Monday, July 6, 2015

Residency Graduation

It's been a bit over a month that I graduated now... Even though I still had to work for 4 weeks after that!  Graduation was on May 28th and the Saulters and Jackson family came up for the occasion.  Unfortunately Stuart had a work issue that came up and couldn't make the actual ceremony, but joined us the next day for a big family dinner and a lot of packing and moving boxes into a Budget truck!

It's really difficult to put into words how I felt graduating from UVA's residency program.  I think it was equal parts:

Elation over having completed 4 years of college + 4 years of medical school + 3 years of residency and finally being able to practice on my own!  Knowing there would never be 30-hour calls again where I'm so delirious I forget I called my mom on the way home from work.  No more night shifts (as long as I stay at my current job), and no more wearing my pager around town in order for clinic patients to page me with questions.  Sprinkled on top of this elation was a bit of pride in knowing that with God's help and a lot of encouragement from family and friends, I DID IT!

Sadness.  No one can really understand the bond between co-residents, and that's because unless you're a physician you can't really understand what going through internship and residency is really like.  I've laughed with them over silly pages we received at 2am, complained over a beer or two at local restaurants, shared fears about mistakes we had made, and cried over those gut-wrenching cases that no one warns you about before medical school.  A recent article I read in the New York Times described co-residents as "war buddies", and I would say that feels like a good description.  These are some of the best friends I've made thus far, and I am so sad about leaving them!

Nervousness over starting my new (FIRST) job.  I am so excited to be working at Georgetown as an academic physician, but this means that suddenly I am transitioning from being the learner to the one that students and residents come to with questions.  All within a couple weeks!  That's a pretty crazy thought, but an exciting one as well.

Here are some pictures from graduation:

Me with some of the boys in my class.  Not sure how I got lucky enough to be invited into this picture!  Haha

The fams

Mom and Dad

Dr Wolf - my advisor/mentor in residency "milestones", career planning, and general life

(most of) the class!

Saturday, July 4, 2015

Frankfurt

Thanks to the odd scheduling of international travel, on the way back from Uganda I had an eight-hour layover in Frankfurt.  Frankfurt is a pretty big airport, but I quickly realized it was only a few minutes from the city center.  The adventuror in me wondered if an eight hour layover for an international flight was enough time to: de-plane, go through customs, do a tour of the city, come back through security, and fly again??  Fortunately I found a tour company called Franfurt on Foot that helps you do just that!  I made my way through security and met Jo, an ex-pat from Ohio that now lives in Frankfurt and does these tours.  She was great, and after a brief train ride we set out on foot to explore the city.

This was my first time in Western Europe (my only other time in Europe was on another layover in Turkey, interestingly).  I figured Frankfurt would be a pretty modern city since it's the center of banking in Europe; however, it has a lot of contrasts.  You'd see big modern skyscrapers next to 300-year-old cathedrals.  My favorite part of the city, and what I didn't expect to see on a brief walking tour, was the Holocaust history sites.  They were quite moving, and really remarkable to see.

Below are some (unedited) pictures from the brief trip.

An example of contrast

The pedestrian market downtown

Wherever I go, I find vegetables!

A Jewish Ghetto was located behind this wall.  Now they have turned the area into apartments, but it still maintains much of the original architecture.

Holocaust memorial

Names of those that were killed

Yep, that's who you think it is!



City Hall, where you must go to get married.  There were two weddings out on the steps just while we were walking around.


Book burning memorial



These two photos were in a monastary downtown; they are murals depicting the life of Christ and I thought were some of the more beautiful I've seen.


And how could you come to Frankfurt and not eat a Brat?!


Sunday, June 28, 2015

Welcome to Takoma Park!

Stuart and I are getting settled into our new place.  He's been here a few weeks and I just moved in about 2 days ago.  It's starting to look like a home, which is a huge relief after living in the "in between" for a few months (or three years, depending on how you look at it).  Before I give you pictures of the apartment, let me tell you about our neighborhood.

