A leukemia patient said her portacath seemed swollen. Since I'm not very familiar with ports, and nothing about the concept of having a big hose hooked up to your veins in a semi-permanent fashion seems normal to me, I asked her nurse to evaluate the port (::shrug::), and then consulted Interventional Radiology, who placed the port, to have a look at it.
During rounds with the new attending today, I explained that I had not seen that many portacaths in my day, and wasn't sure what the range of normal looked like in terms of swelling or if this was an early infection.
His response: "It's like pornography. You know it when you see it. You'll know an infected port if you see one."
Wednesday, September 29, 2010
Monday, September 27, 2010
Saturday, September 25, 2010
Shittiest Day Ever
Warning: this post is not funny.
So here is a note that I started from last night, then fell asleep while I was writing it:
"i'll flesh this out tmrw when i get a chance
basically, shittiest day ever
first, arrived to get signout that one of my most stable patients had nearly coded, and was now dnr/dni on comfort measures (i later pronounced this patient dead). side note: this was the pt that said i was the only doctor he saw for 2 days. the attdg and fellow claimed to have seen him on a daily visit, per the attdg's addendums to my progress notes.
other pt nearly coding in the GI lab
other lady who is still full code but terminal"
So the first patient- the attending said he probably had a pulmonary embolism. It was sudden and unexpected, and there was really nothing anyone could have done. It was incredibly sad, I really liked the patient's family.
Anyway, the second one... got paged by a frantic nurse, telling me that a patient who should have been coming back from the GI lab was actually about to code in the GI lab, and that they needed someone from the primary team (aka ME) there. She was so flustered she couldn't even tell me what happened, and had to pass the phone off to someone else to tell me how to get to the GI lab from the heme-onc floor. When I got to the recovery room, the patient was indeed hypoxic and agitated (vomited and then aspirated post-procedure), and soon after required intubation. Transferred patient to the MICU...
..then back to the heme-onc floor where yet another elderly, frail, sick patient recovering from sepsis, with metastatic cancer was slowly becoming hypoxic and suffering while she dies. I spent maybe an hour and a half over the course of the afternoon in gatherings with the patient and her family talking about what "comfort care" means, and that it's not "giving up" on the patient but rather recognizing that she is nearing the end of her time, and helping her ease the transition and allow her to spend her time in comfort and dignity. They kept going back and forth, and ultimately (yet again at 9pm) I just had to leave the hospital and signed it out to the night float intern (who was understandably very pissed off).
Anyway when I got in today, I found out the patient had gotten a little worse overnight, they had been on the brink of taking her back to the ICU to intubate her when she decided on DNR/DNI status and comfort care.
Sigh.
Ok, no more surprises for the day... I got 2 new patients... I'm covering one of the other intern's patients too, a "stable" one that's just "hanging out" until skilled nursing facility placement... who suddenly also became hypoxic on her way to the commode to take a dump. A deadly deuce. A code on the commode. But seriously- she did become hypoxic, didn't respond to a breathing treatment, lasix, etc., and her chest xray showed (drumroll please) a....crazy pneumonia! Maybe. Some sort of nasty consolidation. Anyway, she was still tachypneic and getting tired on 100% supplemental oxygen, so once AGAIN had to call the MICU to accept a transfer.
The new Fellow covering for today called me a "black cloud." Meaning I'm bad luck and bring bad luck to the service. OR how about... heme onc is a SHITTY service? Period!
Today was another shitty day... I actually had no time to keep track of the Intern Tear Index. Default: 25+.
So here is a note that I started from last night, then fell asleep while I was writing it:
"i'll flesh this out tmrw when i get a chance
basically, shittiest day ever
first, arrived to get signout that one of my most stable patients had nearly coded, and was now dnr/dni on comfort measures (i later pronounced this patient dead). side note: this was the pt that said i was the only doctor he saw for 2 days. the attdg and fellow claimed to have seen him on a daily visit, per the attdg's addendums to my progress notes.
other pt nearly coding in the GI lab
other lady who is still full code but terminal"
So the first patient- the attending said he probably had a pulmonary embolism. It was sudden and unexpected, and there was really nothing anyone could have done. It was incredibly sad, I really liked the patient's family.
