After a fun filled weekend of wine, flight, and sandboarding, we began our tour proper, meeting the remaining 2 members of our group as well as the rest of the tour and set off for our first destination, Puno

At 3800m above sea level, it was an introduction to high altitude living and our first real glimpse of peruvian culture

The hats the women are wearing are actually modifications on the english bowler hat.  Bowler hats have been worn by Quechua and Aymara women in Peru and Bolivia since the 1920s when a shipment of bowler hats was reportedly sent from Europe to Bolivia via Peru for use by Europeans working on the construction of the railroads. The hats were found to be too small and were distributed to locals who have since put their own spin on them

Admittedly, the style is not for everyone

The local supermarket

We wandered about the city, taking in a multitude of sights along the way, but mostly becoming adjusted to the altitude

After getting a feel for the surrounding culture, we started really exploring

The Incas, much like the egyptians and the celts also practiced mummification, although due to a lack of written records we dont know how or why. However, all the mummies whether noble, common, or sacrifices, have been found with knees drawn up in the fetal position.

Then we decided to sample some local delicacies, like this quinoa mousse cake.

Next up was some alpaca steak covered in fried quinoa and alpaca skin and sauca berries

A side order of yucca, or what we took to calling “jenga fries”

And finally the piece de resistance, Cuy!

Or as its better known in english, guinea pig.

Quite the mouthful!

Ending the night by watching some traditional peruvian dances from around the country

We also saw a band with a humongous pan flute

But as they say, size isnt everything, it’s how you use it =P

After a long day of flight and sandboarding, we opted to spend the evening on a tour of several wineries, starting with Tacama

We began to sample a number of wines

A rather large number

Our Guide on this winery tour went by the name of big willie

Quite the rascal that one

A couple of bottles later, we were ready to head on to the next winery. But not before we got our hands dirty learning about how wine is made

Or, more accurately, our feet

We stomped the daylights out of those grapes, while being given copious amounts of pisco, and even samples of juice from the grapes we had just crushed. Yes, we drank our own dirty foot wine

We may have gotten a little tipsy

But in the end, we took it all down, like a sir.

A short distance from Ica where we were staying lies the small desert town of Huacachina. I am not exaggerating when I say small, that is quite literally the entire town you see laid out below you. As resort towns go, it is mostly aimed at backpackers and mostly for one type of activity

Sandboarding. Like snowboarding, but hotter.

We all piled into the dunebuggy, Aytch offering to drive and kindly being declined and set off for the surrounding hills

Then we grabbed our boards, waxed up the underside and set off on an awesome few hours of sandboarding

Wheeeeeee!

A very good day indeed

What has two thumbs and is back from sabbatical? THIS GUY!

Yes, in one of the wiser decisions of my life (and I dont mean that facetiously), I took some time from the job search to make the yearly trip abroad with friends, this time to South America, where we were off to Peru. The next handful of posts will be about that trip, and by the time I am done, hopefully the last post will be about a job. But I digress. We landed in Lima, where we stayed just long enough to have lunch and then set out for a 5 hour bus ride to Ica, near the desert. It would be our staging base for the next two days of adventure before beginning the big tour.

New additions to the travel group this year are two of my oldest friends, aytch and andysensei. I have known these guys since I was in elementary school, and my first trip abroad with a friend was to Japan with andy nigh on a decade ago. So this ought to be interesting.

First order of business was to down a pitcher of Pisco sours, which were….well, okay, not great, but still fun. Then we set about planning our activities on the ground. But before that…

foreign playplace!

My enabler in mischief.

Our first decision was to head out and flyover the Nazca lines

The Nazca lines are a series of ancient geoglyphs located in the desert of southern Peru. Visible only from the air or atop the surrounding foothills, they were constructed with mathematical exactitude by sweeping aside the pebbles to reveal white gray ground underneath

The whale can be seen in the lower right corner

The astronaut

The monkey

Although discovered in 1927, the purpose of the lines remains unclear to this day. SOme scholars have proposed that they were meant to represent astrological data, constellations and planets as an early observatory

The hummingbird

others have theorized that they had religious significance and were meant to bring rain or other blessings to the harsh surroundings

The condor

hands

Still others have theorized that they were landing strips and welcome signs to extraterrestrials.

