Boom in the Bronx

Guess where I am currently rotating? Nope, not even close. That was a bad guess and you should be ashamed of yourself for even thinking it.

I'm in the Bronx, in NYC. Now, as a general rule, when 3 different people warn me that a place "isn't as bad as it used to be," then that area is probably still not all that fantastic. But I'm alive, and I haven't been shot at yet, so its not a warzone by any means. That being said, I was woken up at 3 AM several nights ago to the sound of three loud booms. In my un-asleep-anger, I took them to be gunshots, but in retrospect they were probably fireworks.

Why fireworks? Because in the Bronx, the fourth of July is more of a week than a day, with illegal fireworks as a reoccuring theme during the night. Living in an apartment building next to a large park makes for some beautiful displays and also target practice.

Things I like about the Bronx: they have healthy fruit/veggie shacks all over the place around Montefiore and near the subway stations. Its actually one of the few things I am envious of and wish Toronto could implement in some degree. Availability of fresh fruit/veggies seems to have been a historic problem here, and the fact that every third store is a deli mainly selling preserved goods is a testament to that fact. Then again, the freshness of said fruit after sitting under the sun for several days is questionable.

I'm currently renting a room at a medical resident's apartment, even found a nearby gym. But finding street parking here is just, oh I don't know, hell on earth. It would almost be worth the $200 it costs to park 15 minutes from my place. Too bad I'm not staying long enough to qualify for monthly parking at my building for much cheaper.
Word of the wise: anyone trying to rent an apartment to you will tell you that street parking is free and easy. anyone telling you that is a liar.

Bronx-Lebanon is the hospital I am currently rotating at. Its a good H, good doctors, and I look forward to going in every morning. (Perhaps not so) Surprisingly, a significant number of patients I saw had more social problems than health ones, and the degree of integration of social workers in the hospital was actually a very impressive site. They were consulted on as far as applications to  homes/shelters/home visits by nurses and ensured continuity of care and smoother transfers once the patient recovered. That being said, I could still see financial wastefulness as far as beds being taken up by people with nowhere to go or whose paperwork was still being processed or insurance was just rejecting things left/right/center. It felt to me that transferring them to a more dedicated social unit with a lesser degree of nurse/oriented monitoring would have served everyone better. However, I'm sure that there are legal or financial reasons why this hasn't been implemented yet. I doubt I'll solve all the woes of the US medical system 2 weeks into my first real in-hospital rotation.

Anyways, I travelled to the city (Manhattan) over the weekend. It was a really different feeling. I could understand why people like it, despite the fact that big box chains seem to form 90% of the businesses there and are a boring sore sight after the fifth store. Then the eight one. Booooooring.

Oh, tips for all you Canadian IMGs with a B1 visa: if visiting Canada and then returning to the states, make sure you have a new up-to-date hospital letter and immigration letter when re-entering at the border, REGARDLESS OF WHETHER YOUR B1 VISA IS VALID. I have heard of students encountering these difficulties when re-entering with a B1 visa because they lacked said documents. Be warned.

Other things...lets see, remember that most application for canadian electives require 9 months to process, so start early. I also just found out that spending $1000 and taking the MCCEE is no longer required for a J1 visa (which is the most common visa for IMGs doing their residency in the US). However, it is still required for the canadian residency application via Carms.

Shopping!

So today was grocery day.
Thought I'd try out a few different places to see what they had.

Hess
-all right, this is actually a gas station, but you can't but groceries if you can't get to them
-used the "Gasbuddy" app on my android phone to find the lowest gas station prices near my location
-had a lot of trouble with one of the pumps.

Aldi (8261 Coral Way, 33155)
-far away
-spent about $26 here
-only thing they had significantly superior prices on was skinless boneless chicken breast and some lemons
-Overall: probably not coming again unless im driving to Hess to buy cheap gas as well

Amigos (2460 SW 27th ave)
-spent $3
-run of the mill corner shop, mostly canned goods
-bought some chickpeas and made a killer hummus
-seriously this hummus is so smooth you could pour it into a waterbed and sleep on it
-and then eat it in the morning
-well assuming it hasn't gone bad
-most of their fruit looked sad and poorly nourished
-Overall: great for canned beans?

