Simple Steps for Throwing a British Themed Party

The great thing about a British theme is you can apply it to most types of parties. Whether you are throwing a baby shower, birthday, bon voyage, or simple dinner party, the theme is flexible and can be expressed in a number of creative ways.  My husband is 1/2 English, so we decided to throw a England/London/British themed Valentine’s Day party and called it “Love in London.”


Food

British food has a reputation for being a little dull and boring, but your spread doesn’t have to be. There are so many amazing recipes online, it can be hard to decide just what to make. We opted for sausage rolls, beef wellington (labor intensive & expensive, wouldn’t do it again), fish & chips (just buy ’em & fry ’em), cucumber & tomato salad, cucumber sandwiches and more. You can add some easy flare to your finger foods with these union jack toothpick flags.

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Simple sausage rolls with union jack flags
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Marinated cucumbers, onions & tomatoes add a flavorful vegetable dish

Last but not least, don’t forget proper condiments for your amazing food.  Buy a bottle of malt vinegar for your fish & chips, and a bottle of HP sauce, and you’ve got your bases covered.

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Don’t forget the condiments!

Drink

Ok, depending on your crowd, this might be the most important aspect of the party.  There are lots of great drink options, but a British party wouldn’t be complete without Pims cup.  There’s no exact recipe you have to stick to – I like taking whatever fruit looks fresh at the store and adding it to Sprite and/or ginger beer.  For ease, you can also mix up a whole pitcher to have ready to go, similar to a sangria.

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A spin on the traditional Pims cup

Fortunately we can thank England and Scotland for having a number of great beers.  Head to your local beer/wine outlet and find the “England” section.  We went to Total Wine.  You only need a 6-pack or so of each if you are buying a big selection.  Guests enjoy trying new beers as well as old favorites.

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Assorted British beers we found at TotalWine

If you want to try something really special, and have some time to plan ahead, take a chance on a home brew and create your own.  We made a delicious London Porter in just 4 weeks using this easy home brewing kit.  We also customized the bottle to fit our theme using these handy waterproof labels for your home printer. We sealed the caps with union jack flag stickers for a finishing touch.

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London Porter Home Brew

Dessert

There are many creative options for desserts to fit your theme.  I’m not much for baking, so I cheated and outsourced a bit of this.  The classic English dessert is a trifle, which is simply a layered dessert, typically with pudding, sponge cake and fresh fruit.

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Strawberry trifle with fresh berries

The hallmark of English tea time, after the tea of course, is small cookies.  Any small simple butter cookies will do.  You can make these, but I opted to buy pre-made.  For a mixed display, buy a box of chocolates to add to your 3-tier cake stand, and you’re ready for tea time.

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Traditional 3-tier cake stands with tea time floral designs
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Store-bought coconut macaroons on the bottom tier
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Add a frilly tablecloth to complete the authentic tea time look

For another dessert option (which is a great go-to for any party or theme), consider some custom decorated cookies.  These sugar cookie masterpieces are from Cookies by Design in Virginia Beach.  They are also a hit if you have little kids attending your party.

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Hand-painted London themed cookies by Cookies by Design

Decorations

The easiest way to convey “British” visually is with the union jack flag.  You don’t have to be an artist to create cool and creative decorations.  Add a $5 union jack flag over a white tablecloth to create a bold canvas for your delicious food.

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$5 union jack flag adds an easy visual punch

Simple things like adding a sticker to your cups or nametags can help carry your theme forward in an easy way.

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Cute and easy cups thanks to $3.25 union jack stickers

Another option that requires no artistry, is to apply this $4 union jack duct tape to simple objects.  For this project, buy 3D cardboard letters to spell whatever you choose.  Then wrap them in the duct tape and viola!

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“LOVE” decoration made with 3D letters and duct tape for just $8

If you do consider yourself artistic or crafty, and don’t mind putting in some time cutting objects out, consider making your own garland.  Find any image you like online, print it on photo paper, cut it out, hole punch it and string them together.  Add a lace paper doily for an extra English touch.

