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Subject:Reflections on 2013 & my rather pedestrian goals for 2014...
Time:09:52 pm
So comes time to reflect on things that happened in 2013.  I'd say it was probably the most eventful year of my life...  though oddly enough looking back it's all seem so... unexciting.  But I guess that's a good thing!  At this point in my life excitement is usually a bad thing  :P

Furry-wise, I still managed to get plenty of con-going in.  Furry Fiesta, FCN, AC, Condition, WPAFW and MFF.  All good times.  Even got to visit friends in California, Texas, and Ohio plenty of times in out-of-con settings.  Can't complain.  I got a new partial fursuit in Sydney and got to dress him up a couple times.  Jaggsie got a face makeover thanks to Jill0r.  My online activities have pretty much been limited to Twitter and journals.  Not a big change.  Haven't really done anything significant artistically inna long time.  Hard to justify such a use of my free times...

This year saw me finish residency, take my written boards, move, and start a new job.  Also made some major purchases in a new car, a house, and the used car I've talked so much about (an orange Hummer H3 in case you're wondering.  I know what you're thinking.  Its okay no need to say it, I already know...  :P )

On one hand I kinda can't believe that much has happened in one year.  Doesn't feel like that much has happened or changed...  :P

Got to spend plenty of time with my family.  Went to Banff, and got to spend my birthday and Thanksgiving home with family.  Though I wasn't home for Christmas for the second straight year, I got to have an early one a week early, and for the holiday itself got to spend it with a friend's family...  which meant alot to me.

Sadly I get to spend the last day of this year on call in the hospital.  Ohhh well.  Overall my job has been kind to me, and I can't complain too much.


I think the theme for 2014 will be to get things in order, and to figgure things out.  Nothing too exciting, but important.  I gotta try to pay off these loans I've acquired in 2013, and hopefully position myself to be able to by my long term home in a few years.

And I have to figgure out where I want my long term home to be.  Need to figgure out if this job is the one I want long term.  I can say right now the benefits outweigh the negatives...  but the main negative is I feel lonely and isolated from friends and family sometimes.  Can I go on like this and settle for intermittent visits for the rest of my life?  Planning to move a little bit closer to people once this lease runs out, so hopefully that'll help.  I at least have a goal in mind for where I think I'd like to live some day.  Probably won't figure it all out this year, but I will have to eventually...  The rest of one's life is a long time...  (well in my case, at least I hope so!)

Hmmmmm, what else do I gotta do.  Prepare for and take and pass my oral boards.  Also renew my contract with the group, and hopefully become a partner (if I decide that's what I wanna do).

Furry-wise, planning to go to FC, BLFC, new-FCN, AC, and MFF.  WPAFW, time permitting.  Excited about the new ones I've not been to...

And of course, the usual commitment to stay in touch with my closest friends, and visit friends and family as much as I can.  Be the guy that lives far away and visits from time to time...

So... I don't expect anything drastic to change this year.  Just keep doing my thing, I guess!
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Subject:One week, 2 days in... happy, for nowsssssss
Time:08:14 pm
So I've been at my new job for a week and two days now... I figgure now's a good time to revisit thoughts, and open up my worries about tomorrow...

Basically my group rotates through three different hospitals in the area, one big one, and two smaller hospitals. So far I've only been at one of the smaller ones, then I'll go to the other one for awhile, then finally the big hospital, and ultimately rotate through them all.

I have to say my first several days have gone really well. I've yet to have a bad day, and I think that I've picked up on things pretty quickly. Waking up quite early, like at 5:15 AM, but there's been days where I got out at noon. Today was my longest day, with me leaving at 4 PM. Pretty amazing that 4 PM feels late to me now, considering that I was working 80-100 hr weeks as a resident.

The atmosphere has been great, and I honestly feel like I've left a pretty good impression on the staff. Its pretty often that a nurse or anesthetist that works at that hospital full time says they hope I end up working at this hospital the most. Its pretty flattering to be treated like I'm wanted. Everyone seems to respect each other, and the doctors are treated especially well. I guess that's the benefit of not being a resident anymore. I'm so used to being bottom of the totem poll, its odd being treated so well, and being expected to do so little. There's certain advanced things only I'm allowed to do, but otherwise its alot of supervising other people do all the basic tedious stuff. And if I do help with something like putting an IV in or something, people are all thankful and stuff.