Anyway, the second one... got paged by a frantic nurse, telling me that a patient who should have been coming back from the GI lab was actually about to code in the GI lab, and that they needed someone from the primary team (aka ME) there. She was so flustered she couldn't even tell me what happened, and had to pass the phone off to someone else to tell me how to get to the GI lab from the heme-onc floor. When I got to the recovery room, the patient was indeed hypoxic and agitated (vomited and then aspirated post-procedure), and soon after required intubation. Transferred patient to the MICU...
..then back to the heme-onc floor where yet another elderly, frail, sick patient recovering from sepsis, with metastatic cancer was slowly becoming hypoxic and suffering while she dies. I spent maybe an hour and a half over the course of the afternoon in gatherings with the patient and her family talking about what "comfort care" means, and that it's not "giving up" on the patient but rather recognizing that she is nearing the end of her time, and helping her ease the transition and allow her to spend her time in comfort and dignity. They kept going back and forth, and ultimately (yet again at 9pm) I just had to leave the hospital and signed it out to the night float intern (who was understandably very pissed off).
Anyway when I got in today, I found out the patient had gotten a little worse overnight, they had been on the brink of taking her back to the ICU to intubate her when she decided on DNR/DNI status and comfort care.
Sigh.
Ok, no more surprises for the day... I got 2 new patients... I'm covering one of the other intern's patients too, a "stable" one that's just "hanging out" until skilled nursing facility placement... who suddenly also became hypoxic on her way to the commode to take a dump. A deadly deuce. A code on the commode. But seriously- she did become hypoxic, didn't respond to a breathing treatment, lasix, etc., and her chest xray showed (drumroll please) a....crazy pneumonia! Maybe. Some sort of nasty consolidation. Anyway, she was still tachypneic and getting tired on 100% supplemental oxygen, so once AGAIN had to call the MICU to accept a transfer.
The new Fellow covering for today called me a "black cloud." Meaning I'm bad luck and bring bad luck to the service. OR how about... heme onc is a SHITTY service? Period!
Today was another shitty day... I actually had no time to keep track of the Intern Tear Index. Default: 25+.
Thursday, September 23, 2010
HONC HONC, BEEP BEEP!
I hate Heme-Onc with the fire of a thousand suns. For the second day in a row, I got to work at 6am and didn't get to leave til 8:30pm. Today this one fat lazy nurse kept paging me q15 minutes because the patient's husband wouldn't agree with her so she kept demanding that I talk to him, or would say he was asking to speak to the doctor (which I strongly suspect was not the case based on his surprise every time I kept coming over). Finally I refused to come over and told her if she was unable to speak w the pt's husband she could put him on the phone to speak w me. This nurse wasted so much of my time and the other intern's time. One of the issues she paged me for: to tell the other intern not to hang up on her. I heartily congratulated the other intern, I wish I had the balls!!!
Anyway, had my own patients today, plus covering patients for the intern who had the day off, plus admitting new patients, so overall SHITSTORM DELUXE.
Points of shittiness about the heme-onc service:
# The fellow is a ghost
The fellow is like a junior attending; doing his post-residency training in hematology-oncology fellowship. A lot of great learning could be happening...if the fellow was actually ever around to answer questions or help with patient care issues or ANYTHING. Although he's a very pleasant fellow in person, that helps me not at all when he's gone all day and his page-to-response ratio is 2 or 3:1.
# Drive-by attending
The attending is only in house for about 2 hrs a day from what I can tell. She runs around and sees most of the patients briefly, then we quickly run through the list in the fastest rounds in the west. Efficient rounds are great, but as interns we know not a lot about a lot, and we know jack shit about chemotherapy, so maybe we could take a few min to review w the hapless interns WTF is going on and why the chemo plans are what they are?
# You're on your own
Let's review: the attending is almost never there. The fellow disappears after rounds unless he has a new patient for one of us (and selectively responds to pages) so is also effectively unreachable for most of the day. There is no resident. There are just three deer in the headlights interns managing a slew of sick patients. I have recent ICU transfer pts who get bradycardic and hypotensive annnd I don't have any supervision. AWESOME. I had a patient whose life expectancy, realistically, is maybe several months and the family called me in to talk about chemo treatment options. I DONT KNOW. I deferred the question to my attending who I assured the pt he would see the next day, and for TWO WHOLE FUCKING DAYS he told me I was the only doctor who had been in to see him. Jesus Christ!!!! I don't feel comfortable managing these sick pts who have one foot in the grave and one foot on a banana peel by myself, and it's really frustrating feeling like I have no support.
