FreshMD

Sign in North Vancouver public washroom

I wasn't sure what this sign meant at first, but I don't think I broke any rules.

Things that made me happy at work today

• Camel-coloured corduroy pants paired with rust brown leather shoes on a 53-year-old Iranian man.
• The Emergency Department records on a homicidal psychiatric patient that I sent over last week; they agreed with my assessment and admitted him.
• Arriving at a diagnosis that fit all of the untidy bits and pieces of a patient's presentation into a neat package. Then offering treatment.
• A burrito the size and shape of a swaddled newborn painstakingly served up by a Middle Eastern husband and wife team at a Mexican hole-in-the-wall on Broadway.
• Fifteen minutes of thrifting between the burrito and my one o'clock patient, scoring another vintage record for Saskia's collection.
• Laughing and laughing with the interpreter and an old Afghani man about a translation error.
• Fitting in a few minutes to review thalassemia and learning that the Constant Spring variant is not a sort of 'Fount of Blessing' euphemism, but a reference to the Jamaican location where it was discovered.
• Leaving early into a sunny, cool Vancouver afternoon.

Research

My work brings unusual perks. I may not get medical or dental benefits, but I did receive a large canister of pharmaceutical grade corn starch from the clinic pharmacist a few months ago.

"We were using it in a study," she explained. "Since it's a white, tasteless powder it makes a great placebo."

The other day as I measured out a few more teaspoons of the chalky granules for a batch of cabbage rolls, I had an unsettling thought.

How stupid was I to accept a discarded tub of white powder from a research centre?

Wet Sunday in Deep Cove, again

I wish I could tell you that these photos were done in black and white.

No, this was the view from our place at midday.

Some days I appreciate the gentle gradient of greys washing from the sky, over layers of mountains, to the silver waters of Indian Arm.

But most days I just wish the sun would shine.

Sony Alpha DSLR-A100

I bought the Sony Alpha DSLR-A100 yesterday.

Six years ago my in-laws gave us their Minolta Maxxum 5000, a 35mm SLR. They purchased it in 1985, when my husband was eleven, during a trip to Pennsylvania. I love that camera, for its history and the wonderful photographs it takes. I enjoy bringing the canister of film in to Blacks, and seeing the pictures for the first time when I slide them out of the slim black box an hour later.

Three years ago I purchased a Canon PowerShot A85, a digital point-and-shoot with manual control options. I wanted something I could tuck into the diaper bag, and the liberty to take as many 'free' shots as I wanted. The Minolta was neglected for a year. But when I printed off the digital photos and slotted them into the album, it was obvious that the Minolta images were far superior.

Back to the Minolta. However, I missed the immediate results and the editing ease which the Canon offered. I began to consider a digital SLR, and when the Canon's LCD crashed last week, I decided to take the plunge.

As my life becomes increasingly busy, I have become very efficient at researching products. Hours of study and cost comparison is a luxury I can't afford. After an hour of online research, thirty minutes at Lens and Shutter, and a latte at Starbucks, I purchased the Sony A100. The runners-up were the Canon EOS Digital Rebel XTi and the Nikon D40x. The fact that I already have some fantastic Minolta lenses which are compatible with the Sony (who took over Minolta's camera line in 2006) was a major factor.

I can't remember the last purchase about which I was this excited. The house, maybe? Last night I found myself wondering who I could call to tell about the camera. I was dismayed to learn that the battery would take 235 minutes to charge. And this morning, I woke up trying to remember the very good thing that I was going to get to do today.

I spent much of the day with the new camera, enjoying the solid feel of the body gripped in my hand, the clunk of the shutter, and the very satisfactory pictures it produced.

Lens and Shutter offers a 7-day return or 14-day exchange policy. I'm going to be busy putting this little machine through its paces in the next few days. Bear with me.

Eating well

I spent some time at a private, physician-run weight loss clinic as a resident. My supervisor told me, "None of these people could care less about the medical benefits of weight loss. They just want to fit into a pair of size 4 jeans."

Whatever your reasons for eating well, here's the spiel I regularly give to patients, gleaned from colleagues and professional experience:

• List your five favourite, and five least favourite foods. You can continue to eat your favourites, and permanently remove the ones you dislike from your diet.
• Pick one small thing to change at a time, something you can foresee yourself sticking with indefinitely. Sweeping, drastic changes are almost impossible to maintain. See below for suggestions.
• Avoid extremes. If you love two eggs on toast every morning, don't decide to cut out eggs forever. One egg a day is still a 50% reduction.
• If it's not clear what could be changed, review with your physician or a dietitian.
• Implement this change for 30 days before attempting another. Make it a habit.
• Repeat.

Ideas to get you started:

• If you're hungry between meals, eat a piece of fruit. Once you've eaten your six servings of fruit in a day, you can snack on whatever you want. It'll be harder to get to the Doritos than you think.
• At every meal, aim for half the plate to be filled with vegetables, one quarter with meat/protein, and a quarter grains.
• Drink water, rather than pop or juice, between meals.
• Have dessert only on weekends.
• At a party, eat only the foods you love, rather than snacking on everything presented to you.

Fad diets come and go, but Canada's Food Guide has existed, with modifications, since 1942. It's a great resource. There's more to it than the rainbow poster that hung on your Grade 2 classroom wall.

Not currently in the market myself

I find this graph of baby name popularity over the years strangely fascinating.

Here are some interesting ones to get you started: Frankie (check 'both'), Florence, Jennifer, Ayden and Elizabeth.

Failure

I'm collecting old records to hang on Saskia's wall.

I came home with the one on the far right a few days ago. When I showed it to Saskia she gazed at it, pleased but puzzled.

"You know who that is, right?" I asked.

