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

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.

Hard work

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…

I wanna I wanna…

I’ve been thinking recently about the things that I’ve wanted to do for some time.

I’ve got a stable list of things – many of them professions – that I’ve wanted to engage in regularly for at least 3-5 years. They range from white to blue collar. They range from requiring multiple degrees and certifications to primarilyrequiring a driver’s license, a strong back, and a willingness to listen.

Construction: For several years now, the allure of swinging a hammer and actually building homes has held a definite appeal in my mind. It’s the idea of creating something with a lasting benefit, something tangible that you can look at day-in and day-out. It also may have been a lucrative field – especially since I already had a job with benefits and great hours/pay.

Writing: Hell, right now i’m writing and I’m enjoying it. For sometime now I’ve wanted to describe, create, and give life to complicated, tragically funny, human, and sometimes inhuman characters. I’ve wanted to, again, be creative and craft mysteries and viewpoints that aren’t necessarily commonly held. Unfortunately, I don’t READ enough literature, and haven’t read nearly enough literature to be the amazing writer that I want to be.

Surgeon: I’m on my way. It’s a craft, a certain creativity, another profession with a tangible pursuit – although one that is somewhat more visceral than palpable. I like the combination of detective work and the butchery of it all. I like the hand-eye coordination. I like the technical proficiency, the detail, the creativity (although limited – see below) of it. I like the opportunity to definitively correct pathology, and I like the pressure of it. Ultimately I also like the idea of being more likely to work, medically, with those who acutely need good physicians and are the most unlikely to be able to identify with physicians…I also love the idea of working with my hands. The drawback is how much it seems to interfere with the rest of ones’ life. Which is unfortunate to say the least…

SWAT Team Member: Forgive me if my “adventure spirit” aka. testosterone occasionally gets the better of my judgement and conscience – all I can say is rapelling into a building, smashing windows out, and shooting a gun while yelling/screaming at “bad guys” does still hold some cachet in my brain – even if higher parts of me realize the sophomoric nature of it all… Unfortunately the whole, “being a cop” thing sort of bugs me about it though…

Adventure Athlete / Mountain Climber: Believe it or not, i like trail running – something I discovered when me and Jenn were bombing down a trail on Mt. Si a few years back. I also like the combination of technical proficiency, and the opportunity to be outdoors. Again, the use of ones’ body in the profession is a plus as well. God gave us arms and legs to walk, push, pull, and kick every day….If God wanted us to sit on our ass all day he at the least wouldn’t have given us legs…

Musician: The idea of sitting down every day, notebook in hand, guitar in hand, wearing sunglasses and something awfully rockstar funky, does hold a great amount of appeal. Playing over and over, riff after riff, practicing the craft until I’ve reached a level of technical mastery that seems to be unparalleled is really cool. That passion is something that will help me to become an amazing surgeon – but damn it would be cool to do with music as well…again the creative freedom that music allows is something that I find unique…to my knowledge, no fields offer the same level of expressive freedom as music – you can be very creative in construction, but it’s useless if the building doesn’t remain standing when it rains. You can be creative in surgery every once in a while, but if your patients die, they’ll ask questions…and you’ll have to answer them…Creativity on a SWAT team doesn’t really tend to go over so well “so this time guys, I’m thinking I’m gonna flip a coin before I rappel into the window and if it’s heads – I shoot the bad guys, tails I shoot the person I like least in the room…which isn’t necessarily the bad guy.”

Engineer/Designer: I definitely appreciate good design, and again the creative aspect of the profession combined with the technical proficiency needed to create something useful that won’t fall apart or break when its’ needed the most. I think a lack of true engineering is what has led to our countries’ auto company crisis. I think a lack of true engineering is why our transportation systems are quickly choking and dying. I think a lack of true engineering is why we haven’t figured out more energy efficient solutions to making durable goods easily recycled/repurposed; heating, cooling, and lighting our homes; driving our cars; flying airplanes around; and moving heavy (which if better engineered could be light) freight around. Coupled with a positive aesthetic, good well-engineered stuff

Physicist: String theory is cool. Quarks are exciting. The freedom to be a complete nerd, live in Europe (likely Switzerland), and be on the cutting edge of a whole bunch of things is intriguing. Too bad I’m likely not smart enough to do it…

Economist: The economic choices that our governments, corporations, and people make are interesting to me and I think that many of Western societies ills stem from inappropriate allocation of resources as well as inaccurate valuations of products, processes, assets, and liabilities, whether those be cars, waste treatment, people, homes, transportation options, prisons, police, or schools. Second to being a teacher, I think being an economist could fulfill a cerebral need of mine to truly, contribute to society and make an honest try to make the world a better place for everyone.