We're living in Takoma Park.  I'm still a little confused over the semantics, but there is a neighborhood in Washington DC called Takoma, and a contiguous neighborhood just across the Maryland border called Takoma Park.  Our apartment is literally sitting on the DC/Maryland line, but has a DC address.



Just walking around on foot, it's difficult to tell where one ends and the other begins.  The reason we picked this neighborhood is because it's a perfect mix of "walkability" to just about anything we could need, close to transportation for Stuart, and has lots of grass and friendly people which I needed in order to be able to handle living in a huge city.  Really if you just plopped down in this neighborhood you'd have no idea the White House was just a couple metro stops away.

Now, important to note is Takoma Park is nicknamed "the Berkley of the East".  I've never been to Berkley, but I think everyone knows that it is quite a hippie-liberal-land.  I'm on board with the local food/drink movement and being as environmentally conscious as possible (Prius!), but this neighborhood is taking us a bit outside our comfort zones.  For instance, it's illegal to cut down a tree in your own yard without a permit from the city, and it's also illegal to use fertilizer anywhere in the neighborhood limits.  Lots of folks have multiple tattoos or facial piercings or a combination or both, and some don't look as if they shower often.  It can be a bit, well, different at times.  But probably my favorite aspect of this is that the area is very socially and racially diverse.

Interesting you say, but what is there to DO there?  Well let me tell you.  When you walk out the front door of our apartment building, there is a funky furniture and a Jewish funeral home immediately across the street.  Our apartment already features a small painting from the furniture store.  If you choose to walk to the right, the Metro stops two blocks ahead, and on your way there you'll pass a locally-owned fair-trade coffee shop, the restaurant recently voted “healthiest in DC”, and a "community space" called the Electric Maid.  Mostly they have concerts there for a suggested $10 donation.  Tonight was some rap group and there were throngs of thugged-out teenagers around.  But don't fret - there's no alcohol allowed and the place closes at 10pm sharp!  If it's around rush hour you'll probably also be lucky enough to find some musicians playing around the Metro stop, and a couple of food trucks in the parking lot of that furniture store.
 
Too much excitement there?  If you go behind the complex instead you'll enter Maryland and the historic section of the neighborhood.  This is where Stuart and I dream of owning a house one day (also, isn't it weird that we might live in Maryland?!).  The homes are gorgeous and all look like they date back to about the 1920s.  There are book trade-in stands every few blocks, and families let their kids play out in their front yards with the neighbors.  A couple more blocks back will land you at the Takoma public library and the community center which does family movie nights and book clubs.

If that's not awesome enough for you, you could turn left out of our complex.  Within two blocks of walking you'll find Busboys and Poets, a bookstore/coffee house/restaurant/community theatre combination.  Next to that is a pet store that offers doggie accupuncture, which I'm still not sure what to make of, and a CVS right across the street.  The neighborhood yoga studio is up next, followed by a gelato shop, great restaurant, and a store selling Turkish and Egyptian furniture imports.  BUT WAIT!  As if that isn't enough, exactly two blocks from our house is the year round farmers market!!!!  You can find everything from fresh milk to rabbit meat to cherry tomatoes there.  And most every stand (including a wine stand or two) does free tastings!  It doesn't get much better than that.


Want to come visit us yet?!

Sunday, May 31, 2015

Queen Elizabeth National Park

This trip to Uganda we decided to visit Queen Elizabeth National Park.  I had been there last year but then decided to go again this year.  It was worth it!  Here are some pictures.














Saturday, April 25, 2015

Lake Bunyonyi

On Good Friday, Christina and I took advantage of the very prolonged Easter Holiday and headed about 4 hours southwest to Lake Bunyonyi.  The lake holds a collection of islands and is situated just a hair above the Rwandan border.  I had heard the lake was beautiful and offered some good outdoor activity; with that plus its relatively close location we decided to head out.
We went to the hospital early that morning, and then our “private hire” Dale picked us up at the compound.   We briefly had entertained the idea of taking a public bus to the Lake, but once we saw the quality of the roads paired with the Forrest Gump-like torrential rains we encountered along the way, were happy we decided against it.  Dale kept exclaiming how pleased he was that the roads were much improved since last time he traveled them.  I would hate to see what they were like before! 




