Requisite blog post

Hi ya'all and welcome to another installment of Ishie's blog. It came to my attention that it had been quite a while since I'd had one, giving that whole third year absentee impression that actually seems to be more due to living in NYC than it does to the actual work load of third year, though I'm sure, once I get to my surgery rotation, that impression will change.

Speaking of change, it's pretty remarkable the ones that I've embarked on since I decided to embark on this little venture called "medical school". I feel like I've grown up, grown down, been dressed down, and probably caused two decade's worth of liver damage in a short period of time. Medical school, as an entire experience, including the whole "in the Caribbean" thing, is probably the best and worst thing I could have ever done.

But I'm liking it, facilitated by starting off my third year existence with psych and then transitioning to ER, which keeps things fun, but is also a P/F class that doesn't require *that* much studying. The med surg people seem far less enamored of their lot in life.

Problem with ER is it lends itself to a TON of stories, most of which cannot be relayed on the internet, at least until several months have passed so I don't risk encroaching on the sacred HIPAA rules (man sprayed with mace by drag queen posse) that would risk casting me to the streets loans unpaid.

So that leaves me pretty much regaling my stories of living in NYC for the first time which consists of "spend too much money. Indulge in excess. Spend too much money. Go off on some alcohol fueled Nick and Nora fantasy with a waxing and waning group of friends. Convince one virginal satellite friend to try absinthe. Find exciting new venue you'd never heard of. Spend more money. Repeat. Go to work at 11 and regale the missing medical students and residents of the times you had in your down hours. Repeat."

Oh, and jog. I'm training for a breast cancer fundraiser 5K in September, which goes a small way towards physically and karmically repairing the damage I've been doing otherwise. Monica's helping keep me honest.

On the ER side of things, as mentioned, I finally got my IV sticks. I got on this kick where I could do ANYTHING so long as it didn't involve a vein. Arterial blood draws? Sure! NG tube? Sutures? Staples? No problemo. Simple butterful stick off a vein? Put an IV in an unconscious person? Problem. Complete failure to perform.

But finally kicked that in the ass so now I'm at 3 successful IV pushes to 1 unsuccessful in the last two days. The unsuccessful was on a woman with notoriously difficult veins, whose daughter decided to help me by saying "This experiment is OVER". Can we have a barb wire enclosure where we keep family members? That'd be super awesome. Better yet, if you're going to backseat doctor, how about taking your loved ones to something that isn't a teaching hospital? Mmkay, bye.

Oh, I also won a suture-tying contest, which meant someone else had to do the Guaiac on my patient. Gotta love the small victories.

Short one

Work schedule's a little buggy this week. I've been working the 11 PM to 7 AM shift for a week, had Friday off, and work Saturday Sunday, so I'm leaving for work in approximately (checks watch) 15 minutes.

Uhhh... ER is cool. NYC is cool, though nasty muggy hot lately. Training for a 5K in September with my co-conspirator, Monica. Dog died three days ago, so much crying, staggered by working, staggered by going out drinking with friends. Got two successful IV sticks (FINALLY), and doctor that seemed to hate me now being nice, so hooray.

Ta.

Conference? Nah, let's go to the beach

So because I'm incredibly lucky, yesterday, instead of having to show up for case conferences starting early (which sucks after a 3-11 shift), the residents had a beach BBQ at Jones Beach for the interns, and the medical students were invited. There was a great deal of humming and hawing on our parts since we weren't sure if it was a true invite or a "Oh... um, yeah, if you want to come, that'd be fine or something", but the Resident In Charge Tuesday night was like "You should go. You should totally go", etc, so we went.

I had gone to Jones Beach on the previous Saturday, but really wanted to even out my sunburn since my last trip left me white in the front and red on the back, so I looked like a playing card. Mission accomplished. Now I have a pretty even burn down the front, so no places on my body will have a melanoma advantage over others. I like to be fair.

So that was fun. Doctors aren't as scary when they're in their bathing suits playing volleyball.

