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.