I do have to do alot more talking to patients though. Kinda feel like that's more my job now, talking to patients, nurses, and making decisions, and telling other people what to do. Fortunately I think I actually have a good bedside manner, so that's cool I guess. Have to admit there's an element of missing being in the front lines, getting to do everything myself... but I guess I'll just have to get used to a different role.

Mainly I was ecstatic just realizing that I could actually be good at this job, and be happy too. My biggest fear was wanting to quit after my first week, but so far so good. I could imagine myself doing this the rest of my life. Each and every day feelings of boredom have started to creep in, but I guess that's not necessarily a bad thing. And I know there will be plenty of excitement and fear to keep things interesting in the future.

Tomorrow I have my first day at the main hospital. Feeling anxious cause its a new place, so I'll have to get to know everything again like from scratch. Heck, I don't even know where the locker rooms are, and I'm going there tomorrow with a full slate of responsibilities. They do much bigger scarier cases there, including trauma, heart surgery, etc... and eventually I think they hope that's where I'll spend most my time. So there's still the potential for disaster happening to my happiness with this job. Also, I hear consistently that this main hospital has a more malignant atmosphere, compared to the friendly small-community feel I've had the past week. I really really hope its not too bad, cause I don't work effectively or happily in hostile environments.

*sigh* Guess we'll see.

My backup plan if I hate this hospital, once my contract comes up for renewal next year, I could insist on only working at the place I like or else I'm finding another job. So as of right now, that's my long-term worst-case scenario. That's still loads better than my "I'm quitting this career and going to veterinary school" worst-case-scenario from just over week ago! :P

One step at a time. Next week I have my first overnight call, my first weekend call, and also go to the 3rd hospital for the first time (which has been described as being an average of the other two). So.... more opportunities to have second thoughts about my future...

Nonetheless, so far so goood....
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Subject:A Jaggers life update...
Time:03:25 am
Current Mood:pensivepensive
Had a nice AC, then had a nice vacay with my family in the Calgary and Banff area. Spending some time with my family, with fibre  fibre, and doing alot of studying for my Anesthesia written board exam next Monday.

Things don't slow down from there. Fly back north the next day, then have to get my computer training done for my new job the day after that. Then I got a lil over a week to get settled at my new place, do all my significant moving, and try to get physically and mentally ready for my new job.

Start date is Aug. 12th. Kinda scary and exciting. Mostly scary. Not sure exactly how I'll take to the changes, or what to even expect. I won't have to answer to anyone anymore, but with that comes the responsibility... ALOT more responsibility (and liability, which is scary as hell). The 6x increase in my salary will be nice, so will be the 2x increase in my vacation time... more if I stick around long term. The day to day will HOPEFULLY be less strenous as it was as a resident (though I'm not lettings myself get too hopeful about that). But all that has gotta come at some kind of cost.

It remains to be seen if this will be my long term job. I'm hopeful it'll all work out nicely for me. But who knows.

The hardest adjustment, and quite frankly the one I'm dreading the most, is moving away from where I've been comfortable and happy for the past 4 years. Without going into too much personal detail, I've been blessed with good friends who've made the past few years much more fulfilling than it otherwise could have been. I feel sad knowing that soon I'll be moving away... even if won't be very far.

I wonder to myself sometimes what my purpose is, what my goals are. They certainly don't involved kids, and very likely don't include getting married either.

Aside from the material things like a good job, financial success, a house, a kayak, and a few luxuries here and there, I think I should focus most my out-of-work energies on my relationships.

At this point of my life I'm happy with non-work friends that I have. Most of them are furries at this point, and that's A-okay with me. I've enough "normal" in my life.

I plan on making the most of the extra time I got spending it with my family back home, and with the close friends that have enriched my life these last several years... and of course, mixed in with that valuable time for myself.

I'll still be attending cons regularly, of course. But I don't intend for that to be my primary means of keeping in touch with my friends.

Where will I be 5 years from now? Maybe in the same place I'll be come August. Or maybe 60 miles down the road. Or maybe the next state over. Maybe Canada. Who knows, maybe in 10 years some place completely different again.

One thing I know for sure is I have to keep the important people in my life close, if not physically, at least in the heart.

I think having achieved that, I will have had meaningful life... regardless of how many kids I didn't have, or how many fursuits I've collected :)
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Subject:MEOWMERRRRR!!! (just some thoughts, auto industry)
Time:01:49 am
Nothing exciting. I somehow managed to sleep all day and now I'm awake and not sure what to do with myself!