Lawyer: I like the idea of being a lawyer in a theoretical way only. Lawyers are perhaps those best equipped to handle themselves in our world, mostly due to their understanding of the legal basis by which our world works, as well as the pitfalls and holes that society, as a body of law, has in its’ fabric. Ultimately, at the very least the only thing you can rely upon somewhat is law. If you don’t know it – you don’t really know where you stand. Which is very unfortunate. Why only theoretical as opposed to in practice? Sitting down all day = no deal. I’d go nuts on day three. Suit and tie is okay a couple days a week, but isn’t there something to work on with my hands?

Landscape Architect/Farmer: I like plants. I like the idea of building something – again tangible. Using your body to do it. I like the idea of growing your own food – this was something brought home to me by reading the book the Omnivore’s Dilemma. I say landscape architect/farmer because if I could, I’d re-plant most of urban/suburban America’s boring lawns with self-sustaining gardens that would feed families and their neighbors. I’d allow people to be their own mini-serfdoms, where families could all pitch in and farm one home a week and have a huge bountiful harvest. Ultimately, reclaiming perfectly good, arable land from the chemicals and gunk that goes into “lawns” would prove healthy for our environment, as well as appealing to the eye and palate/stomach. Fresh corn, yams, tomatoes and spinach taste unlike anything I’ve ever experienced and I’d like my kids to know that taste.

Football/Rugby/Hockey: Speed, violence, working with your body, emotion, character, racing to catch your thoughts and your breath. Technical mastery, skill, agility, camraderie, and adrenaline all enter into these sports. The ability to be outdoors often (in all except hockey) holds a great deal of appeal as well. The strategic aspect of the games is enticing. Unfortunately, I have a difficult time feeling like it matters much. It could be different if it was tied to society in some meaningful way – like the winners of a particular team got to vote for a certain charity to be funded or something – but there’s really nothing at all on the line other than a “ring” which honestly – I don’t wear jewelry…

Track and Field / Speed Skating / Race Car Driving: It’s the idea of speed. Speed is very seductive to me. I like to drive fast. I love to run. Speed skating enters the equation because it is sprinting on ice. And god does it look fun. Especially the crashes and corners. The adrenaline in these sports must be sky-high. Again though, it just doesn’t seem like there is much you’d leave behind in terms of tangible accomplishments…

Soldier: Theoretically, being a soldier could be a very cool thing to do. I certainly respect the hell out of soldiers’ for being soliders, but I don’t necessarily respect what the military does. I understand that being a soldier requires two entirely different psychologies, and the ability to nimbly switch between the two personas – much like violent athletics actually – and that problems in a soldiers’ life arise when the two personalities are required to be around simultaneously… In a sense, I think that being a soldier is closer to the truth than at any other moment in one’s life. That is of course an uneducated musing from someone who is NOT a soldier. But there is excitement inherent in being a soldier – gunfire, running, screaming at innocent people to duck, shooting at people, fighting – exorcising the pent-up frustrations and day-to-day anger that “society” promulgates – for ones’ own sanity and clarity, and feeling like you are on the side of principle. Not just an empty vessel of consumerism…Or maybe it’s way less cerebral and much more about the discipline, camraderie, and surge of power and adrenaline that one feels when they shoot guns in teams, and call for their side to rain fire and destruction down on the other side. The only problem I’ve got with it is the idea of being made to kill someone…because of a lack of political will to deal with things in other, nonlethal ways…

Pilot: Again the speed thing is pretty alluring. You essentially strap yourself to the front of a bullet with two or four jet engines (read: mini-rockets) and you hurtle down a straightaway until the damned thing starts to lift off. Once you are at cruising altitude and speed you just watch the skies and talk to air traffic control to make sure you don’t hit someone else who is doing the same exact thing as you. The freedom to travel and see multiple places is cool. The technical proficiency is cool. The nomadic existence, living in hotels all the time is not. Also pilots don’t necessarily get to poke around in the cities that they fly to – they’ve got to sleep and get ready for their next flight oftentimes. All that said, I would absolutely LOOOVE to fly a large jet – not a Boeing 737 or anything like that – I’m thinking of a plane the size of a Lockheed C-5 or C-17…one with the wingtips that look tiny, but are actually 9 feet tall…I have to admit I wish there was a way to fly an airplane and not emit massive amounts of carbon…I also wish there was a way to do that without working for the military OR commercial airlines, both unappealing employers to say the least.