Milam's (2969 SW 32nd ave)
-somehow prices everything at double the average store, yet remains popular
-nice decor, especially the liquor section
-if you are a poor/cost-conscientious student, avoid like the plague
-remember to also avoid actual plagues

Publix (located everywhere)
-pros: very close
-most of the high prices are restricted to the meat and the groceries, which leaves...well, household stuff i suppose. and boxes of cereal
-good cereal selection, now that i think about it
-expensive hummus
-probably isnt anywhere near as smooth as mine
-has the specific kind of milk I buy, and is the only place that seems to carry it
-surprisingly has decent prices on bananas, but theyre always oddly placed
Overall: buy bananas and Lactaid milk, maybe cereal and peas

Costco (somewhere near the airport)
-cons: far away
-amazing prices on bulk frozen strawberries and mixed berries
-very good prices on nuts
-great mixed salad
-great oranges, but surprisingly small selection as far as produce
-holy hell thats a lot of eggs
-Overall: buy nuts, salad, eggs, frozen berries, whatever fruits as looking allright. find friend with membership

GFS
-chicken breast is not as well priced as Aldi's per pound, BUT claims to be antibiotic and hormone free, which is always nice
-great frozen veggies
-much closer location-wise

Despite grocery shopping, I seem to have had trouble finding a decent store that sells quality (damnit Amigos), affordable (no Publix, you don't know what that word means), individual (goddamnit GFS and costco, I dont need 20 onions) fruits/veggies. I've heard there's a place near hear that might have potential. Must scout it out next week.

Fat Hacker Alarm!

My weight loss continues! I'm almost 35 lbs below my heaviest weight that occured during my final Step 1 studying days. Since then I've been on a calorie restriction diet that alternates (depending on what my body tells me) between i)  having 3 light meals each day ii) skipping one meal but having 2 full meals. This has been averaging out to a loss of 2.3 lbs/week. I used an app called MyFitnessPal religiously for a few weeks to estimate my daily calorie intake, until I had a better sense of which of my meals were too high-cal. While I occasionally use that function these days, I mostly just use the app to keep track of my daily weight. I measure at roughly the same time every morning for consistency.

As of ~2 weeks ago, I am no longer in the overweight BMI category. As of today, I have reached my average weight in high school (which, I realize in retrospect, still had lots of love handles).

The two biggest obstables I have faced have been i) the 3 day drive down to Miami ii) my first on-call patient at 2am. Between the fatigue and the irregular hormone levels associated with staying up all night, I ended up breathing in 2 or 3 muffins and a few other complimentary bagels because damn, I felt like I was starving. A rage-ful hunger, if you will. Ended up gaining a consistent 4 lbs in that one night, which took a few days to gradually wear away. But yeah, just remember that there are always small setbacks, but don't forget that gradual calorie restriction works, and that its the goal in the long run that matters. Also...skipping breakfast (and substituting with coffee) is much easier, but having an early and light dinner seems to be more effective as far as hitting the scales goes.
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On-call: So, my attending doctor is on call about half the month, which means I'm on call about half the month. He gets alerted via beeper whenever there is a case, and then he text messages me to come join him. This works well except while I'm sleeping, because text message beeps on android phones (Nexus 5 in my case) are not exactly loud. I slept through the first message, but thankfully my colleague was awake when he received the same message and called me up.

I ended up installing SMS Alarm from the google play store. Its not the most full featured program out there, but its free, and doesn't require learning German, so it'll do the job for now. Namely, sounding a loud alarm whenever my attending sends me a text message.
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On to the next topic: the success of my sleep adjustments after utilizing the electronic timer switch.

Or rather, a lack of adequate data points.

My first night, I got a call at 2AM, and worked till 1PM. Then I had to start working on a powerpoint  presentation. Slept soundly this night.

The next night, I had to work well into the night to continue improving a powerpoint presentation that was having some unfortunate software problems (damnit Libreoffice, convert to .PPT more smoothly!).

The night after that, I was sleeping soundly until 4AM, when Google alerted me at via my phone that a hacker in Nigeria was trying to get into my e-mail account. Password changed, all active sessions were ended, re-enabled 2-step verification, and reviewed my password recovery options. Sleep adequately screwed up.

And finally, this morning, my neighbour's retarded dogs feel the need to bark in the mornings. And they're still barking. Just shut up dog. Such loud. So wow.
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Oh, turns out TD rejected my visa card application.  Apparently I need an income, which is a valid reason, but you would think someone would have explained that in the hour it took me to get through the application.

