California or Bust

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

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

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

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

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.