Skills and Tide

24 06 2009

As the month of July approaches every year – something remarkable in the medical world happens…

The brand new doctors of the world are unleashed onto the floors as interns.

They are confident in some things, but still have a lot to learn about the way the medical system works and how to keep things going. They also have a great deal to learn still… They have many facts crammed into their brains, but they have more to shoehorn into the gyri and sulci of their gray matter.

They also have a new challenge thrust upon them…

Teaching.

They get to teach the brand new 3rd year medical students who have just been flushed out of their basic science courses with a modicum of understanding as to what’s going on in the world, but nowhere near what’s necessary to actually practice clinical medicine.

They too are going to learn new skills and shoehorn facts into their brains.

What is interesting though, is that both intern and medical student have things to teach each other. In other words, it’s a two-way flow of information. Interns learn how to ask questions of medical students. Medical students learn how to ask questions of an intern as well as get their assistance when necessary. They learn how to report information to interns and residents.

They are also good at certain things. An intern, a freshly-hatched doctor, understands how to do things, and when to do those things, but may not remember all of the intricacies of a certain disease pathway. The medical student ostensibly does – but doesn’t quite grasp all of the idiosyncracies and implications of what’s going on.

This makes for an interesting dynamic – as skills and competence grow, the year is almost up. And the cycle is repeated…the interns become residents, more secure in their skills and abilities, with new, different challenges. And the 3rd years go off into the netherworld of 4th year…

In other words, the tide comes back in…and a new crop of MDs and 3rd years reinvent the wheel, all over again…





Driving in the Lazy Gear

24 06 2009

Is it better to be lazy and driven — in other words, determined to succeed with the least effort possible. Or is it better to be terrified and stubborn — in other words motivated by fear and stubborn enough to drag yourself through hell to get where you’re going.

Or is it better to be both?

That’s the crux of my time here in medical school – just wondering if I’ve done enough to get where I’m going. Wondering if I should have been studying 5-6 hours every day, day in, day out. Or have I managed to save enough of myself to make this next two years — the two years everyone has said are the real learning years — manageable.

I guess it all depends on how I did on my boards – so we shall see in a coupla few weeks.

I’m coming to the realization that I’m going to have to buff up my CV pretty heavily here. Now I just need to get into doing it. I’ve got a guaranteed fight on my hands in the next two years…I asked for interesting and challenging…

I’m getting it.





Lies and Regrets

24 06 2009

Her heart barely works anymore.

That’s not to say she isn’t clinging to the life she has left. A ferocious tenor pervades her spirit.

It’s unmistakable. For so long, she’d held onto her health, youth, and virility.

And then she got sick – she had a few heart attacks.

I asked her if she’d smoked. She told me no. I asked about drugs. She said no.
She, I think, lied to me.

She was ashamed and afraid of her mortality – a fear that having your heart literally give out on you tends to impart – a shame that comes with succumbing to an addiction that causes your heart to literally give out on you…

Her husband shot me a question:

“Why is it that doctors come in here, and they ask if you smoke, and tell you not to smoke…”

“yes??”

“and you go outside and you see half of em smoking?”

“It’s not right…I can’t tell you…I just know it’s not right…”





Just realized

28 05 2009

I’ve had my beloved Canon camera for a year now…I love that…just a random observation…





God, gladiators, and Mike Tyson

28 05 2009

It feels good to be writing and posting again…

I was returning from what is supposedly the most important exam of my time in medical school – no idea how I managed to do … only feeling like I’d been kicked in the balls by the test authors and betrayed by my school whose philosophy was to completely ignore preparing us for the board exam much less actually seeing patients…

I was driving back to my girlfriend’s house, about an hour and change away – the promise of a lack of guilt for not continuously studying when I realized that life is HARD…

Not just challenging – life is fucking cruelly hard…sometimes you’ve gotta feel like a gladiator or a warrior – just to survive the most mundane things around…just…to…survive…
And I thought about God watching us all, watching us struggle and fight, watching us survive – barely at times…

And I realized he was cheering for us – we may not have ever asked for it – but we’re apparently gladiators, fighting in front of him…struggling to get where we’re going…and I realized that since God is a part of each of us (at least that’s what I believe)…it would mean we’re all there too – watching the gladiators of the world – fight…and survive…

