The holidays felt like a blur this year, as I spent most of it at the hospital for holiday coverage. In fact, I must’ve over-exerted myself and caught some viral bug last week. Between my intermittent coughs, Melody and I rang in the new year with our sore throats and hoarse voices as we squeaked “Happy New Year!”. With the snowstorm and both of us being sick, we ended up spending much of our time indoors. This also gave us some time to revisit the post-apocalyptic ruins of Washington D.C. in Fallout 3. The game is very reminiscent of our favorite role-playing fantasy game Oblivion, but with guns. With this new generation of video games demanding more and more processor juice, though, I ended up overclocking my 2-year-old processor. So far, I’ve got my 2.4Ghz Athlon X2 running at 2.75Ghz using an 11x multiplier with minimal voltage increase. My hope is to get it up to 3Ghz with a little more tweaking. I’ll just have to be careful not to push it too far, as I often end up doing to myself.

It’s Christmas Eve 2008, and I’m spending it on the 10th floor of the Shapiro Center watching over two floors of cardiology patients while looking out at the quiet blanket of snow over Jamaica Plains. It’s not how I would normally envision spending Christmas Eve. But after an entire month of juggling clinical duties in the day with studying for Step III at night, it was a relief that the exam is finally over. The USMLE Step III occurs over two days. Mine took place within the confines of a drab office building just 5 minutes from my apartment. Much of it felt more like a reading test, as each question tries to throw you off with paragraphs of unnecessary information and extraneous red herrings. Sadly, I had little time to celebrate after it was over, as I was back at the hospital for holiday coverage the very next morning. But even as I sit in my call room, answering the string of pages, I feel a sense of relief as I take on my role as a normal intern again.

Despite having 5-days off for Thanksgiving this year, we had little time to enjoy ourselves with Melody’s oral boards and my Step III exam on the horizon. We spent most of Wednesday studying at the NYPL, breaking only briefly for hotdogs from Gray’s Papaya, which sadly, were no longer the deals they used to be. After a big potluck dinner with the extended family on Thanksgiving Day, we drove up to the Woodbury Outlet Mall to battle the crowds. The last time I went there was exactly 8 years ago, when I stocked more than half my wardrobe. This year was no exception, and the hoards of shoppers made it hard to believe that we’re actually in a recession. After more than 10 hours of bargain hunting, we drove home with a trunk full of clothes and an impressive stash of credit card receipts. We concluded the evening with a birthday dinner for my dad, which included a tasty black bass and a platter of walnut shrimps and fried milk. After lugging our heavy bags of goodies back to Boston, we went straight back to work. With little time left to study and no break until March, I anticipate a bleak winter ahead.

After 4-weeks at the VA hospital, I’ve learned a lot more about practicing medicine outside the sanctity of a large academic hospital – like having to wait an hour for the CT tech to come in for a head scan in the middle of the night, or even worse, waiting an hour for anesthesia to roll out of bed for an emergent intubation while we stood there bagging our hypoxic patient. I also got better at drawing blood, especially when the nurse refuses to do it. As a member of the code team in the MICU, I even got a taste of “code green” (psych code) on my first call night, which involved me running after a crazy old vet with his IV dangling from his arm, hospital gown flapping in the wind, and his naked behind exposed to me as he eloped from the hospital. I guess one of the great things about internship is that it always manages to keep life interesting.

After a gloomy 2-week-long black cloud on the ward service, even the ICU at the VA Hospital seems like a breath of fresh air. The service is lighter, my cloud seems whiter, and after election day last week, the skies appear ever brighter. I’ve also recently discovered an ingenious piece of software called PlayOn. Still under beta testing, the program can stream video content from both Hulu and Netflix directly to my PS3, and thus, my large-screen TV. This has unlocked a whole Pandora’s box of TV shows to procrastinate with, including the first seasons of 30 Rock and Heroes, as well as new episodes of Terminator and SNL. So much to watch … so little time. By the way, photos from our Japan trip are posted here – enjoy!

Traveling to our hotel in Hakone was an adventure itself. After reaching Odawara and its castle by train, we took a mountain tram to Gora, switched to a cable car to Togendai, then boarded a sightseeing boat across Lake Ashi to Moto-Hakone for the bus to our hotel. Though the heavy fog that day made for a misty, romantic view of the sulfur springs in Owakudani and the great torii at Hakone Jinja, our view of Mt Fuji was completely obscured by the blanket of white. Fortunately, we were redeemed on arrival at the Mikawaya Ryokan, where our lavish Kaiseki meal and a soak in our outdoor private hot spring bath melted our stress away. By the time we arrived in Kyoto by shinkansen on Wednesday, we were totally re-invigorated. After checking into our hotel, we wandered down the narrow street of Pontocho, munched on over-spiced okonomiyaki, and finished the night with ramen from another Santouka branch. The next morning, we braved the maze of bus routes to check out Tenryu-ji and the bamboo forest in Arashiyama. From there, we headed east to the famous zen garden at Ryoan-ji, survived the asphyxiating crowds at Kinkaku-ji, and found reprieve at the serene gardens in Koto-in. The afternoon was spent exploring the imperial palace with an hour-long guided tour and gobbling octopus balls at the Nishiki food market. We took a last detour to behold the tunnels of toriis at the Fushimi-Inari-Taisha before rounding the night off with a beautifully-presented yuba dinner at Komameya. On Friday, we went to Higashiyama for a morning view of the Kyoto skyline from the mountain-side temples of Kiyomizu-dera. From there, we strolled through the serene street of Ishibe Koji for a stop at the gardens of Kodai-ji and paid homage to the Ryozen Kannon. Further north, we passed Maruyama Park and listened to the hypnotic Buddhist service at Chion-In. After a lunch break with some nabeyaku udon at Hinode Udon, we wandered down the Philosopher’s Path, with multiple stops for green tea soft-serve, before reaching Ginkaku-ji, which sadly was under renovation. Feeling totally “shrined” out, we spent the late afternoon browsing comic books at the Manga Museum. We concluded our final evening with two dinners – an unagi-don rice bowl and a hearty platter of udon. A perfect ending for any trip.

