Simple Things

2011!

2011-01-09T16:24:00.003-05:00

I know I'm a little behind; I also know that this is a little dramatized, but I'm down with the idea of this video

Happy New Year!

Follow Your Nose, Lucky Charms

2010-11-28T21:31:00.006-05:00

I remember reading an essay from "Surely, you must be joking Mr. Feynman," where good Richard himself describes a scientific publication on the superior olfactory sense of bloodhounds. Led by simple human hubris, he decides to test the olfactory powers of homo sapien, himself. At the time, his wife was in hospital (Is that the way the Brits use it? I hope so cause I really like it) with something serious. On his next visit to hospital, he described to her the publication and his belief that the human nose, when put to the test would outperform expectation. To test his theory, he asked his wife to choose one of the books from a stack of five or ten on the window sill while he was outside of the room. He would return and smell out which of the books she handled. And so it went that he was able to pick the right book. I don't know how many times. I can't even remember if I got all the details right, I'm just going on recall having read the essay one time five years ago. It stuck with me though because I've often noticed how powerful scents can be.

The other morning I was dramatically reminded of this as I walked onto the hospital floor. My resident enthusiastically greeted me, "Hey Jeff! Check out Mrs. W real quick. I think the nurse still has the bed pan. Let me know what you think!" The sun was no where near rising, the majority of the lights on the floor still hadn't come on. Roasters were still in deep slumber, and here I was catching an eye opener of Mrs. W's diarrhea. I dutifully inspected the soupy content for any signs of mal absorption, blood, or infectious process thinking the whole time, "Is this really what I want to do with my life? Seriously, who does this?"

Days have passed; Some days I don't have an answer to that question. And then there are moments, like the few I've experienced over the past couple of days that remind me that it is the uniqueness of our job that makes it so precious.

Ms S traveled to us, transferred by ambulance from a small hospital two hrs away. 39 yrs old, two kids at home, and her parents trailing the ambulance in the slow traffic that always ensues with the year's first snowfall. She left the outside hospital in a stable condition. When she got to us, she had all of the signs of sepsis--an infection that can quickly take the unsuspecting patient to the morgue. Two days later, I stepped into her room, examining a totally different patient. Her skin tone was back, her eyes had cleared, her breathing returned. It was apparent without a stethoscope or any exam that she was out of the storm. My team followed into the room and the parents kept pointing out what a miracle had been worked; going on praising us for the work we did and kindly reminding us that it was God and not the white coat behind it all.

In these instances, you know it is nothing that you did. Of course you did what evidence-based medicine dictates so you never feel like it was something, "you" did; but that still doesn't take away from how awesome you feel in those unique moments. You don't feel pride, you just feel luck. You feel the luck of the situation, that the medicine worked, that this patient is back, smiling along with everyone else in the room, and the luck you have to be a part of it all.

Where is the writer?

2010-10-19T00:43:00.009-04:00

"Is that thing moving anymore? It's been like months"
"No... I keep checking; no sign of life. It's been long, too long"
"Really?
Give it a poke; Get a stick, maybe we could turn it over."
"Sick, what if there is nothing but maggots on the other side?"
"No point in turning it over. It's been so long, that's the only possible thing we could find"
"Oh sick, absolutely! I think I smell them. Do you smell them? Sick, it's on my clothes. Smell my shirt! Let's get out of here!"
"Wait, wait! I need to see, just a peak at what is really on the inside."

How long can one go without writing before it is assumed you are all washed up? This picture I snapped the other day raises the question.

Lying on a Rochester beach post Labor Day = poor prognosis

"When there is nothing left to burn..."

2010-08-15T18:03:00.003-04:00

Surgery clerkship, complete.

I finished the last three weeks on the burn unit. My take home message for us all: Don't throw gasoline on anything!!

I can't believe I made it through Boyscouts, through adolescents, without a serious burn. It turns out that lots of people do get burned when gasoline is mixed with an open flame. Another common combination is chicken and grease. The one I was excited about most was the cigarette and gasoline, just like, Zoolander. The case I was the least excited about was the two year old who tripped into the campfire.

Oh, and the stuntman for all of the Jason, Friday the 13th movies came to the hospital and handed out autographed photos to all of our patients. He is a burn victim himself who spends his spare time making others' lives better. Pretty cool! He actually was burned in a demo tape he made. It was over a year before he was back to his stunts, but though the only door opened by his demo tape was to the hospital, he went on to have an amazing career. He's done many other famous films working as a stunt double for most of the big names in Hollywood.

Keep on grillin, but please, be careful.

On to Geriatrics...

Adventures in General Surgery

2010-07-25T22:17:00.004-04:00

Favorite quotes from my first three weeks of the surgery clerkship

Attending Physician: "What is this?" Pointing to a structure in the heaps of bowel resting partly in the attending's hand, partly in the patients abdomen, and partly on top of the patient's abdomen.
Me: "Is that the appendix?"
AP: (Spoken in strong southern drawl) "Jeffrey, this is not Jeopardy, this is the OR. There is no need to state your answer in the form of a question. What is this?"
Me: "The appendix!" Affirmatively
AP: "That is right!"

Second episode
AP: "What is this?"
Me: "Transversalis fascia"
AP: "Give him a zero!"
Me: "oh, sorry, that is the aponeurosis of the external oblique muscle."
AP: "Correct. Don't apologize to me. You can call your mother and apologize to her. She might appreciate that."

Third episode
AP: (to the scrub nurse) "Scissors to him." "Cut this"
Me: (cut)
AP: "That was too short"
Me: "OK"
30 seconds later
AP: "Cut this"
Me: (cut)
AP: "Too long"
Me: "OK"
60 seconds later
AP: "Cut this"
Me: cut
AP: "Too short"

There are two lengths that a medical student can cut the sutures in a Rochester OR...too short or too long. At least this takes the pressure off of cutting the sutures at the right length.

Good Things to Come

2010-06-18T23:00:00.000-04:00

Tomorrow, I finally get to take my first step, Step 1 USMLE. That stands for United States Medical Licensing Exam, I think. In an effort to kill some time until the exam, I was just perusing the 'ol internet and came upon this little video. And I liked it. Good Things to Come

2010-05-28T18:15:00.000-04:00

I know you are already bored with the water issue. Don't be deceived. This is not about water, sort of. The picture above is taken from my copy of the National Peace Corps Association Worldview, Winter 2005. You may be asking why I have a copy of such a magazine given that I never worked with the Peace Corp and considering the fact that it is 2010. Bueno, that I can't explain. Why is a picture from this magazine posted on my blog? That I can answer. Because this is the very same picture as seen in the April 2010 National Geographic referenced in the previous post on water. You can also find a copy of the picture at this link. Oops, you'll need to search the archive to pull up the April issue.

I guess I just thought that my magazine would provide their own pictures for their magazine; or maybe I had the expectation that they would at least use up-to-date pictures. When I read that article in National Geographic, I thought those people in Rajastan were really thirsty, lined up at that well at the precise moment that I was reading the article--this makes sense because I was reading it late at night, when the sun would be high in the sky over India, as portrayed in the photograph. It turns out that that was so five years ago, maybe more. So what is the story like now in Rajastan? That well is probably dried and gone. Or maybe its the people that are, dried and gone. Or maybe everyone filled their jug and called it a day, everything's fine. I'd like to believe the latter.

"Mock, ing, yeah, bird"

2010-05-25T23:59:00.003-04:00

I decided a few weeks ago to read, To Kill a Mockingbird, every night of this summer. I didn't have a goal to finish it 'X' number of times. I just decided I should keep this as my nightly escape from studying for the boards be it that I read the novel once or fifty times through.

And look who else decided to join me in this: The Whole Country

I don't know, karma, or what. I don't know what this means; perhaps I'll find myself in Bozeman this summer for a little chat with Mista Brokaw.

2010-04-25T21:07:00.019-04:00

The issue of water is not new. The Media has been gabbing about it for years. I remember the first time I personally had to DEAL with it. For six months, I boiled my water in the mountain town of Azogues, Ecuador. After boiling, I'd pour it through a plastic funnel which we had covered with a t-shirt. The t-shirt without fail turned brown, and the water theoretically turned not brown i.e., pure. At points when the water level was running low, the city would shut off water altogether. This happened much more frequently in other cities where we could expect to have running water at certain hours of the day. Of course, there were some days when the pipes were dry during the expected time interval of running water. It was for those kinds of surprises that we kept a handful of gallon jugs filled in the bathroom. Dumping a jug of water over you can some times be a welcome change. Ya know, that added sense of independence: finally liberated from the control of the shower head.

We use a lot of water in the bathroom, but it was in the kitchen where Ecuador taught me the value of water. People were incredibly resourceful with their kitchen water. I felt like I was always looking at a camp kitchen when I saw how little water the Guayaquilenos used to do their dishes. Those in the campo (country) were even more strict, and rightly so; there was one pump that came out of the ground about two miles from our apartment. Bicycles or motorbikes were always parked there, day or night, with people hunched over to fill their plastic jugs.

The water issue came back to the forefront for me when I was in India. Again, more people lining up at the well to get their daily supply of a few liters or whatever they could carry on their head or shoulder.

The sum of all these experiences left the impression that life is different in different parts of the world. I was grateful for the water I enjoyed, and I recognized that others were not as lucky. The whole, "You better eat that; there are starving kids in Africa who would do anything to have those vegetables," lesson came full circle. There... I finally knew with my own two eyes what I'd heard as a child. So mature, right?

Honestly, now that I think about it, those experiences changed me a little more than to believe that I knew more about the disparities in the world. This past summer in Peru, I developed a habit that I still keep (mostly) of turning the water off to lather and then turning it back on to rinse in the shower. And I don't let the faucet run while I'm doing dishes. Score.

However little or much I've done, it doesn't feel nearly enough after reading the April 2010 National Geographic. If you haven't, give it a look. But I warn you that it is tough. In this month's edition, we learn that 40% of the Tibetan Plateau's glaciers could be gone by 2050. "Full-scale glacier shrinkage is inevitable." Ice cover declined in the Tajikistan and northern India regions at rates of 35 and 20 percent over the past five decades.

What happens when glaciers melt? Grazing lands disappear, rivers and cities flood, freshwater supply diminishes, less light is reflected back to the sun, more absorbed, temperatures rise faster, people are displaced, dams are built to control and capture the run-off, 80 million people have been displaced due to dam projects--I saw this in India where a colleague was fighting to keep the tribal community she and her husband had served for 25 years from being displaced. The dam was approved despite two years of legal debate.

The point is, water is scarce in a lot of the world. And we don't care about the consequences of getting what we need. And it looks like it is only going to get worse. With 83 million extra people joining us on Earth each year, how do we accommodate?

The obvious answer is, I don't know. When the facts are drawn up and the numbers tallied, things can look down right depressing. I remember feeling overwhelmed when I saw in the National Aquarium of Baltimore at the ripe age of nine that the Amazon Rainforest would be gone the year...(I can't remember exactly, just the fact that it would be gone was devastating to me, and it still is). I recently heard a news report of a child who found out about global warming on the internet and came to his dad in tears. The more time we have on this planet, the more concerning these issues are.Honestly, I'm still scared. But what can we do beside buy energy saving appliances (which I just did--Yeah, three cheers for the NY energy star appliance swapout!!)?

Why did God rain down manna for the Israelites each morning, but our brothers and sisters in the slums of Dehli wake up and fight one another, sometimes to the death for a place in line to get a little water? Does he love us any less?

Personally, I see three areas where we can contribute to a positive change in the planet's water supply. 1) Pray and ask God to provide the water that we and all of our peeps need. 2) Do the little things that we can to reduce our carbon footprint, if only to feel good inside, and 3) Support organizations that are actively working on issues related to water supply. Oh, and 4) accept that if the environment is no longer amenable here on our planet, than that's it. We'll adapt until we no longer can adapt. Hopefully, adaptation will involve less war and more technology but I imagine that it will involve both.
Picture Key
* Tsunami refugees lined up for what I believe was water and cooking oil. Cuddalore, India 2005
** Tsunami refugees, women getting water from the remaining well. Nagaputtnam, India 2005
*** Glacier lake created from glacier melt. Cordillera Blanca, Peru 2009.
These lakes catch the melt. The Andes are speckled with these lakes. They are beautiful, but very dangerous. In 1941, the rock support gave way to the built up pressure delivering an avalanche wave of water at devastating force on the city of Huaraz. Four to six thousand people died. Many smaller slides have happened in the last fifty years.

**** Summit of Mt. Ishinca, elevation 5530 m, 18,000 ft This trek took us through the path of the 1941 avalanche.

Large Bowel Obstruction

2010-04-11T21:03:00.005-04:00

My surgery rotation starts in July. What will that be like?

Check out the following link to get a glimpse. I'm not sure how much of this is "inside joke" funny or how much of it is just funny; but really, this thing made my eyes water.

Medical Student

Here are a couple others:
Questions
General Surgery

Winter, we bid thee a dieu

2010-04-06T01:14:00.013-04:00

I feel it is time to wave goodbye to old man winter since we've been enjoying summer for the past week or so.

A few parting pics...

Adirondacks Camping, best trip of the winter

Deep contemplations to meet the silence of the forest

A wonderful camping mate, and our portable heater

Gore Mountain, skiing in a whiteout

Rochester sunset, highland park

Cross-country skiing in heaven

Cabin fever, deer tracking/frozen swamp exploration

I think you can figure this one out...

