Level up

If the fact that I have a blog on the internet hasn't already clued you in, I'm a bit of a geek.  And by "bit of" I mean "was raised on video games and Dungeons and Dragons in the way that most teens gossiped on the phone after school or threw balls at things for points"

So to this day, if you give me some sort of objective number to measure and strive for in order to do a job well, I AM ALL OVER THAT SHIT.  If you really want me to get revved up, there needs to be a level of complexity that I can analyze and figure out if option A or B is the way to make number X go up or down.

Hospitalist medicine thrives on these kind of metrics.  Length of Stay, Case Mix index, mortality rate, core measures, relative value units... you can make spreadsheets for days.

It's funny, back in the day "being a good doctor" meant that all your patients were happy, nobody died when you could help it and you kept your white coat clean.  Now, with pressures from patients, insurance companies, healthcare reform acts and your own hospital, it means:

"make the patient better as quickly and inexpensively as possible in a way that meets national standards and they stay healthy once they leave.... and while you're at it, document everything that you did in a way that will maximize the amount of money we get paid by insurance so we can keep the doors open and the lights on."

(For extra fun, try and say all of the above in one breath.)

But hey, I knew exactly what I signed up for when I got into this whole "medicine" thing.  Because I love it, and I do want to be a good doctor.  So we come up with better history & physical forms to make sure we've documented all our patients' multiple and colorful chronic ilnesses, so we can take better care of them and get more money at the same time.  And my numbers go up and I'm happy.

And then when I'm exhausted from all of the above, I put on my running shoes and flee from hordes of shambling zombies.

No, really.

As a blocker who is thinking maybe.... just maybe this jamming thing might be fun too, (Click here if you don't remember the difference) I've had to up my cardio and endurance training.   Given my crazy schedule, I needed something that could be done at almost any time with minimal equipment... which means running

I hate running.

But I love zombies.

Enter Zombies, Run!, a smartphone app that turns running into a pseudo role playing game - you run, and while you're pounding the pavement, the program breaks in with "radio broadcasts" as you listen to a playlist of songs.  Even better, it tracks how far you've gone and lets you pick up items to take back to your base to build up your defenses and open new missions.  So yeah, all of a sudden running is fun again.

Especially when you turn on the interval training mode and it forces you to sprint by playing sounds of zombie moans getting closer and closer... 

But it was the amount of data they collect on you that really got my motor running.  

Now I know which songs I run faster to, how steady my pace is over the run, calories burned and how I do on the sprints.

I should amend that the data in the first screen cap was on skates.  Turns out the only drawback to using this program while on 8 wheels is that you occasionally come to the end of a neighborhood cul-de-sac and even the fastest turnaround-stop means you get your brains eaten. (Hence why I only evaded 1 mob on that particular mission).

The best part, though?  It's kind of like having Eenie Meanie, the vet I always thought of as my derby mentor with me...or at least the zombie version of her.  (You thought doc-roller girl was a good combo? Try undead derby badass.)

Today You, Tomorrow Me.

One of the things I have noticed among my roller derby teammates is that everyone keeps their gear bag stocked with "extras".  Tampons, tylenol, toe-stop wrenches - the essentials for skating.  And it's an unspoken rule that we all share.... even down to the mouthguards.  (Yes, really. Thanks LowBlo!)

Duct tape is especially crucial. Matching laces are just a bonus

Because we've all been the one to show up at scrimmage night with the wrong colour shirt (which recently led to some interesting announcing as two Maggie Kill'n'Brawls lined up on the jammer line... along with some nasty Maggie-on-Maggie violence.) and appreciate it when our teammates help us out.

The same rule applies in medicine.

It had already been a stinker of a day - the IT system maintenance that was supposed to end "in the morning" rendered every computer the equivalent of a LCD paperweight until late afternoon, we were short staffed despite being at No-Room-At-The-Inn capacity for three days straight.

So when the "uncomplicated pneumonia" patient my colleague received from the ER at 6:30 PM on a sunday turned out to be "Oh, Holy CRAP this one is sick" in that internal medicine way - only fixed by personally calling in three consults tonight, running a battery of tests and remembering which serologic marker is affiliated with which nasty auto-immune disease and marching down to the lab to check on the peripheral smear yourself, we rallied.