But the rest... hmm... still have managed to avoid sticking my fingers up anyone's butt, but have had to do a pelvic and watch two of them. The joys of being female. I've given a couple of shots now, screwed up a couple of IVs and blood draws (I used to be able to do them; what happened??), patched up some superficial wounds on a fall victim, and helped splint a leg. I've also helped dissect a pizza that was brought into one of the patient cubicles and screened off, so when I was told to come up, I thought I was being called on to help with a procedure, but turns out I just got first crack at the dinner special. Niiiiiice.

So I'm having fun, feeling more comfortable, and so on.

You know you're out of shape

when you're huffing and puffing while jogging along in the park and you glance over at your (much fitter) roommate and realize he's walking along side you. Time to step up the yoga classes!

Case conferences today topped off by a rousing game of resident jeopardy (med students had the job of sitting there going "Holy crap; am I supposed to KNOW that in two years??), so not a lot to report.

In other news, a lot of people can attest to the fact that I'm not a giant stickler for being clean; I'm not that worried what's in my food and will pretty much try anything no matter what rat-infested street cart it came off and I've been caught sniffing shirts to see if they have another day's wear in them, but that being said, doing real medicine is giving me a serious case of OCD. Yesterday, we had a patient that was... uhh... oozing out of several orifices, one of which she wasn't born with, and stuff was going everywhere. At the time, I was thinking "Wow, this is intense" and also that doing stuff like running to get bedpans and helping do damage control on cleaning up a mess of substances that is too revolting to detail on this blog would help endear me to the nurses, so no big deal; had gloves on, didn't get stuff on my clothes, and did the normal hand wash/hand sanitizer afterward. Got home and started to make dinner... ten minutes later, I'm still scrubbing my hands in the bathroom "Unclean!! Unclean!!!" Go back to the kitchen... nah, probably not clean enough to touch my food. Granted, on a dare, I once ate an ant off a floor, but still don't want to touch my food.

Also, I'm already extremely appreciative of chill patients. When I was giving the tetanus shot and being instructed on technique by the other third year medical student, the patient is saying "Now don't you worry honey. I have had medical students practicing me all the time when I had the surgery, so don't you worry none about hurting me. Yup, you're doing great... heh heh, listen to me telling the medical student what to do." Thank you, incredibly chill patient. One of my friends when she was working prior to medical school had her first blood draw patient tell her something to the effect of "if you screw up, I'm going to sue you", so I know how lucky I am.

Stat!

Started ER yesterday and it's an experience quite removed from psych as anyone can tell you. I also keep introducing myself that way as "this is my first MEDICAL rotation" lest anyone thinks that 6 weeks of dealing with schizophrenia entitles me to put in an IV.

There are two sides to this particular ER: Acute and Urgent. Acute is for people that have complicated diseases, may require being admitted, and may be in danger of dying if not treated fairly immediately. Urgent care is your broken bones, lacerations, stomach pains, throat aches, and that sort of thing. I spent yesterday in Acute care being terrified and trying to elicit a history from a 105 year old without full uhh... mental acuity. I also got seriously pimped for my first time ("This may be your first medical rotation, but I assume you know BASIC physiology?") and learned how to do and somewhat read EKGs.

Today I was on urgent care; saw viral pharyngitis and a corneal abrasion, the latter of which I got to not only examine but say "Uhhh yeah, there's something in his eye" because I could *see* it. They saw it and confirmed with dye and a Wood's lamp, but I suppose I'm not as useless at eye exams as I thought. Either that, or it was a really big piece of something. Then I screwed up by taking the patient's charts up to ophthalmology but not the patient, because I didn't know I was supposed to, so he was like "you forgot me", and it's like "no! I'm just an idiot!"

Then bounced to acute care for a while and had a patient that was kind of a mess, with ulcers, a serious UTI causing sepsis, and a whole host of other problems, so I hung out there for a while, helped the nurse and CPA clean up the mess (don't ask; let's just say, I'm still washing my hands) and in return, got to see a Foley cath and a wound cleaning, which was cool. Came back to urgent care and got to do a tetanus shot (woot!) before interviewing an ob/gyn patient and getting a crash course on pelvic exams (I get to do the next one) and starting IVs (I get to do the next one).