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“Love in London” hearts strung together with lace doilies and twine
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Itty bitty hearts strung together with silver thread to make a precious garland
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Template for tea time heart garland
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Search your house for any knick knacks that fit your theme and display them together
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Colorful tissue poofs are cheap and high impact

Music

Pandora has an array of great themed channels.  The best fit for an all-ages England themed party is British Invasion Radio.

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Games & Fun

Party games and activities are tricky.  Everyone’s been to a party where games feel forced and grueling, but you don’t want a party with everyone just standing around.  Two simple activities I love are photobooths and trivia.  They are great because guests can participate on their own time throughout the party, and they don’t take any bandwidth away from the host or hostess.

Photobooth

Grab some simple props (hats, glasses, boas) and if you want to go big, a life-size celebrity cut-out.  Kate Middleton and Queenie were the life of the party.

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If you entertain a lot, consider investing in the modern polaroid, the FujiFilm Instax mini camera.  It instantly prints a polaroid-style photo that makes a great takeaway memory for your guests.

Trivia

Create a set of questions related to your theme and post them, along with pens and ballots, for guests to fill out.  Winner gets a prize!

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So that’s it, ideas for food, drinks, music, decorations and activities for your next London/British/English themed party.  For additional ideas not mentioned here, check out the Love in London Pinterest board.

~Steph

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A Neuroscientist’s Look Back on his July 4th Ambulance Ride-Along

On July 4, 2013, Dr. Paul Aravich joined TeamLouka on the ambulance as an observer.  He was asked to jot down a few thoughts on his experience.  His essay is shared below.

~Steph


Reflections of a Virginia Beach Volunteer Rescue Squad Lay Observer, July 4, 2013. 

Paul F. Aravich, PhD
998839_10151588264079545_313081585_nStephanie Krebs and Amir Louka are two VBVRS volunteers and EVMS medical students who are “social change agents and leaders for the greater good of the community.” They invited me to run with them at Station 8 on Independence Day, 2013. I saw 2 other EVMS students that day who I also admire: an exceptional paramedic who is a new medical student, and a Navy veteran and physician assistant student who is as gentle as he is tall. I witnessed great respect between VBVRS, fire department and ED personnel in almost every instance. And I saw cutting-edge wireless technology and state-of-the-art equipment—although I am still not sure if it the ambulance is a box or a truck.

At the station I hung-out with a volunteer from York County who served at the World Trade Centers and Katrina, a new EVMS graduate student, a senior volunteer who is a builder of persons as well as of homes and barbecues, a critical care nurse from Chesapeake, and an accountant. We talked about abandoned older persons, defensive medicine, how to read an ECG, challenging behaviors, not getting T-boned at intersections, altruism, family, political turmoil in Egypt, and who catches a baseball better, the bulked-up waiter at IHOP or a nerd like me who, like Winnie the Pooh, is actually a “bear of little brain.” We also wondered if we heard the dispatcher correctly that a person got stabbed in the cheek with a fork. At one point Stephanie bravely gave me her humerus (which is pretty funny) and Amir gave me his stethoscope and cuff so I could learn the proper way to take a blood pressure. Thankfully, Stephanie’s paresthesia lasted only a few minutes. At the nearby Oceania Fire Station we laughed with an Army veteran who has seen more than his fair share of tragedies, discussed the merits of Cheryl Crow as a History Channel commentator, and had a surprising conversation about the nutritional problems of hot dogs that made me worry that firefighters may someday eschew donuts. I saw camaraderie being built during the down times as well as during the calls. And, I talked with a squad member and former court official about the ones that were saved, the ones that got away, and an aging parent with dementia. I was reminded that all of us have to hold on to our victories, let go of our defeats, and understand that we’re in this together.