I knew one of the lab techs and called over to see if they could whip up a slide for us real quick so I could go down and render my verdict (using my pathology skills, which are limited to "That's screwed up" versus "That looks ok").  Anurita had the consultant's personal phone numbers and called both of them before it got to be too late in the night.  Everette had UpToDate open to see if there was anything we forgot to order.

In the meantime, the originally assigned doc had enough time to go back and review the fine details - oh wait, you started taking a new antibiotic a few days ago? - instead of scrambling to get all of the above done.

Which finally brings me back to the title. 

Recognizing that it could just as easily be you left without extra socks or with a patient who can't leave until someone gets them a prescription for their walker is what makes my teams work so well.  It's why I chose them, and it's why I stay.

We even have lockers.

High School never really ends.

Even though I've recently graduated from what could be considered 23rd grade, the refrain remains the same.  Where to sit, who to talk to, what's my locker combination... even the mortification of a bad yearbook photo is repeated when your well-meaning department uses your passport photo (taken after running into CVS through a rainstorm underneath aggressively unflattering fluorescent lighting) as the photo for the "Welcome to Memorial" slideshow that runs on a cycle in the lounge.

You also have a good view of awesome
visiting pharmacist lecturers

The "where you sit" is a big one.

As a resident, I had risen to the top of the food chain - the chiefs had standing "dibs" on the three seats closest to the door during all noon conferences, ostensibly because we were repeatedly getting called out to fix administrative problems or address concerns from the interns and attendings.  (More honestly, it was because we'd then be chosen after 1st and 2nd years for "And can anyone explain why we don't use cephalexin for complicated soft tissue infections anymore?" sort of questions)

But I had to earn it - I first had to sit allll the way on the lefthand table, with the attendings sitting between me and the door.  As upper levels, you graduated to the table near the door - but you still had to sit towards the front.

In front of said bench, with an early
version of my bout "war paint"

Same as the fresh meat.  We always geared up on the benches closest to the glass - at first because we were terrified of the vets and moved in a pack, like antelopes navigating the Serengeti.  Then it was because that's just where the meat sat, and we always had things to talk about amongst ourselves. (Usually about what new gear we had finally purchased or how we'll never understand the mechanics of "Cut Track, Major")

I'm happy to say now that I feel much more at ease among the seasoned skaters, and have graduated to the back bench on occasion.

The meat still stick together frequently, but now it's just because we're super-cool and have secret handshakes and whatnot.


So the last frontier is the RDL.  The mythical "Real Doctors Lounge", so named by the resident for its tales of free, actual breakfast (true.  And dangerous when there's freshly made biscuits and sausage for the taking) unlimited coffee (true, but... barely coffee) and secret cabals of attending physicians chanting incantations to punish residents who don't do their dictation summaries on time. (none that I've seen so far)

In the resident lounge, you could argue about which subspecialists in the hospitalist were the cutest (one of the gastroenterologists) or what shenanigans had gone on in the call room. (None, that I can verify)  We were all equals in there - equally stressed, equally low on the totem pole.

Now, when I walk through the RDL, I'm fresh meat again.  In derby, you're intimiated because Pinot Gringo's ninja hip checks are deadly or Ira Fuse's transitions are effortless.  At the hospital, it's because the cardiothoracic surgeon has been cracking chests since before I graduated high school, or that the pulmonologist has the precognition of Yoda when it comes to respiratory failure and septic shock.

Don't get me wrong - I'm happy to discuss my patients at length with these people, and I will call them at 4 AM if someone is crumping (highly techinical medical term for "They don't look so good"), and they will be friendly and professional in turn.

I just don't know if I'm ready to sit down at the lunch table and share my fries with them.  We'll see.

eta 15 min

So, the name.

Derby names thrive on puns - either on names (my fellow fresh meat Aurie O' Speedwagon) native homelands (our transplanted Texas Chainsaw Mascara) or other distinguishing characteristics (the adorkable Nerd Degree Burn comes to mind).

I knew I wanted something medical, and to my endless frustration "Anna Flacktick" was already taken.  "Sue De Moan Us" was too obscure and we already had one Catatonic on the team.

