bloodwork performed.  Not unusual.  I get stuck a fair bit, and I’m actually a little proud of being good with needles, a talent that’s come with practice 🙂  So, no biggie: I heard my name; I sat in the chair with the funny armrests; I watched as one my usual phlebotomists (who still looks at me like it’s our first time meeting) wrapped a tourniquet around my right arm.  Then I made my first mistake: I asked her whether I needed to change my insurance information at their lab or whether just being in the Penn system would suffice.  Exactly what information she provided was unclear to me; she definitely did not answer my question, but at least she repeated herself multiple times while interrupting me as I tried to clarify.

Next comes the mildly humiliating part.  I’ve been told I’m a hard stick.  My veins, apparently, like to “jump”–as in, the phlebotomist or other care provider will see a nice, juicy vein right below my skin, and think he’s got it made, but then my vein dodges away after the needle pierces my skin, at which point he either attempts another stick or goes digging.  The former is preferred by me.  The latter was attempted by said phlebotomist today.  It was not pretty, and I think this was the first time I actually let a f—! escape from under my breath.  For most caregivers, this would be cue to apologize or demonstrate some empathy, even for a wimp like me.  Her reaction: “Looks like someone’s not good with needles!”

Are you kidding me?

A few more somewhat demeaning interactions later, and I was walking out of the lab livid.  Then I thought: Wait a sec.  She should know better.  I deserve better, and she should want to know how to do better.  So, in a moment of complete stupidity, I walked back into the lab and approached her.  I composed myself, looked into her eyes, referenced our long-standing, normally good relationship.  Then I expressed that I didn’t feel like today went so well, and I enumerated my reasons, using tons of “I” statements (ex. “I felt embarrassed when you commented that I wasn’t good with needles”).  She interrupted me and told me that she was sorry I was upset (which is not a real apology), then proceded to tell me techniques about how to become more comfortable with needles (seriously?).

I’ve decided that she either doesn’t care or she’s an idiot.  Too harsh?  I mean, I know I’m a biased opinion here but, in this case, I do not think this is a problem of anna’s oversensitive nature.

I ran into one of my doctor’s while leaving.  I hadn’t seen her in person in six months, but she called me by name, asked how I was doing, and said that she would call me ASAP with the results of my bloodwork.  She’s a brilliant physician (one of our lecturers at Penn) and she’s socially competent.  Today’s experience reaffirmed that it’s totally possible to be both or neither.

Okay, looks like I’m in this thing for real now.  Today was a beautiful autumn-ish late summer day, the kind that makes you feel like you really should be back in school.

I commuted to the voice of Ira Glass, which definitely helped set the tone of day.  If anyone has good podcast suggestions, I’m all ears (get it?  oh dear :/).  Then three hours of not-so-painful lecture followed by my favorite anatomy session of Mod 2 yet.  May I say, it’s pretty swell when you stand over different cadavers and hearts listening to residents prattle off clinical correlates, and the terms you’re hearing actually sound familiar!  Lunch was spent at the MD/MBE info session (I was supposed to give the student prospective as someone already in the program), and I got my first solid look at a number of members of the current MS1s, already two and a half weeks in and still willing to pounce on any free lunch offered.

Finally, we had our introduction lecture to clinical medicine on adult history and physical examination, in preparation for the start of our clerkships in January:

“Patients usually judge medical quality based on the quality of the relationship not the technical skill.” (Annals of Internal Medicine. 2006; 144: 665-672)

a.k.a. It pays to be nice (quite literally).

Less than four more months!

Not gonna lie, it was pretty difficult to come back to school today after what became an incredibly rich summer vacation.  Sometime this week I’ll finally post some pictures of my recent adventures in LA, Laguna Beach, Yosemite, Palo Alto, Alameda, and San Francisco.  For now, I need to start reviewing the anatomy of the heart like whoa.

Today, my biggest success was getting from my new home to my new lecture room, “the Class of ’62 lecture hall,” without getting lost.  (According to our darling GI course director from the Spring, I half-fulfilled one of the three objectives for a happy life right there.)  As my feet met the Penn grounds this morning, the voice in my head repeated, just don’t walk into Reunion Hall, just don’t walk into Reunion by mistake.  As though it’s not already embarrassing enough to walk into class 30 minutes late on the first day, imagine the horror of walking into the MS1s’ genetics lecture?  llllllllllllllllllllllll…

I wish I had taken more pictures from my last summer hurrah this weekend, but thanks so much to Erica, Dan, Ted, Matt, Claire, Stephie, Kristen, Lisa, Javier, Santiago, Ariel, Evan, and John for making it so delicious!  It was the perfect kind of weekend, days spent getting to know new little corners of NYC and showing off some of my favorite nooks and crannies  of Philly, nights spent enjoying feasts with fabulous company.