So it was an interesting day. I feel like I know absolutely nothing and somehow manage to forget to ask the most basic questions that the residents then immediately ask about like "does the pain radiate to her back?" "Uhhh... no? Okay, I didn't ask. Even though I know to ask."

Oh, now that I'm back at Brooklyn instead of MPC, I get to use meal vouchers, so that should shave a significant portion off my costs. Unfortunately today, I was spectating through lunch and by the time I got to the cafe for my free meal, they were closed. So sad!

Favorite interchange of the week

Situation: Fire-breathing, leather-clad Scottish man, making his way around the audience putting his fire torches on people's tongues, shows hesitation to fully dip a flaming torch into a conservative looking woman's mouth...

Conservative looking woman: "Oh, don't worry; I've done this before."

Outpatient clinic

Just finished three days of that... well, not today, more like Friday.

In psych, we do 6 weeks total, and the vast majority of that is at Manhattan Psych, which is an inpatient facility. Three days of the rotation; however, is at the outpatient clinic in Harlem, aka, right down the street from the Apollo, which is cool. Should have gone over there, but ended up wandering into H&M instead, and spent the evening at Arlene's Grocery over in the Lower East Side, the LES being "where I spend most of my time when I'm not at the hospital". My roommate's love of LES got me hooked and the music kept me going. So far it's delivered two fantastic live music venues, a 'burlesque' show that... uhhh... well, has a serious case of Glen or Glenda, a hookah bar, good food that isn't hideously overpriced, and so on.

Today, I caught a ride to and from Jersey to a wedding party, which was fantastic. I got to see the "Garden State" part of Jersey with winding green pastures going up through increasingly dense forests to arrive at a sprawling beautiful property with a salt water pool... and an open bar... and bbq. The bride is one of my sister Tori Amos fans and presented me with both the cd I'd lent her, and a jacket from Scarlet's Walk, which means if we're the same blood type, she's owed a kidney. I think I already owe someone else my other kidney, so if both collect at the same time, I'm going to be in some serious trouble.

But, going back to psych, because what continuity? Uhhh... outpatient clinic was interesting, but not interesting in the same sense as the acute psych ward is, which was not unexpected, which is why I spent part of Tuesday sulking that I had to spend the rest of the week doing outpatient. Then I remembered that since the outpatient clinic is in Harlem, that means not having to take the Ward Island bus, which means I got to avoid things like people that stare fixedly at you for forty minutes saying "Your skirt's chocolate brown. You like chocolate brown? Melts in your mouth, not in your hand... chocolate brown... yeah.." Fantastic.

Why are there weirder people on the buses than on the subways? Well, usually.

Being at the outpatient clinic also means we spent quite a bit of time between patients no-showing and such reading charts... which sounds uninteresting until the backstory on some of the patients is revealed, which is kind of like watching true crime shows. Even saw two charts for a serious case of folie a deux, which sadly, I know about because of the X-Files. This dorkitron knowledge bank did not start with House, nor will it likely end there.

Staying in tonight

At long last...

Sooo the stuff they say about the psych rotation is pretty true. I'm actually learning a lot, but it is still pretty much like being on vacation, particularly since it's my first rotation and I just got my loan check.

But where was I. Ummm... whew, awesome parties; awesome clubs; awesome bars; awesome restaurants; awesome sites; awesome free Fridays at MoMA; awesome friends; awesome experiences.

That sounds about right. But you people may actually want to know something about what I've been doing school wise.

I'm getting more comfortable in the psych hospital environment. I'm getting to know the patients on my floor and which ones are pretty benign and which ones it's a good idea to make sure I'm standing behind a nurse if I talk to them. Today, due to the rain and a bit too late of a hookah night, I walked in a few minutes late. My patient says "OOOOOOOOH, you gonna get fired! You late!" She then tells me I should have my hair in a ponytail and tries to sculpt it into one. Then, as I was being let into the morning meeting, she yelled "SHE LATE AGAIN!!!" over my head, to the staff's amusement.