Med School tidbits

2010-03-10T00:40:00.003-05:00

Here are a few morsels of knowledge that I've picked up recently.

If you crave ice, that probably means you are anemic i.e., low on the blood supply.

If you itch all over, your liver is probably failing e.g., hepatitis, cancer.

~30% of adults have an STD.

One in three women in the USA has had an elective abortion.

Yeah, kind of shocking. This isn't just taking the number of women in the USA divided by the total number of abortions performed in a year. It is surveying, "have you had an abortion?" And one in three will say yes. I still find that hard to believe, but then I worked in the OB/GYN clinic last week where I overheard a resident explaining to the attending doctor that she just sent a girl to the emergency clinic to get hydrated and she gave the patient the abortion numbers because the girl found out that she was pregnant earlier in the week. Neither she or the father want the kid, and she was really stressed about it, so stressed that she wasn't keeping herself properly hydrated. That was enough to tell the patient to abort the kid. Not exactly what I recognize as quality care that genuinely seeks to provide "medicine of the highest order." Oh, in case you don't watch tv in Rochester, that is the hospital system's slogan.

The Celestial Language

2010-02-15T00:32:00.001-05:00

Tonight was the Rochester Musical Fireside. What is a fireside? You might picture me sitting around the fireplace, blanket over my legs, cup of joe in resting in my lap, and the phonograph playing from the corner of the room. No. That is not a fireside according to Mormon lingo. So what is a fireside? I doubt there is a canonized definition of the term, but I think most Mormons would describe a fireside to be any kind of churchy activity held in the chapel that is not a “church service.” Does that make sense?

So the fireside tonight was a music fireside. Members of the church in Rochester, at least those who go to the same church building as myself (mostly students of one form or another) had the opportunity to showcase their musical talent. Lucky for us, the Eastman School of Music attracts some pretty amazing talent, and they did not hold out on us. Some amazing trumpet, French horn, opera, piano, and the act that won in my book was a violin piece. I couldn’t keep my lips from curling up into a smile during that piece. It was like the music entered my ears, vibrated that tympanic membrane, tweaked my mallaus, stapes and incus in just the right way to jiggle my cochlea in such a way that it fired off my facial nerve which then caused the muscles in my face to contract into a smile. Sorry, what I am saying is that the music made me smile.

Music is SO important to me, to my soul. I find it very, very, very difficult to describe its importance; but I hope that in the next few months I can sort this stuff out through a few blog posts. I am setting the goal right now to dedicate at least six blog posts over the next few months to music. So let it be said, so let it be done.

To be continued…

In the mean time, check this song out. Does the guitar remind you of another song? It isn't terrible similar to this other song I'm thinking of, nor is the other song terribly popular. But wouldn't that be fun if you guessed it!

Master of What?

2010-01-31T23:07:00.004-05:00

The other day in Master Clinician, we spent the afternoon with our "master clinician" at his master clinic. Yes, the program (one doctor works with a group of four med students as they see patients in the hospital) has kind of a funny name, but the experience is very helpful. And, our master clinician is a yoga/meditation instructor at the hospital when he is not seeing patients--very cool.

Before we saw any patients, Master C wanted to get to know who we were, our background/story, and then he told us that the next three years are going to change us. He said that we would change so much from second year med school to first year of residency that we wouldn't recognize the person we are today. Wow! I'm kind of excited about that, but don't worry, so far med school hasn't changed me too much.

I share a moment from last week's lecture as evidence.

There I was sitting in the second-year lecture hall, approximately three-fourths of the way back. The lecturer kept pacing back and forth in his white coat, hands buried deep in the side pockets. Most of the lecturers are really great, but this guy seemed to have missed the memo. He started off by declaring that his lecture was not intended to teach us the subject matter. That was for us to glean from reading the text--fyi, there is NO definitive text in medicine, rather a handful of beastly books that offer endless amounts of information, therefore no one reads the "text." What other platitudes he felt compelled to dispose on us at that time I cannot say. Instead of getting up and leaving the lecture outright, I tuned him out and pulled out a notebook to review material from previous lectures.

The pacing back and forth across the room went on, interrupted periodically with a question that he would pose to an innocent bystander in the audience. And of course, no one ever gave him the right answer. It was always, "well, that's pretty close," or, "not exactly..." He was rifling through the class sparing no one. I still wasn't paying attention to the lecture, but I soon realized that the probability of him calling on me was fairly high and climbing.

Then it happened. "You in the red shirt." I looked up to confirm that his pacing had stopped and that he was staring right at me. Confirmed. Our eyes met and he repeated his question that I missed the first time. "What is the first thing you want to know about this baby?" I stared back looking as neutral as possible. I tried to give a look that sent an ambiguous message of either I speak japanese so I cannot understand, or, I'm thinking deeply about the question, trying to narrow down between a few potential answers that were on the tip of my tongue. Then I felt some agitation building inside. Was that showing on my face? "Look contemplative," I told myself. "Look like I'm thinking between a few things, this will give him a little time to expound on the question." He took the bait and repeated the question with a little more information, "You walk into the NICU to see the jaundiced baby and what is the first thing you want to know?"

That was it, he had given me an out. "I would want to know which baby is my patient!" I replied sincerely and triumphantly.

To my surprise, the class let out an uproar. I expected some kind of a reaction, but this laughter was more boisterous than anticipated. I think we were all feeling the tension that had built up over the entire lecture.

I kept eye contact. The lecturer was stunned, caught off guard. He took one step to try to resume pacing but he couldn't find his rhythm. So he just looked right back at me. I smiled in return; the stir of my classmates really ignited a fire of laughter inside of me. He did not smile back. I then got a little worried. I tried to look innocent. "Put on your innocent face, you are innocent, just being sincere, Jeffrey, look innocent!" But his return stare was sucking the truth right out of me, he knew exactly what was going on and he wasn't going to back down. His stare was pulling away the innocence mask to expose the laughter boiling inside of me that I desperately fought to hold back. That would grant him a warrant to make some kind of a pedantic retort. He could string me up and use me as a lesson to the rest of the class regarding how to survive our next year on the floors. I saw my medical career flash before me, it started with medical school and ended second year of medical school, me, skinned like a cat, hanging from the tops of the lecture hall.

Just before I was about to bust up laughing, a miracle happened. He broke eye contact to fidget with his pager. Phew, that released his death hold on my soul and I could let out a tiny squeak of a laugh, a quiet chuckle, just enough to relieve the tension in my gut before he looked up again. I was spared. He worked back into his left-right pace, and over the remaining twenty minutes of the lecture, I let out the steam in my chest bit by bit each time his back faced me. That was a close one.

I am happy to reflect and see through this anecdote that I am still the same person that was often asked to leave the middle school classroom (Mom, did that get back to you in those parent/teacher conferences?) for like behavior. I'm even happier to report that the lecturer never asked another question of the class from that point on.

The Real Global Warming

2010-01-15T00:36:00.006-05:00

So much time had passed that the mere thought of visiting, Simple Things, generated a sigh just strong enough to extinguish the last candle of hope. The idea of looking at the page, let alone writing, felt useless like checking in on a neglected fishing trap. Why bother pulling it up to the boat? There probably was a fish inside, but only its rotted remains could be there now for retrieval.

Fast forward.

I'm back in the Peds clinic. Time in the clinic means time to think. Everything outside of the clinic is time spent living: lecturers, study, eat, occasional exercise. But being in the clinic is not living. It is the closest I get to working. And it is at work that I find time to think i.e, to live.

Medical school tends to make one oblivious to the real world. If it wasn't for a roommate, and the janitorial staff talking loudly over their morning coffee in the hospital atrium, it could have been days before I knew anything about Haiti. However the clinic, this is where we get to interact with the real world. This is where we can live.

One example. I couldn't tell you anything about this year's American Idol, but I do know the song about, "Looking like a fool with your pants on the ground," because the five yr old boy who's little sister I was seeing sang that line ad nauseum throughout the visit.

Beyond pop culture, clinic presents patients. And what are patients? People: the essence of all culture. (Does that remind anyone of the merman commercial, Zoolander?) Anyway, it is never permissible to judge during a patient encounter, but one cannot ignore the bigger cultural/social picture that all of these experiences produce. One visit in particular is still on my mind. A Turkish family brought their adolescent child in for an evaluation. There was the father, who looked like a mafioso. The wife/mother, who looked like, well, the wife of a mafioso. And there was the translater/friend. Oh, let us not forget the patient. He was there too. A severely autisitic boy of probably eleven years. This little character ran around the entire visit while the parents and I negotiated a meaningful? conversation through the translator. Zoom, the child would pass by. Tug, the child was pulling on one of our sleeves. The thing that has stuck with me from that visit is that this Turkish culture, whatever it is, is going to get washed away sooner or later. The autism will stay, but the language will go, then the cooking, then the clothes. Or maybe it is the clothes first, followed by language. I don't know the exact order, but I'm sure that sooner or later we will all melt together in that great pot.

I remember the video from third grade where I learned that America was a melting pot. The cartoon showed people of all nations jumping into Lady Liberty's sauce pan to be stirred into one wonderful American chowder. I was happy that day. Now, I am sad to think of the outcome of all this stirring and melting. Oh, Christopher Columbus, what have we done?

Maybe forming the Rochester Minutemen facebook group a year ago was more than jest. Maybe.

Scream I

2009-11-24T00:09:00.008-05:00

Have you seen it? Where the Wild Things Are? Growing up, Spike Jonze was my favorite music video director. As a grown up, Dave Eggers is my favorite author that I've never read. The two creative masters somehow met, obviously in some creative way, and co-wrote the screenplay to the movie, Where the Wild Things Are.

One of the opening scenes, perhaps the very, portrays, Max, the pajama bearing protagonist exercising his own creative genius to ambush his teenage sister, Claire, & her friends with snowballs as they leave the house. His plan works perfectly, the kids exit the front door and Max's brilliantly choreographed attack ensues. Once his ammunition is out, Max triumphantly retreats to his igloo fort grinning ear to ear. All of a sudden, his mood is suddenly and literally crushed as one of Claire's friends pounces on the fort decimating it, burying Max and his bliss. The teenagers split, oblivious to the mess they've created and Max erupts with tears, snot and saliva. In this constellation, the flushed cheeks, runny nose, and agitated breathing, this is the first moment in the film where the audience is reminded of what it felt like to be nine. The rest of the movie, scene by scene, reminds the audience of that feeling in equally direct or more roundabout ways—not ignoring the bliss, but focusing on the frustration. From Max's tantrums at home to the howling on the island's cliffs, Where the Wild Things Are is one collective scream; a shout against the ineptitude of childhood; a cry against a world that is incomprehensible; a plea for attention; a yell for someone to come and institute some order and understanding on the island of prepubescence.

This collective scream reminds me of another epic yell. Did you see the movie, Garden State? Perhaps you heard of it. I actually didn't know who Zach Braff was before this movie—no Scrubs at that point in my life. I did, however, know all of the great bands featured in the movie's soundtrack. Basically, write a script about a pretty typical American twenty-something's life. Add an unusual element to the story for hipness—like a friend who has a mansion because he successfully marketed silent velcro—and then play a bunch of awesome songs in the background and you've got a solid movie, Garden State.

One of the closing scenes portrays the main characters of the film donning trash bag rain coats standing on top of an abandoned bus that sits at the bottom of a landfill—I think, can't actually remember if it is a natural gorge or landfill converted junk yard. At this point in the film, the crew has spent the entire day running errands, to what is an unclear end. Regardless of whether they are winners or losers, what is obvious is that they are at the end of their scavenger hunt. Rain is coming down, and it is time to call it quits. Just as the audience settles into emotional coma, Zach and his two friends climb unto this bus and scream, first Zach, and then all three in unison. They scream with everything, they scream with every respiratory muscle from feet to lips. This is it; this is the moment where the film transcends from musical candy to art. This is where the predominantly twenty-something audience wakes up and feels a personal connection, because this is the scream of our generation, the howl of generations past. It is the yell against a world of insurmountable problems--poverty, global warming, war, social security, health care; it is the scream of the heart ache of understanding; it is the yell for being empowered and accomplishing what feels like nothing; it is the scream of emotional incompetency still unshaken from childhood; it is the cry for dead loved ones; it is the yelp for dead love; it is the cry for control in an uncontrollable world. It is the cry for someone to fill the hole in the ozone of adulthood. It is the scream that we all let out when we realize that after all we've done and may hope to do, we are in a giant junk yard, wearing trash bags, and standing on a bus that doesn't work.

Dr. Jerry

2009-11-09T03:59:00.002-05:00

I'm afraid that I'm falling in love, and I can't fight this feeling anymore. This letter is a small token of the significance of this new relationship. I blotted out the name of the sender per our discussion in "advisory dean lunch" about posting patient information on the Internet. Three cheers for HIPAA.

I saw, EB (this is how the medical/science world refers to a patient in public), last week in my preceptor's office. The first thing that caught my attention on her chart was the fact that she was 93. Yes, 93! The laundry list that followed--pneumonia; breast cancer; lower back surgery; vertigo; diabetes--actually seemed short for someone who has lived through two world wars, two influenza pandemics, two atomic bombs, two towers crashing, two presidents Bush, two panda bears born at the DC zoo. It is like she's lived twice, already.

Anyway, I looked up why she was in today, reviewed some lab values in her chart and entered the exam room. I was expecting someone much...older looking, er, someone with less pep. I expected a walker or cane, or a crumpled husband to be at the patient's side. Instead, there was this feisty old woman sitting upright in the chair giving me the sternest yet friendliest of looks. I shook her hand and took a seat as I introduced myself. I then put her bible sized chart on the counter to my side so I could focus on her and not the 93 yrs of health records straining my arm.