If a vacation is judged by the quality of its meals, then our trip to Japan is probably our best by far. We arrived Thursday evening, and had our first bowl of steaming ramen before settling into our hotel. We awoke the next morning to mouth-watering fatty toro at Daiwa Sushi before walking over to the Tsukiji Market. After wading through the bustling aisles of fish stands and watching mammoth hunks of tuna finely carved with samurai swords, we walked through the Hama Rikyu gardens to board the boat cruise to Asakusa. There, we munched on warm red-bean cakes and browsed colorful souvenir stands along Nakamise dori before reaching Sensoji Temple, where we joined the crowds to wash our hands and bathe in incense smoke. In the afternoon, we watched a Kabuki play in Ginza, then checked out the new toys at the Sony building. Saturday morning was spent in Kamakura, where we visted the Daibutsu, braved the caverns at Hasedera, and even watched a Shinto wedding ceremony at the Tsurugaoka Hachimingu. Lunch took place at the Shin-Yokohama Ramen museum with a family friend. To our dismay, we only managed to eat at one of the eight ramen stands there, not realizing that smaller “tasting” portions were also available. For dinner, we met with an old lab-mate for more noodles at Santouka, a ramen chain specializing in tender pork cheek char-shiu, of which only 200g can be obtained from a single hog. On Sunday, we went to Harajuku to gawk at the crazy fashions of Tokyo teens, shop for souvenirs, and eat the famed black pork tonkatsu at Maisen for lunch. Since tickets were sold out for the sumo finals, we spent the rest of the afternoon at Japan’s largest electronics store, Yodobashi Akiba, where I perused the myriad gadgets that lined the store shelves. We met my lab-mate again for dinner, this time for tasty beef tongue and kalbi at a Korean BBQ joint. Yet, our adoration of Japanese beef was pushed even higher the next day. After immersing ourselves in Miyazaki’s enchanted sanctum at the Ghibli Museum, we had our first taste of Matsusaka beef at Satou Steakhouse, where the grilled steaks were so well-marbled they literally melted in our mouths. Rain clouds were setting in by then, so we spent the afternoon with an indoor tea ceremony, then after a brisk walk through Roppongi, caught an evening shot of the Tokyo Tower. Before leaving Tokyo the next morning, we returned to Tsukiji one more time for sushi. Life has never been better.

I was looking at the back of my shoes today, and thought that the logos were printed at an angle … until I realized that my SHOES were at an angle! Looks like internship has taken quite a toll on my soles. My first rotation on a ward service has taught me the importance of having a pair of comfortable shoes that will allow me to run between 8 different floors of the hospital building and still go reasonably well with a pair of slacks. The other thing I’ve learned on general medicine is how much I can hate my pager. As a med student, we wore our pagers like a sheriff’s badge, a symbol of responsibility. Of course, back then, we were just paging each other about what to order for take-out on call nights. But now, with pages ranging from ICU call-outs with acute shortness-of-breath to cross-covers threatening to leave AMA because we won’t feed their narc addiction, the buzz of the pager has come to evoke both a sense of fear and aggravation. I can hardly wait until my upcoming vacation, when I’ll be pager-free for two full weeks.

My elective in medical management has been quite a change of pace from intensive care medicine. Last week, I left the confines of the medical ICU and stepped onto the 11th floor of Prudential Tower, the headquarers of Partners Healthcare Systems. Formed in 1994 by the Brigham and MGH, Partners has become the dominant operator of hospitals and other healthcare facilities in this region with a revenue of $6.5 billion. The reason for its success stems from the ability of organized providers not only to negotiate with payers, but also to provide better and more efficient medical care. Of course, this requires a think tank of businessmen and lawyers whom I got to interact with. From boardroom meetings on public relations strategies to contract negotiations with insurance companies, the experience opened my eyes to the world of corporate medicine. But more importantly, the rotation also gave me my weekends back – allowing me to revisit MGS4 and also check out the new game Spore. From the creator of the Sims, the game encompasses all of evolution. Playing a clearly non-Christian god, you control the fate of an organism from a single-cell stage swimming around in primordial soup to their future as a civilization exploring other worlds in space. So far the game shows some potential, but I’ll have to see if it has good enough replay value for my vacation later this month.

Though my busy schedule this month will preclude our participation in Boston’s Restaurant Week this year, we nevertheless decided to treat ourselves last night to dinner at Chef Gordon Hamersley’s restaurant in the South End, Hamersley’s Bistro. We started with braised mushrooms on top of smooth, creamy polenta with just the right touch of crispiness on the outside. Our other appetizer was a crispy duck confit with peaches and onions that was so tender it fell apart at the touch of our forks. For entrees, we had a creamy monkfish and mussel bourride with saffron, potatoes, and leeks, and a spicy halibut and clam roast with bacon braised greens cooked to a resilient and tender perfection. We finished off by sharing an almond cake with sweet cherry compote and vanilla ice-cream based on our waiter’s advice. Along with switft and friendly service, the meal was hands down our most solid dining experience in Boston, bringing a moment of sweet satisfaction amidst the craziness of the MICU rotation I started last week. By the way, if you haven’t already seen The Dark Knight, I strongly recommend it. I’m just sad that we will not be seeing more of the talented Mr. Ledger who embodied the psychopathic Joker with pinpoint