Except the support of my fellow interns. Because we're all left dangling in the wind together, a lot of treatment decisions are reached after a brief discussion involving many expletives where the intern throws out their best guess of what to do, pages the fellow, who ignores the page, and then a decision is reached based on consensus of interns ("yeah.. that's probably what I'd do.") I don't think this is always the best way to go. Three broken cars won't get you to your destination any faster than one broken car...
# Nurses with rescue fantasies
There are two kinds of nurses who work in oncology. The ones who are truly angels of mercy, and ones who are overly vigilant douchebags with delusions that they are the patient's one and only savior. I've got news for you guys: first of all, uhhhh FUCK YOU. Second of all, I'm changing my goddam pager number so that you won't be able to page me every 5 minutes, preventing me from EVER getting any of my shitty notes DONE.
BEEP BEEP BEEP
(calling nurses station)
"Hi it's Dr. X, I was paged?"
"Yes doctor, the patient has heartburn."
"ok did she respond to the PRN antacid?"
"I don't know, I haven't given it yet."
Wow, you took the time to look up my pager number and page me to let me know she's having heartburn rather than actually giving her heartburn medicine? Outstanding, soldier. OUTSTANDING.
5 min later
BEEP BEEP BEEP
(Calling back nursing station)
"Hi, it's Dr. X. Did you page?"
"Yes, doctor, you see patient's potashium today?"
"Ah, yes."
Pause "It was 3.9 doctor. You want to replete potashium?"
Ah, how about no, I don't want to replete the fucking potassium, because it's fucking NORMAL. Time to get back to my shitty progress note...now what was I thinking? Oh yes....
BEEP BEEP BEEP
(damning the nursing station to hell)
"It's Dr. X. You paged?"
"Just letting you know the new patient you admitted just arrived up to the floor."
"And?"
"Thats it."
Ok great. Don't forget to page me later if she blinks or farts or asks for an extra pillow!!!!!
It is at this point in the day that I start to think I hate my life. "Life" is really too strong of a word to describe my state right now. Can I just get one fucking progress note- BEEP BEEP BEEP BEEP
"Hi. You paged."
"Its the discharge planner. I'm a giant lazy turd of a human being and I'm a huuuuge bitch!"
She actually never says that but it's the gist of what I get out of all our interactions. "Yeah that's great dc planner. Ohhhh you want me to do MORE of your job for you? Sounds great. What else could I POSSIBLY be doing?
The ITI (see last blog) is running high today...maybe I can just finish...one...progress...note... BEEP BEEP BEEP BEEP
Well damn it all to hell. "Yeah, you paged?"
"Patient Z has been blowing her nose and blew her nose really hard and blood came out!!!"
"Is she having a nosebleed?"
"Well- no."
"So there's just blood in the mucus?"
"Yeah, but like, blood!!"
"Is it a lot of blood or a few streaks?"
"Well a few, I mean, it is bright red!"
"Yeah...so no nosebleed and a few streaks after she blew her nose hard. Ok. Well tell her try to blow her nose gently, page me if she gets a nosebleed."
"You want to order a CBC to check on the bleeding?"
Nope. You want to replace the battery in my pager for all the stupid shitty pages I've gotten from you guys all day? I got fewer pages on sicker patients working in the ICU. Fucking heme onc. I can't believe it's only day 4......of 28. :(
Anyway, had my own patients today, plus covering patients for the intern who had the day off, plus admitting new patients, so overall SHITSTORM DELUXE.
Points of shittiness about the heme-onc service:
# The fellow is a ghost
The fellow is like a junior attending; doing his post-residency training in hematology-oncology fellowship. A lot of great learning could be happening...if the fellow was actually ever around to answer questions or help with patient care issues or ANYTHING. Although he's a very pleasant fellow in person, that helps me not at all when he's gone all day and his page-to-response ratio is 2 or 3:1.
# Drive-by attending
The attending is only in house for about 2 hrs a day from what I can tell. She runs around and sees most of the patients briefly, then we quickly run through the list in the fastest rounds in the west. Efficient rounds are great, but as interns we know not a lot about a lot, and we know jack shit about chemotherapy, so maybe we could take a few min to review w the hapless interns WTF is going on and why the chemo plans are what they are?