Coast Guard Rescue Swimmer: You get paid. To jump out of helicopters into pitching and rolling 40 foot seas. Swim to a person who is cold, tired, and likely slowly drowning. Put a harness on them – and then haul their asses out of the water…back into the perfectly good helicopter you jumped out of. You then take care of them while that helicopter hauls ass to the mainland…can you say adrenaline?

High School Teacher / Professor: I can think of no other job more important to society than that of a teacher. It is unfortunate however, that our teachers aren’t the ones held in the highest regard – our teachers are barely paid a living wage, and they are consistently underequipped in terms of learning materials

Dancer: Much like being a musician, being a dancer allows a great deal of creative flexibility, and it also allows you to work with your body. There is a certain adrenaline that goes with performing, and you get to listen to music all day long – although it’s probably the same music, all day long. Unfortunately, the pay sucks and the vicious nature of the business isn’t all that appealing.

So I tried

to have breakfast this morning – it worked somewhat.  Unfortunately both lectures I attended were complete wastes of time and effort.  Both were also pretty boring which made it somewhat difficult for me to seriously pay attention.

But that said, it was the worst case scenario, and I still feel like I did a great job of staying awake.  There is something I’m realizing about the grades and much of the frustration that is coming out of studying here right now.  Your grades on a quiz aren’t directly correlated to how much studying you do.  Nor are they proportional from quiz to quiz.  It depends on what exactly you study, and when you start studying.  Now, if you start studying the “memorization” topics sooner, then you will do just fine on those questions.  The concept questions you have to understand sometime before the quiz, whether its’ 15 minutes or 5 days before.  But you could put 45-50 hours into studying for the quizzes and it doesn’t necessarily matter.  You might barely pass.  And conversely you could cram the night before and you could rock the quiz, scoring well ahead of the pack.  It really just depends on the quiz.

And that is what is frustrating.

There doesn’t seem to be a strong incentive to study and KNOW/UNDERSTAND the important things.  The quizzes represent very little to the students other than random slices of information that may or may not have been covered in the book.

Rarely – well, never actually – are we given explanations to the quiz answers.  Just the answer.  Our quizzes are never returned.  The information is important right now, it will be heavily represented on the boards because it forms the basis of most of the pathology that can go right or wrong.  But the fact of the matter is, we need to have this information mastered, but the quizzes encourage us to NOT master the material, rather they encourage memorization of selected facts that have no basis in reason, and therefore aren’t even permanently reasonable to memorize.

People deserve doctors who actually know what they are doing.  I’ve heard entirely way too many brand new residents say that medical school was a joke and didn’t really teach them what they needed to know – and on top of it, the only reason it was stressful was the hours that you had to work to pass the quizzes.

Why such discontent from a group of highly motivated, self-selected people?  Why such disdain for the educational foundations that the medical establishment has promoted and developed for decades?

Does the discontent carry on into practice?

It seems like it may.  Today the New York Times carried a story about physicians who are completely dissatisfied with the non-clinical aspects of being a physician.  Aggravated by issues such as billing, insurance, paperwork, etc… many physicians are moving to cut insurance companies out of their bottom lines.

To be honest I’m almost considering the exact same policy when I practice, but I’m not sure if I can do that.  Not realistically, not as a surgeon.  Working at an academic hospital.

I heard today that attending spine surgeons can start at 750K per year.  It made me gasp.  The possibility for excellent compensation and great hours definitely looms out there.  I just have to find it.

Perhaps the growing job dissatisfaction and disillusionment of medicine is partially responsible for the divorce rate that hovers around 33% for surgeons.  What is funny is that psychiatrists tend to divorce at about 51%.

