eons of peons

2011-09-02T18:57:00.003-04:00

Diagnosis -- diarrhea.

Days off become very precious. I worked 100 hours over the last week, and come hell or highwater, I am going to wring every last drop of freedom from my days off. During my last day off I had a migraine that started while I was on a run. At the end of the run I noticed a blurry shimmering rainbow blotting out some of my vision. I recognize that old friend -- he comes to tell me:

You're head is going to be a vice soon, enjoy not seeing!

I soldiered through. Finished the run, a handful of ibuprofen and a beer later I was on my way to a movie. I was not going to miss the X-Men for a weeny headache.

So yesterday began as a great Ry-Day. Some coffee, some wife time, some guitar time, a long run, and even frosted mini-wheats. Then the pooping started. My belly gurgled a warning and I headed off to pee out my butt. There is a medical term for this, but honestly this best captures what I spent all of yesterday doing.

I ran out of poop really quickly, but my intestines had an endless supply of water that they were determined to get rid of. Through my butt. I would try to stand, and be doubled over with cramps, then off for more butt-diuresis.

The wife was good. She saved my life, brought gatorade and gingerale, both of which made me feel like my insides were being torn out. She pointed out that this was probably more than my mild inability to digest milk (damn you mini-wheats) since that milk was long-gone by now. She suggested I go over my diet to see if there were any likely offenders.

1) end of day sushi.

For our rotations at the Veterans hospital, we get stacks of 7$ meal card tickets. I have about 50 of these right now. They look like monopoly money, and I eat most of my meals at the hospital since it's free. I usually get done after dinner time, and the hospital cafeteria has OK sushi. And there is never a line for the stuff in the refrigerated section. So, often I get sushi at the end of the day for dinner. Probably not the best time to eat raw fish.

2) old roast beef sandwiches.

There are lots of conferences that have free food. Occasionally the amount of free food supasses the desire for the free food. That was how we wound up with a heap of free sandwiches that were at least an unknown amount of hours old, and made our work room smell like old sandwiches. Not one to pass up a good deal, I ate three of them.

3) coffee and energy drinks.

110 hours at work over the week = 5 or so hours of sleep per night = more coffee and red bull than water. It's sort of sad.

After going over this, sweating and in fetal position, I realized two things: it was probably the roast beef sandwiches, and it's surprising I don't always have diarrhea.

2011-08-18T14:38:00.002-04:00

It has been too long. I've been doing a lot of writing lately, but most -- really all -- is legal documentation. My best piece is:

"Pt slept through the night, denies fevers, chills, nausea, vomiting, diarrhea, chest pain or shortness of breath. Hoping to go home tomorrow. Mentioned that he has not been eating well over the past several months due to losing teeth when he eats solids. States "wife usually mixes up 2-3 quarts of koolaide" this is his main form of nutrition.

-Plan to consult nutrition&dietary"

I've been spending long days and longer nights at the VA hospital. Vets of all ages attend, but our biggest patient population is men who fought in Vietnam and Korea and are in severe decline. Hard living mixed with minimal education, less money and more mental illness make for a hard life, and these vets have it all. They avoid the doctors until a critical breaking point and then they seem to become professional patients. In and out of the hospital, multiple visits per season.

Not by choice.

I love working with these guys. They got drafted and then shunned, and it's nice to be a part of their safety net. They are also tough and nails and have huge balls -- not just from anasarca. They'll limp in gangrenous. Drive in from the country in a deadly heart rhythm, passing out on the freeway.

There are so many small victories and losses that it's hard to keep track of the score. But one take away I've had is that if I see someone stopped in the middle of the highway ever, I'll go and check if that person has a pulse.

2011-08-13T22:11:00.000-04:00

Poor caliente - que una vida preciosa.

2011-04-07T09:47:00.002-04:00

Workin'

In just over two month a bunch of insanity is going down.

-I'm getting married
-I'll be a doctors
-I'll be getting paid for being a doctor.

Over the past two years I have been paying to work an average of 60 - 80 hours per week at the hospital. It's been incredible. I love what I'm doing, I love seeing patients. Even an afternoon of pelvic exams doesn't destroy me when I put it into monetary terms:

Wait -- I'm paying to do what?

At the end of a long day I have enough spiritual energy to work out, make dinner and still be a person. Looking at the variety of things humans do for money, truly loving your job seems rare. There are thousands of obscure jobs that can essentially be termed "accounting," though most workers in said jobs would balk at the title. There are many more jobs where the works sit in front of a computer, trying to not get noticed. And then you can be medical support staff, in the army or work at a restaurant.

I think this covers about 100% of jobs leaving out artists and athletes.

The university just hired me along with most of my cronies to help transition to a new electronic charting system. It's a system used by most of the hospitals in the metro, so we all know how to use it. The only reason that any of us are doing this is to make it rain. The university did not adequately gauge how desperate and poor students are, so starting wages were set at $75/hr.

That's right -- $75 per hour!

I would've done it for $25 -- which would still be more than I've ever made per hour ever. Also several tactless med students shared this information with nurses and others around the hospital so are now universally resented.

Nonetheless, now I am showing up at the university daily, donning a green fleece vest sized made for big people and standing around the hospital as a "green-vest" meaning one who helps physicians use the new computer program.