There's a new patient who's apparently King Allah and a kung fu master. He's got crazy eyes. I'm looking forward to that transition.

The nearly catatonic man is actually making demands, claiming he wants to see the doctor because the man talking to him is "just a nurse", and upping his activities. The staff refers to this as "You woke him up; you fix him".

It's cool stuff. Nearly every day, our doctor gives us an assignment to read from the Blueprints Psych book, so we present, and then he gives us about an hour lecture on whatever the topic is. He's not a big fan of personality disorders, so the psychologist borrowed us yesterday as none of us had anything to do, so we got a close on personal contact on all the Cluster A, B, and C disorders, complete with him doing imitations of the patients. I really like the people at this hospital.

Oh, though there's one medical doctor that's after anyone with small obnoxious habits, so naturally I'm patient zero. He's grabbed my wrist once (I was playing with my watch band), my pen once (no bad habits in front of the patients!), and the psychologist's pen twice. Noooo idea.

We have some lectures; some of them are really good and helpful; some less so. They also have grand rounds and case conferences that a ton of people in the hospital attend, so I've been to a bunch of those. I've been up to the treatment mall to watch some of the patients' classes. We learned about some famous people that had gone through the program as well as the profiles of a few of the more... uhh... criminally memorable people in Kirby.

So no complaints! In my non hospital time, I've pretty much been finding a new venue every night, but tonight I needed a night off to catch up on sleep.

Favorite conversation of the week

Staff member, referencing a patient that keeps acting out and getting sent back to our floor: "What's wrong with this guy?"

Doctor: "He's an asshole."

Staff member: "Is that an Axis II diagnosis?"

Doctor: "It's Axis 6. He's an asshole."

No more stupid flu

And on a related note, I'm so in love with sudafed and Mexican sweet chili tea that it elates me. Pretty much, I spent Friday aching, sleeping, lying in front of the tv, and feeling sorry for myself. Saturday, since our porch is inexplicably leaking onto the falafel place, I got to watch them send people up through our apartment for like three hours, but then felt okay health-wise. Sniffly, but nothing my friends sudafed and tea couldn't handle!

I found a B&N in Park Slope and was able to reserve two of the Blueprints books at it, and when I went over, found the other ones, so now I have the complete series for the cores, plus the Pharmacopoeia. Okay, the latter is 15 dollars, and the thing is the size of a fast food calorie guide. I know it's absolutely wonderful and essential and all that good stuff, but come freaking on. I thought these things were a drug company handout. Are they destroying *all* the perks?

So that venture was hideously expensive, but wound up with me finally getting the B&N membership because it made things cheaper. When I got back, I signed up for the full year USMLEWorld for the step 2 CK, because I figured it would help focus my direction of study for the cores and make sure I know the questions in and out, especially with drugs, where I'm weak.

This all resulted in me spending on study supplies nearly what I spend for a month's rent. So I bought myself a pair of Italian sandals because... I mean, come on. And they were on sale. The books were not.

Ended up heading over to the East Village with Lori for good and pricey Mexican food complete with homemade cheese, followed by live jazz at a place a few doors down.

New Yorkers don't seem to really care how other people dress, which is awesome for me since I have no fashion sense and no money (though I'm waking up latent shopping instincts I've never seen except when I shop for scuba gear), but I discovered the benefit to dressing in those cute little cocktail dresses every woman in the city has rather than the jeans I was kicking it in... people think you work at the restaurants. I got asked when I was walking back to the bathroom and was just "Uhh... no, just passing through."

Which, since NYC is expensive, might be helpful in picking up tips. Also, since a lot of these places charge 7 bucks for a Brooklyn lager, which I can get in 6 pack form at TJs for 8 bucks, I stand to make 34 dollars worth of profit sans tip. Hmmm...