I can't remember the details of the visit as to the specific order of things we covered, but somehow it wasn't long into the visit and we were talking about her restaurant that she owned, that was so, so long ago to her. Even longer back was the divorce of a loveless marriage. Her mother died when she was only 16 (also felt SO long ago for her), leaving a handful of siblings for EB to raise. EB didn't think she would ever marry, at least she would completely take it off the table after the age of 25. Well, luck would have it that at 24 she started dating a young man who eventually proposed to her. She remembers that day at the altar, remembering that she did not love this man, and somehow, the Father understood this, but counseled that this was the right thing to do.

Hello! Can you believe that? This visit started to feel less like I was interviewing a patient and more like I was reading a James Joyce story (The Dead, specifically)! My brain continued with the interview but my mind caught up trying to process the significance of that statement in the patient's life. To live seventy years knowing that you were once married, and divorced of a man you never loved. She went on to tell me more about that situation and others that I would like to write about; but I feel mentioning those things would somehow invade her privacy, even with applying the cloak of anonymity, er, I just want to keep that between us. After the divorce, and back on her own, she dedicated most of her life to raising or caring for extended family, nieces and nephews. A life of total service.

She can't fly on airplanes because of her vertigo. She tires easily, and her hearing is going. She was very supportive of my desire to live to 100, but she had no interest in living another seven years. Despite her indifference over being a centenarian, she seemed so vibrant to me. I don't know, I think she can make it.

There wasn't anything interesting, medically, about this visit. Later that day, and yesterday, I saw some very interesting cases. Cases where I actually knew what I was doing, knew what I was finding on exam. That was really cool. But EB's visit was different. It was one person putting enormous trust into an encounter, the other, putting a lot of honest effort, and hope, and a little bit of expertise; It was two strangers meeting and leaving as friends.

EB stopped in the office the following week to give me this letter. In it was a medallion of the Virgin Mary. It is called the, Miraculous Medal. I am going to keep it in my white coat for as long as I practice, or as long as I wear a white coat, as a reminder of the miracles.

So I'm falling in love with patient care, with internal medicine. I can't help it. And actually, that scares me. I honestly was hoping I'd fall in love with something that pays my loans off. But that is another post...

Before and Happily Ever After II

2009-11-04T04:07:00.000-05:00

It has been so long. And the entry I really wanted to write tonight will have to wait another day. Instead, I hope you find this house update satisfactory.

I closed on the house the day I came back to Rochester, following the escapade in South America. There were nine days remaining before class resumed. I thought about spending that time fishing--something I wouldn't have time for once school kicked up again. But then I thought about how the house was empty, and soon it would be full--well, more full than totally empty; you can't rush furnishings. So I decided to go handyman and refinish the upstairs floors.

Four days of non-stop work from 7:30am to 12:30am and the pictures can show you what we accomplished. Mad props to my momz and Greg and Kamesh and Mac and Miguel for their help on the project. It was slightly less brutal and only possible with their help.

Sorry that the pictures don't match before/after. I wasn't planning on doing any before/after pics. I will try to do that for any future projects. And please overlook the formatting mess. That is another project I am in the middle of, remodeling the white space of el blog. This blog is under construction. Enjoy, but scroll with caution!

Before / After

A Problem of Pediatric Proportion

2009-10-15T23:08:00.000-04:00

I finished my Peds rotation! OK, well, sort of. I'll have to go back to this clinic in January for another five week stint, but for now, I'm finito. At least, I finished enough to call for celebration.

I'm so over children :) Is it the kids that I'm over, or the moms? Before we begin seeing patients in the afternoon, all the residents and I get together with the attending to review some topic of care. Today we were going over asthma but the conversation got a little off track and one of the residents wanted to discuss when the child should be taken away from the mother's care. You know, due to "dumb mother syndrome." See, this is the advantage of being out in the clinics. You don't learn about dumb mother syndrome, DMS, in the classroom.

The manifestation of the disorder is clear. A post pubescent female presents to the pediactric clinic with a small child assumed to be their offspring.

OK, there is more; not every mother who brings their kid in is considered "slow."

The post pubescent female mentioned above, in addition to bringing her child to the pediatrician's, will demonstrate one or more of the following:

Continues to smoke around her baby already diagnosed w asthma
Does not allow her child to be vaccinated
Fails to fill her baby's prescription

Uh, am I missing any? Please be on the lookout for these signs. The CDC has noticed a spike in DMS within the past nine months and we want to put a stop to it before we have two pandemics on our hands. Do your part and report DMS, ASAP, to your PCP, the FBI, CIA, or any other acronymous (just go with it) organization!

Before & Happily Ever After

2009-10-04T23:51:00.000-04:00

A few weeks ago, a patient answered my first question with, "Well, I bought three cars last week." I wasn't expecting to hear anything like that. I did not ask how many cars he or she bought. I did not ask anything related to purchasing behaviors. I just asked why he was here today. It didn't take many more questions before it was clear that he was seeking treatment and help with his bipolar disorder.

I've been suspicious of my own self and my bipolar tendencies ever since my grandfather was diagnosed with this illness. Well, it wasn't three cars, but I did buy a house this summer--slightly manic, yes. My recent conversation with this patient made it clear, however, that I am in no way bipolar.

No, it wasn't mania that led me to purchase a house. I just wanted to take care of something, to be responsible for something--and I was done with landlords, and I thought I could get a good ROI. Most everyone feels this way (responsibility/care) at one point or another in their life; and the traditional response to such a desire is to get a pet. Right? And how likely am I to do the traditional? Hence, the house.

Medical school is not the best occupation for someone interested in hobbies and such :) but here is a start at documenting some of the care I get to provide, outside of the clinics:

A couple of the doors in the house wouldn't shut. And I noticed they had the original door hinges from 1880. The doors needed some adjusting and the hinges just needed some cleaning (many hours of boiling and wire brushing/beeswaxing).

And after taking 140 yrs of paint and gunk off:
PS does anyone have any suggestions on bathroom tiles? Quick, I'm gonna do that soon!

Aphasia

2009-09-11T19:13:00.000-04:00

We're going 21st Century:

I'm pulling out all the stops this year. First, it was pipe cleaners; Now, YouTube. Sometimes, my jokes become a reality...

I was assigned to teach my group about the various aphasias a patient might present with following a stroke. Aphasias are disorders related to language. Some aphasias inhibit one's ability to speak, others inhibit one's ability to understand speech, etc... Aphasias come in all flavors and are absolutely fascinating to observe and ponder the electrical processes going awry in the brain to produce the apparent disorder.

Enjoy!

http://www.youtube.com/watch?v=bBYW7MSKHWg

Picking Apples

2009-08-31T23:39:00.000-04:00

As of this morning, first test of the year, check. Now, how many to go?

I had my fill of being measured (the exam) this morning so I turned the magnifying glass around and spent the evening doing the measuring. I measured heights, weights, muscle tone, bulk, strength, blood pressure, and so on. Today, I went out with a rural med doctor to do visits to the migrant workers in upstate, NY. They come every fall, the fruit pickers from Mexico, to the finger lake region to pick the bounteous harvest of apples, peaches, and such that blanket the area.

Did you check out that link? Because, really, that might be the point of this post...

And the other point...to report that it is awesome to be back in the patient setting. We were doing school physicals for children who just moved up to the region for the picking season. I love riding around the trailer park neighborhoods like I'm some kind of an ice cream/medical truck dude. The kids were actually really excited about their physicals. These exams were less examination and more celebration. One kid, RH, couldn't stop laughing during the hernia check. Whatever; I'm having fun if they are. The kids loved it so much, we hugged me as I and the doc split!

I left the house feeling some kind of a euphoria. It is a feeling that is hard to describe. Cautious joy?

The visit is great, you find that the kid is mostly healthy, you talk about the sports they are going to do in school, all the fun that awaits them, you tell them how great they are, because it's true, you can feel it; but what does the future really hold for the kids? What is the life of a migratory worker? The dinner table is decorated with a big jug of Sunny D and a 12oz can of Coca-Cola at each place mat (we interrupted their dinner). I leave wondering did I counsel them enough about brushing their teeth? Will they really reduce the soda in the diet? Why did I talk about this with the seven year old and not the mom? UGH! So I'm just learning, but is it right for me to chalk up someone else's health care to my learning? It is likely that another year passes before the kids or the parents are seen by a health care provider. Another year may pass without understanding the role their diet plays in their future health. Is it just another year closer to diabetes, or did the visit mean anything more than a formality required by the county/state/fed board of Ed. Only time will tell?

And We're Back

2009-08-24T22:28:00.000-04:00

I wasn't prepared for this summer. I wasn't prepared for how fast it was going to pass, I wasn't prepared for how fun it was going to be, and I especially wasn't prepared for how depressing it was going to feel to return to my career, my life as a student. The drive up to Rochester is always beautiful but this time it was particularly gorgeous. I must have still been experiencing some kind of a traveler's high because the following day I experienced serious withdrawal. Tremors, panting, sweating, flushed face, etc. The realization that I was a student, not a researcher, not a traveler, not an explorer; yes, an abused, debt-riddled student was a little to much for my mind to handle.

And then it happened. I walked into class(we started back on the 10th), fifteen minutes late of course, just in time to catch the closing remarks of the Dean. Five hours later, I was feeling pretty good. And the next day, I felt even better. And the third day, I even got out a pen to take some notes. The notes came so easily and everything about my schedule seemed so routine that I figured being a student was a lot like riding a bike. Now that I think about it, there are more similarities than its ease to pick up again. Both activities make it very difficult to keep let alone gain any weight... Uh, well those are all the similarities. I'd say they were both detrimental to the crotch but the soreness is more generalized from studentry than with cycling. Oh, another similarity, they both are extremely tiring.

Not only the lectures (very tiring to listen to people talk; I thought I was a good listener but it turns out, no, not a core strength for me) but the assignments of a student are draining and are usually carried out in the wee hours of the morning. After merely three days of class, there I was on my living room floor working on a way to teach my colleagues about the circulation of the brain. Pictured below is my answer. I went to the craft store. Yes, that is true. I went to the craft store and bought enough pipe cleaners for me to practice building a couple of models and to cut up pieces for everyone in my group to build an arterial blood circulation model the following morning in our PBL group. It was a huge hit. One student who was not in our PBL asked me later in the day if he could buy my model. I laughed at the idea and offered him another for free, but hey, there is a business plan circulating here!

Oh yeah, appreciate how the anterior cerebral arteries arch back to give branches to the cingulum and frontal lobes. Que Belleza!

uh, yep, this is really what we medical students do after everyone else has gone to bed

It Takes Two, Baby

2009-08-15T23:50:00.000-04:00

My absence on the blog suggests that I was kidnapped by the Shining Path, but fear not I am well (er, that is a tricky statement recognizing that I am back in medical school, back in my cage). It took surprisingly little to adjust from the Inca paths I grew so fond of this summer back to the medical-doctor-business trail. Before I move on to all of the "adventures" of medical school, I want to at least a mention of the adventures experienced in the later half of the summer.

We crossed paths with maybe a handful of people over our six days of climbing and descending mountains in the Vilcabamba range. The barren trails opened mountainside after mountainside to us; each one stood unique in its beauty, yet telling a similar story. They all seemed to say, "go back to where you came from, the land is too high, the rock too deep, the soil too dry, the air too thin, man does not belong here."

The Vilcabamba has always been a region of dry air and impossibly high peaks, fast flowing water, and dry, dry earth. There are very few people eking out a living among the condors and vegetation that now inhabits the Vilcabamba mountain range but this was not the case during the reign of the Inca civilization. They built extensive roads to connect their people and their resources. They built even more extensive waterways to irrigate their brilliant terraces (in Quechua, these are called andinos, hence the Andes). They built entire cities, green, sustainable cities atop mountains. In the day of the Inca, these mountains teemed with life, with running water, with crops year round and storehouses a plenty. The Spanish were never able to cultivate the land like the Inca, so the mountains returned to their uninhabitable state. It is a disgrace that the real caretakers of the land, the Inca, had to give it up to such an incapable, ignorant people.

What was it that enabled the Inca to thrive? Their civilization grew and developed so rapidly because of the unity of the society. Not to say that they were united in freedom--that concept was totally foreign to them--but everyone contributed in some way, whether it be to build the road system, farm terraces, weave clothing, everyone contributed and everyone ate well. Those currently living in this region now struggle on their own to feed their crops and their livestock. Their children are burdened with malnutrition, and despite their isolation, they are dependent on goods from towns that are days away by mule. Take home message: teamwork can lead to great things. The Inca civilization accomplished SO much and it was because they all worked together--we'll ignore the details of how people decided to contribute for now. Seriously though, as I hiked the remains of the Inca trails in the Vilcabamba mountain range for six days, climbing and descending, and climbing, I continually thought how miraculous it was that these people were able to thrive in such a challenging environment. Where it is hard for one man to breath, they were able to build and support an entire community.

So the Beatles had it right, as they always did: "Come together, right now..."

Now a few pictures to show the current state of the Vilcabamba.
HUGE DISCLAIMER: Blogger is pathetically diminishing the size and quality of the photos. Viewers, beware!