Most smart people can navigate easily through a system, and questions come the first time, are answered and don't come again. So most of what I do is play words with friends and angry birds -- for 12 hours. The contracting company is aware of the diminishing need for legions of tech support, and understandable doesn't feel that it is a good use of resources to pay me $900 daily to play scrabble. They have been circulating around the hospital trying to find areas to cut employees from. Naturally this is a cat and mouse game with two strategies. Primarily I try to look busy. I walk around with the care teams on rounds, shoot the shit with nurses if they are standing near a computer and sit in heavily populated areas so that at first glance it may look like I am doing something.

Next -- they can't send you home if they can't find you. I scoot around the hospital, talking to other people sitting at computers, giving the impression that I am engaging in larger-scale tech support.

There is a tremendous toll on my spirit, however. I have never had zero investment in my work. Even working as a server, I liked (most) my patrons and loved my fellow staff. Landscaping I wanted the landscape to look landscaped. But here my goal is to be there for 12 hours so I can get paid for 12 hours. My secondary goal is for the time to pass quickly, but I couldn't give two shits how or why. It's a terrible feeling. I begin each day tired and exit each day empty -- fully knowing that I have accomplished nothing.

This is how people get fat, I think. They have jobs that don't matter, and they are aware of this, and unable to change it. It's a fatness that equates to powerlessness. I do nothing all day except try to avoid being sent home, and then am too tired to do anything other than eat and sleep. I feel like a depressed panda bear.

And I fucking hate polar fleece. Probably the worst thing about being white is the association with polar fleece.

2011-04-02T10:57:00.002-04:00

Popsicles and a doctorate.

After four years of medical school -- and two years of essentially paying a lot to work 60-80 hours per week -- it's over. I graduate in May, but have no more tests, no more hospital time, no more clinic visits. Last day. Completely done. And I didn't even lose my stethoscope!

There were a few close calls, prompting me to shop online for new 'scopes -- it turns out they're expensive.

I've been doing hematology and oncology for the past month -- which is incredible and difficult. The hard part is the introduction. Whenever I meet a patient for the first time I need to explain what hematology and oncology is:

"We're the blood and cancer docs"

Which means that whenever I introduce myself I have generally broken either bad news or raised the imminent possibility of bad news. It's akin to having a normal name, terrible title, like,

"Nice to meet you, I'm Ryan -- I'm the angel of death."

It has a lot of weight, enough so that I make sure I have my entire story perfectly straight before each new patient. Nonetheless I like it. Each encounter is very charged. Each time I bring bad news -- that's the most important thing I'll do that day. Keeping that in the back of my mind is a powerful organizational tool, and the rest just falls in line.

But now I'm done. I won't see another patient for nearly 3 months -- and the next time I do -- I'll be Doc. Clay. Terrifying and exciting. To celebrate my staff bought me a popsicle at the VA cafeteria -- "The Canteen."

We toasted orange deamsicles and talked about the future.

2011-03-28T23:38:00.002-04:00

Hello god? It's me ... claybert.

It's been a while -- but if REM can do it, so can I. This won't be an exciting blog post -- mostly it will just be a blog post. I've loved writing, and when I look over the past two years the majority of my writing has been summaries of individual's bodily functions. Not that I don't love being a poop and pee journalist -- it's more that I can't add a creative flair for fear of legal action. It would not compromise patient care to document,

"Mr. S was complaining of fevers, chills and peeing out his butt,"

But I can see how that would look poorly to another doc doing a chart review. I can also see how that would look even poorly-er in a legal-type setting if Mr. S had a bad outcome and his family got angry. Nonetheless I don't feel stifled, I mostly just feel tired of typing, and after each long day of logging hours on my butt, I feel like off my butt is the place to be while at home.

Turning to a few housekeeping issues, this blog has a lot of baggage. It carries around almost 8 years of gunk. More than once I've had to go back and delete posts that would've made me sound cool to other 19-year-olds but much less cool to possible medical schools and employers. In that sense this blog is a bit of a burden. Automatically it carries around embarrassing pictures of me. I've done my best to mute it by ignoring it and filling it with dead links and outdated formatting, but it still persists.

But writing makes me feel better, akin to sad bastard music. All writers are sad bastards under their dust jackets anyhow.

Lastly, blogger's interface just sucks. Wordpress is so much better, cleaner and simpler. But it doesn't link to my google account. And for that I think I'll keep this blog. Stay tuned for a new background and culling broken links!

<3

RC

2010-10-09T09:48:00.003-04:00

Computer repairman.

My computer is getting on its days. For no reason it will heat up and think way too hard. Just opening the google stresses the little guy out. But for as much of whir and whoosh as my macbook can whip up it still works. And having an old computer is free, that's something that you just can't put a price on.

I was riling up the dog, feeling both guilty and elated because I promised my roommate I'd stop riling up the dog -- even though I love it. Constant riling had started wearing away the dog's training, and he was sliding toward becoming 70 pounds of fuzzy, unbridled public embarrassment. On the couch, wrestling with the dog, someone -- I won't say who -- knocked my laptop from the table I had delicately balanced it on the edge of.

Fuck.

I picked up my computer and opened it -- it froze. I turned it on -- only a white screen and lots of whirring. I assumed this could by related to it falling on the floor, and that likely this was a bad thing. Thinking quickly over everything I ever knew about computers I turned it on and off again six times and punched it twice. I turned it back on -- white screen.