And it’s just this huge struggle…

I got home to the news that Mike Tyson’s daughter had passed away…and I started thinking of the retarded, sick and inhumane comments that people would be making about that poor man while he was grieving hard…his head slung low, hardened to how society perceives him or labels him because it’s the only thing that would allow him to survive…

Suddenly I felt like I understood a large swath of society…we play mental jujitsu with our challenges and struggles…we either battle them directly only to flip them into positives, or we shut pieces of ourselves out of our consciousness merely to maintain some internal stability and consistency…so when something horrible happens – we laugh it off…We joke about it because it’s such a terrible tragedy and it hurts so bad that we are unable to face it directly…

So there I was realizing that the “idiots” who would laugh at a man whose small child passed away realistically probably identify with him… They wish they could be as strong as he is – as fearless as he has been and as unconcerned with the rest of everybody else around as he is…not realizing that it’s a sort of caged freedom…Because he has tuned the rest of us out – he is free…but only while he’s tuned out completely…because as soon as he opens up or tries to engage, he is going to get ripped apart…mostly because it makes us feel better about ourselves and our own myriad tragedies…and there it is…Mike wasn’t only a gladiator in the ring…as a man with a REAL life that has consistently been thrust into the public spotlight by others, he’s been a gladiator while walking down the street every day…He was given unnatural talents – through no fault of his own – and was subsequently used and exploited for those talents…his returns have not reached parity with what he lost…

I talked to a friend of mine about our society – how so much is predicated on tearing people down, destroying their sense of self – so that they’ll buy something…Magazines like Cosmopolitan and Vogue that serve no purpose other than to tell women AND men that if they don’t look a certain way they don’t have any real aesthetic value, nor are they doing their best to help the world out…

And it seemed pretty ludicrous to be quite honest…just another example of us struggling along to find our light and being told that we have none…struggling and fighting

And I wondered to myself – what are we struggling for?  The right to purchase cheap ass plastic toys and cheap, canned foods?

Or don’t we want to be free to go do stuff with our time, and eat delicious meals and watch entertaining stuff…would we even need sports and beer to escape if our world was a little more…humane?

The animal world is just that – the animal world, where nature is all about competition and where the strongest dominate and kill whomever they please…in the human world – we’d call that a despot.

Unfortunately, we go to work for despots…we listen to their opinions on the news every night and we pay them heed by purchasing their cars, clothes, music, and food…We don’t do ourselves any favors by listening to these despots…

But even beneath that layer…you realize that right there – the people who are going to work for those despotic organizations are just people…struggling…fighting…whether its’ literal, or figurative – fighting with fists and knees or consciences, pricinples, and propaganda – we are all fighting…

And living in the animal world – not the human one.

Our world, as humans, is defined by unlimited potential and boundless creativity, energy, and abilities…don’t believe me?

Turn prisons into boot-camp style colleges and watch what happens…
Ensure equal access to scholastic information to everyone around and watch what happens…Stop hoarding and selling knowledge in academic worlds and watch what happens…

We are strong and resilient for having fought…now let’s show God that we are intelligent too…





From Axe to Anxious or the Story of Two Pills and $12

9 04 2009

A few years ago…well almost a decade ago now

I was stuck…in a tiny little tube…I was having trouble breathing, sweaty, struggling to move, on my side, bogged down and completely unable to even wriggle forward or backwards…again, I was stuck.

Lt. Green, the salt-fried truck officer yanked me out of the 6 foot long, 13″ square “confined space” tube and quietly shamed me for not being able to overcome such a tiny little obstacle…literally.

He intimated that men whose gut formed pannuses (what is the plural of pannus anways?) that overlapped their thighs could make it through that tube. He marveled – if the fat-bodies could hump their way through it, but I couldn’t – I bristled. I put my mask back on and I flew through that damned tube – I wormed through like a champ.

Fast forward nine years.

My back, which has hurt for the better part of a half-decade, is starting to hurt for more than just a day at a time. I’m always aware of it, the pain much worse now, is at times barely manageable. It’s likely soft-tissue damage and so the obvious thing to do in order to look at the soft-tissues – is to do an MRI.