# You're on your own
Let's review: the attending is almost never there. The fellow disappears after rounds unless he has a new patient for one of us (and selectively responds to pages) so is also effectively unreachable for most of the day. There is no resident. There are just three deer in the headlights interns managing a slew of sick patients. I have recent ICU transfer pts who get bradycardic and hypotensive annnd I don't have any supervision. AWESOME. I had a patient whose life expectancy, realistically, is maybe several months and the family called me in to talk about chemo treatment options. I DONT KNOW. I deferred the question to my attending who I assured the pt he would see the next day, and for TWO WHOLE FUCKING DAYS he told me I was the only doctor who had been in to see him. Jesus Christ!!!! I don't feel comfortable managing these sick pts who have one foot in the grave and one foot on a banana peel by myself, and it's really frustrating feeling like I have no support.
Except the support of my fellow interns. Because we're all left dangling in the wind together, a lot of treatment decisions are reached after a brief discussion involving many expletives where the intern throws out their best guess of what to do, pages the fellow, who ignores the page, and then a decision is reached based on consensus of interns ("yeah.. that's probably what I'd do.") I don't think this is always the best way to go. Three broken cars won't get you to your destination any faster than one broken car...
# Nurses with rescue fantasies
There are two kinds of nurses who work in oncology. The ones who are truly angels of mercy, and ones who are overly vigilant douchebags with delusions that they are the patient's one and only savior. I've got news for you guys: first of all, uhhhh FUCK YOU. Second of all, I'm changing my goddam pager number so that you won't be able to page me every 5 minutes, preventing me from EVER getting any of my shitty notes DONE.
BEEP BEEP BEEP
(calling nurses station)
"Hi it's Dr. X, I was paged?"
"Yes doctor, the patient has heartburn."
"ok did she respond to the PRN antacid?"
"I don't know, I haven't given it yet."
Wow, you took the time to look up my pager number and page me to let me know she's having heartburn rather than actually giving her heartburn medicine? Outstanding, soldier. OUTSTANDING.
5 min later
BEEP BEEP BEEP
(Calling back nursing station)
"Hi, it's Dr. X. Did you page?"
"Yes, doctor, you see patient's potashium today?"
"Ah, yes."
Pause "It was 3.9 doctor. You want to replete potashium?"
Ah, how about no, I don't want to replete the fucking potassium, because it's fucking NORMAL. Time to get back to my shitty progress note...now what was I thinking? Oh yes....
BEEP BEEP BEEP
(damning the nursing station to hell)
"It's Dr. X. You paged?"
"Just letting you know the new patient you admitted just arrived up to the floor."
"And?"
"Thats it."
Ok great. Don't forget to page me later if she blinks or farts or asks for an extra pillow!!!!!
It is at this point in the day that I start to think I hate my life. "Life" is really too strong of a word to describe my state right now. Can I just get one fucking progress note- BEEP BEEP BEEP BEEP
"Hi. You paged."
"Its the discharge planner. I'm a giant lazy turd of a human being and I'm a huuuuge bitch!"
She actually never says that but it's the gist of what I get out of all our interactions. "Yeah that's great dc planner. Ohhhh you want me to do MORE of your job for you? Sounds great. What else could I POSSIBLY be doing?
The ITI (see last blog) is running high today...maybe I can just finish...one...progress...note... BEEP BEEP BEEP BEEP
Well damn it all to hell. "Yeah, you paged?"
"Patient Z has been blowing her nose and blew her nose really hard and blood came out!!!"
"Is she having a nosebleed?"
"Well- no."
"So there's just blood in the mucus?"
"Yeah, but like, blood!!"
"Is it a lot of blood or a few streaks?"
"Well a few, I mean, it is bright red!"
"Yeah...so no nosebleed and a few streaks after she blew her nose hard. Ok. Well tell her try to blow her nose gently, page me if she gets a nosebleed."
"You want to order a CBC to check on the bleeding?"
Nope. You want to replace the battery in my pager for all the stupid shitty pages I've gotten from you guys all day? I got fewer pages on sicker patients working in the ICU. Fucking heme onc. I can't believe it's only day 4......of 28. :(
Tuesday, September 21, 2010
Monday, September 20, 2010
Honk if you love Heme-Onc!
::SILENCE::
Day 1 of Heme-Onc. The best thing I can say so far is that there are only 27 days left to go.
I came up with a measurement scale today to quantify how bad the day was. It's called the ITI, or Intern Tear Index. It's measured by a sad face drawn on the white board at the beginning of the day, then the interns add tears to the face every time their day gets especially shitty. Today's ITI was 6.