Above the hands and the tree you can see the highway running by and get an idea of the relative size of the lines. Though smaller than we had initially thought they were still quite impressive. We also got to listen to the pilot talk to us with unique peruvian slang…every other sentence started with “my friends”. 

Though no one knows their purpose, the lines remain quite prevalent around Nazca

Best. flyover. ever.

The job search is finally drawing to a close, and the hope is that I shall begin working as a hospitalist in the southern california area soon. More on that as it develops. In the meantime, I am blessed with the lovely lynn as my girlfriend, working on a few projects i had put off for far too long, and getting in shape to hike the inca trail in peru, my last hurrah before i begin working full time.

Not that you care about any of that of course, =p. So how about some medical comics!

cocci a common infection is pronounced cock-sai, for those of you not in the know. thats what makes this so funny

I will have to try this one

it’s true. I totally would do the same thing

ah cyanide and happiness…there must be at least one medical person hidden away in your staff

i do, too

okay that will do for this installment. keep laughing folks!

Hello dear subscribers

Those of you who have been following me for a long time know that in addition to traveling and medicine, one of the hobbies near and dear to my heart is food-cooking, eating, history, what have you. You may even remember ancient “cooking with Dr J” posts.

Well, I have now begun a new blog solely dedicated to my culinary exploits, be they at home or about town over at wordpress, entitled The Great Ingestion, a play on words from the Great Depression. It is coauthored and photogged by my lovely ladyfriend Lynn. 

http://thegreatingestion.wordpress.com/

Fear not, I have no intention of abandoning xanga, as I have put down roots here too deep to dig up. However, for those of you who enjoy reading my cooking and or restaurant posts, I encourage you to stop over and say hi-all the same writing style you have become accustomed to here, but with an emphasis on my fat-assery!

That is all for now.

-Dr J

Hello Again, internet.

It’s been quite some time since I checked in here, and even longer since I put up a travel post. So, in brief: I am finally out of my residency and in the midst of a job search. More posts on that when I have something worth reporting. In the meantime, I am going to focus on finishing up the Scotland Posts, and enjoying time with the new ladyfriend. Free of my residency at last, everything is coming up milhouse!

—————–

Years and Years of books and films about Scotland have taught me one thing; namely, no trip to Scotland is complete without a visit to the highlands, for in the end, there can be only one

 

so off Brian and I set for the home of William Wallace and the highlanders, with a brief stop along the way to visit one of the most well known residents of the highlands

Hamish, the Hairy Coo, the most photographed animal in all of Scotland

Friendly. Powerful. Dopey. These are all descriptions that immediately leap to mind at the site of these gentle, goofy beasts

Hamish is a single dad, with his two calves, Hamish Jr and I forget.

A couple veggies are all it takes to get their undivided attention

But we had to bid a fond farewell to Hamish and his fold as we set off for the deep highlands, where along the way we hoped to catch a glimpse of the Hogwarts express coming back from summer break

Sadly, either the express was not running, or the train was not visible to our muggle eyes

The highlands are covered in bogs, peath and heather. They are Magnificent, marvelous…

And incredibly, freaking cold. These mountains create hardy folk, and being a bit of a mountain person myself, I can vouch that you do not want to mess with anyone who grew up in these hills

On rainy days, this river turns into a raging torrent that weeps for the slaughter carried out on the highlanders by the british king Longshanks

however, even the greatest sorrow must eventually heal, and even the worst weather will pass

and without rain, there would be no rainbows

As the fog lifted briefly, we journey deeper into the highlands and deeper into mystery, to begin our search for one of the most infamous lost legends still around