"Never let HR interfere with your education" - Arthur

It has been a long few days. Very frustrating, hair-pulling, bikini-waxing, administration-calling, landlord-yelling, traffic-negotiating few days.

Let me start with the first success I've had here.

First off...some of you may remember that on the island, I had difficulties sleeping. It took me months to find a setting in my first apartment that produced a good nights sleep occasionally, and during my fourth semester I never caught a wink of sleep. My grades, energy, and mood suffered enormously. For those that have studied well, its common knowledge that sleep and depression are tightly linked. A person that develops depression often starts having sleep disorders, and a person that develops sleeping disorders may start developing depression.

So when I came down to Miami and started having sleep difficulties again, I was worried. I noticed the pattern suggesting I only woke up between 4-7am. I quickly tried testing out my old theories on the cause of my own sleep problems.
a) noise levels caused by the mini-fridge & window A/C in my room
b) as the temperature rises, it kicks off my physiological 'wake the fuck up' routine.

What tools did I have now that I didn't have on the island, though?

1) Amazon.com
2) credit card

I wanted to order a timer switch (in addition to books and a shiny new case for my shiny new phone) that has programmable hours. Downstream devices turn on and off only within the hours I set. However,  having used mechanical versions of these timers before, I knew they themselves could be annoyingly loud. So I found a silent electronic version (this model) and set it up last night.

I woke up at 8 am this morning. First full 8 hours of sleep in weeks. This is a promising result!

So there you have it.. I prevented depression for $17. Now if I can just write this down as a hypothesis and record some data points, I can write a research paper.


Other one-offs:
1) tap water in miami tastes really wierd. i dont usually use bottled water, but this is the first time I don't feel particularly bad creating plastic waste.

2) Frank's Red Hot Sauce is basically just red sauce. There is no hot in your hot sauce, Frank. I am disappointed. Still tastes decent though.

3) My car's air-conditioner broke again halfway through my 3-day trip to Miami. Arthur, I am disappointed at your attempt towards a repair job. Maybe next time  I will use the actual spray I was supposed to, instead of just grabbing something from my garage >.>

4) At target, I saw 2 lbs of chicken breast sell for $10. At GFS near my hosue, I saw 10 lbs of chicken breast sell for $20. Guess where I bought a months supply of chicken :D

5) I have a tendency to over-salt my chickens while they fry. or bake. or boil. I have yet to broil chickens.

6) I dealt with a nice young man working in the American TD bank that helped me get a credit card. He somehow managed to print the wrong information out four times that I caught by reviewing the application. How do you type a name wrong when you are literally copying it off a driver's licence? Hell, the application only had 14 fields you could input. Not surprisingly, I received a notice yesterday stating the application was rejected because I needed to supply more information.

7) CHS. Center for Haitian Studies. Basically, the organization that handles a large majority of the Ross and AUC students rotating in South Florida. They have 5-6 administrators between then juggling hundreds of students and paperwork, often leaving students in extremely shitty situations. I refer to CHS as the Titanic, because they are one iceberg away from leaving hundreds of students floundering. Also, because CHS lacks lifeboats. And also because I'm in the mood to watch Titanic again.

Yes Titanic, I kind of noticed that you knew my scheduled location for a month and didn't tell me until the last possible day, after everyone had already rented a place to stay that may be up to 2 hours away from their clinic. Thanks a lot, dickweed.

Yes Titanic, I kind of noticed that it takes you six weeks to issue a hospital badge for a rotation that lasts exactly six weeks. Or 2 weeks. or 3 months. Not cool brah, not cool.

I know the five administrators at CHS are working hard and on limited resources. But they are over-leveraged and have the potential to create extremely poor learning rotations as a result. One student confided that during his IM rotation at CHS, his physician was on vacation for 5 weeks, so he was told to study at home. After the physician returned, she saw about one patient per day. And that it took him 3 months to get his hospital badge. This is bordering on fraud on the part of CHS. Accepting money to schedule students for a medical education while failing to provide either is about as fraud as it gets.

As for the badge....jesus, what a cock-up. Medical education in the U.S. seems to be 95% liability and 5% signing paperwork.
I have updated the maxim "not allowing his schooling to interfere with his education," oft attributed to Grant Allen or Mark Twain, to modern times. It proudly sits atop this blog post as the title.

8) I have loads more I can write about (read: complain, whine, praise, suggest, waste both your time and mine) but I should get working! And also I finished eating breakfast 30 minutes ago.