Eh, prolly illegal.

Park Slope has some great brunch deals (like 4 dollar all you can drink sangria, which is a *great* idea), so did that with a big group this morning, followed by climbing up someone's fire escape to a HUGE roof space connecting all the apartments. Cue Dick van Dyke impressions.

Tomorrow, back to the hospital to present my SOAP notes and hope clinical skills has prepared me well. Problem is, the SOAP notes we did for physiology were pretty different, plus relied on a medical history (not psych) that was written up, not gained from an interview. The write ups we did for clinical skills were ridiculously long and involved questions that annoyed the doctors and made a patient interview take 45 minutes on a simple and focused procedure.

We'll see how it goes.

H1N1?

So I have the stupid flu. I don't know whether I have the stupid *swine* flu, but death doesn't seem too imminent, so I'm not all that worried, though it did mean missing a day of my psych rotation because I woke up feeling like I'd been beaten and the perpetrator had stuffed all my head holes with dead jellyfish.

Weirdly, due to the surprisingly interesting nature of this rotation, I'm less worried about my grade and more irritated that the new admit to our ward had promised some really interesting fireworks today, and I had to miss them because I was lying in bed or in front of our new (LCD!) tv playing the "drastically varying temperature" game with my fever.

Psych is... hmm... I can't say I want to go into it as a specialty because there's too many hopeless cases, and for criminal psych, I don't like people with antisocial personality disorder (who does?), but I can say the rotation is proving way more elucidating and fun that I ever expected. Nearly every day that I'm there gives me some new "holy crap, this patient..." story, and our attending is really good. He's a really good instructor and likes to give us sort of mini assignments rather than just pimping us, and then focuses a specific lecture around it the next day, largely geared toward the boards, but illustrating examples with memorable patients we've seen during rounds.

So never forgetting what schizoaffective, bipolar type looks like. It's uh... memorable.

The deal is that there are eight of us assigned to the hospital (up off Harlem, so kind of a gnarly commute from Brooklyn), and then we're split off into twos and assigned to different wards. My cohort and I had the good luck of being assigned to the acute psych ward, which gives up the weirdest cases and the best excuses for being late to lecture "sorry we're late, there was a woman blocking the door that was trying to grab us while calling one of the doctors many varieties of MF, and it took a minute to get her out of the way because everyone else on the ward was getting an extremely noncompliant patient down the hall so she wouldn't kick the social worker halfway across the room again."

It's a good program though, but the patient population frequently is from a criminal background and extremely difficult cases, so the rehab can be hard, but they have a whole series of classrooms in the upper part of the building called the "Mall" where patients are expected to report for classes that can teach them anything from art to activities of daily living, the latter of which has a kitchen to learn how to cook, a room they have to clean, lessons on how to apply for an apartment lease and how to open a bank account, so the ones that can eventually be discharged are able to function in society through a variety of community outreach programs, which is cool.

It also helps stimulate their minds, even for the patients that do need extensive inpatient care, and most of them really seem to look forward to it, so you don't get that "screaming in a tiny room at the walls all day every day" thing we saw in Grenada.

It's weird; because the hospital is such a "last resort" place, people keep asking us if we're surprised by it. I say considering what we saw at Mount Gay, it was surprising in a good way.

I think we are getting the chill rotation though, and our attending is particularly chill, so the hours are good, thus last Wednesday, after getting off at 3, we all met for the pre-Happy Hour in Manhattan, which was quite cool.

Oh, I'm going to have to turn in my first patient write up, which makes for interesting reading, since the patient goes extreme flight-of-ideas mode, so my write up included looking up what on earth ma'afa meant, as well as the word "bullshit", just like that, in quotes.

So, so far (except for the flu), I'm really enjoying NY and I'm really enjoying the rotation.

First week, check

So one week of rotations under my belt, and uhh... not so bad so far. Of course, I'm in psych, which is classically not one of the miserable rotations. I have friends that are already taking overnight call, inserting foley catheters, starting IVs, and getting seriously pimped, so I think I just drew the lucky first rotation.