As our Toyota lurched over speed humps and sidled over 12-inch drop offs, I just kept trying to prevent my head from whacking the side window.  From time to time we would encounter a road block: sometimes it was a big truck stuck in the muddy road, other times it was cows being herded to market for the Easter holiday.  We couldn’t see much scenery other than swift clay-colored water moving past the tires until the weather finally cleared a few hours out.  Then we were greeted by the “Swaziland of Uganda” as Dale called it.  I’ve never been to Swaziland, but now figure I probably should.  Uganda is one of the most beautiful places I’ve traveled, but this took it to a new level.  There were so many shades of green that my eyes got blurry after a few minutes of looking out the window.  The mountains surrounding us were just ever so slightly lighter green than the grass, and peasant farmers had marked out their plots of land by thin rows of banana trees marching down the mountain side.  The steepness would easily cause erosion in the heavy rains, so the folks living there had carved terraces in the side where the planted their crops and perched their one-room homes. 


The increasing altitude made my ears pop and the dropping temperatures were quickly noticeable.   We passed through several villages along the way and saw hundreds of people walking along the sides of the roads carrying crosses.  Some were large and elaborate others small and obviously handmade out of papyrus or banana leaves.  Assuming it was related to the holiday, I asked Dale to explain.  He said that this is a Good Friday tradition where people carry their handmade crosses some distance, to show they have suffered as Jesus had.  I kept wondering to myself why they felt they needed to this to show suffering, when I’ve already seen so much while I’ve been here.
When we arrived at Bunyonyi Overland Camp we were greeted at the gate by another one of those blue suit guards with a rifle.  Fortunately my name was on the list (i.e., my 24-hour prior reservation actually worked) and we drove in.  The receptionist was the only unfriendly Ugandan I’ve ever met, and he gave us the keys to “tent 15”.  I didn’t really know what to expect, but we got lucky!  We had a beautiful tarp tent that zipped and even locked, with two twin beds and towels, and a lake front view!  Pretty amazing. 




We were starving by the time we got there, and headed up the hill to the buffet dinner.  It took a few minutes to actually walk up the hill because the elevation at Bunyonyi is 6,437 feet, but once we made it dinner was lovely.  There was crayfish masala, vegetable curry, and of course rice and chapatti. However, we were tricked because we thought the buffet was 8,000 shillings and were surprised to get the bill for 28,000 shillings!  We were upset until we did the math and realized we had dinner and drinks for about $13 each.  After dinner we were pooped, and got ready for bed.  I feel asleep quickly but woke up around 3am to the sound of scratching on the roof of our tent.  I turned on my flashlight and was happy to find that whatever it was was on the outside and not the inside.  I could see the roof of the tent bouncing as it moved and scratched around.  Perhaps it saw my light because it then moved over to my side of the tent, scratched a while, and then fell off and ran away.  By my guess at its size and the fact that it likely had toenails, I was excitedly hoping it was a monkey.  But then we asked the staff and they explained monkeys don’t live in Bunyoni, so it was likely just a rat.  At least it wasn’t inside!

Despite the interruption in sleep, the next morning we woke up ready to greet the day.  Breakfast was served and we had omelets, toast, and more fruit than you could shake a stick at.  The powdered coffee, well, tasted like powdered coffee.  But it gave me a boost for our outing.  Previously we had read about all the different islands in the lake and had picked three we wanted to travel to.  The choices are either rowing your own canoe or hiring a local fisherman to take you on their motorboat.  Being adventurous we obviously decided to do it ourselves, so after breakfast we puffed our way up the hill to registration where we excitedly asked to rent a canoe.  He non-excitedly obliged but unfortunately didn’t have a map for us to use to navigate toward Bushara island, the biggest of the ones we wanted to see.  He then stated, “you should not go to these islands.  It is too far, and you might get caught in a windstorm”.  We sheepishly stated we wouldn’t go, then he led us down the hill to a row dugout canoes.  By “dugout canoe”, I mean that these used to be giant trees subsequently chopped down with their insides removed, so all that remains is a thin shell just big enough for someone’s behind.  We (un)gracefully got in, trying to not tip ourselves over at the very beginning, and then the gentleman shoved us off into the lake.