Day 1 of Heme-Onc. The best thing I can say so far is that there are only 27 days left to go.
I came up with a measurement scale today to quantify how bad the day was. It's called the ITI, or Intern Tear Index. It's measured by a sad face drawn on the white board at the beginning of the day, then the interns add tears to the face every time their day gets especially shitty. Today's ITI was 6.
Saturday, September 18, 2010
Wards
Dear UC Wards:
Could I please have the last 4 weeks of my life back? No? OKAY GREAT. My experience on any given service is almost entirely determined by how I feel about my coworkers. I loved the attending and the resident we had for the first week. The med students did their work and best of all, did their own thing, and I rarely saw them. The last few weeks, our resident has been an interesting mix of micro-managing and work-averse, our attending has been very nice but also somewhat intimidating and a bit of a fan of the traumatic Socratic teaching method (ie, pimps me with questions during walk-rounds while I'm day-dreaming and not even realizing that the attending was talking to me, so I look like a big time ra-tard). Although I will admit the teaching was good. The other intern was solid and took care of his work.
The fourth year student, doing his "acting internship", was brilliant. The problem is, he is remarkably arrogant and pompous for one so young and unaccomplished and constantly infuriated me by making remarks such as a certain patient I took on call would be good for me to "practice what you learned during rounds" (after the pharmacy resident prepared a very nice presentation for us on opioid equivalents and conversions that day), or not to worry that "not much is expected of you at your level of training" in terms of teaching the med students. Or how about the time he tried to sign out to me getting outside hospital medical records for the patient he'd had for the past 5 days on his day off when I was cross-covering his patients? JACKASS.
The third year student was another little slice of heaven. No sense of personal space (we had to have a talk about what "personal space" means), wouldn't cover his mouth when he COUGHED until I asked him to repeatedly, and subsequently shared his cold with me, and I was sick for 3 WEEKS. Apparently taking overnight call isn't the best way to get over a cold. Anyway, he also decided not to listen to any of my suggestions for his notes or presentations... but he WOULD completely copy and paste my progress notes (when I confronted him about this he flatly denied... come on, he even copied my physical exam!). The BEST incidence was on our last post-call day; I offered to meet with him before rounds to go over his presentation. We sit down, his plan sounds good, but so familiar... until I look down and realized he is READING MY OWN H&P TO ME, WORD FOR WORD, and passing it off as his own!!! I interrupted him and said, "I feel like you're reading my own H&P to me." He again, FLATLY DENIED and said, "Oh no, this is MY H&P." "Okay, but the wording is exactly the same as my H&P-" "That's because we talked about the plan last night." "Right, but I wouldn't expect the wording to be exactly the same, the sentence structure, organization..." at this point he paused, then continued to read MY OWN assessment and plan to me. After listening to him read a few more sentences verbatim from my H&P, I interrupted him and said, "Ok, well you know that I'm going to agree with the rest of your plan since I wrote it, so I think we're done here." I felt kind of bad, but I was also kind of outraged that he was plagiarizing my work and then insulted me by lying about it to my face! Plagiarism is something students can fail rotations for! And it was the third time I had confronted him about it! WTF man!
But what about the patient care? ...what about it? It happened. There is so much going on with juggling your patients on most days it's like... imagine running down the length of a soccer field and there are dodgeballs coming at you from both directions. You have 3 minutes to reach the other end of the field, avoiding being hit by any of the balls. Oh, side note, the air is full of butterflies and you have to catch 20 of them on your way. With your bare hands. And protect them on your way to the other end of the field. And occasionally a great big wolly mammoth comes and just stands in your way, and asks you why we run across fields, what the butterflies are, and why you're in such a hurry. This is a wolly med student. So if every day was like this for 4 weeks... you can imagine that most days wouldn't be too memorable unless something especially good or especially bad happened. The only patients that really stick out are the young alcoholic who died from liver failure, and the diabetic man who forgot my name but asked my attending to thank me for all my hard work and care the day he was discharged (I was off that day).
Moving on.
Starting the heme-onc service Monday. For a month. The silver lining around the oncology cloud is that the other interns I'm going to be working with are EXCELLENT. I'm looking forward to commiserating with my comrades to power through the next 4 weeks. I'm also looking forward to theme days. Like Fergie Tuesdays. Whatever Fergie means to you, that is what your day should be about. Fancy Friday? Mustache Monday? I'll work on it.