So went to a flea market today, then did some final cleaning to my Camry to get ready for trade in. Went to a Thai restaurant for lunch and ate yummy things.

Those who know me well know I've been all waiting and excited for my new car to arrive. No I did not buy a Smart car. That post was completely fictitious, made for my own amusement.

Estimated arrival date was supposed to be April 7th. Finally decided to just call the dealership to get an update. They finally connected me to the manager and he initially told me the car would be arriving "momentarily". But then when I asked him if that meant I could come get it today, he was like oh wait, its not actually getting here til Tuesday. Oh, and it so happens that Jimmy (the name of the sales man I made the deal with) is getting back from vacation on Tuesday as well.

Not long after that phone call I get a phone call back from the manager and he says something like "hey, I was just wondering if you guys could come on Monday instead". Then there's an awkward silence, and he realizes that he accidentally called me.

I'm not sure exactly what it means, but I have a feeling that my car was supposed to come today and when he realized that "Jimmy" was the guy who sold me the car he told me it wouldn't come til the day he got back from vacation. And then maybe went so far as to delay the delivery in case I decided to show up and take a look for myself (which I did intend to do).

I wouldn't have minded waiting for my sales man to come back. He deserves the commission, and I would happily wait til Tuesday. I'm sure there'd be paperwork issues too. But I don't understand why it's necessary to unnecessarily lie to me? I'm pretty sure that's what happened.

Is it just me, or does pretty much every business related to the car industry have a strange fetish with lying and trying to cheat people? Why did Dollar rental car charge me a $25 "service fee" for the $1 toll I owed in Florida? Why did the lady at Hertz lie to me and tell me ALL THE SUVs were gone when I'd made the reservation for one, and that she could give me a mini-van instead (one eventually magically became available when I complained, and when I went to get it there were TONS of SUVs sitting there). When an alert in my Camry came on because of the gas cap needing replacement, why did the guy at the auto-shop tell me much more would need to be replaced than the gas cap?

Seriously, I'm not stupid. Just tell me the freakin truth. :P

Anyhow, so now I have to wait until at least Tuesday to get my car. RIGHT before FCN. I'm going to have to sneak out early to make it happen on Tuesday. Uggggh.

When I got home from lunch I made myself another lunch. Watched Hunger Games on Netflix, which I admit was better than I expected. Then I fell asleep on my bed for like 8 hours or so. Not sure if it was from being knocked out from all the food I ate at once, or from fatigue, or the emotional blow of disappointment. Probably the food. I'm not that upset, just annoyed.
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Subject:Actual serious post: future thoughts, emphasis on optimisms
Time:08:36 pm
If you pay attentions to me here and/or on Twitter, you've probably noticed a healthy serving of anxious and pessimistic things I might say.  Alot of it is mostly true, but its also largely a side effect of me using the internet, and furry in general, as an outlet to let out stem, as as much as a recreational source.

I figure it'd be nice to post some of my thoughts on the future, with focus on the optimistic and good stuff.

I'd also like to use this as a way to communicate, especially to my closest friends, what my plans are for the future, without necessarily having to trouble them with bringing up these topics in person.


When it comes to work, I'm pretty much in cruise control at this point.  My residency ends at the end of June, and aside from a few loose ends to tie up, I'm pretty much ready to move on.  My personal assessment is I think I've done a very good job the last few years, and I think I'm going to be good at what I do.  I think I have the skills, physical, mental, and interpersonal, to be confident I have a great chance to be excellent at my job.  I truly believe this.  The deficiencies I have I have plenty of time to work on, and I've proven to myself that I'm fast at learning.  Alot will come with experience.  Even though I often comment about it, I honestly don't regret doing what I'm doing.  I'm optimistic that when I retire I will have no regrets, and I wouldn't have done anything significantly different.  I wouldn't give up this job for any other job in the world (that I was capable of doing).

In August I will start my new job.  I chose a potentially more difficult job, which has its obvious pitfalls, but it'll test my abilities, and I will learn alot from it.  I'm not moving too far away from where I am now.  That was one of the biggest questions was where I would end up.  Ultimately I knew I had to be close to either friends and/or family, so it ended up being between Ohio in Texas.  The reasons are multi-factoral, but I'm happy that I'm gonna be close to my friends up here.  I'm truly sad that I won't see my family and friends in Texas as much as I could have, but I should have a decent amount of vacation time to still go to cons, and more importantly, visit home often.