Time to ask the internet, I thought. I googled my problem, "White screen of death," came up several times. I was hosed. Then there were some suggestions. Apparently holding down random combinations of keys while booting a computer up somehow communicates to it on a deeper level. Like saying, "OK -- I know you were acting broken, but now for real turn on because I don't want to go to the Apple store and spend over $1000 because I don't know what I'm doing."

On combination involved mashing 4-6 keys. The computer restarted 5 times. I let go of the keys, and it turned off. I turned it on again.

White screen -- of doom.

I shook it once, and slammed it gently on the table. The internet also suggested holding "C" while restarting the computer, presumably because "c" is for computer.

I held c, held my breath and restarted -- fixed.

The whole scenario makes complete sense. The computer broke because I knocked it off a table, and all I had to do was punch it, turn it off and on 20 times and hold "c" while turning it on.

Computer genius.

2010-08-30T11:17:00.002-04:00

Smells like Beck in here.

When I first moved back to Minnesota I was skeptical. But I've learned to love the place after some time here. Two wonderful safety-net hospitals, great music, vibrant immigrant communities, Al Franken and a bunch of fiery Dems and my two most-favorite hard-luck sports teams.

But lately things are looking worse. It's starting to smell a little like Beck in here. Tim Pawlenty an oily excuse for an afterbirth, much less a human being is encouraging laws decrease the amount of foreign languages spoken in Minnesota.

One backwards town has already passed an English-only law which mostly amounts only to a legal proclamation of xenophobia and racism. Luckily the throngs of immigrants hell-bent on cul-de-sac life in Lino Lakes have been headed off at the pass.

Anti-Islam sentiment is high here as well, and there are Tea Party movements on Minnesotan soil. Beck's recent perverse rally churned my stomach. What hurts more than the fact that MLK's niece is a bigoted idiot is seeing so many young people in attendance. Looking at national trends, one of the greatest hopes is the numbers games. Those against gay marriage are dying out. But misguided youth are falling back into the GOP co-opted Tea Party under the guise of some bogus new libertarian scheme.

I listened to Beck and listened hard, and his message seems two-fold. The first fold is that our country is going to shit, and we've been on the brink of an apocalyptic disaster that only he can predict. The second fold is that we need to bring America back to freedom. At face value he speaks like a libertarian. But inside that second fold is a third fold, and the third fold is purulent and ugly.

Beck wants a theocracy with deregulation and Christendom only, and it's alarming that so many of his followers want this too. True libertarians want nothing, and rich libertarians want to stay rich, and Glen Beck is a way of getting a bunch of simpletons to vote in favor of some thing that will have libertarian-esque tax policies.

America is founded on religious freedom. Yet there is this perverse movement to call Islam anti-American. We are supposedly a haven for freedom. The Tea Party movement is supposedly for freedom too -- but it propagates hatred and a mean-spirited drive toward Christian theocracy. The debate on the Muslim community center by the old WTC site shouldn't even be a debate, but because we had a low flu season last year and apparently idiocy is contagious, here again we have a debate. But for a debate to move forward you have to actually have an argument.

The craziest part of all of this is that the mere presence of democrats in congress has all these crazies foaming at the mouth. And even crazier than that is the sheer amount of crazy people who believe absolutely anything as long as it came from a slightly overweight guy who sort of looks like a plain-clothes Nazi.

2010-08-03T11:17:00.002-04:00

Career change.

Right now I am doing an Emergency Medicine rotation which brilliantly includes an ambulance ride-along as part of the curriculum. In St. Paul the first-responder ambulances are manned by the St. Paul Fire Dept, so the end result was that I got to hang out with real live firefighters.

I have always idolized firefighters. One of my favorite toys as a kid was a pseudo-remote control fire engine with flashing lights and sirens that when turned on made brave circles beneath the dining room table. They are a profession that really only seems to do good. They put out fires, they work as a team, they rescue people and they are known for liking dalmatians.

At the station my first question was -- can I also ride on the fire truck even though I'm here for the ambulance?

The answer was yes.

"I mean -- you never hope for fires," the captain started, "but if tonight is one of the nights that has a fire, I hope it's tonight so that we can get on on the engine."

From there it was a childhood dream filled. Every nozzle and lever was explained to me on the fire truck. The cooking rotation was explained to me. The different hoses were shown to me and explained. I got to see all the different axes and implements of destruction, I got to sit in the fire truck.

I slid down the fire pole -- which most fire stations totally have.

And then in the field the impossible happened -- the captain turned to me and said,

"You know, I'm not sure what is going on here, but do you think she needs to come into the hospital?"

It was like that seen in the movie where the pupil final bests the master. My first thought was "don't cry in public," and my second thought was:

"Yes -- she definitely does need to come in."

Retrospectively, of course I am more equipped to make meticulous medical decisions than firefighters. But these guys were so cool that I couldn't wrap my mind around them caring what I thought.

In between dispatch calls we hung out, ate lasagna and watched the baseball game and talked about blue collar stuff.

What I need to find is joint MD / firefighter residency program. That way I could learn to be the kind of doctor who specializes in also riding in fire trucks, eating lasagna and watching baseball.

2010-07-30T11:10:00.003-04:00

A stitch in time.

Bloody mouth, dirty mouth. Both verbally and literally. I made the mistake of asking what happened.