I've been accounting for this discrepancy in hours by going out damn near every night. Can't tell you how much I'm loving NYC and its perpetual live music, fantastic food, copious well drinks, and festivals.

For psych, I have quite a long commute, since the psych portion for Brooklyn hospital, for us, at least, is at Manhattan Psychiatric Center, which is two subway transfers and a bus ride from where I live in Brooklyn to where it is up off Harlem.

On the other hand, most of what we're doing is "watching". There aren't that many procedures to learn in psych, except on the hypothetical. It all gears around the patient interview and knowing the meds patients are on, but otherwise, what is there for us to do? And the floor I'm on is the most acute psychiatric patient care one, so I can't really help with their work schedule by taking cases since no one's about to let a small inexperienced female medical student into a room by herself with a patient that hasn't been able to get along on the other floors.

It's interesting though. I've seen one patient that is showing remarkable improvement due to some pretty creative prescribing and House-ian thinking on the part of our attending. We have one patient that required five people to hold her down and still managed to tag a nurse pretty badly. Another patient, everyone's favorite, that they had me interview, which involved her ranting at me for about 10 minutes. I'm assured she'll probably cuss me out three or four times in our six week hiatus.

Today, I'm heading out to walk around Prospect Park for a while. Should be a blast.

I'm back, baby!

I love internet so much it consumes me. And though I love my little Blackberry storm because it enables me to not only look up all the stuff I don't know, but also to use my phone like a little GPS finder to locate the right subway, it just doesn't match the pure unadulterated joy of full screen, full access surf-mania. Ahhhhhh...

BROOKLYN! Like all the major changes in my life, of which there have been many, I was approaching the move to New York as if it were going to be some huge horrible thing where the second I got here, I was going to be apartment-less, followed by being tortured and robbed.

So, yeah... freaking loving New York City. The food is so good and the band schedule line ups so copious that I may never leave. I have a sweet pad and roommate (SGU!) in Park Slope, I'm surrounded by ethnic food, Italian ice, and organic grocery stores, and I live staggering-home-drunk distance from the subway, which weirdly, manages *not* to pass under my apartment and vibrate my walls.

In the slightly-more-than-a-week time, I've managed to do SO much stuff. Daniel and his Zipcar(tm) got me to and from Ikea so I could put my bedroom together without trying to cram 400 lbs worth of furniture onto a subway. The food here is SOOO good. Tonight it was cheap/trendy Thai food. Yesterday, it was home cooked turkey burritos courtesy of a collection from Trader Joe's. Thanks to Lori, it was Vietnamese food and french chocolates. It was organic veggies saturated with some sort of heaven-sent vinegarette. It's Mexican chili tea and iced coffee and microwavable naan, and and and. And wine. Lots of it. Good and varied.

Coupled with walks through Grand Central Station, Central Park, St. Patrick's Cathedral, and the East Village, and thanks to Lori, base of the Brooklyn Bridge, across the Brooklyn Bridge, city hall, courthouse, Ground Zero, Chinatown, Little Italy, Soho, Noho, Nolita, Union Square and mojitos and more. With guided history. And with Daniel, Times Square, Union Square again with bonus capoiera, the food carts that won the "Vendy" awards, Gramercy Park, the closing Virgin Megastore where I got the Tori Amos album and a cloth messenger bag for 35 bucks, Greenwich Village.

Not including the grand tour of Park Slope I gave myself simply by strolling around aimlessly while I did my freaking laundry. Used bookstores, parks, churches, old houses.

And the guy threatening to slit a cabbie's throat, and a woman smacking a car for cutting off a pregnant woman trying to cross the street. A thousand "give me money" subway announcements. An improv doo wop band on the M train that actually did manage to get some money because they made me smile. Cellists and guitar players and dobroists wherever they feel like setting up. Secret service-like men in black guarding the Armani store from the poor people. BBQs and border collies and old friends in Jersey. Sin City and Zinfindel.