One of the big pluses with this job is its only a one year path to partnership.  The first year I am strictly salaried.  After that, should they choose to keep me, they will offer me an equal partnership in the group.  That is an awesome situation to be in because I'm looking at this first year as a test drive.  If everything works out great, I like the group, they like me, and I'm happy living in that city, then I get to become a partner and my future will be bright.  If not, worst case is I got good experience, learned alot, I'm not committed to stay, and I'm free go find something better.  So the potential is still there for me to move to a happier location.  So I still got alot of flexibility on my side.  That's a very good thing.  The main thing I'm trying to communicate to everyone is this is not necessarily a permanent thing, all my eggs aren't in the basket just yet.

As long as things go as planned, the increase in my income will be a wonderful thing.  I know that money can't buy happiness, but I know that financial security can.  Being able to splurge here and there will be real nice.  Unfortunately I don't really have a dream car (if anything I used to want a yellow hummer... which you can't get new anymore), but I'm really really excited about the car I'm having built.  It was pretty much love at first sight, and I got to design it exactly as I wanted.  Super excited.  Also its kind of my reward for myself, and kind of symbolic of the fact that I've made it.

The other thing is I have no plans to get married.  I'm not going to have kids for sure.  Aside from my coworkers and my patients, my true family will be my parents, my sisters, and my friends.  I hope as long as I am alive and capable, I can do right by them.  I'm willing to make sacrifices if necessary to achieve that end.  I suppose for me that's the most noble thing I can achieve in my life.  Do my job well.  Be a positive force in the lives of the people I love most.  That's all.  I'm under no delusion I'll make any difference in the world as a whole, that's something reserved for the truly brilliant, or the truly altruistic.  And trust me, I (and I doubt any of you), are either of those things.

I'm in pretty good health.  I'm not thrilled about 30, but I'm glad that I'm healthy as I am, and so long as I can, I intend to stay this way.

So... all in all, things are looking good!  Furry Fiesta was largely a failure for me, but I'm looking forward to FCN, and I'm looking to seeing my friends there.  And I'm looking forward to many many happy experiences with my friends for years to come.  I'll always be here for you, in one way or the other.  Please don't forget that, even when it may not seem that way.  I'll try my best to remember it too...
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Subject:Life Update - Furry and Real Life
Time:09:57 pm

Looking forward to going to WPAFW in Pittsburgh next weekend for the 4th straight year! Primarily looking forward to local eats, the mini road trip, the BBQ, and the charity auction thingie! marymouse  marymouse, mintzbuck  mintzbuck, and scardykat85  scardykat85 will be there. You should be there too!

I'm planning to go to FCN 2013. That's my top priority for next year cons. AC 2013 should be good for me to cause that'll be happening right after I finish residency! Unfortunately MFF is an extreme long-shot for me. Furry Fiesta is also on the bubble. I'm thinking 50% chance I'll be there. I just don't see having the vacation for both it and FCN... :(


Mind is focused on two things right now. First is my future job. Unfortunately I can't seriously plan for anything in my future until I know where I'll be living next year. I've pared down the places I'm seriously looking to Central, East, and NE Ohio, and NE and SE Texas. I've been on 3 interviews so far. Monday I have one in Youngstown, and next month I got 2 in Dallas. I'm expecting to get an interview at a big group in Houston later this year. I hope other interview offers will trickle in, but I'm satisfied with what I got so far. Looks like most these places have second interviews, and I can't expect any serious offers til January or so. *sigh*. So much is out of my control.

The impression I've gotten is the market is very competitive. Especially the kind of practice I'm looking for. If I had to wager a bet, I'm guessing I'm gonna either end up in Youngstown, or accepting a less-than-ideal offer in Houston. We'll see... maybe the evil empire Houston group won't be as hostile as I've heard... or maybe one of the more desirable groups will make me a good offer? I can only hope...

As of right now I'm not seriously looking at any other locations. Not enough time and energy. I've got some recruiters persistently trying to get me to check out random groups in places like Michigan and Iowa. No way!

Second thing on my mind is I need to make sure I'm ready to pass the Anesthesia boards at the end of July next year. Study study study. So hard to do when there's so much other things to do. Such as work itself!