We found out recently that John cannot request vacation time during the two weeks I have off at the end of second year.  As I come off an 11-day vacation sans husband (ready as all get out to see the main squeeze waiting for me at the arrivals gate and shamelessly seize the Love Actually moment), I’m a bit blue about this news.  Not to say that we haven’t had some wonderful trips together in the last year—our much delayed honeymoon; our Thanksgiving excursion to Tuscany; our week at the beach with some of the best people on Earth; little getaways hither and tither—but it feels like so many of our memorable adventures have been experienced separately.  They’re always choices, of course, and I don’t think either of us regrets our decisions toward brief separations in favor of, say…a summer of medical service in Guatemala…a clerkship in Ghana…a backpacking trip through Europe, Northern Africa, and the Middle East…a quick couple weeks in post-earthquake Port-au-Prince.

A colleague of mine once commented that he appreciated how John and I have maintained our independent pursuits and personalities within our marriage and that we support each other’s separate, distinct passions.  Especially considering there is so much overlap in our professional and personal interests, this is one of my absolute favorite compliments.  While I certainly feel changed by my marriage (and I think I have, to some extent, had an effect on John as well), it’s important that I keep a sense of self outside of it as well, which runs far deeper than our series of solo journeys.

A family friend once jokingly teased John that he was surprised that he let me go off to medical school a couple hundred miles away.  John didn’t miss a beat: “I don’t let her do anything.”  True, but he could have made the whole experience a hell of a lot worse.

I really love this bit about us.  And yet, though I’ll do my damnedest to not pout quite so much when John leaves me for his next “man week” (hopefully not on our anniversary this time around), I hope this is the last year in which we’ll have to do the bulk of our adventuring separately.  Just hoping…now if some of the higher powers at Penn and Christiana could throw us a frickin’ bone, that’d be swell.

Glacier Point. Alon (adventure buddy/photographer): "Smooches for John!"

P.S. Will I totally gross you out if I share some entirely too cutesy traditions of mine?  1) I love postcards.  The pictures are way better than anything I can capture, and the postage is less than that of a letter.  I try to send John a postcard from every place I travel, even if we’re there together…so it’s kind of like I’m receiving the card as well…what started as something somewhat romantic has become mostly self-serving.  Aren’t I the loving wife?  2) So…I just noticed this about myself on this last trip.  Turns out, when I travel without John, I almost always choose a song that I, for that trip only, associate with him.  I’ll listen to it once or twice (or more) a day and give myself permission to think about and miss him.  God, I’m like a small child needing a lullaby to coax myself to sleep, but it actually helps.  When I studied abroad in college, I used “In My Place” by Coldplay.  When I moved to Philly, it was Nickel Creek’s “When You Come Back Down.”  This time it was “Airplanes” by the Local Natives.  Kind of weird that I took part in this ritual for so long without realizing…not weird at all that I use music as a coping mechanism.

Hello from beautiful Los Angeles, where there’s never a cloud in the sky, the temperature never drops below 61 or rises above 82, and humidity and allergies are foreign concepts.  Oh, and some of my closest friends also call this place home, so it’s been a pretty fantastic vacation so far.

The only hiccup in travel so far–knock on wood–was on day one, when I was taking the train to the Philadelphia airport from University City.  As the ticket-hole-puncher-guy (what is his title?  I was about to call him the “ticket master”) walked by to tell me to move my suitcase, he looked at me inquisitively, “So, where are you going, anyway?”  When I told him that I was going to the airport, he responded, “Well then, you have other problems.”  The train was definitely going to Wilmington, and I would have to take a train back into the city and wait for the next train to the airport.

So, it’s me, right?  Tears, of course, started welling up in my eyes as I ran through all the worse case scenarios (which, let’s be honest, are inconvenient at worst but not that bad).  This woman, Lorraine, three rows ahead turned around, “Why don’t you get off with me at my stop, and I’ll drive you to the airport?  I live like 10 minutes away, and I just need to pick up my three-year-old on the way.  Really, it’s no trouble.”

As we walked to her car she reassured me, “Don’t worry at all about all this, it happens all the time.  They really need to mark those damn trains better.”  Sure enough, when her daughter, Brianna, hopped into the car, she looked at me in the front seat, then turned to Lorraine, “Mom, are we going to the airport again?”  Adorable.