"I'm suing those fuckers, countersuing. That's it. You need to take pictures before you start sewing, I want the full treatment laser pictures and shit. Evidence. Those fuckers won't ..."

Dude chill! We don't have a camera. Your mouth is still going to look awful tomorrow, but it will have stitches so it wont look awful forever. Take pictures then.

"Fuck this, you can't, you just want to, stop shining that light on my face, fuck!"

Settle. I need to see your lip so I can repair it. I'm going to give you some numbing medicine. Close your eyes

"Don't tell me to close my eyes, I can."

As I advanced to needle to his rapidly flapping lips I realized this was going to be an ongoing problem. He smelled like a brewery. He had 4-8 teeth.

"Those fuckers knocked my teeth out -- well not all of them were new,"

Stop talking. I've got a needle in your mouth, you need to stop talking.

"You know, I've sued Kings county hospital, those fuckers,"

Sir, you're in Hope county stop talking.

"I want the name of every single ..."

Stop talking. When you talk your mouth moves. Your mouth that I am sewing. Your mouth that I have a needle inside of right now.

Silence. Then movement

Stop moving your head. Why are you so hyper? You're using again?

"No no, shit now, just been out and then those fuckers, I'm getting my three-grand back..."

Dude, stop talking!

2010-07-15T00:36:00.002-04:00

LVAD

First -- oh blog, I'm sorry I have forsaken thee.

Look at this little guy -- pretty slick eh?
It's called a Left-Ventricular-Assist-Device, or LVAD for short. The left ventricle is the moneymaker of the heart (hey don't tell the right ventricle!). It is the chamber in the mammalian heart that pumps the oxygenated blood from the legs throughout the whole body.

When a person's heart fails -- say, Dick Cheney's -- the heart no longer squeezes as it should. It fails to act as an efficient pump. The most common reason for heart failure in the US is that the heart has been starved from blood for too long. This is your old man's angina. Plugged up arteries starve the heart, it dies, begins to balloon out and fail.

LVADs are installed to buy people with severely failing hearts a year or two extra. Tops. It is a pump that sucks blood from the weakened left ventricle and squirts it right into the aorta. This is where my guit-happy story begins.

I saw in the news today that Dick Cheney is recovering from LVAD placement. This means that he is going to last 2 years max, and given his epic cardiac history, 2 years is a long shot. The take away from this is that he has an LVAD because he is not a transplant candidate any more than he is a presidential candidate.

Unless he's planning some FDR-Truman-inspired fiasco.

2010-04-17T12:50:00.002-04:00

Pressure ulcer.

As the Spring turns warm -- it is an excellent reason for medical students to get increasingly stressed out. The entire admissions process is bred to burst brain aneurysms. It turns a four-year undergraduate degree into an arduous screening program. Pre-meds are salmon swimming upstream, loaded with eggs and hope, and only a few make it.

Med school proper feigns support for the first two years, and then we are doomed to repeat our futile stressful lifestyle. So now as we are supposed to figure out what we want to do with our lives -- eg -- what type of doc -- it begins anew. I was asking a seasoned veteran for advice, what kinds of questions to anticipate when interviewing for residency, and she said the only question that took her by surprise was this:

"What is one time you had a conflict with your attending, and how did you resolve it?"

For those not in the system, an attending is our boss, the top of the foodchain, and we learn from an early age to do everything possible to avoid a conflict with an attending. If what the attending says is incorrect, we can at most helpfully suggest alternatives in the form of a question when no one else is watching, and more likely, modify the orders to the actual helpful therapy when the attending has left the room.

But the veteran said -- simply avoiding conflicts is not enough, they pushed for more dirt -- they wanted answers.

And I have one -- however -- most conflicts with attendings seem to boil down to pure craziness, as an actual real conflict is extremely easy to avoid as a good med student knows to live in fear of his (or her!) attending.

I had finished sewing a scalp laceration that was an excellent argument for wearing a bike helmet in itself. I had put on a bunch of bacitracin and was going to send my patient on her way, when my attending came by.

"Clay -- bring me a roll of gauze, a piece of tape and two cotton balls -- I'm going to show you how to do a correct head dressing."

The implication being here that antibiotic goo and hair was incorrect. Cotton balls are rarely needed as there are literally thousands of other dressings, swabs, bandages and wispy things that have capably taken their place. I went on my mission, gauze and tape in hand -- I asked one of the MAs (medical assistants -- overworked, amazing and underappreciated. Also a lot of them are cute) for cotton balls, and was given a handful.

"Clay -- I only need two cotton balls, bring the rest back to where you found them."

I obliged, dumping a wad of cotton balls in my lunch bag.

Back in action, my attending had succeeded in making my patient a mummy from the top of her head to her eyebrows. My suturing made the statement,

"Hey -- there's nothing wrong with this 24-year-old women, because the stitches are hidden by hair."

His dressing said:

"Please make sure this women does not have a seizure, and please don't date her."

Nonetheless, it was time to place the cotton balls. One behind each ear for comfort. The attending dropped one.

"Clay -- bring me more cotton balls."

I obliged. The scene had also attracted a small crowd of nurses, residents and MAs stifling laughter. I swallowed my own, placed the last cotton ball, and voilaá!

"Now that's a head dressing, Clay," the attending said.

My patient looked at me, and when the attending left the room, told me that the stitches kicked ass, and asked if she was OK to go out drinking tonight.