That's about it. Yep my mind is being boring these days.
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Subject:I evolve in a week... and what's in store for the year...
Time:12:04 am
On Sunday I am on call. Like a Pokemon, I will evolve into a CA-3 (Clinical Anesthesia Year 3) on that day. In other words, it'll mark the start of my fourth and final year of residency before I become ready (in theory) to be a full-fledged attending.

Kinda scary. Hopefully I'll learn many new, more powerful, moves this year, to kill all those annoying Lapr-asses that think they're so cute.

Lots of things will be happening this year. Things I have to accomplish. Furry things I have to do mixed in. In many ways this will be the most important year of my life.

- I'm going to kick off the year by using up half my vacation days to take two weeks off in July. Gonna be going home for most of that time. I'll have to take advantage of time with the family since I won't really have any other chances this year. Gonna go to a resort in Cabo San Lucas with my parents for several days during that time. That should be nice. Get away from everything. Get away from the country. I haven't had a vacation with just my parents since we went to China over 5 years ago. I'm looking forward to it...

- after my trip home marymouse  marymouse and I are going up to London, Canada for a weekend to go to Condition: Blue. She's the GoH! Just gonna be there Friday and Saturday night. Probably gonna bring Jaggsie. Looking forward to just hanging out. Gonna see lanakila  lanakila there. Not sure who else I know that will be going! :P

- I would LIKE TO go to the NEOFurs picnic this year... but IS IT EVEN HAPPENING?? I haven't heard anything!

- I'm gonna have to ramp up the studying to make sure I pass my boards in a year. Not good to not pass that :P

- I'm gonna have to start looking for job openings. And go to job interviews and stuff. This'll be the first time I've ever interviewed for a REAL JOB. Ideally by early 2013, or even late 2012 I will have offers and be able to make the VERY HARD decision on what job to take. I'm not sure how choosy I'll get to be. I could go for pages and pages bout my options, my hopes and dreams, but that's a journal for another day...

- In September (28-30th), I plan to go to either WPAFW in Pittsburgh, or Furlaxation in Columbus. Unfortunately they scheduled them the same weekend. Which I choose to go to depends partly on the weather, and partly on whether or not Furlaxation looks like it'll be worth passing on WPAFW for...

- UNFORTUNATELY I am going to be in the ICU again in November. This pretty much means I will be missing MFF this year (even though I desperately want to go). It also means I'll be away from home on my Birthday and Thanksgiving for only the second time ever in my life... Needless to say this will be a very cranky month for me.

- I already know I'm on call on Christmas this year. So, first time in my life away from home that day. It'll be a pretty miserable holiday, I'm already anticipating. At least I won't be alone on Christmas. Probably less depressing to be working than home alone :P

- Planning to go to Furry Fiesta again in February =) Might even take the whole week off again and attach a vacation to it. Not sure what yet, but that's the plan for now!

- HOPEFULLY can make it to FCN in April. Even if just for the weekend. =)

- Will graduate from residency at the end of June 2013, one year from now! HOLY CRAP!

- I was ecstatic to find out that AC 2013 happens over July 4th weekend. Since I'll be fresh done, I should be able to go to the whole thing without using vacation, in a joyful mood, and looking forward to the future! It'll be like FWA 2009 all over again! =)

- after that it'll be STUDY STUDY STUDY for the Anesthesia Board Exams at the end of July...

- What happens after July? Right now I have NO FREAKIN' CLUE. I can only imagine things. Will have to figgure that out. Right now its scary to look that far ahead. But exciting too...

Anyhow, one thing at a time. For now, focus on evolving and learning Leaf Blade... Lapras thinks its so freakin' cute
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Subject:Why I actually like my job (or at least don't regret it)
Time:12:31 am
this is a followup to this post


robypanther  robypanther had asked me "as a potential pick me up and becaus I'd be interested, try typing up a similar post for what you do like about what you are doing, and where you see the future taking you."

I kinda never felt in the mood to do it, but as I got this weekend off, with AC coming, maybe I'll be up to it!

One thing to note was that particular journal was about working in the ICU specifically. This is not what I intend to do with my life, and after I finish the last two months I have to do before I finish residency, I intend to NEVER spend any time there again.

My plan is to be an Anesthesiologist. NOT a critical care doc. NOT a chronic pain doc. Those are sub-specialties I hate that we have to rotate through them as residents, but once I'm done I'm done. So no worries, I might complain like there's no tomorrow during those months, but that's not my future.