An MRI is a test where the area to be imaged, in placed in the center of a huge magnet – basically you find yourself in the middle of a tube, while what sounds like a jackhammer thumps and tumbles all around your body. There is about 2″ of clearance all the way around you. It’s a tight fit – at least for me it was…

And it’s been a terrifying fit too. For some reason being on the table on my back, being in the magnet – unable to put my hands up to my eyes or anywhere near my face, over my chest, nothing – is unabashedly terrifying. It conjures up images of some of my most incredible fears – being buried alive. For that reason I’d rather be cremated than anything else – I have no desires to be buried.

I had gone from axe-swinging to anxious. I’d lost the fire in my belly. At least that’s how it’s seemed. I’d love to be able to tell you I finished the test – completely under my own willpower – but in a shockingly powerful way, my brain told ME ,that I wasn’t getting in that tube. At least not headfirst. I wondered if I could jump in the tube feet first. I wondered if I could be knocked out cold with a horse-dose of sedatives.

I’ve thought about losing weight – even going as far as making a bet with a fellow classmate who is entirely too skinny to want to lose weight – to make the tube a less claustrophobic and intimidating place to spend an hour of my time.

I’ve thought about zoning out – pretending I’m in outer space, and that I have to lie perfectly still in order to stay in my oxygen bubble – but that there was ultimately nothing that would keep me calmly lodged in the narrow little tube.

Damn. My doctor prescribed me some sedatives.

The tranquilizers by the way – two pills total, cost me and my insurance company $11.99. They were almost wholly ineffective to boot. I couldn’t help but think that it was why people didn’t go to their doctor – so that he could tell them to buy two expensive ass pills that gave them funky side effects and didn’t really do much to help them feel any better.

So now tangentially, as I’m getting my medication filled – I’m wondering if the exorbitant prices of drugs is one of the driving reasons behind the health disparities that we see in America. I’m wondering if it’s one of the driving reasons behind the amount of chronic disease we see in America – and I’m wondering if it’s the reason that we see people end up completely noncompliant with the regimens that doctors prescribe their patients.

The two pills never even touched the anxiety, the crushing feeling that prompted me to feel like I was suffocating even though I had just drawn in a deep breath of “fresh” air. My stomach tightened and I was having crushing palpitations. Physiologically, I was fighting for my life – my heart fluttering wildly, pupils dilating, and me shaking uncontrollably. I belched and passed gas for a solid ten minutes after the attempt. I walked out in the cool night angry, frustrated with myself and more importantly my head for fearing death in a way I’d always hoped I was immune to.

On tranquilizers, 20 minutes after the procedure had short-circuited a second time due to my overactive limbic system – my pulse was a solid twenty beats a minute above its’ normal. I still felt nauseous. The fight or flight response was still kicked into gear. I wondered what it might be like for those who had random panic attacks when they went about their daily life – doing things like going to the doctor, dentist, post-office. Going to school or the aquarium. At home with relatives, out at a grocery store. On an airplane.

I reflected on the last flight I was on – with a woman who seemed a little edgy and as it turned out she was – fairly afraid of flying – especially through turbulence. Her body language betrayed the shitstorm of fear that was flying through her mind. Her hands clutched out in vain for some sort of safety bar – but then she realized it would’ve been attached to the very airplane she thought was crashing.

A friend of mine summed it up quite succinctly and nicely – “when you are starting to panic, there is a duality in the logic you use to attempt to calm yourself down – you are able to tell yourself that nothing is wrong, and that you are perfectly safe, because there is nothing threatening or harmful happening…but then you realize that even if nothing threatening or harmful is going on – and you feel the way you do, something MUST be wrong, and now you don’t know WHAT it is.”

His understanding made me both laugh, and comforted me.

Now I’m confronting my own mortality. I’ve put on some years, and I’ve begun to learn about all of the myriad ways people can not only die – but degrade and die. I’ve also become much more aware of my place in the world and the world itself. This world is a terrifying and sickening place.

And so naturally, I’ve become more fearful, more anxious in general – and I’m wondering if its’ natural manifestation is via my irrational expression of fears. I’m wondering if I’m doomed to a semi-decrepit body that hurts but isn’t diseased enough to warrant much treatment.