The waters of the local lochs began to darken, obscuring what may lie beneath. This region is no place to go unprotected

so we paid homage to the fighting men of the green berets

They trained in the highlands, some of the harshest conditions imaginable to survive in

hope and blessings restored we continued on to the little town of Ness

locks at the loch enable ferries, and perhaps other things to travel uphill and upriver

The sun briefly came out, but the fog quickly rolled back in. A mysterious and enchanted place this was

The townsfolk pay tribute to their patron

The black waters of Loch Ness are 21.8 square miles across and 230m (755 ft) deep, deeper than the height of London’s BT tower

It contains more fresh water than all the lakes in England and Wales combined and the low visibility of the water is due to the high peat content

seriously. freezing.

Scanning every inch from bow to stern, looking deep within the murkey waters, our eyes strained for a glimpse of the fabled monster

 

The earliest report of a monster associated with the vicinity of Loch Ness appears in the Life of St. Columba by Adomnán, written in the 7th century.According to Adomnán, writing about a century after the events he described, the Irish monk Saint Columba was staying in the land of the Picts with his companions when he came across the locals burying a man by the River Ness. They explained that the man had been swimming the river when he was attacked by a “water beast” that had mauled him and dragged him under. They tried to rescue him in a boat, but were able only to drag up his corpse. Hearing this, Columba stunned the Picts by sending his follower Luigne moccu Min to swim across the river. The beast came after him, but Columba made the sign of the cross and commanded: “Go no further. Do not touch the man. Go back at once

A brief glimpse of the monster confirmed its existence, and though we gave chase, it slipped away in the storm. So Brian and I had no choice but to turn back, wondering if any would believe our tale. It mattered not however; we knew the truth. So we climbed back on our bus and returned to Edinburgh from the highlands

and watched as the sun set on another adventure filled day.

Big updates to cover in this post, so lets get started

First and Foremost, I am no longer a resident physician. The committee who originally placed me in my current straits once again met, reviewed my performance and evaluations of the last 6 months of my remediation and decided I had sufficiently overcome any deficiencies (at least as defined by them) and could be allowed to graduate early, not being required to finish out the full year of remediation.

So for those of you who have followed me since I was just Josh, all the way from a young pre-med, to an idealistic medical student, through the slightly cynical almost Dr J through alternating optimistic and burned out resident Dr J, thanks for being along for the ride and I step into my future role as a staff/attending physician. 

The last six months I have worked my ass off, trying to demonstrate to people I cant stand and have little to no respect for that I am as good or better than the arbitrary standards they have set for me…and i have DONE it. No one was going to shorten my punishment out of the goodness of their hearts, I have forced them to acknowledge me in the only way I can.

A few excerpts from the last several months:

“Dr. D demonstrates clinical skills expected at his level of training. I found his knowledge base to be at or above his level of training as well; most questions I posed to the interns on the team which they could not answer, he was able to do so. Managing his team of interns, he was prepared for attending rounds, aware of the plan for each patient, and provided requested data when interns were unable. When asked to identify deficiencies in the interns for me to address, his specificity regarding this assured me of his adequate oversight over them. His efforts to communicate with patients and their families provided them confidence in our service’s abilities. As an attending physician on R-service I will often receive 1 or 2 afterhours calls from patients’ families inquiring about a patient’s condition, which was never the case with Dr. D as the resident. He demonstrated commitment to teaching as well, focusing on various topics during rounds to review with the interns and, without prompting, volunteered to present an article. On one occasion, a patient of ours became unstable. Dr. D directed the stablization of the patient calmly and with focused attention until her transfer to the ICU. In the time I worked with Dr. D it was evident to me he had overcome the deficiencies prompting his remediation”

“Dr D once again performed in a stellar fashion on this rotation. His management of each patient was appropriate and measured. He was well aware of the developments in each patient’s case, and handled them according to standard of care. He triaged patients well and was able to prioritize work. His documentation was concise, but showed the appropriate level of detail.  Teaching residents and medical students is a priority to Dr D: he puts time aside to do teaching sessions. He actively listens to all team members and tries to take into account the feedback of junior residents and students. I personally elicited the impressions of other team members of Dr D: they felt that he provided excellent oversight, taught well, and respected each and every one of them. Several of those team membetrs highlighted the fact that in this rotation, they received a higher level of quality teaching at the resident level, than on most of their other rotations. 