I don't imagine most people really understand what the heck an anesthesiologist is, so just read this if you wanna be bored. http://www.anesthesiazone.com/anest.....formation.aspx

Or just look on wiki. :P

I often say I wish I went to veterinary school instead. Because animals are so much more pleasant than humans. But in all reality, if I could do life all over again, I probably wouldn't change a thing.

Yes, residency is hard. I work REALLY LONG HOURS. But there's light at the end of the tunnel. Just one more year and it'll be better. There will always be miserable moments. That's true for all jobs. But in the end, no regrets. Or at least I hope!

Reasons I like my job:
(notice alot of them are the exact opposite of my previously listed reasons for hating the ICU!)

No Continuity of Care - every day you have a new set of patients. You get them through surgery, you make sure they're fine immediately afterwords, then they're no longer your responsibility. Most importantly, no rounding!

Doing Things Myself - I hate giving nurses and other staff orders and having to count on them to do it. Its so inefficient. In the OR, if I decide to do something, give a medication, or do some kind of intervention, I just do it myself. Of course this may change if I join a practice where I have to supervise CRNAs or residents, but if I'm lucky I'll find something where I get to do MD-only cases.

Procedures - doing procedures is fun. We get to do lots with our hands (without having to be surgeons). Its very satisfying to accomplish things with your hands. Spending most your career talking to patients, thinking, writing notes, and ordering tests, like primary care docs do? Not so much :P

Job Security - sure I could always do something REALLY STUPID and lose my license, but people will always need surgery, and people will need anesthesia for it. All them baby boomers are getting old. Its one of the few jobs out there where demand continues to grow. That's a very reassuring thing...

Financial Security - if I were in it for the money I would have been a lawyer or gone to business school. Going into medicine for the money is stupid (unless you do dermatology). At least money can't be the primary reason, because that alone does not make it worth it. But as long as you have other legitimate reasons do to it, the paycheck becomes a very nice icing on the cake.

Respect - people generally respect doctors, and that comes with some nice perks. They tend to assume I'm smart and hard working and moral, and all that good stuff. Haha, if only they knew what I did on my free time...

Sense of Purpose - much more gratifying than what other people think is the feeling that I can make a profound difference in peoples lives day to day, maybe even help save a life from time to time. This isn't to say you have to do what I do to make a difference. But for me, its the best I got. I won't ever have kids. I don't even plan to get married. So in some weird way, even though their strangers, the patients fill some of that void. There's something special about taking such direct care of patients when they're at their most vulnerable, not just when their anesthetized, but immediately before or afterward. I see patients from all walks of life, all ages, all races, all sorts of different personalities. They're often at their most helpless, most terrified, moments in life. My goal is to get them through it, emotionally and physically. That takes a combination of skill, good bedside manner, and mental fortitude to do well consistently. ... oh, and full access to all sorts of powerful IV medications helps too... ;) In the end, it can be a very satisfying experience.

Scrubs - finally, scrubs have got to be one of the most comfortable work uniforms you can find. That alone makes it worth it. Now, if only I could get them to approve the wearing of fursuits in the OR...
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Subject:Lookit new fursuit!!! =) =) =)
Time:09:06 pm
sophiecabra  sophiecabra did such an awesome job bringing one of my characters to life, yet again! Very happy with how he came out!


Plan is for him to be hanging out at AC =)

reference art by marymouse  marymouse


original Furrimon design by me, just a lil over a year ago!


For some insight into his character and stuff... if you are curious :P


I have an idea in my head how I envision him being... though I dunno if I'm gonna be able to act like him effectively. We'll see... Worse case he's just too overwhelmed with AC and just stands in the corner of the convention hall the whole time =)
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Subject:Why I hate what I am doing right now...
Time:10:56 am
About 6% of critical care physicians are Anesthesiologists. Otherwise the vast majority are trained in primary care specialties like Internal Medicine and Neurology.

There are many kinda of ICUs. Pediatric ICUs, Medical ICUs, Cardiovascular ICUs, Neurological ICUs, Neonatal ICUs...

In general a critical care anesthesiologist works in the Surgical ICU, taking care of patients who had surgeries that are too sick or dying to go the the regular hospital floor.