All these facts swirling around in my head make me wonder what I’m doing here sometimes.  In general I would like to ensure that I have some days that tend to be long, and other days that are short and easy.  I would be fine with working three 24 hour shifts a week including trauma call.  That would put me at 72 hours a week, but with 4 whole days to spend with family.

It’s interesting to think about the possibilities.  All I ever wanted was to be content.  I’m going to have to figure out a way to manufacture contentment in the context of school and almost irresponsible lecture quality.  I’m realizing that I will have to TEACH MYSELF medicine.  I’m not sure how that makes me feel about the doctors that I’ve seen in the past.

Medical school is amazing in its’ ability to prompt long-lasting, deep seated anxiety.  I’m going to be just fine.  The investment I’m making in myself will pay lasting dividends.  I’m just hoping I get to engage in something that I actually like.  Because right now that doesn’t feel assured.

Then again this is the real world where nothing is…

One guy, fit to be tied

I hate cramming.

Or maybe its more that I hate myself when i feel the need to cram.  Or maybe I hate myself, when I feel the need to cram, and hate the system for making class so unpalatable that I feel like cramming on the last day before a quiz is better than going to class…only to have to cram on the last day before a quiz.

The fact of the matter is, everyone hates cramming.

People would rather be doing something else – sleeping, out drinking, dancing, going for long drives, riding their bikes, working out, watching paint dry, taking a shower, cleaning up their apartments, taking nighttime photos – really almost anything else other than cramming.

So why cram the day before an exam?  Because I procrastinated.

Procrastination is my last devil.  I’m going to slay it.  I SWEAR.  Not to any of you, but to me.  I HAVE to kill the procrastinating tendencies in my soul.  Only then will I unlock the potential that lies deep inside.  And that takes us back to why cramming makes us so angry.

Cramming is almost always a symptom of a) structural incompetence on the part of the education system but more so it is b) a reminder that we have, locked away, an endless reservoir of talent that is going unused.  So we naturally feel uninspired when we cram, because we feel as if somehow we’ve wasted ourselves, both before cramming – by doing what came naturally to us – and during the cramming, while we are toiling away, trying to memorize something that often confuses us only nominally.

Some of the greatest mathematicians were immensely creative people.  They were able to memorize all of the “rules” and “tricks” and they spent their time trying to solve problems according to the “rules” using the tricks.  Or they tried to circumvent the “rules”.  But in order to have that type of creativity, the rules had to come to them lightning quick – they had to have them committed to memory.

It’s not as if our schools don’t know what we need to memorize.  They just don’t really present things as if we need to memorize them.  When in reality we do.  If you want to teach people to understand, you do that, and you FOCUS on concepts.  Understanding is what gets the people the better grades.  They take a step back, start looking at the forest, making connections in their minds, mapping things out.

But if you want to teach people to memorize things.  You repeat them.  Over and over and over.  Repetition.  Dull, rote, drilling.  Repetition.  That’s how people memorize things.  Repetition works.  You form “knowledge habits”.  I still have a habit of knocking on the door to a bathroom.  Even if I know its’ unoccupied – a habit picked up in the fire department during training.  I can still recite the pump procedures for making a fire engine pump water – the result of doing it hundreds of times.  Repetition works – unfortunately our schools tend to de-emphasize memorization ability.  They emphasize “understanding”.  But how do you understand information if you don’t even remember it.

All of these are things that we think of when we cram.

Why don’t I remember this stuff?  Why is this so hard to keep straight in my head?  God I wish I had looked at this stuff earlier.

I do too.  One day I’ll have a patient’s life under my influence.  What I am able to recall is going to be the major determinant of what happens with the patient.

Oh well, enough procrastinating, back to studying…

I can envision

A time when I’m studying for boards, studying HARD when I’m walking around somewhere in Europe, camera in hand, snapping photos and listening to music and practicing my French, Spanish, and listening to question/answers on drugs, bugs, and cells. Occasionally stopping to look at histology slides that I’ve conveniently “lifted” from our website, and the websites of many other places. I hope to develop the software to do that on an iPhone over this summer and into the next year. I also hope to do some mathematical modeling of trauma in underserved communities + mathematical modeling of infectious diseases and their correlations to chronic disease in underserved communities – another exciting research opportunity dropped right into my lap the other day.