The town of Cachora is exploding with development due to the increased tourism to Choquequirao. Choquequirao is the sister city of Machu Picchu. Much larger, much more spread out, much further from civilization, much harder to reach (can only get there by foot), and much less of it has been excavated. The later reasons are why few go to check this place out. Lucky for us. Cachora is where you start the trek to Choquequirao. Got it? The picture was taken at the entrance to the house where we loaded up our mules and headed out on the six day journey.

OK, so exploding may have been a little strong to describe Cachora's development...

The end of Cachora, the beginning of the trek.

Behold, the barrenness

Yes, that is the barren trail you see

Barrenness, day two

Plenty of vegetation, but no civilization.

Where life once thrived, Choquequirao

this is what greeted us on day four upon reaching Victoria Pass; after climbing all afternoon the day before and the entire morning; from the river bed of the valley, up ancient Inca stairs, above seemingly all living things.

We decided it was a nice spot to appreciate the barrenness over lunch.

In the interest of time, and storage space, I'll finish the rest of that trek with a quick summary. We spent the rest of day four, and the majority of day five hiking at the feet of glaciers. Day six was a gradual decent to the ceja de selba, or the "eyebrow of the jungle" in English. We reached Aguas Caliente by night and day seven was spent on Machu Picchu--I actually opted out of MP since I was there two years ago but hiked up a neighboring mountain, Cusiputu, instead.

The view of Machu Picchu from atop Cusiputu

These stairs continued for about 100m. I took the picture on my way down.

Update: Because I Have a Second Tonight

2009-07-15T23:40:00.000-04:00

It´s been a little difficult to get to the cybercafe lately. I apologize for the delay, but here is an attempt to keep you updated. Thanks for checking in :)

Making my way along the old caminos of the Inca

The bath house, because the inhabitants of Choquequirao had to bathe themselves somewhere.

Strike Two

2009-06-30T15:23:00.001-04:00

We left Aguas this morning on the 530am train to Ollantaytambo as planned amd that is where our plan started to fall apart. Wouldn´t you know it, a strike was planned for today to close all of the roads to and out of Cusco. Luckily, it was still early in the day and there was one country road that a taxi driver believed would still be open. We worked out a deal for him to take the three of us and three other American girls we met on a previous train (we kept running into them over the past two days) to the promised land, Cusco. We tore out of that small town, Ollantaytambo, like a saint out of hell--really, what does a bat have against damnation? I felt bad for the droves of people stranded in Ollantaytambo´s main plaza as we passed by but there wasn´t really anything we could do aside from be grateful for our transport. We still were not sure if the road would be open the whole way. There was one point we came to a log laid across the road. The driver jumped out to quickly move it but it was too big for one man. Zach and I immediately followed out of the van to move the log. We later debated the possibility of having significantly harmed our back or neck in the process but we got the log off the road and our van was on the move again. From then on we made it to Cusco without problems!

Instead of taking a bus out of Cusco at 11am for Lima, our voyage is delayed until this evening, giving us enough time for the blockade to be taken down (for the farmers to go home and let buses through) by the time we reach the perimeter of the strike.

This means I have an extra afternoon in Cusco. Let´s try to upload some photos!

We hired a boy to carry our packs for a half a mile or so. We hired four or five bikes throughout the hike, none able to help for more than half a mile, unfortunately. Some bikes were even threatened or attacked by the strikers at the road blocks. The indigenas on strike did not want anyone helping us on our way. They let the air out of one poor boy´s tires. That made me mad to the point that I pushed one of the farmers away from the kid´s bike. Then this old farmer got in my face (more like my chest cause of height issues) and we grabbed our packs and split without looking back.

One of the blockades had trucks backed up for about half a mile. Locals had painted the sides of the buses and trucks with their propaganda.

The afternoon on Choquequirao. Chillin on the terraces.

One of the glaciers we walked by on our trek. The highest pass that we crossed was about 14-15,000ft above sea level.

Uploading is taking WAY to long. Esto es todo por ahora. chao!

30 hrs in Aguas Calientes

2009-06-30T00:07:00.000-04:00

OH my! We made it to Aguas Calientes (the small village at the base of Machu Picchu) last night. I would love to post pics of our trek over the past week but the internet connection is not wide enough here, ya know, band width ´n such. Seriously, I just waited twenty minutes to upload ONE picture--not happening. Hopefully there will be time to post some pics tomorrow before we leave for Lima (We are taking the train out of Aguas in about five hrs, I´ll have to write about Machu Picchu another time).

The gist of the past week: We left Cusco at 6am, four hr drive to a small village called, Cachora. There, we met up with Alfredo, the useless guide, Chino, the chef, Florantino, the leader of the pack (the pack being two guys that un/packed the mules and tended to other duties, and our new friend, Keeko, he is the guy who we met in Sicuani. After about an hour of eating and organizing the gear, we took off on the trail to Choquequirao. Two days later, we arrived at the largest mountaintop city of the great Inca Empire. An immediate sense of reverence was felt upon entering the high andean city. No tourists, no guides, no nothing; only an occasional flock of bright green birds shreiked through the sky disrupting the quiet that lay over the city. It felt like a ghost town. It felt like the city´s inhabitants split in serious haste leaving nothing but a curse on those who followed. It was a bit eerie, if I haven´t gotten that across yet. Most of the trails were unmarked and had to be explored, the exploring we did as kids in uncharted forest (remember, Jayden and others). Instead of uncovering salamanders and fishing holes, we came upon homes, garden terraces, and bathing pools. We spent the remains of the afternoon exploring what we could and then retired to our campsite on Choquequirao´s hillside. We took up more exploring at sunrise and moved on from the ruins at about 12 noon.

What followed was what felt like an eternal decent. A literal falling from grace as we dropped down the backside of the lofty city. We took the trail down, down, down for two hrs, broke for lunch (my knees, my body couldn´t take anymore), and then climbed, climbed, climbed for about three hrs. Completely exhausted, we camped on a small farmer´s plot at the top of Choquequirao´s neighboring mountain, Maisal. We got there just in time to watch the sun drop behind the high shelf of snowcaps lining the western horizon. In a matter of minutes, the sky went from gray to rose to black, followed by a tremendous display of stars in every direction.

I think it was Ronan who explained that the Incans made constellations out of the dark patches in the sky, rather than the stars themselves. That makes total sense when looking at the sky from a Peruvian mountaintop. The milkyway and the stars are so bright that it is easier to pick out shapes of black--and there are far less black splotches than stars to keep track of. We star gazed and chatted with the polish couple also trekking through the Incan wilderness until we were too cold and in need of warming up with mate and soup complements of Chino & company.

The following day we continued our climb on Incan trails, passing old incan mines, climbing stone stairs laid by the Incan laborers, until we reached Victoria pass, somewhere around 14-15,000 ft above sea level. It is hard to describe the experience rounding the bend of that pass. First you gasp, and then you walk another ten feet and just laugh because it all seems too beautiful to believe--or perhaps it´s the lack of oxygen.

So that was the first three or four days. There are a couple more days of the trek to explain, but I have to leave it there. Each day deserves a complete chapter, but this is a blog, not a book. Besides, I can´t spend all my money on internet. There is still much to do over the next few weeks.

I know words are wordy and pictures are not, so pictures you shall have! I hope...

hasta la pròxima,

36 hrs in Cusco

2009-06-22T23:48:00.000-04:00

I think I traveled for longer to reach Cusco than I will spend enjoying the great Incan capital. That is ok, because in six hrs I leave for an eight day trek (this is our vacation travel time of the summer, Yeah!). First to Choqueqirao http://travel.nytimes.com/2007/06/03/travel/03inca.html?scp=1&sq=choquequirao&st=cse

and then to Macchu Picchu. The three of us, and possibly this guy we met in the hostel who also made the journey to Cusco from Sicuani. His name is keecko! He was smart and bought a bike to get across all the road blocks. We met him having dinner in Sicuani (we stayed there one night) and then he passed us the next day on his new bike, and then he sits down next to us this morning as we eat breakfast on the roof-top terrace of the hostal in Cusco. Crazy small world.

much love,

36 Hours to Cusco

2009-06-22T23:36:00.000-04:00

We finished our work in Arequipa and the plan was to head to Puno to check out the indigenas people living on the floating islands of Lake Titicaca. Nothing about this summer has been very ¨planned¨but so it goes, the best laid plans, even the not-best laid plans of mice and men oft go awry; they especially go awry when one is in South America. From Puno, we planned to head north to Cusco. The details were all worked out, meaning we bought the tickets to Puno. But then we learned that the strike that the indigenas people were leading had not ended and that all the roads were closed from Puno to Cusco. All the roads were closed from Arequipa to Cusco as well, but we also learned from some locals that the road blocks were very short at one point between Arequipa and Cusco. We decided to take the locals´advice and to believe the bus company that was running to the city where the strike was supposed to be only 5km deep. That means, the plan was to bus to the city, Sicuani, and then walk past the road blocks. After 5km, we would reach the end of the strike where buses would take us to Cusco.

Sounded simple enough but the road blocks turned out to be 50km long. It was a horrendous 36 hrs journey to Cusco. I walked and walked like a pioneer, I rode on motorcycles, hid in the back of a truck, paid kids to carry our packs on a tricycle, etc. We made the epic voyage with a Belgian, his Italian girlfriend, 3 Argentines, and a Frech dude. So much more to tell, so much. but the hostel guy is telling me to get off the computer.

Safe and sound. Signing off...

Sueños

2009-06-18T00:37:00.000-04:00

The computer is not behaving with respect to photos so you are just going to have to imagine Arequipa through my very very brief post--if only there were time for more.

The city is nestled between an active volcano, el Misti that seriously rises into the sky like it is ready to burst. thirty sixty degrees to the west stands a great wall of snow capped mountains that were once volcanoes. The city is nicknamed the ´white city´because almost every building is made from the white lava (sillar) that has formed an interminable quary from previous volcanic eruptions. Pictures another day.

Our commute to school involves a short walk to the main street where we catch a taxi. In contrast to Lima, the air is pure and cool, the sky is clear and the sun is beaming down by 7am with intensity. I was waiting outside of a classroomthe other morning and a recollection of Provo came to mind. Why? I always thought the mts of Utah were kind of brown and well, not so grandiose. I think it was a combination of the air, the sun, and being on a campus.

After a hard day of work, we come home to our Arequipeña home with the familia Barrios. I couldn´t be happier with the set up. First thing, we get into our pajamas. Second, we help out with dinner, or sometimes just talk with the mom (Hermana Nelly) in the kitchen and then we enjoy an amazing meal followed by a couple hours of conversation over a variety of herbal teas. This is the life! I love our dinner table/tea time. This is what I love most about life, just talking with friends and family over an emptied table. Once we´ve covered all the bases, history, food, politicis, hobbies, literature, etc... we clean up and head to bed (or to drop a blog post). I´m kind of living my dream here in Arequipa. But it all ends this weekend and once again returns to being just a dream.

Sorry I don´t have more pics. There are muchos that I´d love to post but no time.Our morning walk

The view from our front door

Cooking the Lomo Saltado. SOOO GOOOD!

Peeling the papas for a little chicken al cial!

Carta

2009-06-14T19:33:00.000-04:00

Carta is the spanish word for letter, but it is also used as ´card´as in playing cards. We have ¨played¨ a few cartas on this trip so far. I´ll get back to the cartas in a second...

We left Lima yesterday morning to head south. Our next destination, Arequipa. The medical school here is smaller, everything in Arequipa is smaller, hasta los taxis, y la gente so we expect the work to be a little less stressful--we´ll see tomorrow.

Our trip out of Lima, the gray city, consisted in a 5hr bus ride south along the coast. The poverty we drove through was horrendous. I´m no stranger to it, but I don´t know if it was the endless gray I´ve lived under for the past ten days or what, but this poverty was hard to see. I couldn´t see the hope in any of the shanty towns we passed. Maybe the difference is that I didn´t see the people, no faces,only my imagination to draw a miserable pictureof life in these pueblos.

We finally reached Ica where we took a taxi out to this little oasis five miles fromtown where the most incredible sand dunes rose high, high above the gloom of the coast. There, we were greeted with smiles, the people were happy and suddenly I found myself enjoying a small piece of paradise. We rented some sandboards for $3 dollars and spent the afternoon carving up these enormous slopes until the sun had well set and the dessert cold was blowing in. It wasn´t hard to imagine while walking up these dunes that I was in the Nimibian dessert in Africa or well, the Peruvian dessert in Peru.

We boarded another bus at 8pm to head down to Arequipa where we arrived at 8am. Just enough time to take a taxi to church for a little Sunday worship. Here is where we pulled out another ´carta.´ We spent a couple hrs one afternoon in Lima passing out surveys in a hospital as part of a project ofsome local investigators in Lima. We completed the same amount of surveys as other researches did in twice the time it took us. We chalked it up to the international card. I also credit it to my aptitude to just walk into anywhere when I am in a foreign country. That´s how I ended up in the office of the director of health services for Andhra Pradesh when I was in India. OK, other cards played, the gringo card-no understand spanish-Rochester card, people oddly know more about the school here than I did before I came. Now in Arequipa, it was time to play the ´mormon´card. A friend inLima has a boyfriend, who´s family lives in Arequipa. The mom was baptized four years ago and hethought she would love to meet us. So we went to her house for lunch and after being in the home for five minutes, they refused to let us find a hotel or hostel. The family is so, so nice. And the house is great. I took a hot shower with pressure and all for the first time today since I left DC. We will be here in Arequipa until our work is done. Probably three or four days.