And that whole med student thing. I started my psych rotation, and randomly got assigned to the most acute of the psych wards that they'd actually let medical students into, but the staff are incredibly chill, and the patients fascinating. I get a triple transfer hour long commute to get there, but that gives me plenty of time to catch up on my HP Lovecraft when I'm not perfecting my thousand yard subway stare.

Freaking... Love... It.

Not doing third year abandonment

Just woefully out of internet (most of the time) until next Wednesday when we can get it installed.

Quick summary: Brooklyn. Awesome. Roommate. Awesome. Food. Awesome. Trader Joe's in easy subway distance (if you don't take four subways in the wrong direction because you're me). Awesome.

I'm a fan. And already did a dry run to the hospital where I'm orienting, but going to head to Manhattan for my psych hospital dry run tomorrow, since it's considerably farther away, and where I'm starting out.

Girly crap

Thanks to realizing clinical rotations were starting and I pretty much owned *no* nice clothes save for a kind of weird patterned go go dress I got at Goodwill for three dollars, I had to engage in a two day estrogen-fest at the local mall for a day of clothes shopping, including *finally* buying a couple nice dresses so I don't have to beg clothes off people for social events, and a day of shoe shopping, while looking longingly at Spencer's Gifts.

Shoe shopping and I... ergh. My shoe shopping expeditions used to consist of going to Payless and picking out keds, wearing them out, and repeating. I tried for hipper shoes, but I was a pennyless teenager, so I occasionally was able to score cooler stuff from thrift stores. Then I got converted to running shoes, which I'd long associated with being part of the consumerist establishment, but like portable electronic devices, that was before I discovered how freaking awesome they are.

So my pattern until today: Go to New Balance store. Tell them exactly what I want. Have them bring out three pairs of shoes, from which I generally choose one, not particularly mindful of what it looks like, leave store within twenty minutes. Wear shoes for 1-2 years until I have destroyed them. Repeat. Expanded slightly for Grenada because I needed two pairs of shoes prior to going.

The last two days; however, I feel I've finally lived the "girl" experience of having to hunt down sales because nice clothes are frigging expensive, and then having to spend another day hopping from shoe store to shoe store in an attempt to find a nice, hospital appropriate shoe that remotely matches the crap I had to buy the previous day, isn't 80 dollars, and doesn't leave leather-strap induced ulcers all over my feet.

This is no easy task.

Being a former ice skater (I know), I was also confident in my strength of ankles, thus my ability to walk in heels without snapping off part of my fibula, until I fell off a half inch path at Aquarium for no particular reason and turned one of my ankles into a bloated Christmas tree first term, and now I'm all paranoid.

Shoe shopping seems to spark a very teenage sense of rebellion in me as I'm looking at my 17th pair of 'why the hell do we have to be going into summer and there are NO close-toed shoes' and as I'm passing the hipster shoe stores, I get a nearly overwhelming urge to just throw caution to the wind and buy a pair of stiletto heels that appear to be made of pink care bear fur, largely because they were probably the most hideous things I've ever seen, which made me want them. And, by the letter of the law, conformed to most hospital dress code policies, but would have likely netted me a nasty write-up about professionalism.

This is why I buy running shoes. And then run in them. But after a ridiculously long mall trip, and a ridiculous number of stores and sales, I have shoes for work and shoes for play. Oh, and shoes for *real* play, which are my beloved trail runners that I've had to shower cow/horse/goat crap off of on no less than three occasions. If my new nice shoes and clothes can survive a hash as well, I may change my tune.

Addendum, for those wondering why I'm shopping for clothes and shoes in Modesto when I'm going to be living in NYC, it's because in one of the three episodes of Sex and the City that I have ever seen, one of the sociopaths/main characters is having some sort of Sophie's Choice moment over a pair of 400 dollar shoes, so I became instantly convinced that to buy work shoes in New York, I'd need to supplement my student loans. And yes, I believe everything I see on television.