And then I was sitting in the lounge, playing the semi-morbid, definitely black-humor mandatory game we play as residents.  It's the response/protocol game.

Each time a trauma victim hits the ER, the team is notified via page of either a protocol or a response.   From there, a strangely elegant choreographed sequence of events take place.  The involved members gear up in bright red leaded aprons over scrubs, the extra-bright, extra-hot overhead lights get powered up and roles are assigned.  One to do the primary survey (the beloved ABC's of airway, breathing and circulation), one to get an arterial blood gas to get immediate results on hemoglobin, acidosis and oxygen saturation, one to fufill the "finger or tube in every orifice" mandate of trauma evaluations.

(And one to in the darkness, bind them.)

I've been in on a handful of Trauma Protocols myself and it's amazing to be among all these fantastically skilled people, moving in tandem to achieve one all-important goal.


Really, there was no option when it came to picking a roller derby name.

The difference between Trauma Protocols and Responses (which does happen to be my dear husband's name) usually relates to how unstable the patient is when they're evaluated outside the hospital.  Intubation and on the ventilator automatically gets you protocol status, same as a blood pressure less than 90 or a glasgow coma scale less than 10. (incidentally, that was also almost my number, but since almost every page is estimated to arrive in 15 minutes, I had to go with it) Responses require injury to 2 or more body regions, spinal cord injuries or to be stabbed somewhere relatively important.  Suffice to say you don't want to be either... and not just for the finger/tube in orifices part.

The photo above is an example of one of the pages.  Demonstrated by "Trauma BROtocol", as James is my brother from another mother, even when he's grumpy from being on said Trauma team all month and I have to cheer him up with artery-clogging breakfasts.

Which (finally) brings me back around to the game.  When the aforementioned pages come through, resident the first holds the pager to their forehead, Johnny Carson-Carnac style, and the rest of us try to divine the nature of the injury.

I am terrible at the game, for the record.  It would help if I stopped guessing things like "accidental spearfishing injury".

Team sports weren't really my thing

The last team I played on for any kind of organized sport was called the "Blue Bombers".  Summer youth soccer, the kind of team where everyone gets play time and the only real identity is based on what color jerseys we were issued.

Though the orange slices that the parents brought for halftime were pretty ace.

That's not to say I didn't love being part of a team - high school, and even residency were filled with great team experiences... however, they were primarily related to medical trivia, odyssey of the mind.. and of course the historic run that was the Port Huron Quiz Bowl 2000-2001.

Doing my part to dispel the myth that derby girls are somehow "cool"

But the trappings of my first "real" game were... new.   Everyone going through their pre-game rituals, figuring out how to patch up "I really need to get new wrist guards" gear and doing our best to guard against floor burn via layered tights and duct tape.

I knew from movie and television tropes that there's a "give em hell" pre-game speech from the coach in the locker room.  It was another thing entirely to look at my teammates in full battle dress as we all listened to the heartfelt and inspiring words, feeling like I belonged with a group of women I'd spent the last year idolizing.

Go ahead, try and figure out who's skating for the first time in this photo.  

I fumbled awkwardly with my helmet for the first few bars of the national anthem, until I could look over and see what the vets did with theirs.   Truth be told, I was absolutely certain that my newbie status would be painfully obvious from minute one, that the other team would see me as a weak link and target me.  (I later learned that while the other team did deal out some profound hits, it wasn't because they scented blood in the water.)

Getting low is my only recourse against these
women and their mack truck hits.

The other trope that is completely and utterly true is that you don't hear the crowd, the announcers, or anything but your captain, pivots and bench managers.   Your focus shrinks to the red jerseys, the rope and tape-lined track boundaries and the steady stream inside your own head "Reform the line! Watch for the jammer.  Get low, brace for the hit!"

Now, if this were television, I'd be back with the story about how we pulled out a stunning last minute win to thunderous applause and my unexpected turn as a jammer.    But because this is real life, we got beaten by a team who had our number - as much as we took the fight to them, worked on strategy for weeks and left our hearts on the track, they were the better team and walked away with a win.

I will someday use this photo as proof to my children that yes -

 for a single moment, your mother was both cool and tough as nails.