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Dr. Aravich & us outside Sentara Virginia Beach General Hospital

Throughout the day I was humbled and inspired by consistent displays of commitment and professionalism, humanism and compassion, and collegiality and mutual support. I saw a successfully aged person with a rare and serious injury that causes significant pain in others but did not in her and wondered if it would steal her independence. I saw an isolated older woman and cancer survivor with depression and abdominal pain and hoped that her GI cancer was not coming back. I saw a frightened young mother fighting addiction and hoped that today will be the first day of the rest of her life. I saw an injured skateboarder who should have known about helmets. I saw a scared older person with breathlessness and fatigue and a family history of heart attack who should not have been cutting grass in the middle of a hot day. I saw the basic life support team immediately recognized the severity of this situation and calmly and effectively take precautions before the paramedic arrived. I saw the paramedic take an ECG in the truck and learned later that it showed the more severe type of heart attack called a STEMI (ST Elevation Myocardial Infarction). I saw the paramedic taking care of this person inside the moving and turning ambulance by, e.g., drawing blood, giving nitroglycerine, sending ECG telemetry to the ED, and offering words of encouragement. Finally, on the 4th of July I saw a crying spouse, caring neighbors, and engaged citizens volunteering to help others when almost everyone else was relaxing.

If, in the Jeffersonian tradition, the pursuit of happiness importantly involves pursuing the greater good, then the VBVRS is full of happy people. And, if people are not distinguished by doing what they have to do but are distinguished by doing what they don’t have to do, the VBVRS is full of very distinguished people. Thank you Stephanie, Amir and the VBVRS for allowing me to see the important volunteer work you do without charging patients. Lives do indeed need saving, both physically and emotionally. All of you saved lives today. Is there any greater compliment? Meantime, a few words about hot dogs: it is OK to bad-mouth hotdogs—but not on the 4th of July.


Dr. Paul Aravich is a behavioral neuroscientist and Professor of Pathology & Anatomy, Internal Medicine, and Physical Medicine and Rehabilitation at Eastern Virginia Medical School (EVMS). He is the former of the Virginia Brain Injury Council and its Ad Hoc Neurobehavioral Committee. He also chaired the Virginia Governor’s Public Guardian & Conservator Advisory Board and sits on the Boards of the Mary Buckley Foundation for brain injury survivors & their families; the I Need a Lighthouse Foundation for suicide awareness; and Alternatives, a nationally recognized youth empowerment organization. He won an AOA Glaser Distinguished Teacher Award. It is the highest award for medical education in the United States and Canada and is presented at the annual meeting of the Association of American Medical Colleges. He also won a Virginia State Council of Higher Education Outstanding Faculty Award, which is Virginia’s highest award for research, teaching and service.
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EVMS Graduation, May 2014
You can view his 2009 TEDTalk here:
To learn more about volunteer opportunities with the Virginia Beach Rescue Squads, visit LivesNeedSaving.com.

Go Go Gadget Defibrillator: What I Do and Don’t Carry on Duty

Everything lies on a spectrum, especially in the world of medicine, and a medic’s choice of personal kit is no different. From Mr. “I don’t care if it’s a rectal bleed, gloves are for rookies,” to your favorite Rescue Rambo, who would use a Medivac unit as his daily commuter if he could, we each choose a few (possibly) useful things to keep within arm’s reach while on duty. While Steph and I may work at the busiest Level 1 in the state, and have any and all imaginable technology at our disposal while there, being outside the hospital is a different story entirely. So here’s a look at what I choose to bring along and what I feel can make a difference when the tones go off.

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Photo copyright: The Lonely Medic

1. My very own pulse ox

A few years ago these things could set you back a few hundred dollars, but now you can pick one up on Amazon for about $20 with free shipping. Beyond the general appearance of a patient (Again, a spectrum: from “Ugh, why 3am?” to “Oh… that can’t be good.”) few things can give you as much information about the person in front of you as this tiny device. Patient looks like he’s working to breath? Maybe it has something to do with that O2 sat of 65% – better call back the engine you just cancelled.

It’s part of my approach to almost every patient I encounter – I introduce myself while lowering myself to their level (standing over a patient is imposing and dominant, even if you’re not 6’5” like me, and not generally comforting to little old ladies). I slip on a pulse ox while taking his/her hand and wrist to feel a pulse. As well as instantly assessing perfusion, motor and sensory function, that simple, brief human contact goes a long way in gaining trust and establishing rapport. Fun fact: the servers at Hooters do exactly the same thing.