That said, enough procrastination…

Nonprofit Media

As a part of my career I want to produce some types of media – both video/film, scientifically accurate animations, and possibly game-show like questions. I want to produce things that people will be both proud of, and able to utilize. I want to design things and then show them off visually. I want to be paid to do that. But I want more than money for creative endeavors. I want them to influence people towards doing something beneficial and altruistic. I want to make short films that highlight problems in the world – drama, but still drama that shows how things are unfolding and that shows what is actually happening with our world – what people are actually capable of doing. A new visual anthropology. Films that show solutions and begin to drum support. Films that advertise ways of helping people. Advertise community based solutions that do not require governmental interjection. I think that is the only way we will solve a multitude of problems in our own cities and communities, and in those of our neighbors around the world.

Africa, America, and Infrastructure…Strange Sisters?

So we just had a fascinating lecture about Global Child Health and Nutrition. The two are inextricably linked, and a number of diseases and disabilities are tied to malnutrition. But also to infrastructure deficiencies such as lack of clean drinking water and electricity. Now one might say – “well that’s government’s role to fund and develop adequate infrastructure for its’ citizens and their reluctance to do so just shows that they don’t want to help themselves.” While I don’t agree with that statement in totality – especially the assertion that governments in sub-saharan Africa do not want to help their citizens – I can agree with parts of it. A researcher recently brought to light the “3/97″ problem. There are at least two categories of research when it comes to therapies for simple diseases: efficacy and deployment/use. Improvements in efficacy are said to represent the potential(in Africa) of saving 22% more lives, and receive 97% of NIH funding focused on such improvements. Improvements in deployment and use of developed technology meanwhile receives only 3% of NIH funding while promising potential (in Africa) of saving 63% more lives. Unfortunately for Africans, this results in an inability to get meaningful and proven medical and infrastructure interventions to where they need to go. It is also unfortunate for us. On a domestic level – we have a major problem with health care costs in this country, and have to date been unable to rein them in. The American medical system is the tail wagging the dog. We face the same exact problem – deployment and infrastructure – as subsaharan Africa does. Educational infrastructure, and techonological infrastructure as well as health care infrastructure in both is drastically deficient. Spending to improve the deployment of simple measures such as childhood immunization, early testing and intervention for chronic non-communicable diseases such as in America will benefit many children, but also our economy – both by providing a steady stream of non-exportable jobs, and by lessening incidence of communicable disease and therefore health care costs. The same goes for Africa. And it is here where we realize the next dimension of our choices in research focuses. Researching things that will actually change not only our world and the world of countries that not only need us but are looking for help builds allies. Strategically, Africa is the place we need to have an absolute grip on in terms of the feelings about democracy and the United States. If Africa continues to experience the level of despair, exploitation, and global disenfranchisement that is has, it will begin to become a security risk for the rest of the world. Doing things that have the most bang for their buck in terms of foreign aid will work to build our standing internationally. Currently I think the strategies that are warranted in terms of foreign aid to Africa involve water. Fresh water. If we can ensure fresh water to more areas of Africa we enable them to feed themselves, and improve sanitation and hygiene.

But we also secure an area that is soon to be a contentious one – water rights and resources. In America we waste billions of gallons of water. We’ve destroyed fresh water rivers, lakes, and streams. We’ve done this in multiple ways, but at this point we need a sensible water policy. Otherwise we will soon have to deal with the drought and inhospitable environment, famine, and lack of adequate access to sanitation that many parts of Africa have.

Let me know what you think…it’s only a draft, I still need to cite some sources, etc…but it’s a start too…

Autism, Addiction, Depression, Strokes, Traumatic Brain Injury and Neurosurgery

These are some of the people I think about when I think neurosurgery is something I’d like to go into – it seems like a very rewarding field due to the people and the disability that you are attempting to correct. There is definitely a reason right here in these two people to actually try to help understand what is happening in their brains, and if there is something that can be safely corrected doing so…This story almost made me cry…

Kids at play are fascinating – their behavior is controlled by their big brains. It makes me wonder what a good neurosurgeon can do to help his and her patients…

Then I start thinking about problems like schizophrenia, and strange neurological disorders like this one and then our veterans many of whom join the military in the first place because of poor job and educational prospects, and then I start thinking about drug addicts and alcoholics that I can honestly think of almost as friends…Names like Otha, Rex, and Joyce.