The upside is that I learned a whole hell of a lot, and so did my teammates - we learned how to fine tune our offensive and defensive decisionmaking, and ways to control the pack.

And if there's one things you can guarantee from the Savannah Derby Devils is that we're going to have a blast on the track, win or lose.

And as the addendum to what was already an experience to last a lifetime - we were given the opportunity to come back out onto the track to scrimmage our A team at the end of the night.  Talk about ridiculous amounts of fun - even though putting on just worn, cooled off gear is the derby equivalent of sleeping in the wet spot.

Trauma Response

Roller Derby is a Team Sport.

You've seen many of them already, heard me talk about the Devils I skate with for 6+ hours every week.  Women like Ace & Eenie Meanie, a derby wife combo who had endless amounts of patience for us fresh meat when it came to teaching, or Drrty Grrl who never fails to get the rest of us fired up - either by dancing on the jammer line or her patented war cry.

They're the ones who all pile in for the Big Group Photo, to share in that sweaty happy moment at the end of a bout where you're just happy to have played the best damn sport on 8 wheels.

But there's a team you don't see on the website or in the photos.   There's the team who gets dinner on the table when work runs late but we still need to gear up at 7:30.  There's the team who cheers and buys tickets and who will still hug you after a bout when you smell like rancid goat butt.

The parents, for one - they've been my cheerleaders from day one and so now they wear my Derby Name on their shirts and share in my post-bout highs via skype.    It's been so gratifying to see the important people in our lives come together as part of the larger derby family.  From Brute's Quad Squad and Sin Derr Hella's Fella to my little sister reposting my latest bout pics on facebook, our joy is magnified tenfold when we can share it with our loved ones.

But speaking of fellas...

It takes a special kind of husband to say ok to "Hey, I know I have this crazy 80 hour a week job and we almost never see each other, but I'm just going to jump headlong into this equally bonkers sport that requires almost every shred of time I have left over after work."

But this is the man I agreed to run off with - to have crazy adventures with for the rest of my life, so of course he's going to say yes.  And so he's the Trauma Response to my Protocol, my backbone and strength when I've gotten up from that last big hit... and the first person I find to kiss when I come off the track.  (And yes, his name will be explained too - all in due time!)

Well, now you HAVE to do it.

I'm a big fan of making commitments which then force me to figure out how I'm going to follow through on them.

Case the first:

December, 2004 - sitting in the Laguardia airport I get news that I'm accepted to Wayne State University School of Medicine.  (my dear, sweet mother had taken her semi-basket-case daughter to New York so she'd stop freaking out over med school interviews) Narrowly avoid being detained by air marshalls due to ensuing happy shrieks and dancing.

Returned home to get inked:

Little did I know I was fufilling my other requisite for derby at the same time

I got a caduceus, which has been adopted by the medical community as a symbol.  My reasoning at the time?  "This way, I can't wash out of medicine... I'll look like the world's biggest dork if I have this tattoo but don't finish med school/residency."  

And yes, I know the caduceus is techinically not the ancient symbol of medicine (see: Rod of Asclepius, which I think is ugly) and instead is tied to Hermes, protector of thieves and tricksters.  On my most cynical days, I think I chose the more accurate symbol for my profession.  

Case the Second:

2.5 years after the tattoo, I started dating The Boy.  Who, at the time was hell-bent on getting out of Michigan and moving south.  This caused much angst during our early relationship until I figured out The Boy was The One and I just said "Fine, I'll find a residency in the South and we'll go together."

Trust me, I was really happy the day I matched in Savannah, for obvious reasons.

Seen here with aforementioned wonderful mother.

Case the Third:

Roughly on par with permanent skin mutilation and moving-cross country to stay with the man I loved....

I bought Makeup Setting Spray.

Given that I'm not much of a makeup wearer on a regular basis, and certainly don't require it to stay in place through a night of sweaty club dancing to Thoompa-Thoompa-Thoompa music.... there's really only one reason for it to be in my bathroom.

Yes, I do love Lush Products that much.

It helps keep Derby War Paint on when you catch an errant elbow, boob or helmet to the face.   So my carefully painted on EKG tracing looks just as fresh for the last jam as it does the first.