I fear that inattention and slow decline exquisitely. More than ever before I realize the potency and happiness of youth. And I’m very glad I blew all of my money and did as much as I could when I was young. I’m glad I was mostly single – I’m glad I came out of my early twenties and late teens without children or hard committments to anyone other than myself.

But now I have to make sure that in this next few decades, I can learn to live in a fearless manner. They are there – I just need to ignore them. That’s a strength that I’m going to have to develop. As you grow older – the monsters under your bed don’t go away – they just change clothes and get jobs as attorneys or politicians. Or creditors. Or police.

I can’t help but wonder how people feel when they go to the doctor. Do they think they have a crushing super-debilitating illness? Do they feel like its’ going to be a pop-fly illness? Or is it going to be a chronic slog through misery?

Are their physicians going to make it any better? Can their physicians make it any better? How are they going to deal with it? Are their physicians going to even attempt to protect them from their own vulnerabilities and insecurities? Their unique neuroses?

My doctor did. A healthy dose of razzing followed. But he went on and sent me to a physiatrist even though he knows they are going to look at him like he’s not doing his best for not getting me into an MRI. But he did his best – both for the specialist I’m going to see, but also – and ultimately more importantly – for me.





Who knew Ethan Hawke…

8 04 2009

Could write so well???
In the latest issue of Rolling Stone magazine, Ethan Hawke wrote a pretty damned long article about Kris Kristofferson – the songwriter-singer-actor who spent his life jumping from career to career without much (apparent) fear or self-loathing.

Kristofferson is now a role model of mine – a man who was a rugby player, Rhodes scholar, Army captain who taught literature and then flew helicopters and demanded to be sent to Vietnam before leaving all of that behind to work as a janitor in Nashville with the hopes of becoming a songwriter of country music.

He is old school. Photos in the article of Kristofferson dripping with so much male swagger and testosterone that you couldn’t doubt any of the authenticity of the lyrics he ‘d penned. A scholar-soldier. Poetic officer. A man who understood the bullshit and told the truth both in terms of his life as well as his art.

So, now he’s someone that is a role-model of sorts – he fought for his art – he lost two wives (I don’t plan on emulating that part) and a significant part of his liver for it all. His parents disowned him for his choices – but he stood tall and kept on working at his craft.

But, what I left impressed with – wasn’t all due to Kristofferson. It was due to the writing that Hawke, an actor-director, concocted to cover this apparent mountain of a man. Flattering to say the least – Hawke made it perfectly clear that he looked up to Kristofferson – it just kept on bouncing on through the life story it was trying to tell. Hawke originally wanted to produce a film on the subject – a “Walk the Line”-esque biopic in the similar vein as was done with Johnny Cash (incidentally, one of Kristofferson’s close friends) and Kristofferson refused, making Hawke settle for one hell of an interview.

He did a good job. I’m now a fan of the music and the man behind the music. I walked away from reading Rolling Stone – of all things…inspired.

Kris Kristofferson – he’s what’s RIGHT with country music.





Launch me into space…

1 04 2009

…Was the refrain of a song I was listening to earlier.

It was an almost comedic refrain – but it seemed to resonate with me.

You see, I’m starting to get loopy and sore. Stiff and restless. I’ve been studying now for approximately nine hours. I haven’t really moved around much. It’s prompted a lot of thought actually.

I’m not used to – and never have been used to sitting for nine hours.

Imagine how much I’d weigh if I sat around for nine hours a day, and never walked or went outside…wait a minute…

That sounds like 90% of the population in the U.S.

Scary. So then I started thinking about why I’ve been sitting down for so long – and it’s because I’ve been driving through the pharmacology text in preparation for the boards. I’ve got 195 questions to answer (I wrote them over the last several hours) which will take about three or four more hours I think. This is a break right now.

I’ve covered a multitude of drugs. Beta-blockers, alpha-blockers, alpha agonists, anticholinergics, anesthetics, central nervous system stimulants, anxiolytics. And honestly, it’s all a large soup. And then as I began to take a break – I decided to cruise over to the New York Times Health section – because there’s nothing like taking a break from studying medicine than reading what laypeople have to say about…medicine.

I guess I’m shifting my addictions (Facebook has been excommunicated since the 27th of March). Anyways, I digress.

Midway through reading about all of this pharmacology and trying to learn what some of the adverse reactions are – and what do I see – an article about polypharmacy. Which is a big problem in the U.S.