Soon thereafter we realized steering a dugout canoe is one of the more difficult outdoor activities that exists.  Because the bottom is so wide and really doesn’t have much shape to it, any effort in steering would easily cause the canoe to overcorrect.  And if a strong wind or motorboat came by and left a wake behind it, we turned around in circles like we were in a whirlpool.  Reportedly that’s called the “muzungu circle”, and is why every motorboat that passed us was full of muzungus, and every canoe that past had locals rowing, speeding along in a perfectly straight line.  We finally got the hang of it, though it was definitely more upper body work than I had done in a while, and paddled out of the inlet where our lodge was.  Immediately we found ourselves out on the open lake with dozens of islands equidistance from our canoe.  My trusty guidebook said Bushara was only 30 minutes by canoe ride and was somewhat developed.  The trouble was that all the islands looked the same distance, and all had at least a few buildings on them!  We decided to pick one and make that our directional target, hoping that we might somehow see a sign somewhere along the way.  Meanwhile as we would occasionally need to rest our aching arms and would subsequently have the winds spin our canoe around in circles.  I suddenly had terrible visions of the torrential rains from the day before starting, our canoe filling with water and us sinking in the middle of Lake Bunyonyi.  But we kept paddling and the sun kept shining.  Just as we were about to lose hope that we would ever make it anywhere productive, we hear a motorboat coming up.  We wave them over and yell, “where is Bushara?!?!”; they laugh and say “you’ve passed it”!  Sure enough we had paddled about 100 yards past Bushara Island, thinking it was just another island covered with trees.  So after a total of 2.5 hours we got out and were very glad to see land! 



We walked up the Eucalyptus Trail to the Bushara Island Camp and restaurant.  This was a more “rugged” resort if you will, and we ordered lunch while we relaxed our aching muscles.  I had “vegetarian chili” which turned out to be basically beans and carrots but was delicious, and was a nice touch on kind of a cool day.  After lunch we had to visit the latrines … which is always a good time … and then we set out on a hike around the perimeter of the island.  This place was a bird-watcher’s paradise. I don’t know the names of many birds, but there have to be dozens or more of different types.  I even saw a miniature hummingbird that my camera was unfortunately not quick enough to catch.  If you stood still and listened you could hear at least 10 different birdsongs at any moment.  And if you looked around at the leaves they were all covered in bird poop.









After our hike we found our canoe just as we’d left it; however, the little man who said he’d be there all day and would help us push off was missing.  So we maneuvered into the canoe and pushed off ourselves.  Again, somewhat ungracefully, but we made it nonetheless!  We briefly considered going to other islands but were too exhausted so we headed home.  By that time we were dugout canoe pros and the trip back was much quicker than getting there – only about 45 minutes.  When we maneuvered into the landing back at the resort, I’d like to think that the workers were somewhat impressed with our canoe navigational skills.  At least we were!

We went back to the tent and collapsed on the beds.  That lead to an accidental nap, and after we woke up we spent a little time reading and then headed up to the restaurant for dinner.  We didn’t want to be fooled again by the 28K dinner, so we asked what else was cooking.  We found out there was a special Easter BBQ going on, and we could get a 15K plate full of roasted goat or chicken, as well as matoke (mashed plantains), irish (potatoes) and salad (chopped up cabbage).  We chose that and it was the right pick!  Perhaps it was because I was exhausted and starving, but that was some of the best chicken I’ve ever eaten.  During dinner the workers started up a campfire which gave nice ambience, but also made a lot of ashes fall on my plate.  We both kept yawning and embarrassingly realized it was only about 830, but decided to head down to the tent and read a while.  That lasted about 45 minutes and then I was dead to the world.