Now of course, I need to be rostered for it to be of use - something that is rare for fresh meat on a well-established derby team, especially one with 40 members.   So I figured it would sit on my shelf for the first year, a daily reminder of what I was working toward, every time I saw it.

Well, in another week I'll be putting it to the test.

Through a combination of players being out to injury/life, our new floor at practice being hugely suited to my skating style and nightly pleas to the derby gods, I got put on the official roster for the Hostess City Hellions, Savannah Derby's B team, taking on the Charlotte Speed Demons on September 29th.

There were similar undignified noises and dancing to those mentioned in Case the First.

So yes, this is your official invitation to watch my non-meat Debut.  5 PM, at the Civic Center in Savannah, Georgia.

....for the next week, I'll be going over last minute strategy, abstaining from all alcohol, hydrating like crazy - and most importantly, figuring out what clever trauma-related slogan I can decorate my booty shorts with.

Rank and File.

There's a certain phenomenon that I've seen and heard about in the roller derby community.

It's the Whip It thing.

Girls come through tryouts thinking they're going to be the great new hope for the team.  Eye of the Tiger playing over their training montage, Face on the poster, Vets lift you on their shoulders for a victory lap, you're a Big Damn Deal.

There's a certain phenomenon I've witnessed time and time again in residency.

It's the intern thing.

You watched scrubs, you passed your step exams with flying colours and you are Ready To Save Some Lives.   Heart-warming moments at the bedside as you hold grandma's hand, after which you run the perfect Code Blue and bring the guy down the hall back to life and ultimately finish the day by proving your attending wrong about an obscure and tricky diagnosis.

...Ellen Page and Doogie Howser make you want to have those same cinematic moments.

Now don't get me wrong, every established institution needs regular infusions of new blood (or fresh meat, depending on the nomenclature) - people who bring energy and new ideas to the experienced members for the group.   Those of us who have come through the new period and have the priviledge of teaching those behind us find it deeply fufilling and inspire us to work harder.

But they need to know their (expletive redacted) place.

Residency is at least structured, with finite years and levels to separate each young Doc.  Cower before your upper levels, puny intern! You must collect 200 hours ICU experience before passing go!

Derby, not so much.   You come up through boot camps or rec nights, tryouts and then have your traditional fresh meat period - but after that's it's all fair game.  The very nature of the sport (and injuries, and women in the 20's and 30's with the "9 month injury") means your team is comprised of all different skill levels, some coming back to the track after years of skating.   To add even more confusion, you can have equally skilled players who fill very different positions on the track.

The best advice I've been given so far about Derby is that you have to work hard and set goals to earn your spot.  "Find someone who skates better than you, and make her your rabbit."  Make the roster selection committee pay attention to you - not by dramatic behavior or trash talking, but leave everything you've got on the track every time until they have no choice but to list you.  Up until that point, don't expect to be given anything, just because you show up.

My point to all of this is to show some respect to your elders and realize what your place is in the wider scope of things.  You may be faster off the jammer line or in the ER, but there's people all around you who have been doing your job for awhile now - and it's best to heed their advice.  You should also be a little grateful when they take the time to give you said advice - after all, it's their spot you're gunning for someday.

The amount of *stuff* required

When I was a wee little med student, I weighed my white coat.  It was in the double digits.   This is fairly standard practice during medical training, as outlined by Michelle Au's fantabulous comic.  I  carried around so much stuff, it actually took me 7 minutes, 41 seconds just to go through it all.

Oh, young me.  Young me with that reflex hammer.

Now, in line with said comic - I've streamlined.

Truth of the matter, I pretty much carry my pocket medicine guide and pharmacopeia because they have important numbers that I simply Cannot Remember (like my georgia license number, or the access code to call long distance from a hospital phone) written in them.  The rest includes cheat sheets for billing, derby flyers, my badge & pen, a patient list and my pocket pulse oximeter.

And of course, my dueling banjos cellphones.  (In a fun throwback to the above video, the background on my work phone is the "Don't Panic!" logo)

Derby goes the opposite way.

The first time I skated as fresh meat, I had the following: skates, pads, helmet, mouth guard, water bottle.  I had the wheels and toe-stops that came factory standard.  Everything I wore was off the rack - nothing spray-painted, ironed-on or even stickered.