2010-03-22T11:47:00.002-04:00

Healthy.

This is not my last rant on the subject, but ... thanks Barack and Nancy -- this is only the beginning.

Abortion was already not federally funded. After months of bickering, it still isn't, but now we finally have some more healthcare. Much of the GOP's fundamental opposition to the healthcare reform is based on a libertarian ideal of the complete freedom to choose any damn thing. So where does that lie with the their simultaneous blanket support of women NOT being able to choose?

I don't care where people draw the line with a gooey blob of cells. Abortion is a toxic and unresolvable issue that will continue to camp out in a political no man's land. George Bush didn't take it away, and Obama didn't make it accessible. It is what it is, and forever will be, broken political promises amen. Anyone that thinks otherwise can continue to keep the posterboard, sharpies and yardstick business booming. What I do care about is the logical fallacy of digging up "freedom" as an argument against healthcare -- it's galvanized nearly half the country to kick and scream against having health insurance without realizing that they are that drunk wearing a lampshade.

Whatever the right says, insulin is a lot cheaper than a below-the-knee amputation complicated by pulmonary embolus, and taking your daily lisinopril and lipitor is a lot more pleasant than a stat trip to the cath lab that may be your last trip anywhere.

With healthcare reform these fucking idiots are in danger of living longer and better, and I hope that some day they'll take a minute and realize that what happened today was actually a good first step.

2010-03-14T03:47:00.002-04:00

Dough-faced hick with a five head.

The above state rep is proposing legislation in Kentucky that will actively make Kentucky -- a state we can all agree isn't populating the nation with nobel-prize-winners as it is -- even dumber.

The United States is a unique place where a frighteningly large amount of our elected officials actively oppose scientific progress and knowledge. The slack jawed idiot above wants to expand the fight against knowledge to include not only evolution but also climate change. This whole current is something I just don't understand. As the rest of the world surges forward, America is biting, kicking and scratching at the idea of thinking. Rather than having our schools controlled by actual scholars, they are tweaked by local politicians who answer to counties of TVdinner idiots.

As far as legislation like this is concerned, it isn't a problem as long as none of the cretins it produces ever come into positions of leadership or authority. Luckily genetics and schooling isoloate most people who think like this from a position of influence -- but scarily, enough of them -- tons of them -- squirm through the cracks into relative success and influence. Not to hearken back to that incredible Luke Wilson movie that Comedy Central almost never plays, but things like this are a scary misstep in the wrong direction.

2010-03-10T19:48:00.002-05:00

See balls, for free!

But not in like, a creepy illegal way. This guy has a house of balls, which you can see -- for free! Balls and sculptures -- like the one above. It's like if you made axman surplus into a house of art. He's been compared to Willy Wonka, and it all happens on March 20.

Info: here.

***

On an unrelated note, I learned today that agitated patients often get a lot less agitated when you speak to them in their language. This is not a metaphor, I wish it were. This guy's nursing home told us:

"He speaks Spanish or French or something -- but definitely not English."

French and Spanish speakers are exceptionally easy to come by, and there's generally no reason to disbelieve a patient's nursing home. However, this patient actually spoke Somali, and not any Spanish or French. He spoke Somali, because he is from Somalia, and he was agitated because some guys stuffed him in an ambulance to go somewhere and get poked with needles while people tried to explain what was happening in Spanish and French.

On a related note, I know what nursing home NOT to send my Grandma to.

2010-02-26T19:46:00.003-05:00

... if only those children were zombies ...

I wanted to write something about Tim Pawlenty, his idiotic dismantling of GAMC and bankrupting of HCMC. It came off a little too rant-y. But I'll say this. He's cutting the healthcare of 60,000, switching some 20,000 over to the more expensive and less comprehensive Minnesotacare and abandoning the other 40,000. Additionally he wants to build a staggering new facility to incarcerate sex offenders who haven't been caught yet.

It's as if he thought, one morning while he was filing his horns,

"I hate poor people, but I hate sex offenders even more."

This is a way to fuck both of them over -- but only one party will enjoy it. Get it -- pun. Kidding aside, a hundred-million dollar home for imaginary sex offenders does nothing to solve a problem. It actually creates the problem of paying for indefinite incarceration, another bill Pawlenty is trying to pass. Indefinitely locking up 10% of the sex offenders caught (most are much better at not being caught) does nothing for a problem, except be expensive. Therapy for sex offenders and regular follow up with their PO is a ton cheaper, and works okay. And in terms of whether or not it's worth sacrificing the best hospital in the region, and the safety new for all Minnesotans to lock up an additional 400 expensive perverts ...

I hope the hospital with the hands makes it.

2010-02-16T18:39:00.002-05:00

Stupid RSV.

I spent the last 6 weeks helping babies that can't breath, babies that cough and babies that sneeze. It was awesome. I've since moved on to working with sex offenders, perverts and peepers, and I miss the babies.

The babies gave me a lasting souvenir though -- the respiratory syncytial virus, RSV. I'm coughing, it hurts when I breath in, and my gums are itchy. RSV is just a cold for grownups, but for little ones it makes them so snotty that they can't clear their airways and they needed to be hospitalized, sucked out, and put on oxygen.