Lima

2009-06-13T02:00:00.000-04:00

We´ve been working from 8am to 8pm six days a week since the day I arrived in Lima. The
pictures I posted in the last entry suggest otherwise, sorry. Today, we finished our work at 6pm. Just enough time to pick up our washed clothes, grab dinner, pick up a gift for our host family, and pack for our travels tomorrow--oh, and Zach and Ronin went out for the night with some of our limeno friends. I thought I´d get to bed at a decent hour but it takes so long to plan things! I am just now getting to the blog.

I ate cow hearts (anticuchos) last night because our lima peeps wanted us to enjoy some of their favorite cuisine. Just wanted to make a note of that. What else do you want me to say, pues. Thanks!

Our last focus group in Lima!

The waiting areas are always full hasta the hallways in this hospital

Outside of the Hospital, I wish this guy replaced the hotdog vendors outside of the school´s hospital in Rochester.

He was actually very happy that I asked to take his picture. Seriously!

Debbie thought the food was...hilarious

It was so good, Leslie called everyone about it

We met up with Rochesterians Tuesday night for a late dinner at the famous, Astrid y Gaston ( unfortunately, they were just stopping in for a day, we think?)

Una foto, una foto

2009-06-08T22:19:00.000-04:00

Hola desde Peru. Why am I here? I planned on writing a post before I left to explain what I plan on doing here. The long and short: we are a mobile species. The more educated, the more mobile. This is great for the educated but the uneducated, surprise, surprise, lose. So doctors are leaving Peru to practice in better places, like Rochester. I am here with two colleagues to find out why medical students choose to stay and practice in Peru or why others choose to leave their homeland for ¨better¨land. Oh no, my Spanish is already ruining my English, ¡que horror! Seriously, that makes me sad, pero bueno, asi es.

The other part of the study is that almost a third of all doctors currently practicing in the US come from other countries. I attended a meeting a couple months back where the New York congress presented a new bill to excuse visa regulations for any foreign doctor as long as they practiced in under-represented rural or urban areas. Really? There is a lot of ethics to pull out of this but I don´t have the time, ahorrita.

So here I am in Peru, surveying and meeting with students in focus groups to understand their perspective, and to understand if they understand what they are bargaining for when they sign up for a residency in the Johnny (USA). Understand?

A few pictures outside of the University, Enjoy!

This is a poster in the University of San Marcos of Medicine. Those lines are SO latino. Gotta love how romantic the culture is.

Eating a local treat, Picarrones. Yes, they were delicious.

Pigeons never go hungry, 1st or 3rd world.

Plaza de Armas, Lima´s central plaza, behind is the, Hotel Bolivar

Yes, a little discotequing, of course. The best part was when the power went out around 12am throughout the entire district. I love Sur America!

Wouldn´t be Sur America without cathedrals

Are You?

2009-05-31T22:20:00.000-04:00

Actually, the question is, WERE you prepared for your final exam? Friday marked my last exam of year 2 of 5 (Final is relative). And the answer....I don't know. I'm not sure if the results of the final exam are posted yet. If they aren't posted before I leave DC, there is a good chance I won't know until I return to school in August. That is just how it goes in the world of graduate education. BYU (undergrad) posted exam results on a big screen, literally seconds after you walked out of the testing center. Right there in your face, no way of avoiding that stressful instant when you find the last four of your social security # on the screen and look one column to the right for the score. Now, I fumble my way to the front of the room to turn in my exam and days go by before the email appears in my Inbox reporting the class avg, etc and prompting me to login and check my score.

That is how most exams go in med school, but when it comes to the end of the year, I just don't take the time to log on and figure out what I scored--I'm onto bigger fish. I have no idea what I scored last yearon my final exams for my summer MBA courses. I have never even looked to see what my overall grade was for each class. What difference does it make? Is any doctor going to ask me what I got in Corporate Finance? I took the exam and what is done is done. Is my knowledge of Organizational Behavior dependent on me knowing my grade in econ 403? No. It is a liberating feeling to ignore the score. Empowering. It helps me believe that I am actually in school to earn an education instead of a transcript.

My fellow Americans, don't do it! Avoid those stressful moments of finding out your grade by never finding out. Be positive and believe that you did well. This is the freedom our founding fathers and people like Bob Marley were trying to help us achieve. Do it and you will feel this new sense of power, I promise...barring no emails show up from the dean reporting that you are on academic probation.

If you aren't taking tests at this point in your life, find some kind of reporting process at work that you can avoid. If you aren't taking tests and you aren't working, identify some form of feedback you receive and ignore it!

Yeah, a policy like this probably doesn't reflect kindly on my comprehension of organizational behavior. Hmmm.

Spring Happens Outside of the Hospital

2009-05-24T23:03:00.000-04:00

Lilac Festival, Rochester '09

The Remains of a Saturday Trip to the Market

The spinach in my bag was off the chain

Looking into the Crystal Ball

2009-04-26T22:01:00.000-04:00

Dr. A: Do you know what you want to go into yet?

Me: I don't know, I've really liked everything I've been exposed to.

Dr. A: Yeah, I can tell you are going to go into Family Medicine. You don't care about making money and I can tell you really care about the people.

Me: Yeah, (nodding, slightly flattered, slightly disturbed)

....Same day, three hours later...

Dr. A: So why did you go into medicine?

Me: Oh, I (Dr A cuts me off)

Dr. A: You probably went into medicine because you want to help people

Me: Yes, that's why I wanted to do medicine. I'm sure I would have been happy doing a lot of different things, but there is nothing I really WANTED to do like medicine.

Dr. A: Most people go into medicine because they want to help people out, but the truth is that you can't really help anyone change. They have to be the one to change.

Me: Yeah

Dr A: If you go into medicine wanting to change people, you are going to have a very unhappy life

Me: Yeah, I get that

Dr A: I think you would definitely suffer an existential crises if you specialized.

Me: haha, yeah, I could see that, haha (slightly flattered, slightly disturbed)

“This is not my beautiful house?”

2009-04-17T01:14:00.001-04:00

Some classmates were talking about this program yesterday over our advisory dean lunch. It is a TV documentary that follows seven Harvard medical students from their first day of medical school in ~1985 and then looks at where they are now. You can watch six minute clips of the show but I warn you that you can't watch just one… I highly recommend the program.

http://www.pbs.org/wgbh/nova/doctors/program.html

I watched it last night as I finished up some work for today. I think I watched it out of curiosity. I wanted to know what medical school was like in the eighties. Was it any different? Was it any better? I think I was just curious to learn what this medical school experience meant to others with the hope that that would tell me what this experience meant to me.

I am sure I will spend the rest of my time here at Rochester trying to figure out what it is this experience means to me. These are not questions like, what am I doing here? Is this the right place for me? These are questions like, what does it mean that I spend all of my days looking at or talking about illness/health? Will the next five minutes of what the lecturer says affect a patient's health at any point in my future career? Will the feeling of not knowing enough go away tomorrow? Do I "work"? Am I asking the patient this for her sake? For mine? Where is my place in society? What is a medical student?

Dr. E shed a little light on the answer to that today. This afternoon, half of our class went to their respective clinics and the other half stayed at school to learn about the knee and ankle exam. I and eight of my classmates spent the afternoon with Dr. E, a world renowned orthopedic S. He spent the earlier half of the week with the Cornell Law faculty and students. According to him, law school doesn't really make the student think; he followed that with an equally presumptuous claim that he got the feeling that medical students are smarter than law students.

Just to clear his name (for all lawyers in the audience), Dr. E is a genuinely good man, a really caring doctor. He belongs to the old class of physicians who should have retired twenty years ago but they can't hang it up. They love to teach, they love patients, they love students. I am so lucky to have so many professors like this. Unfortunately, their passion for medicine can lead them to say things that aren't true.

Wrecking Ball

2009-04-07T02:17:00.001-04:00

Working in the community health clinic makes me feel like I am on one of those Japanese game shows where the contestants attempt to navigate an impossible course of physically challenging and utterly embarrassing stunts. Here is how the sequence of events went today. Got out of lunch meeting late, got to the clinic late, nurse hands me a chart the second I walk back to the doctor offices, seconds later I am sitting down with a 52 yr female patient and her husband trying to go through the thick, cluttered PAPER medical chart while listening to her in Spanish as she rifles off a litany of symptoms, writing down what I deem pertinent, asking questions I deem relevant, and listening to her husband in English as he talks to me and to the patient.

I, myself started to feel a little sick trying to process all of the above. The first five or six minutes of the visit were almost completely lost. I did get some helpful information, but I felt so out of control that it was hard for me to recognize at the time that the information was salvageable, that it was actually telling me anything. With the rash and the fever I was thinking about the microbiology I studied on Saturday. The issues of vertigo had me thinking back to HSF and the inner ear complications. Her uncontrolled diabetes was working like a wrecking ball destroying the city of organization, the city of understanding that I desperately hoped to erect in my mind.

Then, after I accepted that the first five minutes was a loss, I observed the damaged city and was able to sift through the rubble to move the visit forward with an albeit tenuous plan. Some patients I present to my preceptor having a pretty good idea that my exam covered the right bases and led to the right diagnosis/plan. Then there are visits like this one where I report a weak hypothesis, essentially a white flag, to the preceptor and hope that he or she will look upon me with compassion. Today felt like there were only white flags, but now that I think about everyone I saw, I realize I forgot some of the simple, stress free victories of the day.

One reason why I might feel like there were no victories today was because before I leave the office in the evening, my preceptor and I sit down to go over any questions about the day's cases. I usually ask a couple, and then I have to answer her questions. It is a fun game we play, doctor vs student, and I actually like that I never win! I better get out my anatomy text already.

War, What is it Good For?

2009-04-03T03:42:00.000-04:00

Is it any wonder this man was known for his skills with the ladies? Something he is somewhat better recognized for are his books: the ones that he wrote. This is, indeed, the young Lev Nikolayevich Tolstoy, the world's greatest novelist.

I finished, War and Peace, over the Christmas break. It took me about a year of reading here a little, there a little. Now I frequently pull the book out at night to thumb through my favorite passages.

Here, read this is one: Just to explain a bit of the piece, Boris and Nickolay Rostov are soldiers in the military, they are also childhood buddies. Enjoy!

At that instant the door opened.
"Here he is at last!" shouted Rostov. "And Berg too. Ah, petisanfan, alley cooshey dormir!" he cried, repeating the saying of their old nurse's that had once been a joke with him and Boris. "Goodness, how changed you are!" Boris got up to greet Rostov, but as he rose, he did not forget to hold the board, and to put back the falling pieces. He was about to embrace his friend, but Nikolay drew back from him. With that peculiarly youthful feeling of fearing beaten tracks, of wanting to avoid imitation, to express one's feelings in some new way of one's own, so as to escape the forms often conventionally used by one's elders, Nikolay wanted to do something striking on meeting his friend. He wanted somehow to give him a pinch, to give Berg a shove, anything rather than to kiss, as people always did on such occasions. Boris, on the contrary, embraced Rostov in a composed and friendly manner, and gave him three kisses. It was almost six months since they had seen each other. And being at the stage when young men take their first steps along the path of life, each found immense changes in the other, quite new reflections of the different society in which they had taken those first steps. Both had changed greatly since they were last together, and both wanted to show as soon as possible what a change had taken place.

Don't you feel like you were inside Rostov's head, yet totally aware of what is going on with Berg and Boris? I especially relate to Rostov and his struggle to do something with this unique, intense feeling of love, friendship & celebration. Yet Tolstoy had it right. This is how it often plays out. The two people do whatever is customary even though it may fall short of what they truly feel. And it's all right because that is all we've got: the customary.

Another comment about this piece, it reminds me of a comment I posted long ago on a Writing Fellows blog in college. I was making a case for Americans to greet one another with a kiss like the Latin culture does. It just feels better. I remember citing that Christ's apostles greeted one another with a "holy kiss," so we should at least go for a greeting kiss. Maybe I've lost some of the love over the years because I don't think I endorse such a policy now. I even feel awkward customarily greeting a latina. Pobrecito, yo. Maybe that will change again after this summer...

California or Bust

2009-03-26T22:47:00.000-04:00

I am posting this as an explanation for where I've been lately. Nine days in San Francisco visiting TK, Petra, and nature.

Getting started at Point Reyes

After six miles, we looked down upon our destination. Yeah it was a little foggy

Look closely! You can spot our tent. It's the orange dot on the cliff.

Shout out to Steinbeck, Monterey

Big Sur

More Big Sur

The morning bathing hole
And many more @ this link: Spring Break Web Album

Phone Bill Tells the Story of a Society

2009-03-12T01:01:00.001-04:00

Manifestations of my latest phone bill:

One month of phone service…………………………………….$39.99

Minutes used…………………………………………………………….87

Cost per minute……….…………………………………………..…..$0.46

Txt Messaging Charge……………………………………………….$15.20

Cost per Txt above 200^th txt......……..………………………..$0.10

Differential Diagnosis:

Patient is asocial, lacks people skills

Patient has speech disability (aphasia)

Patient simply prefers the written word

Patient needs to finish business school and recognize the more economic mode

Positive indication of social phenomena of the txt killing voice like video killed the radio star

Adventures in Albany

2009-03-04T00:05:00.001-05:00

My alarm went off with a pronounced fury this morning! I set it at about 12:30, was in bed by 1am and next thing I knew, the alarm was blarring at 3:07am. I had to catch a bus to Albany that was scheduled to leave at 4am. In the forty-three minutes between killing the alarm and boarding the bus, I managed to shower; pack a pillow and books, and pen; pick up a classmate; go to school and get my white coat from my locker; and drive the however many minutes it took to get to Pittsford where the bus was waiting.