2. A radio

We take them for granted, but this thing is your ticket to unlimited resources on-scene and your lifeline when SHTF (like this day in Virginia Beach in April 2012). Need manpower? Engine’s en route. Leave something in the truck? Someone can grab it on the way in. When my partner had a seizure on duty and wasn’t breathing, I hit that little orange button and said a few words… You’d have thought WWIII had broken out. When every unit in a five mile radius was headed my way in seconds, I realized that motorola is more than a faceless voice that tells you where to go. I keep mine in a reflective shoulder strap for added safety, to which I also attach the pulse ox for quick and easy access.

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3. A knife/multitool/trauma shears

I carry one of the above, depending which I can find while getting ready for duty at 4am. I don’t carry all of them. I don’t carry multiples of any of them. No boot knives or ninja stars, no Ka-Bar combat bayonets. It’s volunteer EMS, not Vietnam. I use it to cut stuff.

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Every squad has this dude.  You know who I’m talking about.

4. A mini maglite

One of the things I love about getting outside the hospital are the places we go. We often see another side of society we otherwise never would – dark alleys, abandoned buildings, and deep ditches in the dead of night. I’ve had a mini maglite since day one, and it’s never let me down. If I have a funny feeling about a place, I might bring along one of the big D cells we keep in the truck, but 99% of the time the mini gets the job done.

5. Steel toed boots and well made pants 

Steph regularly wears shorts and sneakers on duty. I just don’t get it. Even if it’s 100F in the shade, you’ll find me sweating in my 5.11s. Who knows where you’ll find yourself, or what you’ll find yourself in, on the next call. Safety first.

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6. My brain 

Forget everything I’ve said up to this point. Brainpower is the only thing you NEED to bring along. This is how you’ll navigate tough problems, assess complex patients and choose the right interventions. Without it, you’re no good to anyone. With it, you’re a real-life hero. Signing up to take care of people in need is also a commitment to lifelong learning. You owe it to your patients to practice, stay up to date, to learn new things and continually improve. If you’re reading this, you’re probably on the right track. And keep in mind, your partner probably has one too, complete with its own experience, training and know-how. Use ‘em.

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Honorable Mention: A stethoscope 

You might have noticed the most ubiquitous piece of medical equipment missing from the list above. Truth be told, these things are living dinosaurs. This year happens to be the 200th anniversary of the stethoscope’s invention, but contrary to what Mr. Littman would have you believe, they have barely changed in all that time. Too often, the scene is just too noisy and chaotic get an accurate exam, and in most circumstances requiring immediate intervention you can get the same information in other ways. Breathing difficulty with a history of both CHF and COPD? Try a neb while looking for other signs like JVD and pitting edema. It’s rarely exclusively one or the other. Tube placement? If you’re not using end-tidal you’re behind the times. Trauma and hypotension? Prepare to dart the chest and get moving.

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For the record, using the shared stethoscope in the jump bag is not an option. This is what grew from swabs Steph took off a stethoscope.

In my experience, the rubber necklace acts more like a police officers badge or firefighter’s helmet than a diagnostic instrument in the field, clearly identifying you as medical personnel. That’s a perfectly good reason to keep one with you though, so feel free. But if you’re like me, it usually stays in the truck.

All that said, the day they come out with a pocket defibrillator, I’ll be first in line.

~Amir

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Understanding the Origins of the Cincinnati Prehospital Stroke Scale

We all learned it in EMT-B class.  The Cincinnati Prehospital Stroke Scale (CPSS) is the core assessment tool for EMS providers to evaluate possible stroke patients in the field.  But, have you ever wondered where it came from?  Why does it have 3 parts? Why test speech and not eyesight?  What part of the brain is really injured? Let’s take a deeper dive.

What is the CPSS?

For a quick review, the CPSS is comprised of three individual tests, each of which get interpreted as either normal or abnormal by the EMS provider.   The tests as well as interpretation are summarized in the table below.