"No," she said slowly. "I don't know their names. Yet!"

I am ashamed that I have reared a child to the age of six without introducing her to Ernie and Bert.

Discreet

My father-in-law last year as we drove down Grandview, past the bold sign for the Sexually Transmitted Disease Clinic: "Whoa! Guess you wouldn't want to be seen walking in there without a white coat!"

He must not have been the only one to make that observation, because I noticed yesterday as we drove into town that the sign has been changed to read, simply, "Clinic".

I do not offer this to the patient as consolation

An English professor once told me that he considered 'syphilis' to be the most beautiful word in the English language.

I think of this every time I make the diagnosis.

Wet Sunday in Deep Cove

Chair

My decision to purchase this chair was heavily influenced by the handwriting on the tag.

Almost everyone who works at my preferred thrift store is old and has blue eyes. I can see the white-haired men in the back of the store repairing washing machines and testing toasters. Every item is marked with a sticker, with the details carefully documented in cursive writing.

I never argue with a price or doubt a description that looks like it was written by my grandfather.

Suffering

I saw a patient last week who had had her pregnancy terminated four days prior, at twenty-one weeks gestation. The fetus had been diagnosed with cardiac abnormalities on ultrasound, and would have required several major surgeries in infancy and childhood. The patient had originally opted to continue the pregnancy, although her husband wanted to terminate; she eventually agreed.

She had been induced and delivered a male fetus, 476 grams.

The patient was new to Canada, and to me, and I learned all this as I flipped through the chart while we waited for the interpreter. The woman and her husband sat in silence. Her chin was pressed against her chest, buried in her black wool coat. He wore a pink dress shirt, slacks, and nice shoes.

"I'm sorry about all that's happened in the last few days," I said when the interpreter arrived. He translated matter-of-factly. It didn't feel right, watching condolences being relayed so efficiently.

We reviewed the cramping and bleeding. "That's normal," I told the woman. "Your uterus was like this." I made a full, round shape with my hands. "Now it's squeezing down, like this." I clenched my fist. The gestures felt terrible.

"Can you make my breasts stop hurting?" she asked. "They're leaking milk." She seemed surprised. I explained binding, cold compresses, and analgesia.

We sat in silence. They had waited for over three hours. I wasn't sure what they wanted.

"How are you feeling?" I asked. She started to cry, hands burrowed in her pockets, refusing Kleenex.

"Bad. Very bad," said the interpreter.

The husband spoke. "We didn't want him to suffer. We didn't think it would be right for him to be born, to suffer." No one said anything.

I thought of my patient in labour, a nightmarish ending to her first pregnancy. I imagined the fetus emerging into the world, and leaving it. I wondered if the mother had seen him, and whether the father had been present.

We arranged a follow-up appointment for two weeks. As she left, her sagging shoulders small and black, the woman shook my hand and thanked me. She thanked me for the things I said.

Her sorrow and misery followed me for the rest of the week. But only a week.

Thrifted Books

Books on the natural world enthrall my kids, and I'll happily read them a beautifully illustrated story full of interesting facts. Especially forty-year-old books with worn pages, curled edges, and softened covers. For pennies apiece.

Who doesn't want to know what birds do at night?

Heartwarming

Nurse, as we discuss the high yield on stool samples in our refugee population, and how that excites the microbiologists:

"A few years ago Parasitology sent us the cutest Christmas card ever, with little worms on it, to thank us for all the great specimens we had sent them over the past year."

Not in the catalogue

When I was in medical school, every first-year student was issued a skull to study for the gross anatomy course. Each skull was to be discreetly transported to and from class in a sturdy brown plastic bucket. These containers were Tupperware.

I find this interesting. Does Tupperware have a little-known line of medical products, that get no mention on their website or promotions at parties? Did the UBC lab contract them to manufacture a set of burpable, lifetime-guaranteed skull containers? Or were these large food canisters, intended for flour and sugar, that had been cleverly repurposed?

I checked Tupperware's website. There are 133 search results for 'skull storage container,' but none of the items match what I'm looking for.

Free melon baller if you can solve the puzzle.

Green Girl

I'm always on the lookout for original, affordable children's wall decor that I can appreciate as much as my six-year-old does. This precludes this.

My latest discovery is Lori Joy Smith, a Vancouver artist from whom I recently ordered a custom piece. I ran over to her apartment building in the rain on my lunch break last week and we did the handover in the lobby. Green Girl then came with me to a Main Street coffee shop where I had tea and repeatedly peeked into the bag to admire her.

When I introduced her to my daughter, Saskia studied her for a while. "How come she's not smiling?" she finally asked.

"She's shy. She was nervous about having her portrait done," I offered.

Satisfied, she pointed to the yellow heart floating above Green Girl's head. "Hey! Her barrette fell out!"

My colleague, reminiscing about medical school:

"I had a bipolar surgical attending once. The days he wore the red coat, you had to watch it. Those were the days he threw bedpans."

Myth

I remember how disappointed I was as a kid to learn that breaking a limb did not necessarily include a severed appendage. Windows, dishes, and almost everything else you break in childhood shatters into pieces. How could a broken arm not involve amputation?

Now, when I tell my kids to stop roughhousing on the stairs because, "Someone's going to break a leg!" they pause to consider the warning. I know they're picturing a lone leg, snapped off at the hip, thudding down the steps. "You could break your neck!" prompts even deeper reflection.

I haven't corrected them yet. They already know the truth about Santa and the Tooth Fairy. I'll let them hold onto this one a little while longer.

Couldn't she have just showered?

A patient at the clinic last week, when I asked her to remove her shirt so I could listen to her chest:

"Sorry, my personal hygiene has been poor lately. But I did spray myself with lemon-scented room deodorizer before I came."