I went to Albany today to participate in a rally on the capital steps. I've been intrigued by, and at times, in support of any sort of organized protest since my Rage Against the Machine days, so when I found out about the opportunity to do some fighting for health care reform, I didn't need any persuasion. Part of the reason I wanted to be a doctor was to earn a seat at the reform table. Today's experience was...I'm still not sure if it encouraged or discouraged me about getting involved in politics.

The day started out with a number of speeches inside this giant egg. Yes, we gathered inside of a giant egg--Albany is a weird place. This picture I snagged off the Internet falls short but is the best I could find to portray a little of the fantasy land these politicians call home. Yes, the speeches were great. It kind of felt like I was listening to a State of the Union Address with all the standing and clapping we were doing. In all honestly, I was impressed with the governor's address, I wanted to vote for him in the upcoming election.

Politicians have this thing about them, this presence that is so engaging. Three words out of their mouth and you are smiling, three complete phrases and you feel as if the two of you are best friends. It happened today over and over again; it happened at my work when the governor (Maryland) came and spoke to us briefly, it happened at the inaugural ball '04 when President Bush shared a few words. Seriously, it made perfect sense to vote for him at that moment. Today, my experience moved past passive listener in the audience to the "I'm in your office, let's talk," phase.

After the morning of speeches, we marched out to the capital steps, had our little rally outside, and then we went to meet with the senators over our district. I was accompanied by a few other medical students and physicians who were in practice here in Rochester. In the first senator's office we visited, the physicians laid out their agenda first and the Senator listened to their agenda and then responding to their ideas like they were clay verbally squishing them into a ball to toss in the trash. He managed to do this in a way that did not even offend anyone. I think the doctors were all smiling and nodding. I seemed to be the only one that heard the clay thump into the waste basket. I grabbed the moment of silence to let the Senator know why students come to Rochester to train but do not plan to stay and care for the community when they graduate because of the hostile litigious environment and the poor reimbursement rates by what is essentially a local insurance monopoly. He changed the subject a few times, the ball went back to the physicians, we all agreed that collective bargaining is the right thing to do, and then we were conveniently out of time. We all stood up, the Senator grabbed my arm and looked at everyone else like we were posing for a picture and said, "now promise me you are going to stay and practice in the area." His smile and his grip were almost too much but before I robotically returned the smile and said yes, a stroke of reality awakened me from the politician's trance and I said, "As soon as we see collective bargaining with setting reimbursement rates in Rochester." We all chuckled politely and my team made our exit.

This kind of scenario repeated itself three more times throughout the afternoon. My favorite moment of the afternoon was when I told the staffer who was sitting in place of another busy senator we were to meet with, that "By the time I start working full-time, my loans will be around half a million dollars and there is absolutely no way I will stay to practice in Rochester if tort reform and reimbursement rates are in the same mess they are in now. Either it gets fixed, or I and my colleagues take our skills elsewhere." I thought that sounded pretty good, and unfortunately, 100% true. The physicians in the room backed me up with nods and grunt-like affirmation. What did the staffer do? She nodded her head in rhythm with all the other head nods she gave to everyone's comments. Her pen remained capped in hand, her notebook remained closed. That is when it struck me. I shouldn't be rallying for health care reform. Yes, the system may be broken, but why should we devote any effort to that when our very own staffers don't know how to write?

Educators, you win. Pay those teachers first! And maybe then we'll see what is left over for health care.

Why Did you Break my Heart

2009-02-25T00:41:00.001-05:00

I heard the saddest words today. I spend one afternoon each week working in an adult/peds medical clinic where I see mostly infants and toddlers for their well-child visits. I talk with mom about the baby's diet, ask about sleeping behavior, feeding habits, etc. I advise on things the parents should be doing, things they should not be doing, and things to expect in the upcoming weeks/months as far as their child's development goes. Sometimes there is crying involved, sometimes I end up with a little slobber on my tie, and sometimes I open the diaper to find a little surprise waiting for me; but all in all, these visits are pretty low stress.

There is however, at least one visit each week where everything with the patient (the child) is going very well, but the child's environment is crumbling. My first week on the job, the mom just flat out said she doesn't like her one year old girl. Forget love, we are just working for a "like." Another week, after ten minutes of conversation, the mom shared with me the fact that she was going to be kicked out of her apartment by the end of the week. She wanted to know where the nearest shelter was that she and her baby could stay. For some reason, I like those moments of the visit the best—second favorite is the moment I take the baby from mom to do the physical exam, twisted, huh. I think that I like the moments when the visit takes a turn for the worse because I see it as a challenge. What the challenge is exactly is not clear. Maybe for me to connect with this mom and really communicate, really understand what is going on in her and her baby's world. This is the part of the visit that no algorithm can handle. That is why this is my favorite part of the visit.

Today, my last appointment of the day was the special visit where the algorithm got tossed —That is only considering the well-child checks, because I did see a latino man paralyzed by a gun shot to his 4^th lumbar and now dealing with a giant flesh eating pressure ulcer on his right foot. He also was my first patient where I got to use my Spanish. Back to the special visit, the patient was a five yr old male accompanied by mom. The child had been performing poorly this year (compared to last) in school. The teacher called frequently to report behavior and overall performance problems in class. The mom had noticed similar behavior at home, etc. The mom came to a stop in her story, then, it was my turn to figure out why the abrupt change in behavior. My face contorted to a pensive shape and I think the mom realized the game I was about to begin. She cut me off before a question could be asked and just said straight up, "I know what the problem is, he wants his father around but his father don't wanna be around."

Punch to the stomach. The part of my brain working on the first round of questions shut down and I started to focus all of my thoughts on the father, or lack thereof. Images of all those Salvador Dali paintings with the father/son shadows started to fill my mind, no, just kidding.

Actually, what struck my mind, and I report for some reason with some chagrin, a news clip I saw on CNBC or something last week about the epidemic in America of fatherless school children. I also thought of a case I read earlier this morning where the resident suspected child abuse and totally lost his cool with the mom's boyfriend right there in the examination room. Could you imagine me pinning the dad against the wall in a fit of anger? Me neither. Besides, dad or ex-boyfriend wasn't even there to pin against the wall.

The frustrating thing about this visit is that there was little I could do outside of the algorithm routine. I talked about mom spending extra one-on-one with the little guy. I gave him a sticker and a book and talked to mom about reading with him; but aside from that I had to consult the social worker about availability for family counseling. Social workers, I love you!

Should I have asked more about the parents' relationship? The mom wanted the father around; that much was obvious by her body language; but he didn't want to be there, and he obviously didn't want to be at the doctor's appt. What could I do? What could she do? This episode reminded me of when I was in Ecuador. So, so, so often, many, many, problems stemmed from a bad relationship between mother/father, boyfriend/girlfriend. If things were OK between the two, everything else seemed to fix itself. I probably failed to appreciate the complexity of those situations, but I often wished people would just change their heart, like that Beck song. The way I saw it, everything else would be fine. In today's case, I wasn't hoping for any change of heart. I just wanted a wand to wave over the situation and put the father back in the home. So I'm barely into this medicine thing and I'm already looking for magic solutions. Hmm, that isn't the best of signs.

Moral of the story: Don't be making kids UNLESS you're gonna be together (child-makers) to do the entire child development part. For serious!

Home is Where You Feed Your Heart

2009-02-13T01:15:00.001-05:00

This map suggests that the Bible Belt is due for a change of name. Seriously, who carries their Bible on their belt? Let's tell it like it is: The Obesity Belt. Notice this graph is just deaths related to CHD between the years listed. If it were to show obesity rates in 2008, every state in the US of A would be dark red. The epidemic has reached every state of the Union. And the Belt continues to expand its circumference around the globe. Cholesterol levels are skyrocketing in China as they westernize.

Christ was clear to his apostles that the gospel should be preached to everyone, that it should spread to all the Earth; But what if obesity has its way. It's a showdown: the good word vs the saturated fat. Hmm, maybe there is something to the mandate that missionaries exercise daily?

We were lectured to this afternoon by a preventative cardiologist. The take home message was this: DON'T EAT ANYTHING ASIDE FROM GRASS AND/OR ANIMALS THAT EAT ONLY GRASS! EXERCISE! JUST DO IT. REGULARLY!

The message was enough to get me out of the library and over to the gym tonight. I can feel the LDL Cholesterol going down already!

Exercise! And eat well! In case you missed the point.

Memorial Service Speech

2009-02-03T18:14:00.001-05:00

A few weeks ago, our class held a memorial service in behalf of the donors who's bodies we used in the anatomy lab. Individuals volunteer to donate their body to our anatomy lab when they die so that young medical students such as myself can learn a little about the marvels of the human body. So I spoke at this service. Read below.

Jan-16-09

Can anyone tell me what nerve is making my heart race right now? And where its cell body is found?...(I'm moving the podium around hoping that my palms will dry up and that my voice will refrain from any cracking; you probably know that's a problem of mine that failed to resolve itself post-puberty). I was sort of volunteered to share some thoughts with you today, and I sort of volunteered to speak today.[i]

There are times when ideas fill your mind like water rushing from a geyser, and there are times when the ideas appear more like dew on the morning grass. The water from the geyser is strong, and direct, the dew is ubiquitous but very difficult to collect. I felt like I was gleaning dew as I prepared a few words to share today. An idea appeared in my head a couple months ago as we started the anatomy lab. Like the dew, I was certain it appeared; but when I took a moment to articulate the idea, it was difficult to gather. I moved on with life, and into block II[ii] and the idea came back. I tried then to give it a little structure but again, I came up with nothing. This process went on for the remainder of our time in HSF, which could mean one of two things, either 1) the idea itself was of little substance, or 2) it just needed some more patience and attention from me to develop into something meaningful. My hope is that the latter is the truth, but don’t hesitate to let me know if it was the first.

I remember feeling pretty nervous about the anatomy lab. There was anxiety about how it would feel to skin the back, the arm, the hands of another human being, to look at this person on the inside, literally. Was this OK? Seeing a person on the inside was supposed to be just a symbolic thing, right? I had never cut into a human back before; knowing that anatomy lab was an inevitable part of the curriculum, I tried to reason away the uneasiness. Was it ethically OK? Yes. Would I be capable of the lab work? Yes. I couldn’t find a reason why this would be wrong, so I ruled any anatomy dissection from here on out, OK and attributed any uneasiness to the fact that running a knife through a human body for the first time was not supposed to feel OK. Whatever the reason for the concern, in less than one lab, my nervousness was fully replaced with fascination. I quickly realized that this donor would submit to everything I and my tablemates deemed beneficial to our learning. There was mild protest at times manifest through a stiff arm or extra tough fascia, but that was negligible. The donor let us cut open her back on that first day, just as she would soon open her arms to us. And she did, just as she gave up her lungs. And after beating its final beat, she gave up her heart, shedding the pericardial sheath to share it in the flesh for the very first time. And then came the neck, the head, and of course, the brain. Dr. Piekut was at my side to help cut free the remaining cranial root as I lifted the brain up and yelled, “It’s a girl!”

These were exciting moments. We were seeing the human body in ways that we never had and may never again see. An author once described the anatomy experience as an intimate connection with another human being because we see the body in its entirety. The author claimed that the experience was more intimate than making love. Is that true? Did I get to know this donor as deeply as the author suggests? I just described some very intimate experiences with the donor, but is that really getting to know the person?

This question about “knowing a person” first came to me, albeit from a slightly different angle, while studying one afternoon in the anatomy lab. I was carefully going through the nerves and muscles of the forearm. I sat on one of the steal stools beside the donor with my left hand separating the muscles to better understand what was there and where it was going. With my right hand, I picked up the donors left hand to appreciate the underside. And there I was, high-fiving with the donor. But there wasn’t anyone on the other end, right? Well, who’s hand was I holding up if there was no one on the other end? I was obviously holding a hand that was attached to an arm that was attached to a torso where a neck and head attached. Judging by everything I could see there was a person on the other end of this high five. At one point, that was true, but despite what my eyes told me in the anatomy lab, there was only the body of a person, but not a person. I could touch, poke, smell, see, even taste this body but it would not allow me to truly know this person.

And this is the idea that I want to share, that we cannot truly know a person, a disease, a whatever, if all we go on is observation. What we observe is never what is truly there; it is only what we are able to observe. In other words, observation is not capable of bringing us to a full knowledge. This is certainly the case in the art of medicine. Look back at the cancer screening lectures of yesterday and the day before. After all of the meta-analyses, the only certainty is that we certainly don’t know what to do about screening. Any search in Up-to-Date will show the same thing, one anecdote followed by a recommendation that replaces the previous collection of anecdotes and recommendations. What is unsettling and true is that all of what we are learning in medicine is grounded in observation. Which leads us to a postmodern predicament: how can we say to our patient that we know what is going on with them if all we go on is grounded in an incomplete modality: observation.

I’m going to leave medicine for a minute in its little quandary and now ask if it is also true that to know a person we must supersede our faculties of observation. I am sure that many of you can relate to a mental flash where a classmate from grade school pops into your head. Their name, face, maybe even one particular interaction suddenly comes to mind, and then you realize that although you went to the same school for four, six, ten years, their memory is reduced to that one interaction or maybe just a face or name. Did you really know this person? Can you say that you know this person anymore?