Cool

Looks like my muffler has to be replaced.

I learned today that banks have very stringent rules...and that tellers frequently find ways to bypass them.

On the plus side, I did fix the climate control circuit on my car. Here are some fun pictures of the process.

Up(to)date

Well, someone in my house accidentally nabbed my keys. At least that's resolved.

Lenovo apologized for the delay. Doesn't really help with the situation at hand, however.

Going to stay home today and try to catch up on some study material. No exercise for me :(

The landlord responded today asking which room I wanted pictures of.

Yup.

Because attaching 2 images to a single email is still beyond the capabilities of personal computers.

edit: LO AND BEHOLD SHE FOUND OUT SHE COULD ATTACH TWO PHOTOS, BUT THAT ONLY ONE PHOTO COULD BE OF A ROOM.

double edit: I now have the room deposit paid and taken care of.

I also found a place nearby that can probably patch up my muffler leak easily. While I have the basic tools to do it, I don't really have a way to lift the car up, and I definitely don't want to start disassembling my muffler just to do a quick weld. It will be ~$20 well spent.

The car's A/C problem, though, is another problem entirely...the buttons are becoming less responsive by the day.

However, thus far I've fixed the rear O2 sensor (which caused its own exhaust leak + threw a Check Engine Light code), the windshield washer fluid sensor, and my turn signal switch, all for about $70 (would have only cost $15 if I had bothered waiting another day). I think I can handle a few sticky buttons.

On a side note, many thanks to Matthew, who helped unfreeze my e-brake several years back. If only he were in town.... we could rotate my tires >.>

Ants

Little problems are starting to creep up, and they are annoying me to no end.

One, which is entirely my fault, is that I may have lost my keys today. If this is the case, not only is it a first, but an annoying first. Between a coat and a jacket (yes, we had another snowstorm today), 2 books and a hat, its possible my keys fell out of my pocket while on the bus. This brings me great sorrow, as I've been trying to stay on top of things I can control, and that's evidently not the case.

Another snowstorm hit today. After clearing two driveways and waiting an hour for a bus (on which bus I would likely later lose my keys), I realized we might have another 2 days of snowstorm left. I also have the TTC lost and found to look forward to, but first I need to also check all the snowbanks for needles. err. keys.

The landlord I have been talking to about renting has been ridiculously slow at sending pictures of the apartment. Its been four days thus far. The house is in a great location, rent is affordable, and the landlord seems like a real person as opposed to one of an endless number of scams. BUT if a landlord is this slow trying to get a tenant, imagine how slow she will react when there is an actual problem. 

Its been a year since my laptop died while in transit. Traveling to and fro on the island, as well as between the island and canada, took its toll on my fiesty little machine. During a final flight, a single bump knocked out the monitor, and soon the rest of the computer followed. In preparation for my upcoming trip, I purchased a Lenovo laptop from the company. I called up the company, asked where a particular model would be shipping from and the actual ship date (to make sure it would be here before my own trip began) and purchased it based on that information.

Of course, the salesperson's information was complete garbage, as its now four days past the first estimate, and current estimates put it at another 6 days until they actually ship. This will put the laptop's earliest arrival date at ~2 days after I originally planned to leave. Thank you, asshat. Oh, and lying about the laptop being in your warehouse (as opposed to it actually being manufactured + shipped over from China after I purchased it) is a real classy move. 

I'm looking at the drive down from Toronto to Miami. My mother wants to accompany me on the trip. A full 24 hours of backseat driving. I don't look forward to it. Not to mention, it negates any benefit of having a Nexus card, as I can no longer use the Nexus lane.

Aaaaand finally, I'm worried my muffler might have a hole in it. This would be easier to check if, once again, we actually had some weather warmer than 5 degrees C. Not that it matters, as I'm currently lacking the keys to the car.

So yeah. I can't drive without a key, my car has problems regardless, even if it works I have to deal with a passenger, I currently don't have a confirmed place to stay, and I have no method of studying once I get there. And there's nothing I can fix by myself.


EDIT: in retrospect, none of these are really little problems. (except maybe the drive down with my mom >.>)

GAH PAPERWORK

So a few months back, I applied to NEXUS. Its basically a cool little card that let's you skip longer lines at the airport/land crossings (and marine crossings, but I'm not familiar with that process). The initial application costs a few pretty pennies (~$50), and it takes 2-3 months for them to verify the initial application. After you've been verified, you have 30 days to schedule an interview.