A huge problem…Haha – actually like the massive patients that tomorrow’s physicians (me and my peoples) will treat.

Suddenly I began to realize how much more important research and making it as efficient as possible is. It’s the only place that major breakthroughs in health are going to come from.

On another note – I’m amazed at how much more time I have now that I’ve decided to cast aside facebook. I’m using twitter much more – but honestly – the amount of time I spent on Facebook basically academically crippled me over the last two years…I can’t help but think I’m supposed to know so much more of this stuff…

oh well…
do work…

ciao





Hard work

30 03 2009

So, I’m effectively cut off from the Internet and going through computer withdrawals.

I’m typing this from my iPhone. Thank God for my iPhone.

My post today is about hardwork. The kind that makes other people say – dude that’s insanity, slow down just a bit. It’s my style – excitedly working on getting myself somewhere – diet coke in hand, charging hard through the thickets of work that interect themselves into my day. I’m by nature a bipolar person when it comes to work. I either want to – or I don’t. Spring is the time when I want to the least and fall is probably when I’m at my best… At least that’s my thought…

I recently decided to claim my rightful place in a top-notch residency. I’m smart enough for it…now I just have to work hard enough for it…

Three days outside of Facebook and while I sadly miss it – I’m on the way to making up for it with a vengeance…I can do this all day and night long.

I have two more weeks to be here…I’ve gotta make them count like there’s no tomorrow…because while that statement is a stretch – there is some truth in it…we aren’t measured in life by what we’re GOING to do. Or what we plan to do…We’re measured in life by what we’ve done.

That basically sums up this entire post. I’m not going to fight to get back west. I’m FIGHTING to go back west.

Nuff said, it’s time for a self-imposed drill school

Discipline is my friend…Discipline is my friend…





Outbreak Investigations vs. Clinical Use of Antibiotics

26 03 2009

These midday realizations that come when I’m supposed to be focusing

So I’m sitting in class, listening to a lecturer whose verbal filter matches mine. He’s got an unassuming opinionated swagger to him and is hilarious as he speaks – albeit possibly slightly insulting. He’s a good lecturer though which I appreciate. Lots of pictures. Lots of metaphors. He’s hilarious… Lectures are education – but in order to be memorable (and therefore effective) they must be entertainment as well.

I’m realizing that people who are unhappy shouldn’t influence your definition of yourself…it’s just a bad idea. In this case, I’m talking about my roommates – we aren’t agreeing on anything. In fact, we aren’t talking at all. I definitely share responsibility in the situation – but ultimately, the reactions, words, attitudes, and responses were irresponsible and disrespectful. I realized its’ projected unhappiness – I’ve done my own projecting too. But ultimately, it’s a shame that some people don’t quite get the whole teamwork aspect of it all. I guess the rule here is you don’t shit were you sleep.

Dockers are incredibly comfortable pants – and it’s a good idea to wear them. By them, I mean comfortable pants – mostly because that way you are comfortable. It’s rare that shirts aren’t comfortable – but pants can be horrible. The other two types of pants that are incredibly comfortable are scrubs and corduroy pants. I like them.

Your parents in the 60s and 70s were right. Eat your fruits and vegetables. Try your best. Wash your hands often. If you don’t have anything nice to say – don’t say anything at all.

My friend and I may start a joke/gag band. It’ll be called MegaFauna. We’ve got a bunch of awesome song titles. I think my favorite so far might be “Shaking Out the Holy Water”…that’s one that I can see having so few words and so much rock…Another is “I get no satisf(action)”…And another is “You’re (Pretty) Fucking Sane”…It’d be cool to rock shit hard core in a small bar. Secretly, my motivation is a blend between Rock Band, Guitar Hero, and performing with my only friend who is an actor…Secretly, I think the other friends’ motivation is Hedwig…

I love learning about new music and food and places. I wish I felt like I had the time and money to explore our world a bit more. Exploration is where its’ at…

No one knows or can define you but you. People can relate, but they cannot sum. Even you don’t completely know yourself. There’s a scripture about that in the bible – about God knowing you better than you know yourself…it’s something I’m inclined to believe to be honest…It tends to inspire faith – understanding that there are depths and heights that you may or may not know about…It also inspires effort.