Components of the Cincinnati Prehospital Stroke Scale

Adopted from Kothari, et al, 1996 

Test

Normal

Abnormal

1

 

Facial Droop

 

Patient smiles or shows teeth Both side of face move equally One side of the face does not move as well as the other (or not at all)

2

 

Arm Drift

 

Patient extends arms out, closes eyes, and holds in place x 10 seconds Both arms move the same, or both arms stay in position One arm does not move or drifts downward compared to the other

3

 

Speech

 

Patient repeats “You can’t teach an old dog new tricks” Patient repeats back correct words with no slurring of words Patient can’t speak, says the wrong words, or slurs words

The CPSS is positive if any one of the three tests is deemed abnormal.  In studies comparing Physicians vs EMS providers when performing the CPSS, when performed by an EMS provider, if the patient scored positive for one component, the sensitivity was 59%, meaning just over half of the patients who indeed had a stroke were identified by the EMS provider as having a stroke.  The specificity was 89%, meaning that 89% of people who had a positive CPSS (1/3 components) indeed had a stroke.  In other words, they caught just over half of the true strokes, but they also obtained a positive CPSS on some patients that didn’t have a stroke. The best example is a patient who is intoxicated.  They likely have slurred speech, and therefore a positive CPSS, but aren’t actually having a stroke.  Most tests in medicine are like this, you miss some, and you catch some that don’t really have the disease.  We call these false negatives and false positives.  Oh, and did I mentioned that EMT-Bs scored just as reliably as the Paramedics in the study?

The CPSS intentionally misses some strokes

To understand what the CPSS is looking for, it’s important to know a bit about the history of how it was created and why.  The CPSS was developed at the University of Cincinnati Medical Center in 1997.  tPA had just been approved by the FDA in June 1996.  The CPSS is derived from the NIH Stroke Scale (NIHSS).  You can read more about it here, but simply put, it’s a 15 part assessment where the patient gets scored according to their symptoms.  The NIHSS was developed to identify neurological deficits that correspond to specific geographic tissue damage in the brain.  MDCalc offers a great online calculator for helping determine a patient’s NIH Stroke Scale score.  The NIHSS was condensed down, with some categories eliminated and some combined, to make the CPSS simple and easy to use, but also to help identify those patients who would be potential candidates for tPA.   Not all strokes are created equal, and not all strokes are elligible for tPA, even if identified within the 4.5 hour time window.  Strokes of the anterior cerebral artery and middle cerebral artery are better tPA candidates that other types of stroke.  The CPSS focuses on identifying those strokes, but not posterior strokes for example.

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The future of the CPSS and prehospital stroke identification

As I mentioned, the CPSS is not designed to detect things like posterior circulation strokes that affect the cerebellum, the balance center of the brain.  Historically, efforts focused on early identification of tPA candidates.  As new surgical and pharmacological advancements develop for other types of stroke, there’s a greater emphasis on early identification of all strokes.  As such, there’s a lot of research going on right now studying new or modified prehospital stroke assessment tools.  One front-runner is the B-FAST, which adds one more test to the CPSS to test for balance, and potentially identify posterior circulation strokes.  The posterior circulation (basilar artery in the diagram above) supplies blood flow to the cerebellum, the balance center of the brain.

B – Balance, tested by having the patient walk

F – Face, same as CPSS

A – Arms, same as CPSS

S – Speech, same as CPSS

T – Time, to remind us that time is brain

If you want to impress with your turnover on your next stroke patient, be sure to test for balance disturbances by (carefully) ambulating your patient.  If the patient stumbles or can’t walk without assistance, that’s a pertinent positive.  In the original Cincinnati study by Kothari, the CPSS missed 13 patients with stroke, but 10 of those were posterior circulation strokes, notoriously difficult to diagnose clinically, and often missed by even the best Emergency Medicine physicians.


 

As always, feel free to share any tips you have on helping assess for stroke in the field.

~Steph

Some references:
Kothari R1, Hall K, Brott T, Broderick J. Early stroke recognition: developing an out-of-hospital NIH Stroke Scale. Acad Emerg Med. 1997 Oct;4(10):986-90.
Kothari RU1, Pancioli A, Liu T, Brott T, Broderick J. Ann Cincinnati Prehospital Stroke Scale: reproducibility and validity. Emerg Med. 1999 Apr;33(4):373-8.