I'm much less of a baby than those babies, since all I did was stay home from my psych rotation at the Center for Sexual Health. Since I've been home today I made a cube out of magnets. I watched 3 episodes of the office, took a man bath, drank some tea, ate mad amounts of generic triscuits, and found out that I'm not the only one on the internet who gets itchy gums with colds.

I also found that there is no medical literature supporting this. The literature thinks that I have oral cancer -- but my whole life, my gums itch whenever I'm getting a cold. It's one of those things I can't wait to tell children and grandchildren -- itching gums, sickness comes.

... on ur face.

2010-01-28T23:38:00.002-05:00

A tattered paperback.

I don't have a lot of free-time. I've redefined my idea of a light week to 60 hours at the hospital rather than 80. I'm not looking for sympathy here, I've made my bed, and I love rolling around in it.

...

What I am looking for is a little understanding of why I've been reading a 202-page book since this summer, and am still a few pages shy of the halfway mark.

In case any free-time rears its lusty head, I've been toting Salinger's Franny and Zooey around in my messenger bag for the past six months. I'll read a couple pages here and there. This morning I noticed it's multiple battle scars while packing my lunch. I knew I wouldn't get to it today, so I took it out of my bag so that it may live for me to finish it.

A few hours later, J.D. Salinger died.

2010-01-16T23:52:00.003-05:00

Don't look inside.

It's a common story. A young lady, slightly obese, has high stress and intermittent belly pain. Belly pain is troubling, so is the stress and the two dovetail together until she decides:

enough.

So she comes in, argues her way into gallbladder surgery based on her family history, the fact that she is pretty charming, and the additional fact that gallbladders really aren't all that necessary. She gets scheduled for a laparoscopic cholecystectomy, and that is where I meet her.

Laparoscopic surgery is incredible. It seems just like what aliens would do to us if we were abducted. You poke a small hole into a patient's belly and inflate them with gas to give yourself room to work, and insert a camera through it. You then poke 3 to 4 more holes (more if needed) and insert long instruments through these. Cautery, sutures, clamps and needles all at the end of slender metal rods. From there the surgery becomes a video game. The coolest fucking video game ever. You glide over the liver, slide membranes out of the way, run loops of bowel over each other. You are the magic school bus.

We were inside our lady. Her belly distended from the carbon dioxide we'd inflated her with, the faint red light of our camera illuminated her skin from the inside out. We glanced at the span of her liver, and something was wrong. Large blue domes dotted the vista of her liver, each dome full of tangled blood vessels. There was something beautiful and alien about the landscape her liver created. Something dangerous. We poked one of the domes, nothing happened. It didn't yield. We took a picture. Then we took our her gallbladder. Then we thought about it some more and snipped out a piece of one of the domes and sent it to pathology for studies.

Four days later a note popped up in her chart -- her pathology was back. She had an aggressive small cell cancer, metastasized to her liver, and clinically probably less than one year to live.

And her belly still hurts.

2010-01-02T15:34:00.002-05:00

Zampfh!

Every morning the pediatrics team gets together and checks on all the patients assigned to our service. There are multiple teams and multiple services, and the time when the team plows through all its patients is known as rounds.

On the team it's my responsibility to know everything about my patients. How well they slept, pooped, farted and ate. What their birth was like, and if their second cousin has asthma -- that sort of thing. Then we present our patient to the big boss doctor in front of our team, and figure out a day-to-day plan.

Rounds is great when you present your own patient. You get to figure out what to do for the little guy, and you have the chance to make a decision that could change how / if the little guy gets better. But when you aren't listening to what will happen to your patient, rounds can be paralyzingly boring. In pediatrics, 80% of the patients have the same viral illness, which gets the same treatment, and 18/20ths of the time, you are not presenting.

This is when the mind wanders.

A lot of my team members are women with strong accents and soft voices, which is a perfect storm for tuning out. On top of that, pediatric floors are equipped with tropical fish tanks. Tropical fish tanks are wonderful things to stare blankly at when you are letting time pass.

One time, men came from an aquarium company and were putting new fish into the aquarium on the 6th floor. I watched them, little slivers of bright color and bug eyes bobbing in inflated plastic bags. The aquamen were rearranging coral, and adding new pieces.

Then, like in a dream, I heard,

"Ryan -- what is the significance behind the patient's abdominal pain?"

I can't believe the boss knows my name, I thought, and then, fuck!

2009-12-24T14:33:00.002-05:00

Man-play

I biked through the blizzard at 9 PM last night. Snow insulated all the sound. I heard snow shusshing around my bike tires and my treads whirring as I spun through powdery fresh snow, the only living thing outside at that moment. After meeting with friends and killing time with scrabble while snow filled in my lonely tire tracks, we went back out after midnight, once again the only living creatures outside. We walked across the frozen lake, snow up to our shins, unable to see across the lake. Everything around us was just a purple-white sheet.

Then we tackled the shit out of each other. For a few hours. Four grown-ups tearing ass across a frozen lake. We launched ourselves into each other. I was breathless, sweaty and in mild pain the entire time. It was exactly what I would have done in second grade in a blizzard except now I'm a hell of a lot bigger, stronger and faster. So are my buddies, which makes things interesting, rapid and painful.

In true little kid fashion we played until someone got hurt, apparently grown-ups do more damage.

Then we shushed back home through the snow.