Now, being from Toronto, the nearest interview center is at Pearson Int'l Airport. The wait list is abouuuut 3 months after your initial verification. I was able to schedule myself about 2 days after verification (I kept checking every minute for a cancellation and lucked out after 20 minutes).

Next began the gathering phase. As in, gather every piece of documentation that you need as proof. I arrived early (suited up, of course, but that proved to be unnecessary). I had 2 border agents (one Canadian, one U.S.) simultaneously ask questions or explain facts/procedures, but nothing stressful. Card should be in the mail soon.

After that and a coffee, I called up my car insurance agency to figure out something that's been causing me many headaches. My insurance broker had initially told me that I need new car insurance about a week after leave Canada and arrive in the states. BUT: assuming other companies have similar terms, then every other medical student I asked was breaking their policy contracts and lacked adequate car insurance.

So I called up a rival company, received a quote and asked the very same question. They told me I can easily spend a couple months in the states and still have adequate insurance. But they were also giving a much higher monthly quote than I'm currently paying. So I called up my current insurance brokerage company (On Saturday, when my regular broker isn't working) and asked another broker and someone in customer service.

It turns out, I can spend 6 months in the U.S. with my current insurance. Then, I need to come back to Toronto for a day and tell my insurance company I'm back. That's all it takes to leave for another 6 months with valid insurance.

So: is my regular insurance broker flat out wrong, or is their customer service + TD insurance wrong?

YOU DECIDE.

Actually, no. I decided. My regular broker is wrong.

Also, my apartment search has neared its end. But I'll write about that soon.

R&R

This last month has been nice and relaxing.

I recently started a diet to reduce some of that Step 1 15 (your weight and IQ go up by 15, it lasts about 15 weeks, and you spend $1500). Its been going well, with about 20 pounds lost as of today. I recall the day after my finals in university where I stepped on the scale and thought..."screw it, I'll deal with this another day." This is that day. Well....span of days....lasting many weeks.

During this diet, I went on a short vacation to New Orleans. The land of food and drink. My travelling companion, who I shall henceforth refer to as Luce, did her NOLA research on both cheap/fine dining, accommodations, sights and sounds. She had instructions on what time we should both arrive, and to leave the rest to her.

Of course, both are flights were delayed for hours. Take THAT, sensible planning. Oh, and I found out our accommodation was a couch in a random strangers house. But they proved to be two terrific people. Kind of. My only regret is that crawfish weren't in season.

That's a lie. My regret is that I didn't buy my plane tickets one day earlier than I originally planned, because the ICE STORM FROM HELL RAINED UPON TORONTO and knocked out all the electricity and internet. So much for buying airline tickets. Calling a travel agency a few days later (after figuring out how to maintain the house) also led me to the realization that travel agencies are not just mostly redundant, but also pretty terrible at doing their jobs: namely, finding flights that arrive/land at certain times in an efficient manner. Quoting me a flight that's $120 above the flight I've found, with the added benefit that it leaves at 4am in the morning and a 5 hour wait for a connecting flight does not win you customers. Though, this travel agency is still doing better than Ross Universities recommended travel agency did 2 years ago, when they suggesting a plan that had me on FOUR connecting flights (spanning nearly 24 hours) while I found a much cheaper arrangement with just one connecting flight.

So yeah.

Oh, in other fun news: actually, no, I'll wait a day before posting pictures. At the moment its just a bundle of electrical wires that looks more like an insurance broker's wet dream than a fun side project. But I did wire up one of these for a DIY sous vide cooker. Now all i need is steak to cook at low temperatures over an 8 hour period...in a water bath.

Speaking of the ice storm from hell, the last big project I have lined up is a way to hook up a generator to the house furnace. Apparently the one switch I need is sold out across Toronto, so I will master the waiting game until then.

Finally:  Ross scheduled me for my initial rotations. I apparently had to do a whole set of additional paperwork for my first rotation in Miami. Most of it was a breeze to fill out, but some is also completely inaccessible to me (as no organizations provide level 2 background checks in Canada). Additionally, one document requires a B1 visa number, which I won't receive until I cross the border. Hurray for beaurocracy.
I'm just doing some readings now to prep, as my clinical skills are a bit rusty.

What's going on in your lives, dear reader?