Every observation you made of that person was added to a mental file and stored until updated by a future observation. Just as in Up-to-Date, our brain is busy adding to the mental files we store on the people in our life and with each new anecdote comes a revised recommendation e.g., avoid this person, love this person, listen to this person, laugh at what this person says, etc. Our knowledge of this person and therefore our behavior is based on a very limited set of data. How can we be sure that we actually know our colleague? How can we be sure we know our patients? It doesn’t seem like we can. We will continually operate on incomplete information, our biased and short-sighted observation, leading us to act with incomplete understanding.

Recognizing this state brings to mind the words of the apostle Paul to his fellow saints in Corinth, “Now we see through a glass darkly.” It was true then, and despite all of the wonderful innovations in the world, your glass and mine remains dark. Our understanding of medicine is incomplete, and we don’t fully know our neighbor.

So what? You might be thinking. “Thank you for pointing out that my glass is dark. Is that it? Well, yes, but there is something we can do as we look into medicine and look into people through our shaded glass. Paul, in his same letter to the Corinthians, identifies three things that will enable us to overcome the limitations of our darkened glass i.e., our incomplete understanding. These are faith, hope, and charity. Faith is recognizing that there is more to this person than what we now see. It is acting on this belief to discover more about them; it is basing our judgments not only on anecdotes but on the eternal nature and goodness of the person. We can have faith to research and discover more about a disease. We can have faith in our classmates; in our professors; in our patients. Hope gives direction to our faith. We hope that good things will come out of our actions and our interactions. We hope that the treatment will work; that the grant will be accepted; that greeting our patient with a smile will help them feel at ease; we hope that a nod to a classmate across the lecture hall will communicate something, we hope it will communicate that we are glad to share this space and this experience with them. Charity is forgetting about our self, it is leaving the self-interest at the door. With charity, we stay until all of the patients are seen. We forgive the person who was harsh towards us. Out of charity, we fill out our course evaluations. I have faith, and I hope that you get the idea here. I will now exercise some charity and end this talk.

In closing, I believe it is through faith, hope, and charity that we can move beyond observation and truly know a person or a disease. These principles enable us to observe as God observes all things in their true and complete state. I give thanks to the donors who through faith in us, hope in our future, and charity in their soul shared everything they could. Now let’s try to apply these principles to enrich our experiences in life with a more full knowledge and to enrich the life of those around us. Thank you.

[i] Our anatomy professors who were in attendance were known for their zeal in testing our knowledge of nerve fibers. They loved to point to an organ of the body and ask what nerves innervated said organ and where the nerves originated. Thankfully, this opening that did in fact come to me just before I got up to speak got the audience laughing and helped me feel a bit at ease—I was really nervous, sweaty palms and all, pathetic, huh.

[ii] The class that involved the anatomy lab was called HSF. It was organized into four blocks that covered a little over three months time.

Just for Today

2009-01-21T00:34:00.000-05:00

I intended to celebrate Martin Luther King, Jr. Day, I really did. First on the holiday agenda was breakfast. This initial celebratory act consisted of one avacado, one kiwi, and one bowl of Honey Chex. It is the middle of January and I ate kiwi and avacado for breakfast. America was celebrating MLK, I, on the other hand was celebrating globalization.

The second celebratory act of the day was getting dressed (no shower for water conservation, or perhaps laziness): one pair of Tommy Hilfiger 100% wool slacks, acquired from a thrift store in Berkeley, CA, one alpaca sweater de calidad exportativa, hecho en Peru. Again, I was celebrating the flatness of our planet and the ease it affords us to travel to far away places where we buy hairy fabric.

Happy MLK Day! Happy Inauguration! and three cheers for globalization, just for today!

Winter Wonder

2009-01-20T00:38:00.000-05:00

I decided that I was going to die Friday night. I knew exactly how it was going to happen. I decided Friday night as I walked home from the hospital that if I were not a medical student, but a soldier in Napoleon's army on the long march out of Russia, I would have let myself die that night. It wouldn't have mattered who was waiting for me back home. There was no escaping the cold this particular night. No 19th century coat would have been capable of preserving my will to live. Being in that cold through the entire night, only to wake to it biting at your nose, your lips, all of your tips... Why endure such suffering when there were so many miles to go. Just imagining that conjured up the comparison of a capsized crew in the middle of the ocean with no raft or life jackets. This is how I imagine I would feel were I in the middle of nowhere, Russia on a night as cold as this. The hopelessness of it all would have reached a breaking point. Unlike most nights, I wouldn't gather around the campfire to sing with the men or to tell my jokes and do a dance for my mates. Instead, I would have avoided the water and cabbage dinner, I would have walked away from camp, past the tents, telling the soldiers standing guard that I had a fit of terrible bowel movements coming on and that they better let me pass or they would regret it. Once I was far enough away so that the light from all of the campfires had merged in my eyes to be a faint, questionable glow, I would burrow myself down in the snow and go to sleep.

I'm pretty sure that is what I would have done, or at least that is what I imagined I would do as I walked home in my 21st century gear the other night: 700 fill down coat, alpaca wool hat, some sweet suede shoes, 100% cotton blue jeans (these actually helped simulate how a Napoleonic soldier felt on those bitter Russian nights.

Luckily, I am a medical student and not a soldier weary from marching for years across eastern Europe. Yeah, I'm not even in eastern Europe. I'm in Rochester, New York. It may be hard to tell from the beginning, but this post takes a quick, middle of the night-I was up til 4am last night-and I better do better this night-though things aren't looking too good if I want to actually write this-post (BTW, that was all one word) look into why I love this place I currently call home.

Friday night was pretty cold, but walking home Sunday night was overwhelming with joy. One of the great things about a snowy winter is that the nights are never that dark. The white ground reflects any natural light. Speaking of natural light (not the beverage), Rochester nights often have amazing moons.There is actually just one moon in the sky, sorry if that is confusing. What I'm trying to say is that the moon looks amazing here. Better than a bright night, the thing that is great about all the snow is that it is transformative. Seriously. Winter in Maryland is a season when the Earth turns brown and barren, and the temperature drops and the chill gets to your bones. It looks the same in January as it does in September, but too cold to be outside. In Rochester, I feel like when the leaves fell from the trees this fall, the stage props completely changed and I now find myself acting in a totally different play.

Today I woke up, looked out of my window, and what did I see... Sorry, no popcorn balls.

A confirmation that I was no longer whereever I was in the fall and summer, but still living in this make-believe land. This is a shot out of my bedroom window this morning. The nieghborhood you are looking at is called the, White Coat Ghetto. It borders the hospital and is filled with medical students, doctors, nurses, etc. I walk around in this neighborhood visiting friends or heading to school and it is like I no longer live wherever I lived in the fall. It is a completely new experience. Maybe that is what is so great about this place. It's a place of change, change that I believe in.

The Best Gift of Christmas

2008-12-31T17:04:00.000-05:00

We draw names from a hat (or bowl) every year to see which family member we will give a gift to on Christmas Eve. This year was special because our grandma spent the holiday with us. We included Grandma in the name drawing and wouldn't ya know it, she drew my name.

I sent a wish list out to the family to help them in their gift giving pursuits. This chance comes only once a year so you would think the list would be pretty long; unfortunately, after typing it out, my list looked pretty weak.

My Plan:

I added some pretend items to the wish list in an attempt to give a false appearance of variety for family members: they would see a healthy list of gifts and would think to themselves, "so many options, I can definitely find something on that list that I would like to give." As they scanned the list, they would weed out the fake wishes and pick a real one as their targeted gift.

Christmas Eve came, we ate our traditional dinner, we read Luke 2, sang carols around the piano, and then the gift giving began. This was the first test for my wish-list-plan. My turn to open my gift came and this is what I found.
I didn't know what to think when I unwrapped the jack-o-lantern and pulled out these devilish boxers. I was in a slight state of shock. Then I remembered that I asked for breakdancing underwear. Grandma had looked over my list and she shared with my mom her concern that she just couldn't figure out what breakdancing underwear was. The joke was on me when Grandma called me on this and actually gave me her interpretation (a brilliant one, at that) of breakdancing underwear.

Me, breakdancing. My apologies that the photo doesn't tell the whole story

HSF Highlights

2008-12-24T01:31:00.000-05:00

The Top Ten Moments of HSF[i]

1. Dr. Dirksen’s WWF Dance[ii]

2. TA Debbie Dao hemostating Dr. O on the last day of anatomy[iii]

3. Hemostating[iv]

4. Belinda Carlisle[v]

5. Dr. Pickett, “So much for…”[vi]

6. Impromptu yoga session in anatomy lab[vii]

7. “That’s what she said”[viii]

8. Dr. Davis’s Histo review[ix]

9. The arrhythmia video[x]

10. Cher[xi]

[i] Our school curriculum 'subjects' us to one course at a time. Human Structure and Function is the four month course we completed on the 19^th of December, 2008. The following was taken from the course intro: The HSF course encompasses the subject matter traditionally taught in separate courses in

physiology, anatomy, histology and embryology. However, the course extends beyond these

traditional boundaries by providing the opportunity to integrate the facts and concepts across

disciplines, and to apply this knowledge to clinical problem-solving in your PBL cases. Finally,

the HSF course is integrated with the Introduction to Clinical Medicine (ICM) course.

The subject matter taught in the HSF course is coordinated with and complements your

introduction to the basic skills required to perform a physical examination on a patient, and your

HSF/ICM Integration Conferences are designed to emphasize the clinical application of the basic

science concepts taught in HSF.

[ii] This gets the number one spot because Dr. Dirksen blew us all away when the music came on in the middle of his lecture and he did a very convincing Wrestlemania victory dance for a solid minute. This teaching moment taught us that 1) our professors could be crazy and funny, and 2) that med school was going to be more fun than we had anticipated.

[iii] See below for “hemostating.” On our very last day of anatomy lab, Debbie Dao did the unthinkable. With all of the room sneaking a peak from their own dissection table, she clipped a hemostat right onto Dr. O’s scrubs as he taught table #24 about lower limb joints . The hemostat clanked twice against the dissection table and then no one could hold it back. The room erupted with laughter. Thanks to Debbie for sacrificing a letter of reccomendation for that moment.

[iv] This is a game we started to play to keep the mood light in the anatomy lab—as if our room needed anything more. We already had windows spanning one side of our newly refurbished 5^th floor anatomy loft. The sun was shining (or the snow was falling) and we were never short on laughter. So the purpose of hemostating is to clip a hemostat onto the clothing of a neighboring student without them noticing. I believe Drew won the medal of honor for getting five hemostats clipped to his back before he realized what was going on. I also should get an award for almost reaching the elevators before Zach let me know about the hemostat on my pants pocket.

[v]Our anatomy table broke out in Belinda Carlisle’s, “Heaven on Earth” one day. What can you do when something like that happens beside dance like you’re in the music video? Never mind that table 22 was the only all-male table.

[vi]One of the HSF all-stars, Dr. Pickett subconsciously (we believe) closed out each portion of the lecture with her signature line, “so much for, insert the organ or tissue of focus e.g. brain, heart. It never failed to get a shout out in intra-class conversation later that day.

[vii] We just started doing yoga one afternoon in anatomy lab. What more can I say. It was awesome, and yes, I may have had something to do with initiating/leading the session.

[viii]This never grew old for Bryan, and hence, only occasionally grew old for anatomy table #22—we’re a team no matter what.

[ix] Not only did these reviews help 90% of the class to pass the histology, this also made the list because of moments like Judge Jerry, the Dr. P impersonation, and every other attention grabber attributed to the HSF all-star, Dr. Davis.

[x] There is really no way to describe this. You’ve just gotta watch it!

[xi] No one can explain how, perhaps there was a subliminal link between a Dr. Davis lecture, but one day table #22 (mostly myself) spontaneously started singing Cher, “If I Could Turn Back Time.” Maybe we were just lucky that day!

Haunting or Hilarious

2008-12-10T00:21:00.000-05:00

I almost laughed out loud walking home from the hospital this afternoon.

The application process for medical school is not like any other graduate school application process. First, it takes more than a tanking economy for someone to decide to apply. Second, it involves more than a purchase of a Kaplan review book, some letters of recommendation, and a $200 exam. It is more like an application for the FBI or CIA; I confess that I have never applied for a job with the CIA or with the FBI and therefore have no idea what the application process looks like; but if I could imagine, dream, postulate on the details, I would say there is a lot of screening, a lot of interviewing, a lot of intimidating going on. If this is true, than my experience of applying to become a doctor was indeed very much like applying to work as an FBI agent.

I was interviewed fifteen times, including the two at BYU used to judge if I was suitable to even apply to medical school, at seven different schools throughout the application process. As far as the screening goes, I wrote essays on every ethical issue under the sun, wrote a 3,000 word personal biography, and did an interpretive tap dance of photosynthesis for one particularly demanding dean of admissions. That is just the direct screening. There was plenty of non-direct screening and intimidating to pass around. Every time I told anyone I was interested in medicine, and by anyone, I mean anyone not enrolled in an undergraduate institution, their face would contort into this marquee flashing messages like "You are crazy!","You are evil","You have no idea..." and so forth. Truthfully though, none of that amounted to much in my head.

One of the things that actually did concern me about the decision to be a doctor was whether I could handle the anatomy lab. I heard that students dissected their way entirely through a human cadaver. I confirmed this at one of my interviews when the student giving me a tour unexpectedly pulled back the sheet over his cadaver, mid-sentence! It was every bit repulsive as I imagined.