That quickly changed - this is the haul I pulled out of my gear bag just last tuesday:

And yes, the Mr. Bump bag has all my med supplies in it.

Everything from tampons to tourniquets.

I find that derby girls take a survivalist mentality to their gear bags. "What if I am stranded in a blizzard/slick-as-snot track/zombie uprising and need different wheels/laces/socks so that I may survive?" So now I have backups and extras.  (Shamefully, this was taken just before I got a new shipment of 4 new extra-sticky Venom wheels, bearings, and a mouthguard)

The only thing scarier than sheer amount of stuff is the smell of it.  (Not as bad as hockey smell, at least on par with football or soccer)

As much as I make fun of myself, it's been extremely handy to tote all this around.  Helps on nights like tonight, when I managed to pack the following outfit for practice: tights, 3 tank tops and 1 sock.

Adjusting my Harris Benedict Coefficient.

For a long, long time 1400 was my magic number.

My basal metabolic rate was 1428.5, and I factored in a multiplier that accounted for the step just above sedentary.  As a resident, I did spend most of my day walking, and I usually made my team climb stairs whenever possible.  So to run at a 500 calorie deficit every day, I aimed for 1400.

I knew the caloric content of every piece of food in the resident lounge.  (Of course, it was usually the same combination of pop, chips, cereal, sandwiches and the much-fought-over banana)

Over time, I got a little obsessive over the number.   It wasn't uncommon to find me exercising on the Wii Fit at 9 PM so I could hit 120 calories burned and I could have a glass of wine after.

Looking back, it's cringe-inducing to see how wrong I was on my own nutrition.

Sure, I could set up the perfect blend of lipids and carbs for a septic patient with ventilator weaning issues in the ICU.  I could rattle off the importance of respiratory quotients and protein balance.

All while I was chowing down on starched carbohydrates and getting to the gym every blue moon.

It's no wonder that derby kicked my rear in the beginning - I had zero conditioning and was giving my body crap fuel.

These days, I've let go of the numbers.  I just had no more use for them - not when I know I need to get a good balance of protein, fiber and to hydrate as much as possible.  Hence the "rules" (which do get broken on occasion, I am no saint.)

1.  Thou shalt not drink calories. (unless it is to prevent Acute Loss of Sanity)

Pop is held in reserve for when other caffeine is not accessible. (Think about how often you want something salty to go with your Diet Coke)   I stick to coffee with splenda or unsweet tea (it helps to be a yankee here) Foofy coffee drinks are also verboten.  Example of the exceptions: 6 admits in the ER by 10pm or an excellent single-malt scotch on the rocks.

Example of a sanity-preserving margaritas, circa intern year.

2. Thou shalt keep water on hand.  

I hate the waste that is plastic water bottles, but after losing half a dozen re-fillable bottles, I accepted defeat. I do refill them when at home and for practices, at least.   I shoot for 4 bottles a day.  (Peeing clear is a good goal.)

3. Thou shalt not consume alcohol for 24 hours before hardcore skating.

You will feel it in your body when you're dehydrated and one of the most effective over-the-counter diuretics is alcohol.  For example, I broke 2 of my rules last night (one can't expect me to have ginger ale in the house and NOT mix it with whiskey...) and was dragging at practice today as a result.

4. Break thy fast.

Don't let yourself become a no-breakfast person.  I took this one from Alton Brown (to be honest, my whole regimen borrows heavily from his excellent episode of Good Eats, "Live and Let Diet".  Seriously, go watch it.) and it's a good rule.  Now that you've started revving your basal metabolic rate with regular exercise, fasting for 12+ hours at a time is just foolish.

5. Honor the protein, and keep it lean.

I trust the holy trinity of proteins: Fish, Nuts and man-made.  It took some time to learn how to cook fish in a relatively low fat way (tuna and salmon are the easiest I've found) and I switched my go-to-snack from cereal to raw almonds.  I laughed the first time the GIANT TUB O' PROTEIN (which always calls to mind Weight Gain 4000 from South Park) made its way into my cart, but there's really no better way to get my breakfast smoothie into the protein regime.   (My favourite, BTW: banana, frozen strawberries, orange/carrot juice, scoop vanilla protein powder)

That's it.  I refuse to wage war on carbs - a life without rice, potatoes or pasta is just not worth it for me.  I don't do paleo, and there's definitely processed materials in my daily diet.  But I can usually keep to these five rules, and they've served me well so far.