This morning we awoke to bird songs and headed up the hill for the last time for breakfast.  I had beans (kind of weird) and an omelet with fruit, and more powdered coffee.  Our driver was there right on time and we headed back to Mbarara town.  On the drive back we were pondering if we should walk to the city market or not to get some groceries when we passed a nice roadside market.  We pulled over and got our weeks’ worth of fruits and veggies.  Further down the road I almost had to pull out some of my mangoes as we got stuck in another traffic jam or two, but a few hours later we made it home (and I realized the effect a bumpy ride can have on bananas).  It was a good trip!



Thursday, April 2, 2015

Last post before Easter Holiday trip!


Today I took a break from the wards to spend the day in the brand new pulmonary clinic.  As you may (or may not) know, the lungs are my favorite organ and I briefly (or not so briefly) entertained the idea of going into pulmonology.  This clinic just started a few weeks ago and already has 47 patients enrolled.  They are going to have the capability to do pulmonary function testing next week, which is the primary way asthma/COPD and some other lung diseases can be diagnosed.  Today I sat in the tiny clinic room with Dan, a now-attending who was resident last year, his nurse, and three nursing students as each patient was called in.  Generally they carried their own medical record from home, as well as any chest x-rays or CT scans they had had done at other facilities.  Then we would review their records, examine them, and review their scans.  Today there were 2 cases of severe asthma, one likely COPD, one interstitial lung disease, one likely MDRTB (multi-drug resistant TB) or malignancy, and a few folks that had chest pain that wound up being from a cause other than the lungs.  It was a lot of fun, and since Dan is a regular internal medicine doc just doing this clinic out of the goodness of his heart and not because he’s specialized, I was able to teach him a few helpful things.  Subsequently I got recruited to teach him and possibly the residents how to interpret those pulmonary function tests that they will start next week.

After clinic it was time for lunch.  There are two places to get lunch in the hospital; one by the river and the other in the HIV clinic.  The river canteen is more popular with the residents, but the HIV clinic canteen has much better food.  It’s always a tough choice, but I usually pick the HIV clinic.  Today I had beans and rice with a side of squash and greens.  The greens are my favorite part, even though each bite gives small crunch like sand I figure is dirt. But they use them more as “decoration” or “accompaniment” and seem confused when I want more of them.  Oh and don’t forget freshly squeezed pineapple juice.  The juice changes daily and is amazing … but it might be perhaps why I have:


It’s not bothering me too much, so I’m probably going to keep the juice going.  It’s just so daggum good!  We had lunch today with Okello, one of the attendings here.  Christina from my residency program arrived yesterday, and since she was new he wanted to take us on an extended tour of the hospital after lunch.  We saw everything from the HIV pharmacy to the private patient ward, where you pay more to get a private room, to the new cancer center, which is basically just a humble concrete building with a few cots and IV poles for infusion chemotherapy.  After that it was getting late in the afternoon and we headed home to go for an evening walk before the rains came.  Once we got hungry, we were thinking of cooking, but Emily reminded us of the love of roasted pork that most Ugandans have.  We called a taxi and drove a mile or two down the road to a restaurant called Diners.  It was a humble concrete awning with a bar, next to another concrete building with smoke billowing out of it.   We ordered a few sticks of roasted pork each, along with chips (fries) and salad, and about 30 minutes after the smoke furiously billowed out of that building, our dinner arrived.  Meanwhile we enjoyed watching some Ugandan soap opera/musicals on the television at the bar.  The pork was delicious while somewhat tough, and we stuffed our faces and came home to bed!

Since Easter holiday consists of Easter Thur/Fri/Sat/Sun/Monday in Uganda, all of which are public holidays, Christina and I have decided to take a little trip to a place called Lake Bunyonyi.  I'll be taking my fancy camera and will hopefully have some good pictures for you!