One and a half weeks in

It's a little weird to identify myself as the pulmonary fellow, after three years of being the medicine resident. It's a little weird to be on strictly first name basis with all the attendings. It's great, though, to be white-coat less (mine is still on order, perhaps a California IOU?) and tie-less. It's about 50/50 here, and I've made a decision to join the tie-less 50%. Which means that the Osler tie will get a much needed rest.

The VA is very laid back, and not the learning curve of the rotations at the main hospital (I'll start there in September). Which is not a bad thing considering the last bit of my residency, the move-out, the drive, and the move-in. I'm using the BART and MUNI to get to work, which unfortunately takes around 1.5 hrs there and back. Which is excusable now, as I am studying for the boards. But this could be irritating. The VA is the farthest out, though, and the other hospitals should be better.

Immediately, changes become obvious.

The old view from the MICU nurses' station:


The new view from the MICU nurses' station:


The old view from the parking lot:


The new view from the parking lot:

July 1

Today was July 1, the worst day of the year to be sick. The new interns, residents, and fellows started today. I started at the VA, which apparently has the best view and the worst food in all of the Bay Area.

So far it seems like an easy rotation, though on BART/MUNI it takes me 1.5 hrs to get there. Right now, it's OK as I am studying for my boards and reading while riding, but that may get irritating.

Part of what strikes me about this whole thing is between today and yesterday we had around 9 hours of orientation. Next to none of this had to do with being a pulmonary fellow. Almost all of it had to do with "The ACGME/JCAHO/Regulatory Commission XYZ has required that we tell you about this random fact." Which I have now heard at least 3 or 4 times. It also took me 3 hours in line to get an ID, on a day which every single year they know they will be issuing 200+ IDs. The scary fact is I was lucky to get an ID; there were plenty of people behind me when I got my ID finally at 4:30 PM and they were threatening to close at 5 PM.

Tom Friedman wrote a book about how the world was becoming flat. While he meant this as the development of economic parity between the developing and developed world, I think he missed the boat. What's really going on is, with 9/11 as a catalyst, there is a great leveling of the bureaucratic nightmare between the developed and developing world.

My dear wife, as a semester abroad student in Israel, once attempted to get a deposit back in the days when you needed to put a deposit down on a phone. She showed up with a huge stack of papers and bills in order to do this. My dear uncle explained that the clerk was highly trained by the Israeli bureaucracy to rifle through a stack of paper and quickly identify the one paper which you did not have. True to form, in under a minute, the clerk identified she did not have her first month's bill and to this day we are still waiting for a check from Bezeq.

Such has become the experience in getting licensed in California, in getting a DEA number, in trying to start the process of registering a car, in getting a driver's license, in trying to get deposits back for things like E-Z Pass in Maryland, and so forth. Friends starting in Maryland or *gasp* for the federal government agency of the NIH have had it as bad or worse. Like any good third world nation, though, California's budget crisis has forced most state government to close at random times and on random days with the only apparent rationale being that the days they are closed happen to coincide with the only convenient days for you. I only got my license (today!) after basically cajoling my way through the lackey on the phone in order to talk to the muckety-muck. I applied for it in February, and was lucky. Last I heard they were still processing November applications. I also have a dire lack of protectsia in the new state which doesn't help things out.

Anyway, I expect by 2011 that we will need to be offering bribes in order to get simple tasks done. Mark my words and start hoarding $20 bills.