TeamLouka 2015: Our Virtual Christmas Card

Friends & Family,

We are trying something new this year.  Maybe it will stick, maybe not.  We’re providing a virtual Christmas card, our 2015 in review.  Just a few highlights to share some of our favorite moments.

Year 2 of 3 of our Residency Training

We stayed very busy with work this year, transitioning from Interns to “Upper levels” within the Emergency Department.  We studied for and passed Step 3 of our medical boards, and even ran simultaneous “codes” (cardiac arrests) which both resulted in “conversions” (return to a regular heart rhythm).

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Love in London

In February, we had a week of vacation, but opted to do a “staycation” and throw a London-themed Valentine’s Day party.  Jackie and Chrissy made us some amazing cookies.  We were joined by old friends, family, neighbors, and even The Queen herself!

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Bought a New Car

CarMax never knew what hit ’em!  We sold Amir’s old 1999 Mercury Cougar and upgraded to a 2011 JEEP Grand Cherokee.  After all the snow last winter, we knew we needed a more reliable way to get to work in bad weather.  The Emergency Department (ED) never closes, so we go in during hurricanes, floods and blizzards.

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Phoenix & Sedona, AZ

In April we both flew to Arizona for a national emergency medicine educators conference where Amir presented a patient he saw in the ED. We rented a JEEP named Jennie and went off-road.  Amir’s write-up of the adventure was published on JPFreek.com!

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18th Annual Krebs/Louka Crab Bake

In May, we co-hosted the 18th Annual Crab Bake with The Krebs, and lots of help from Amir’s mom, Julia.  A later date meant more plentiful crabs, better weather and the return of Giant Jenga.  The highlight was when little Zee crawled out on the pool cover.  Thankfully with 20+ paramedics and doctors at the party, a rescue wasn’t far off.  Ray Jr. to the rescue!

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Cara & Sean’s Wedding

If you know me, you’ve almost certainly met Cara Reske, one of my two best friends since elementary school.  One of the highlights of the year was October 17, the wedding of Cara to Sean Monahan, a wonderful guy she met up in Baltimore.  Sean works as a real estate agent and is a diehard Orioles fan.

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FloydFiesta Block Party 

Every day we grow to love Richmond (or RVA as locals call it) even more.  Part of that is because of our amazing neighbors.  Each year we have an old-fashioned block party where we shut down the street and bring in bands, food trucks and friends.  We’ve also come to be known for our mobile bar on wheels.  Last year we made Dark N’ Stormies; this year we made friends serving Orange Crushes, a Virginia Beach classic, and now a favorite of The Fan District.

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UCI Road World Championships

Before September, I knew nothing about professional cycling, except bits and pieces of the Lance Armstrong scandal.  The Tour de France is actually part of a “triple crown” in professional cycling.  The other two events are the Tour de Vuelta, held in Spain, and the Road Worlds, which rotates locations each year.  This year it took place in our city, Richmond, VA.  We were able to participate on many levels, working the medical tent, assisting with drug testing, riding around in the “Doctor Lexus,” the chase car following all of the cyclists, and of course as spectators.  The event brought an extra 650,000 people to Richmond, and introduced us both to an amazing sport.

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“Studycation” to The Inn at Tabbs Creek

In early October, we spent5 days and 4 nights at a little B&B on the Chesapeake Bay while we studied for part 3 of our medical licensing exam. The breakfasts were delicious, the crabbing plentiful, and relaxation abundant.

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Tariq & Anna’s Wedding

Just this weekend, we were fortunately enough to spend a lovely evening celebrating the wedding of Amir’s brother, Tariq (the lawyer), to the lovely and wonderful Anna Kozicki. They’ve had a difficult year, so it was great to see them both smiling ear to ear.

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And like most years, the days in between were filled with random dinners with friends, rescue shifts, studying to be better doctors, writing blog posts, and spending time with family.  We wish we could have seen everyone this year, but even if we didn’t, know that we think of you often.

Wishing you love & joy this holiday season,

Amir, Stephanie & Winston

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