These are a lot of the stories that I see when I think about neurosurgery. When I think about research. It fascinates me to see these people who are only a few steps away from interacting with general society in a fully productive manner…unfortunately the steps loom large…

Oh blogging…my favorite new distraction
paz…

56+ pages

What I’ve realized is that basically medical school years 1 and 2 will be difficult for a couple of reasons…

1) You don’t actually learn/retain a lot of things…you hear/read a ton of things, you memorize as much as you can – you hope to hold onto it for the boards, and then you actually go learn how to be a doctor…

2) The material is so far out of context, that it makes it almost impossible to retain what’s happening in any systematic framework. Organic chemists have the IUPAC naming conventions, we have the nucleus retroambigualis and glossopharyngeal nerve and petrosal ganglion…

So as I sit here, pondering my needing to read/memorize approximately 70 pages of material, as well as watch well over 8 hours of lecture video – I wonder why medical school is the way it is…I also think if I had it to do again I would have pursued Duke Medical School really strongly. I could have dealt with North Carolina – I could have dealt with Durham. I might have also pursued Stanford Medical school a little bit harder. The first two years of medical school really should only take 1 year. They should absolutely drill things into your heads so that when the boards come up you are ready to burst with medical knowledge. They should give you a year to pursue an MBA, outside research, volunteering in Ghana or Belize, They should then give you a SOLID two years of experience in an inner city hospital, busting your ass so that you are ready to handle whatever is thrown your way during your internship and residency.

So that is my naieve 1st year perspective on things, I don’t view this as a waste of time so much as I view it as suboptimally used time…but then that may just be a reflection on my character – I tend to be extremely impatient, I tend to see really green grass on the other side. I guess next year will reinforce most of this year, and being at Stanford or Duke would have taxed me in terms of my actual location, finances, and time management MUCH more than being here has…oh by the way – can you tell I’m avoiding naming my school…I don’t want any random repercussions…

So I’m learning patience, work ethic, time management, professionalism in the proper settings, how to drink wine with the best of em, and a little bit about friendship – developing new ones in a distant city. What’s funny is I’ve never consciously set out to climb the social ladder – I’ve always just tried to get by, and I always have, just gotten by…Maybe I’ve been trying too hard to in my first few months…maybe I just need to chill, be myself, do my things, and just be patient and persevering…

So other things about medical school that I could give you the reader, things that aren’t my heart on my sleeve?

Don’t procrastinate – ever…it’s bad for your grades…

Medical school in the first two years so far seems like learning a language and a new city at the same time…after medical school I could probably just fly into another city and take two years learning its’ streets, locations, and language…

Medical students aren’t all incredibly talented socially…

Medical students aren’t all incredible talented intellectually…

Being interested and deeply involved in a broad swath of things will definitely help you in your undergraduate years…being interested and involved in a broad swath of things in medical school will prove extremely distracting, and possibly fruitless.

Don’t procrastinate – Don’t read other peoples blogs (haha – my new worst habit), don’t read the newspaper online, don’t watch TV, don’t play video games, don’t “go for walks”, don’t clean your apartment repetitively, and for some strange reason – don’t listen to music with lyrics while you are studying… It really helps to know these things going into new subjects

For each subject that you come across, try to learn all of the vocabulary as quickly as possible – then try to learn how the vocabulary (anatomy, functions, molecules, etc.) are interrelated. If you can say what happens three doors down to Hemoglobin in the lungs when the muscles start kicking out a ton of lactic acid you are going to do very well.

For each subject that you come across – don’t study for longer than 30 minutes at a time (especially if you are highly distractable like myself), this prevents you from wasting valuable study time…especially in the first two years, what you want to do is take some time every day to study for your boards (almost the only thing that counts) and read a medical journal like NEJM or JAMA…if your block is concentrated on hepatology – reading a hepatology journal isn’t a bad idea

Get and then stay current with the literature of the field you are interested in – even if it changes…it will help later on

Get interested in a field and try to focus early – it will help later on even if you change your mind…

So now that I’ve procrastinated (I did it for you…readers) on my pulmonary physiology to the tune of 30 minutes, I need to go back in and learn something…test in two days

Oh yeah – one more thing – Even if you don’t have to – cram, because realistically…you have to…