So I almost laughed out loud as I walked home from the hospital this afternoon smiling at everyone and everything I passed, thinking about how awesome the dissection of the pelvis (yes, that required us to split the pelvis with a handsaw and dissect the leg with a scalpel) was that I just did, and how much I LOVE the anatomy lab, and comparing that with my pre-med concern. The contrast nearly put me in stitches.

Dining in the New World

2008-11-28T22:14:00.000-05:00

My medical school class is 104 students small. I know approximately 99 of these students by name and consider all of them friends. We usually cross paths, me and one or two or three other students as we walk to campus each morning. If I don't join up with any friends on the neighborhood sidewalks, I usually greet a classmate at the bike racks outside of school. If I still haven't bumped into classmates (meaning that I am still reading my morning magazine, The Economist or National Geographic) as I enter the hospital, then I'm sure to join up with a handful of classmates getting their coffee or hot chocolate outside the student lounge. We converge every weekday morning at approximately 7:57 on the lecture hall indicated in our syllabus.

I spend most of my day with fellow students of medicine be it in lecture, lab, lunch, or small group. I study with med students outside of school, I eat dinner with friends from class, I go to movies or shows with med students. I play sports with other medical students. I'm not writing this thinking the reader is interested in knowing how I spend my am/pm hours. I am writing this to justify what I said at the dinner table Wednesday night.

Classes ended Wednesday at 12pm. I was on a plane two hours later bound for DC. Lil Sis picked me up and we cruised out to Poolesville for our first of many family dinners over this Thanksgiving break. The house as usual smelled incredible. Mom was near completion on some Indian soup masterpiece. It wasn't long before J & J arrived with the flat bread and away we ate. I don't know where the conversation was going (perhaps someone can chime in) but I enthusiastically announced, "Well, I was digging poop out of a cadaver this morning!" I realized, with the chorus of spoons clanking against the bowl that I just said something very, very disgusting. A split second later, the sound of the spoons dropping was replaced with moans of, "Ah, that is DISGUSTING...SICK...You just ruined everything, I can't believe you said that, that is DISGUSTING, I can't believe...!" All of the above accompanied of course with terrible looks of pain, anguish, and a pinch of anger.

I tried my best to recover, "Oh my, I'm sorry, I mean, I just made some precise incisions at various points along the small and large intestine to appreciate the differentiation of tissue & musculature...It's really not that gross, I mean, it wasn't like that...PROMISE, I'm sorry. Just looking at muscle..."

But the damage was done. There's no recovery from something like that. It rolled right off my tongue like it was common place, totally normal. Family holiday dinner conversation can get a little out of line but my family members were no where near prepared to handle something like that. I was honestly just as shocked as the rest of the family that I gave utterance to such a foul phrase. It took me a while to realize why I thought that was OK to say in the first place.

And now I realize: I'm always around med students. Our world of cadavers, histology, and physical exams is just that: our world. For better or worse, I am always around people who spend a couple hours a day dissecting, examining, and removing body parts from cadavers. What was at first overwhelming and taboo to us is now part of the daily grind. And it is only natural that my language reflect this new environment of medicine.

Declaring the above does not excuse me from respecting what is predictably and understandably disgusting to the rest of the world. I recognize this new language tendency has a time and a place. Please know that I will do my best to remember that; but if I do slip and say something that makes you feel a bit queasy, well, just take it as an invitation to join me in this new found world of mine.

Shorts, Tis Never the Season?

2008-11-24T23:52:00.000-05:00

I pasted below an article I wrote last week for the school paper--the b-school paper, because there is no med school paper. Med students don't have time to write! It's a little more facetious than usual. Enjoy!

Economists and financial experts around the globe have tried to pinpoint the cause of the financial market collapse. Some policy wonks claim that our financiers got too smart, that our derivatives became too creative. I don’t know about you but I’ve never been taught that creative talent was a bad thing. Others try to say that we got too greedy, that we wanted things we couldn’t really afford. Again, I firmly believe that progress can only come about by pursuing those things that are at present out of our reach. The true reason why this country is in recession is because we as a nation have come up short with our dress codes. Standards are so lax that we are wearing shorts when pants are needed. We are wearing shorts to school; we are even wearing shorts to work!

In the Max Farash lecture on the 13^th of November, Daniel Forrester presented a very inspiring and powerful formula for better decision-making. He argued that Simon students must rely on data; they must possess the ability to tell the story; they must be visual and conceptual thinkers; and they must reflect and iterate on their work. The contributors of the Simonist fully agree with the above formula, but we recognize it omits one critical element to informed decision-making: pants.

We’ve made a lot of poor decisions in recent years. All of those telecom mergers, health savings accounts, subprime mortgaging, leadership over the wars in Iraq and Afghanistan. These are a few examples of some of the poor decisions we’ve made, decisions that for the most part were made by people dressed in shorts, or camouflage—equally bad.

How did this happen? Many human resource departments cite global warming for their shorts friendly dress codes. The most famous example is the UN. The UN announced this past July that it was going to reduce its carbon footprint by raising the temperature of its historic world headquarters building in New York. The announcement was hailed by the media as a green move. Not so fast, Simon readers! The true motivation behind the policy change was to allow employees to wear shorts! UN workers were encouraged to discard the professional suit and tie to “comfortably” work in a warmer climate. UN Secretary General Ban Ki-moon crowned himself the “environmental secretary-general,” but the truth is that the Secretary had a fall out with his tailor and could not keep wearing his 2002 trousers around his 2008 waist. And what can be said about the productivity of the UN under its new A/C policy? Their absence on the Georgia invasion and they’re failure with everything they recently tried to put their hands on in Africa: Congo, Zimbabwe, South Africa, etc, highlights the effect of shorts in the work place.

This professional slide in America to casual wear is a direct effect of school children who were educated in pro-shorts institutions. Many American public and private schools at one time required children to wear trousers to class until the seminal ruling in 1979 when Moody v Cronin 484 F. Supp. 270 (C.D. Ill. 1979) ruled in behalf of the students—a decision made by individuals dressed in robes, not pants. This ruling led to many other dress codes being overturned. School children united and fought any school policies framing the issue as an anti-shorts policy. This cleaver campaign attracted huge donations from powerful organizations such as the ACLU and Sesame Street. The school administrators managed to get AARP behind them but that was not enough to counter the strength of the anti-shorts campaign.

I remember the monumental day when the no shorts law was revoked by my local school district. Many readers can recall such a day in their own past. It seemed so much like the right thing for us to do then. We saw a nation no longer divided by a pant line; we believed freedom of expression, we believed self-actualization would come from this change. Little did we know the consequences would be so grave. Now we know, and knowing is half the battle. Let’s take care of the other half and put America back on track. Let’s wear our dress pants to campus lectures and activities, and when we reenter the work force, let’s be dressed in our best slacks. We won’t get out of this recession until we get back into our pants.

"The results are in amigo. What's left to ponder?"

2008-11-05T00:01:00.000-05:00

Obama Wins!! or is it, Campaign Ends!!

I was studying on the undergrad campus when the official report came in declaring Barack Obama winner of the election. A girl with a heavily foreign accent shrieked with joy, "I'm so happy!" I met eyes with the two undergrads across from me and we all made the same what the? face. Following our group facial expression hug, one of the undergrads said, "cool" with a warm smile. I nodded my head and returned the smile.

I am entirely enthused that Barack Obama will be taking over as Commander in Chief, President of the USA, Leader of the Free World, as some of the more patriotic journalists like to believe. I also want to take a second to give a cheer in recognition that the campaign is over. No more campaign coverage, no more money poured down the drain to defame the opposing candidate in the most expensive way possible--I'm really thinking of the local elections here in NY, come on people, show me some creativity. Now we can recognize that Russia attacked Georgia!! We can go back to talking about the war in Iraq, the war in Afghanistan, the mounting problems with the US Mexican border, we can palpate the woes of Wall Street, plan against the inevitable peak in energy production, comprehend the inevitable bankruptcy of the health system. No more Joe the Plumber, no more Palin bloopers, etc... hurray!

Actually, that is what the media will go back to talking about. What will I return to talking about? My conversations will have less of, "yeah, McCain really threw the race when he picked Sarah Palin; so the olfactory nerve crosses the cribriform plate of the ethmoid bone to enter the scull, right?" to more of "hmm, the facial nerve has a motor branch and a sensory branch (intermedius nervious), both of which leave the ventral base of pons and pass through the internal acoustic meatus, bla, bla, bla." As one can see, the short-term outcome of this election is small to very small in my world. I do, however, believe the long-term outcome is change, yes, we can believe in. Why do I say so? As the ever insightful Beck sings, "Things are gonna change, I can feel it."

Fish Tails

2008-10-29T03:33:00.000-04:00

Again, why am I starting a blog?

As you can already tell, it isn't to perfect my white spacing, my designer intuition, or to kill time. I honestly don't have a good answer for this question other than I for some reason think it will be fun. Oh, those anticipated benefits were actually a huge part in the reversal of the decision, Sparenborg vs. Blog. Yes, because I wrote this quick, garbled email to my immediate family about a week ago and by their responses, it became apparent that I could be better at communicating. And, of course, now I can keep up with all of my friends who are so well experienced in this bloggy blog world.

The impetus for a first entry came just tonight. I received a reply email from Sarah indicating that what I had written was "blog worthy." It was odd to read a comment like that. I read blogs but I never thought about what makes something “blog worthy.” And without any further consideration on the matter, I decided to just do it, start a blog, amen—I am trying to avoid any classification of entries and will try to avoid any blog stereotypes with Simple Things e.g. using it as a showcase for my amateur photography, turning it into a journal, only posting vacation pics and updates, etc...

I don't agree with Sarah that what she saw to be blog worthy is actually so (this is good because we recently decided to make a concerted effort to disagree more often, sort of, but let's be real, her blogging skills go back to somewhere circa 2005, so my opinion holds nothing against her honed judgment). Still, I do want to share the part of the email she did not find to be blog worthy.

I went to the stream yesterday for my post exam detox. Myself, Frank, and Doran. All three decked out in blue jeans and hoodies, we stopped at the local outdoors shop to get our licenses (fishing licenses in NY end every October) and made it to Allen's Creek before any other anglers. I was operating on shady equipment: an ultralight rod, tip broken off, 6lb line. That's not your ideal rig to catch 15lb+ chinook salmon but the bottom line is that the trip goes down in the books as one of the top five fishing trips ever--and I've been on a lot.

I set up my rig at the water's edge and balanced across a path of stones til I was about twenty feet from shore and forty feet from the base of a waterfall. Perched on two solid rocks, I watched with my mouth half open these enormous fish leap out of the water in futile attempts to clear the falls and continue upstream. Our timing was perfect. The salmon were running in the stream according to their instinct. They return to the tributaries every fall to spawn. Witnessing the salmon run, alone was amazing. I stood still listening to the gurgle and surge of the water, smelling the layers of air coming off the surface of the water.

I gazed over the water back and forth in search of shadows flashing in the pools near my feet and then I took my best guess and cast my bait where I anticipated the shadows to appear next. A father with his three girls and dog came by splashing and watching, hoping to see a catch. They headed down stream and yelled to get my attention. I flattered them and went to see what it was, knowing quite well that it was another shadow, one just like all the others I was watching at the pooling of the falls. Those little girls were so excited to help out, how could I ignore them?

I returned to my preferred spot and cast for another twenty minutes until it happened. No sign of warning, no splash, no shadow appeared. My line just started zooming out of my reel and I felt the tip of my poor little ultralight bend in submission to the salmon. Silence, then noisy reel giving line and giving line, then splashing, two, three violent turns, tail whipping, then a leap out of the water, then another, then quiet, no sign of a fish except that the rod bent further begging the fish to stop. My forearm couldn't handle it, muscles ached. I held on with both hands laughing. I struggled, he struggled. After some time, ten minutes, maybe fifteen, we came together in the shallows and I knelt to place my left hand around its enormous body just in front of the tail fin, the caudal peduncle, if you will. We were both exhausted; we were both smiling. I placed my right hand under its front end and lifted just enough to appreciate its color, its power, its strength. I placed him back in the water and waited for both of our respiratory rates to relax. It was a delicious moment. I still smell it on my hands, er, I did this morning (pre-shower). Mmmm. Thank you waterfall, thank you salmon.

The Beginning

2008-10-28T20:56:00.000-04:00

It has always been too easy for me to quickly dismiss the idea of writing a blog: No time, too invasive, overall lack of interest, philosophically against the idea. The list goes on, yet here I am.

Concerns with starting a blog:

That my life will turn into blog entries
That blog entries will turn into my life
That I will neglect even more of the already neglected important things in my life
That my blog becomes a substitute for conversations with friends & family
That my entries will be utterly boring, so much so that my friends are no longer my friends
That some weird stranger will habitually read my blog
That the name of the blog will always be this lame

Anticipated benefits with starting a blog:

My family & friends will know more of what I'm up to (pretty bad in our age of cell phones)
That I find posting stuff to be personally fulfilling, push me in some self-discovery path, or just reward me in some short term egotistical way. I'll take what I can get.

Any others...? I'll update that as needed. Oh, and when you read this, "...?," that is Simple Things blog code for "readers comments are welcome." I guess that is implied with any part of a post, but it is emphasized wherever the appropriate code appears i.e., please give it your best shot to add something witty, funny, ridiculous (that will always be welcome on this blog), insightful, coincidental, and/or relevant.