2009-12-18T14:18:00.002-05:00

Vacay

I don't function outside the vortex of medical school. I am used to having zero time, which allows me to do -- anything -- during my free time. But with that removed (vacation) my motivation drops dangerously low.

With the exception of my motivation to watch entire seasons of sitcoms on Hulu.

It's a dangerous trap. I'll procrastinate activities I normally use to procrastinate, but it's all a farce because what I'm actually procrastinating will be something menial like buying new coffee.

2009-12-15T09:45:00.002-05:00

Snow emergency!

Snow plows are the coolest. My driving increases 50% in the winter to involve switching sides of the street to avoid the tow.

2009-12-12T22:55:00.002-05:00

Me and Sarah (sic) went to a dinner party. These things are happening more frequently because we are older, and established adults (parents) are starting to invite us to these things. I was a little excited for this one because I love my parents, love chasing the dog and like eating and drinking.

The goal was to welcome some relatively new neighbors and just enjoy each others' company. One couple brought their kids -- kids who are hilarious. But that was my problem. I'm good with dogs. I can rile a dog and unrile a dog when it's time to stop. With kids I can only rile them further. Or I can go into doctor mode -- but doctor mode only really works in a doctor's office. I can't bust out the white coat and stethoscope in the living room.

I started with my old favorite joke -- I told a four-year-old that my girlfriend was only three years old, and also that she is a robot. Sarah beeped and slumped over on cue. The kid laughed and gurgled. Kids have such impossibly big heads for their little bodies.

Anyhow -- this was the high point. The kids quickly realized that they could climb on us, and that this was the best thing to do. We tried to stop them. Their parents tried to stop them. Then something incredible happened -- all the other adults talked and drank and ate while Sarah and I found ourselves babysitting ...

For free.

The only thing that I do for free is school. I am paying to be at the hospital up to 80 hours a week -- anything else and best believe I'm charging by the hour. There was no escaping. We had been nominated childcare by quiet committee. Then my neighbors starting asking Sarah about whether we would get married. It was getting hot inside my head.

Then I heard a 7-year old girl whisper to Sarah that she thought that I was hot. It creeped me out. Sarah's eyes got wide like Graves' Disease as the little girl trotted over to me to tell me to my face that I was hot.

No book has prepared me for what to do in that situation. I had wanted to deactivate the children two hours ago, but now shit was getting real, and I still hadn't had a chance to enjoy my drink. Powerless to control the madness, the girl trotted from me to tell her mom how hot I was.

The girl's mom yelled. She yelled that it is inappropriate to talk that way about adults.

I took the child-free moment to enjoy a gulp of wine and feel uncomfortable.

2009-12-11T00:10:00.002-05:00

Free bacon -- you will pay

Look at the dumb bloke. In the past they did not know that free bacon and PBR would ever have any repercussions. It turns out that it does. I lost my Thursday morning and afternoon to free-bacon Wednesdays at the Triple Rock.

On their calender it simply says "Free bacon: 9 - 11 PM." I'm hella on vacation. I'm so on vacation that I have to parse out errands, one for each day, so that I feel like there is a greater purpose to my life. Wednesday I mailed a letter. Today I bought triple-A batteries. Tuesday I cleaned a bicycle. And so on. So, I am perfectly poised to take advantage of late-night bacon specials around the Twin Cities.

We slid into a booth, and a waitress took our order -- two PBR tall boys, keep the tab open.

"Do you boys want free bacon," she asked.

As if.

We got two baskets stuffed full of bacon. It was an opposite reality. Bacon, usually the limiting reagent was in surplus, and there was beer. We dug in, one basket of bacon per person, and it felt a little wrong, but oh so good.

But today my stomach was angry, hurt and confused. That was why, in addition to going to target to buy batteries, I also took between two and three naps today, because the burden of wakefulness made my stomach churn.

2009-12-07T18:20:00.003-05:00

Look what I made:

The old components looked like they'd been salvaged from the Titanic.
I got this mountain bike for my birthday when I was 14, and rode it for a good part of last winter when my main bike got stolen by some worthless, nutless waste-of-flesh-mouth-breathers. Anyhow, the frame was OK, and I noticed that riding something with big honkin' tires allowed me to keep the rubber side down a lot more than I was used to. My mix of poor attentiveness and icy surfaces had me writhing on the pavement more often than not last winter, so this winter I decided things would be different.

So now I have the beast to ride. All new parts except the rims, stem and frame. The old bike didn't really brake or go that well, but this bike goes and stops.

Luxury!

2009-11-26T22:59:00.002-05:00

Forgetful.

There is angry dementia and cute dementia. It's an awful disease -- progressive with no cure and no way to slow its progression. Dementia takes a tremendous emotional toll on the afflicted person's caregivers.

It marches on inexorably, and people can live on their own with cognitive decline for a long time until they fall below a threshold -- and that brings them into the hospital. The threshold seems sudden, but really it's a a marker of longstanding cumulative damage. There are warning signs. Spoiled veggies in the fridge. Poor hygiene. Bizarre phone calls. Previously controlled medical conditions spiral out of control with forgotten pills.

One of my patient's was in the hospital for just that reason -- he was just a pinch short on having enough functioning brain to care for himself -- other than that, he was okay, we just needed to hold him until his family figured out a safe place for him to live. In the mean time he developed really bothersome diarrhea. Diarrhea is bad enough, but when you're always confused, a little dizzy and very slow on your feet, that's when diarrhea is the worst. A quick peak at the guy's chart showed that he is lactose intolerant. An open box of frosted flakes and two empty milk cartons sat on his hospital tray.