At the beginning of the rotation and throughout the rotation, I had offered Dr D several minor suggestions. Almost immediately, he attended to each of these suggestions and implemented them well, even better than can be expected. He was very receptive to any advice give, and did not any time, show resistance to being re-directed. Dr D readily admitted fault when necessary; he never shrunk away from responsibility.As on his last rotation with me, he functioned at a level much superior to many that graduated from residency last June. He showed a capacity to function masterfully at an attending level. I strongly believe that Dr D has demonstrated mastery of all core competencies. I am fully aware of the deficits in the past that necessitated remedial work; in my opinion, Dr D has done signifcant and sufficient work to remedy these problems. Hence, I confidently recommend him for graduation as of December, 2012. Furthermore, I endorse his candidacy for gastroenterology fellowship.”

Now they can all just suck it. That said, while my candidacy for gastroenterology fellowship was endorsed, it was not granted. I had hoped, but held realistic expectations. Although I had matched once into this program, the unfortunate reality is that GI is one of the most competitive fields to enter, and I had been amazingly fortunate to obtain a position the first time around. This time, I had no additional research, minimal updates to letters of rec as I could not exit my home facility to do electives, and a black mark against my name from being on probation that anywhere I applied would see. Almost, it is like checking off being an ex-convict on a job application-companies will look, but nobody really wants that risk around their office.

And so, I have achieved half my resolutions-I forced them to allow me to go in time to prepare for a GI fellowship I shant be getting. At least this year. I will take time to think if I wish to reapply yet again with all the baggage attached to my name now, or If i rather will enter the workforce, and begin my practice as a outpatient doc or hospitalist, start repaying my loans and living the life the universe has deemed fit for me.

While the whole situation has been terribly frustrating, I at least have the knowledge that I did make it once…ergo, I’m good enough, I’m smart enough, and gosh darn it, people like me! 

My official date of graduation is Dec 31st although my clinical duties the remainder of the month are mostly restricted to a couple clinic days and administrative educational activites. On Jan 1st, I begin the new year as a new doc, a new person, and who knows, perhaps we will cross paths one day. That said, the adventure will continue as I learn my way through the recruitment process and the first fumbling steps of a new attending, and I hope you will all still come back for regular visits with this virtual doc

-The Real Dr J

I’m a scotch fan. It’s true, I said it. Back in my younger days, couldnt stand the taste of beer, much less brown liquor. Then, on my entry into medical school, I suddenly found the incentive to drink. And the universe provided me with a wonderful teacher, one of my closest friends, Jayan, who tragically, is now deceased. One of the last gifts I received from him was a bottle of Aberlour 12 year single malt liquor. And my drinking life changed forever. 

So of course there was no way I was going to go to Scotland without partaking of the national drink!

Prepare to have a Scotch Whisky Experience!

First we went on a pirates of the carribean style ride in a whisky barrel, learning about the distilling process and signing yo ho yo ho, lets drink some whisky!

This was my favorite room on the ride.

After a brief tasting (to be fair, though brief, it was already the 4th tasting for us of the morning, and we were perhaps a little tipsy-hence lack of detail in these posts) we went on to see one of the largest scotch collections in the world. Please brace yourselves

Headless Monk Scotch on the right…

Golf Scotch center

The oldest bottles in the collection, almost entirely evaporated to the Angels

Yes, I drank all of that

And might have believed that barrel was also full of scotch, or that I had developed super strength. Things get hazy at this point, but use the redness of my face to light your way home

I spent about 300 on Scotch to bring back with me, including An Noc Peter Arkle limited 1st edition, Mortlach Flora and Fauna and Ben Riadh 15 year…all single malts, all difficult to get outside of the UK and all delicious. They have been added to my current collection which also includes the standard Aberlour 12 year, Lagavulin 16, Ardberg 10, Cutty Sark, and The only blend in my collection, a bottle of Johnny Blue.