Reason #487 why Philadelphia really is the city of Brotherly/Sisterly love.

By contrast, on my first day in LA, we accidentally happened upon a manhunt on Mulholland Drive and a man vigorously masturbating on Spring Street.  But the weather and the company are the best!

John and I stayed at “our” place in the city last night (a.k.a. our friend’s studio that he is generously letting us enjoy while he’s away).  I don’t think we even realized how wonderfully like a vacation it could be.

John just got his schedule and realized that he had two days off in a row.  When in residency, this was almost unheard of, so I think we’re still in the take-advantage-and-go-do-something-while-you-have-the-chance mode…not a bad place to be.  We ran down our list of options: camping; B&B; trip to Fallingwater; another treehouse overnight; a quick excursion to NYC or D.C.  Then we though, f— it.  We totally love road-tripping together and all, but sometimes the last thing you want to do is really go somewhere.

This Center City studio gave us the luxury of having a night on the town (without having to worry about staying sober enough to get home) and the novelty of staying somewhere other than at our actual home (pretending for a night to be a fancy-smancy two-home type of couple…yyyeeaaaah, with hundreds of thousands of dollars of student loans, like that will be happening ever).  After dinner and fro-yo, we finally made it out to this old speakeasy I’d been hoping to try.  I had the Continental Divide, followed by the Dead Turk., and I was completely sloshed.  Hep A has really done a number on my tolerance.

We slept in, then had brunch at Ants Pants, which is kind of an institution around here.  I’d never been because the line is always around the block on the weekends, but at 11am on a Monday, it was pretty sleepy.  Deliciously so, in every respect.

It was one delightfully sticky summer retreat in the city, a very much appreciated getaway!

You might remember, I was hesitant at first about moving out to the ‘burbs.  I love my city, and I love city life…being able to to pick up an emergency roll of toilet paper from the corner Foodery at 11:30pm, to bike to school, to turn a corner and land in the Italian Market, to walk 100 yards to the Emergency Room (ya know, in case I happen to fall off my bike a block from home).  To be practically non-reliant on a car or any form of public transport, it’s a beautiful thing.

But where we live now, just outside city limits, is unlike any suburb I’ve ever known.  Maybe it’s because we’re a five-minute walk to the light rail.  Maybe it’s the young, somewhat hippie-ish energy of our neighborhood.  More than that, however, I think it’s the town feel of a it all.  We’re surrounded by independent businesses, by people who support them, by organized community gatherings, by scenic outdoor areas.  It doesn’t just feel like an extension of Philadelphia.

Today I took advantage of one of the Groupon Now! deals, and attended a $5 yoga class at this local studio I’d been dying to try.  (And now I’m just sort of dying a little, because Mark kicked my ass!  I swear, every single one of my intercostal muscles is sore…is that even possible?)

I got to talking with another woman in the class (who’s an ophthalmologist–jeez!), who recommended I go to the neighborhood cheese shop for their iced coffee.  They use ice cubes made out of coffee–brilliant!  Dear Dunkin’: maybe if you took a page from the cheese co. book, you wouldn’t have to double brew your iced beverages.

On the way home, I stopped byour nut store because our basil plant is growing like a freakin’ weed, I have to keep making pesto.  (Does anyone know if this stuff freezes well?)  The Head Nut also sells like every spice known to man (in bulk!) and gluten-free soy sauce (in original, organic, and low sodium varieties).

I think I’m becoming a townie.  Weird.

My bioethics paper is late.  And I’ve decided that the reason I’m having trouble writing it is because I have to write this post first.  It’s been on my mind a lot recently and, frankly, I’ve been avoiding it because I honestly don’t know how to begin or end it, or really what should go in the middle.  It’s on the topic of a community of friends that is rooted so snuggly into my semblance of self, I can’t comprehend how any facet of my life could be complete without it.  Maybe it’s arrogant of me, but I’ve come to believe that a group of this kind is far from commonplace, and I never cease to be bewildered by the luck I have to be a part of it.

You’ve seen/heard me reference them before, often calling them the Y’s or the Y’s & HMC for short, largely because I didn’t want to take the time to explain the meaning, but partially because I didn’t want to have to defend the name.  We are the Ya-Yas & Handsome Men’s Club, proudly.