An Anesthesiology residency is 4 years long. I am about to finish my 3rd year. After those four years I could do an extra year of fellowship to subspecialize in something. Critical Care is one of those. I absolutely have not interest in it or any other fellowship. Unfortunately, we still have to do 6 months of critical care during our 4 year program. Right now I'm in my 4th month of it.

One could argue these 6 months are the most miserable of my life. It represents so much of what I hate and want to avoid in medicine. I went into Anesthesiology because I like doing procedures, I like being in the OR, there's no continuity of care, no clinic, and I don't have to deal with the the crap I hate about inpatient medicine.

But the ICU... its so much of what I hate the most:

Rounding - Every day I show up at 6 AM or so to get sign out from the person that was on overnight. This is when you find out what disasters happened overnight are now YOUR problem for the day. Then you scramble to see all your patients. At around 8 AM the attending shows up. You spend on average 4 hours seeing every patient, writing a note, and coming up with the plan for the day. At least once or twice you contemplate suicide. Later in the afternoon you do it all over again. At least afternoon rounds are quick.

Continuity of Care - Some people love getting to know their patients, seeing them over and over. I hate it. I want to be done with a patient, move on to another, and never worry about them again. In the ICU you come back to the same patients over and over. I hate going home and worry what will happen to a patient while I'm gone. Again, so people dig it. For me, its emotionally exhausting.

Disasters - For every 3 or so patients that have a normal short course in the ICU, you get a disaster patient that is so sick its a miracle they're alive. But thanks to medical science you keep them from falling over the edge. But at any moment they could tip in the wrong direction... its kinda stressful.

Hopelessness - For every 2 or so disasters that make it through, you have one that is pretty much a hopeless cause. Maybe you keep them alive. But they're gonna be on the ventilator forever, they're going to be on continuous dialysis forever, they're going to be on pressors forever, etc etc. Its inevitable that they're gonna die. You can extend their life a good long time, you can put days of work into them... but their demise is inevitable. Or at best, they're be in a terrible state for the rest of their life. Either way, its not gonna be pleasant... not for them, or for anyone...

Families - For every 4 families that are a positive presense you get the terrible family that's completely irrational and a terror to talk to. Even worse when you have an awesome family for one of the hopeless patients. Cause then you feel bad for them. You feel especially terrible when they hold out on hope that a miracle will happen, when you know that it won't happen. They take one piece of modest good news and don't think about the big picture. You either have to be the one to crush their hope slowly, or let all hope blow up at once when their loved one suddenly takes the inevitable turn for the worse.

Nurses - Most the nurses are really good. Most of them do what you say. But some of them are bitches. And regardless of how good the nurse is I HATE relying on them to do things for me. You have to put an order in the computer, then you have to tell them personally, then you have to go back later and make sure it actually happened. If it doesn't happen, its your fault. Meanwhile they constantly come to you for problems. And that's the way inpatient medicine is designed. The doctor gives orders. The nurse carries them out. I'd rather do both.

Respiratory Therapy - We manage the ventilators 100% in the operating room, we are the airway experts... but for some damned reason we're not allowed to touch the ventilators in the ICU. Cause that's the Respiratory Therapist's job. So what do I have to do when I want to make a small change in the settings? You find the ONE respiratory therapist that happens to be covering the ICU that day and ask them to do it for you. Remember what I said about how I feel about relying on other people???

Medical Students - I've been blessed with having a couple of REALLY GOOD medical students this month. They've been helpful, they work really hard. But I'm starting to realize how much I sucked as a student. They often get in the way. They often slow things down. They ask you stupid questions, or don't know how to do things that are so trivial to you. I enjoy teaching them and taking them under my wing... but at the same time it can get distracting and annoying... They also take FOREVER to present a patient.

Surgeons - Unfortunately the surgeons still have a say in patient care since they were their patients to begin with. So there is often a battle between us and them about their care. Often the biggest battle is whether or not a patient is sick enough to come to the ICU, or leave the ICU. We want to send back any patients that are remotely close to being stable. They don't want to be responsible for any patients that are still remotely sick. And of course it starts with residents fighting with residents. Then works its way up the chain to the surgeon and my attending. As the resident you are stuck in the middle of it all. Politics! Its all politics!!!

Crankiness - There is no shortage of crankiness in the ICU. I'm cranky most of the time. The other residents are cranky. The attending is cranky. The surgeons are cranky. The secretary is cranky. The nurses are cranky. The patient is cranky. The family is cranky. All with good reason. But its not a happy place to be. EVER.
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