Other adventures were had that day, but with the warmth in my belly and the smile on my face, I have all the memories I need.

Slainte! (pronounced slan-ja) to all of you, i’ve inspired myself to have a glass of scotch before bed.

That right there is my family Coat of Arms. Pretty sweet, right? But what is a coat of arms?

Well the introduction of armour in the twelfth century made it essential for knights to wear appropriate colors or markings by which he could be recognized on the field by friend or foe. Since the use of armour and heraldry became widespread in Europe, there was danger that two or more knights might choose the same identifiying symbols, and so to obviate the confusion, the sovereign appropriated the right to approve the particular distinguishing marks to be used by those entitled to display a coat of arms. Therefore the right to use specific and distintive devices became a mark of nobility or honor in the realm

While in Scotland, located at Edinburgh Castle, Brian and I came across a herald who had a large logbook of family crests and coats of arms, so on a whim we decided to see if our family was registered as I had been told often by my parents as a child that we come from Russian Nobility. As it turns out, we do! 

The shield is in red, representing fire and fortitude, depicting three scythe blades issuing from a rose in the center all done in silver which stands for peace and nobility. The scythe expresses the hope of a fruitful harvest of things longed for and the rose, reckoned the first among flowers is held to be typical of beauty, grace, and hope

The crest, shows a knights helmet representing wisdom in defence and is topped by a ducal coronet denoting royal or seigniorial authority in gold, the color of purity and valour. Rising out of it are a plume of five ostrich feathers signifying willing obedience and serenity, also done in silver

The heraldric supporters are two bulls (my zodiac sign is Taurus-score!) which represent valour and magnaminity

The family motto is Nichevo which roughly translates as “Let things take their course”

This discovery came at a perfect time and really touches some important notes with me. I have some blue blood, apparently associated with bravery and serenity, family values which are right in line with my history of risk taking and remaining calm under pressure, I can be magnanimous as noted by my very own zodiac sign who is my heraldric supporter. 

I am slightly less thrilled about my family motto although it is still very appropriate. I had hoped for a badass family motto, like never say die, or strength in all things. Instead, Nichevo is a uniquely russian word that translates as “let things take their course” or “it cant be helped” or basically “shit happens”

A family motto to me means something your family can draw on in times of hardship, reminding you from where you came, where you are going. Mine is basically a shrug. When the going gets tough, …eh, it is what it is. 

The more I thought about it though, the more I realized that like it or not, this is exactly what most of the men in our family have done. My grandfather, My father, Myself, we are not big complainers. When faced with challenges, we tend to carry on as usual and let the universe sort itself out. This doesnt mean we dont constantly work to better ourselves, but that we acknowledge we can only change ourselves, not our circumstances. 

Thinking back to my work drama, I have lived this motto wholeheartedly. The decision to hold me for probation and all the the chaos that ensued was never in my control. Not the length of time, not who I worked under or with, and not the terms. I was angry, and depressed, and the more I struggled and fought the situation, going to lawyers, counseling, bitching nonstop to friends or online, threatening to leave medicine, the less things changed. When I simply accepted that I couldnt change my circumstances but could work within them, I ended up rediscovering my love of teaching students and interns, becoming a more careful and meticulous physician, and getting some of the best evaluations I have had in the entire residency. I still dont care for my hospital, but when I just let things take their course, everything solved itself.

So although my family motto may not be as badass as I hoped, it taught me that since 1413 my ancestors have bred an impressive equanimity into ourselves, and if I tap into that family faith in the universe, things will be okay. Trouble may often come to call, but that doesnt mean it has to stay

SO the next time I have drama or problems, I will look at this over my desk, throw up my hands, and say “nichevo”

After all, it’s in my genes.