Ten years ago, at the urging of two of my closest girlfriends, I read Divine Secrets of the Ya-Ya Sisterhood by Rebecca Wells.  I won’t try to pass it off as “high-brow literature,” but I think it should be a must-read for all adolescent girls.  Unlike any story I’ve known, it depicts what sensational relationships can exist between women.  I think it’s the first book that ever made me cry, although that’s now a regular occurrence.  (For those of you that have a copy, turn to 217 and read to 230, when Sister Solange and Genevieve save Vivi from Saint Augustine’s.  I think reading this passage might have also given me my first inkling that I wanted to go into medicine, as well as my affinity for lavender.)

And so, at the end of our senior year of high school, Erica, Liz, Stephie, and I formed our own Ya-Ya sisterhood, and soon our own listserv (because nothing says commitment like an electronic mailing list).  Within a year it grew to include a small handful of other women we love from high school, and then our men (best friends and/or life loves).  We became the Y’s & Co. and remained so for a long time.  But when the men equaled (or surpassed) the number of women, when they independently created “man adventures” and contributed to/facilitated/took part in leading group-wide events (like our annual reunions at Thanksgiving, New Years, and Beach Weeks), “& Co.” just didn’t cut it as a title.  “HMC” it was, although, for the life of me, I have no idea how we came upon that name.  I think our little group is something around 30 strong at this point.

These are the friends you write home about, the people you can literally trust with anything, who will always be there when you absolutely need them—I know this all sounds so hokey (are you vomiting a little in your mouth yet?), but it’s very much true.  When I was heartbroken and sobbing over the telephone, my closest friend nearly drove to the airport to catch a plane in order to be with me, and I’m sure he would had if I had asked.  When I needed a place to stay one summer in college, more than one ya-ya family gave me the key to their home, my own bed and drawer space.  On the day my MA thesis was due, Y’s & HMC far and wide sent me funny pictures, heart-warming articles, inspiring videos to get my spirit up.  Although John was inducted into the group years prior, I needed the approval of the Y’s & HMC to marry him, it simply wouldn’t have felt right otherwise.  (Incidentally, John, when you do finally read this book, you’ll be pleased to know that for years the ya-yas referred to you as “such a Chick,” Teensy’s husband, who’s kind of the only husband who really gets the ya-yas, who makes them dinner while they have their much needed sisterhood time.)

Members of this group have written term papers on the nature of our friendship, have visited each other across the continent and overseas, have been sounding boards or active influences in most major life decisions.  We look each other in the eye when we toast.  (“Otherwise, the ritual has no meaning, it’s just pure show.  And that is something the Ya-Yas are not.” p. 16)  We spend hours curled up on each other’s bed, beach towels, or kitchen floors (often with brownie batter in hand in the latter setting).  We rent out entire inns when one of us gets married.  And year after year, for ten years now, we plan our vacation days around Beach Week, one designated week of the summer during which we all descend upon a house in Corolla, the Outer Banks (or a suitable alternative site)—might sound simple, but many  google spreadsheets are involved in this organization.

We are screenwriters, physicists, music directors, rocket scientists, paleoanthropologists, musicians, graduate students (you name it, we’ve got it), physicians, yoga instructors, teachers, consultants, government employees, military officers, peace creators, freelancers…and the list continues.  We are foodies, world travelers, readers, athletes, adventure makers, sharers, lovers, and listeners.  We are strong, creative, thoughtful, beautiful, courageous, and simply better because we have each other.  We are so much more than I can express in words.

Happy ten years!  Ya-Ya!

(I guess I should get started on my paper now?)

Remember that fabulous artist and professor whose exhibition I got to see last month?  Well, I was most certainly surprised and entirely flattered when he asked me to model for one of his characters in his third graphic novel.  What a fun, novel experience!  My character is “the runaway,” one of the female love interests/antagonists of series protagonist “German.”  I don’t want to spoil what I know of the plot by giving away too much, but this photo shoot was blast, consisting of a range of scenes, from a butterfly chase to me vomiting in a sandpit.

Here’s an unfinished page of the novel Jeremy was kind enough to let me share:

The two best parts: 1) Since the pictures were going to be converted into drawings, the pressure was off.  We didn’t have to worry about getting the right light or angle, I didn’t have to be concerned about my clothes or facial expressions being perfect (which is awesome because a model, I am not).  To the best of my ability, I could just let myself have fun!  2) When a good friend finds someone who makes her so happy, its a joy and privilege to get to know that person.  How lucky am I to have this time with Jeremy Waltman, albeit a bit outside of my comfort zone 😉

For more of Jeremy’s work: www.jeremywaltman.com.