Leaner and Meaner these days...

Why the necklace?

Pearls are my armor, my game face, my shield.

(after our first public scrimmage, photographic evidence 

of someone else's arm-sharpied number on my neck)

The first instance pre-dates derby by several months.  One of my duties as chief resident last year was to interview potential residency candidates and help rank them for our eventual match list in the spring. After a moment of "Dear God, I've just now figured out what I'M doing here, how can I interview someone else for a spot?" I started thinking of ways that I could fake looking dignified and competent in front of the applicants.  

In the south, for women - this is an occasion for a dress, heels and pearls.   I showed up looking like a reasonable facsimile of a model resident physician and the interviews all went wonderfully.  (My knowledgeable, wise demeanor cracked only for a moment when I HAD to high-five one of the interviewees over our shared love of quirky guilty-pleasure competition reality television shows.  BTW: Work of Art, you need to watch it.)

The transition to wearing them for roller derby was accidental.

As is anything in a resident's life, I had to go straight from the hospital to Roller Derby Boot Camp and change in the bathroom of our skating rink.  Consequently, I still had on the pearl necklace I'd worn to work that day - and skated way better than I had on the previous nights.  So I deemed them my lucky charm and kept them on whenever I could for skating.

Including one night before tryouts, my fellow fresh meat pointed out their absence so we sharpied "PEARLS" across my collarbone. (In the future, I will be investing in temporary tattoos)

A few of the vets commented that they remembered me for my little jewelry quirk and we'd even thrown around a few derby names based on pearl necklace. (ultimately vetoed due to unintentional non-family friendly connotations)

So now they're my thing.  I wore them first because I needed some outward display of confidence and authority - after months of hitting harder and skating faster because I had my lucky charm with me, I've finally developed some of my own.

And to answer the FAQ's: Yes, they're real.  No, I don't wear them for full-contact hitting/scrimmaging. Yes, they've broken once, doing a totally benign, slow speed, no-impact demonstration of a baseball slide for our boot campers.

I'll explain where the name came from later

So this is me:

Newly minted Internal Medicine doc - ready to take on diabetes, the uninsured - and by extension, the world.  I've happily signed over the next few years of my life to in order to practice as a hospitalist at a tertiary care, level one trauma center academic hospital.  I see a lot of broke, chronically ill people with no durable access to health care.

This is also me:

One of the newest members of the Savannah Derby Devils, Trauma Protocol.  I spend hours each week skating, taking full body hits from women with names like "Violet Seizure" or "Beat-a-trick Kiddo" and working on the skills to make it to the next roster.  I see a lot of bruises.





I understand the cognitive dissonance, I had it myself at the beginning.

I also had the "resident 15": weight gained from a high stress, low-sleep, only food available in the hospital are carbs lifestyle and no real motivation to exercise when I got home at 7 pm.  Roller Derby boot camp was my savior.

Don't get me wrong, I love my job and wouldn't trade it for the world.  But it can be frustrating, with discharge instructions such as "In order to prevent asthma attacks, please avoid smoking crack" and explaining to people that if they just cut down to half a pack a day, they'd have enough money to buy insulin every month.

So now my hobby is to hit people, as hard as I can - and usually get a high five from them for it afterward.  It's time-effective stress relief that keeps me in shape despite the free cookies in the Doctor's lounge.

I won't profess to be very skilled at either of these things yet - I don't have the years of wisdom and experience that I see in my peers and hope to achieve someday.  But it wouldn't be nearly as fun to read that person's blog.  This is going to be the stumbling mis-steps, the excitement of overcoming barriers and knowing that the next patient, or the next practice may teach me something I didn't know before.

What I already know is the maximum daily safe dose of ibuprofen and the symptoms of Acute Renal Failure due to NSAID induced interstitial nephritis.   Being a roller girl/medicine doc does have its perks on occasion.