The only other thing I'm looking forward to, in life, is HALLOWEEN. ONLY 6 WEEKS LEFT TO GET YOUR DECORATIONS UP!!!
Could I please have the last 4 weeks of my life back? No? OKAY GREAT. My experience on any given service is almost entirely determined by how I feel about my coworkers. I loved the attending and the resident we had for the first week. The med students did their work and best of all, did their own thing, and I rarely saw them. The last few weeks, our resident has been an interesting mix of micro-managing and work-averse, our attending has been very nice but also somewhat intimidating and a bit of a fan of the traumatic Socratic teaching method (ie, pimps me with questions during walk-rounds while I'm day-dreaming and not even realizing that the attending was talking to me, so I look like a big time ra-tard). Although I will admit the teaching was good. The other intern was solid and took care of his work.
The fourth year student, doing his "acting internship", was brilliant. The problem is, he is remarkably arrogant and pompous for one so young and unaccomplished and constantly infuriated me by making remarks such as a certain patient I took on call would be good for me to "practice what you learned during rounds" (after the pharmacy resident prepared a very nice presentation for us on opioid equivalents and conversions that day), or not to worry that "not much is expected of you at your level of training" in terms of teaching the med students. Or how about the time he tried to sign out to me getting outside hospital medical records for the patient he'd had for the past 5 days on his day off when I was cross-covering his patients? JACKASS.
The third year student was another little slice of heaven. No sense of personal space (we had to have a talk about what "personal space" means), wouldn't cover his mouth when he COUGHED until I asked him to repeatedly, and subsequently shared his cold with me, and I was sick for 3 WEEKS. Apparently taking overnight call isn't the best way to get over a cold. Anyway, he also decided not to listen to any of my suggestions for his notes or presentations... but he WOULD completely copy and paste my progress notes (when I confronted him about this he flatly denied... come on, he even copied my physical exam!). The BEST incidence was on our last post-call day; I offered to meet with him before rounds to go over his presentation. We sit down, his plan sounds good, but so familiar... until I look down and realized he is READING MY OWN H&P TO ME, WORD FOR WORD, and passing it off as his own!!! I interrupted him and said, "I feel like you're reading my own H&P to me." He again, FLATLY DENIED and said, "Oh no, this is MY H&P." "Okay, but the wording is exactly the same as my H&P-" "That's because we talked about the plan last night." "Right, but I wouldn't expect the wording to be exactly the same, the sentence structure, organization..." at this point he paused, then continued to read MY OWN assessment and plan to me. After listening to him read a few more sentences verbatim from my H&P, I interrupted him and said, "Ok, well you know that I'm going to agree with the rest of your plan since I wrote it, so I think we're done here." I felt kind of bad, but I was also kind of outraged that he was plagiarizing my work and then insulted me by lying about it to my face! Plagiarism is something students can fail rotations for! And it was the third time I had confronted him about it! WTF man!
But what about the patient care? ...what about it? It happened. There is so much going on with juggling your patients on most days it's like... imagine running down the length of a soccer field and there are dodgeballs coming at you from both directions. You have 3 minutes to reach the other end of the field, avoiding being hit by any of the balls. Oh, side note, the air is full of butterflies and you have to catch 20 of them on your way. With your bare hands. And protect them on your way to the other end of the field. And occasionally a great big wolly mammoth comes and just stands in your way, and asks you why we run across fields, what the butterflies are, and why you're in such a hurry. This is a wolly med student. So if every day was like this for 4 weeks... you can imagine that most days wouldn't be too memorable unless something especially good or especially bad happened. The only patients that really stick out are the young alcoholic who died from liver failure, and the diabetic man who forgot my name but asked my attending to thank me for all my hard work and care the day he was discharged (I was off that day).
Moving on.
Starting the heme-onc service Monday. For a month. The silver lining around the oncology cloud is that the other interns I'm going to be working with are EXCELLENT. I'm looking forward to commiserating with my comrades to power through the next 4 weeks. I'm also looking forward to theme days. Like Fergie Tuesdays. Whatever Fergie means to you, that is what your day should be about. Fancy Friday? Mustache Monday? I'll work on it.
The only other thing I'm looking forward to, in life, is HALLOWEEN. ONLY 6 WEEKS LEFT TO GET YOUR DECORATIONS UP!!!
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