"Sir," I said, "Do you have a hard time digesting milk maybe?"

"I suppose," my patient told me.

"Have you been drinking a lot of milk here?" I asked.

"I have," he said. "I've had more diarrhea than I have ever had in my life."

That was the first medical mystery I solved. I told his nurse, phoned nutrition, and wrote an additional note in his chart instructing providers to read his chart and not give him any more milk.

The next day I rounded before breakfast and intercepted two more milks before my patient had a change to give himself diarrhea.

One of his doctors ordered a screening test for an intestinal infection.

I asked his nurse to block any dairy from entering his room. And then I felt like I accomplished something.

2009-11-23T08:25:00.002-05:00

Batman gloves.

Minnesota has more of a "pre-winter" season than a fall proper -- but pre-winter is still mild compared with the real thing. Winter requires windproof lobster gloves, alpine mittens and gear that looks like it was made with technology. During pre-winter you can still wear clothing that looks relatively normal and not freeze your important parts off from exposure.

My favorite gloves for pre winter are the thin stretchy gloves for robbers and kindergartners at the bus stop. They aren't really made for adults anymore at target, but the ones in the kids aisle stretch to fit all hands. Being in the kids aisle, I had my choice between girl colors, Dora the Explorer, Batman, some other superheros and a few Japanese cartoon things. I picked Batman.

Yesterday I was ungloving at the coop to bag and buy a pound of sweet precious coffee. After checking out I realized I down one batman woolly.

"Whoever lost their batman glove, please come pick it up at customer service," the PA chirped. "Again, whoever lost their batman glove -- we have it at customer service.

I trotted over to customer service, wearing one batman glove.

2009-11-18T19:21:00.003-05:00

Greenway'd

Minneapolis developed a bike highway some years back, paving over an old rail line to make a direct East-West cut across the metro for bikers, they called it the Greenway, and the deemed it good.

It was sort of good -- it's also sort of bad -- really bad. It turns out when you make a 5.5 mile corridor of unpoliced poorly-lit public land, you get 5.5 miles of assault and mugging. Worthless fucks have been toppling late night commuters off their bikes for the past few years, and in a state where the sun rises at 8AM and sets promptly at 4PM, it's pretty fucking difficult to avoid riding in the dark, and because the city is too incompetent to do anything, bike commuters take the hit. On the road we're already worrying about every Joe Cholesterol behind the wheel gunning for us, and now there are idiot kids with nothing to lose trying to mug bike commuters. Ridiculous.

The city put in some lights, the police urged cyclists to avoid using the highway made specifically for bicycles. That's it, call it a day. Policing enough to deter crime is too costly because it technically isn't a road. Lack of motor vehicle access sites makes rapid police response nearly impossible from a number of areas, and the design and lighting of the bikeway has a few natural hideouts for would-be assailants.

Last week this kid died trying to mug someone who stabbed the kid in self defense and fled to the greenway. It's horrible. I'm not rooting for the bad guy here -- I just don't think he ought to die. When people are packing weapons in self-defense, the public works have failed. Minneapolis needs to pull its head out of its ass and do something.

So fast forward to yesterday when a group of idiots release a video of themselves assaulting bikers on the Greenway. It's a group of kids who identify themselves by face and name in the video on youtube, and then taped themselves pushing strangers off bikes and loaded it on to the internet. It's one of those things where you figure that natural selection will deal with idiots like this deftly and justly, but it's still absolutely maddening. These are the fuckers who come into the hospitals for acute help because they did something idiotic, and these are the same assholes fucking with me on my ride home from work.

I feel like I need some sort of medic badge, don't mug me, I'm a friendly, something to identify that taking me down is in bad taste since I'm one of the people who will eventually prop them back up.

Anyways, here's the video -- youtube keeps taking it down because of evidence, or investigation or some shit, and probably to protect the identities of the kids who put it up since now a group of them are in custody and being investigated. Mercifully, a lot of those fuckers are over 18, so if this does go to trial, they can get justly and properly fucked over. So watch the video. Feel angry. Feel invaded, and show it to all of your friends. If anyone deserves to have their identities spread and smeared, it's these assholes. When you have people with minor drug charges and cleaned up alcoholics stuck in unemployment because of ridiculous criminal background protocol, these kids deserve every roadblock and hurdle to happiness that our fucked country can through at them. They are taking glee in directly causing others misery. Fucked.

The real yeast of the matter is that Minneapolis is too much of a pussy to do a fucking thing about it without a victim coming forward. Police state that possible victims do not have visual ID of the assailants. Minneapolis doesn't have the balls to prosecute clearly identified men committing crimes on public land for the sake of public safety and basic human rights. They still haven't done a thing to clean up the situation around the Greenway, yet they've dumped money into redesigning large stretches of down town to make them less safe for bikers and pedestrians. It's not fair. Statistics show that most people will die from heart attack or stroke, but my biggest risk factor is getting creamed by one of those fat fucks in their car.

This whole situation makes me so fucking mad I just devolve into expletives and gibberish.

All I want is to not get mugged on my way home from work. I hate feeling paranoid on the way home. There's a lot of really boring studies in psychiatry that say that constant paranoia is not healthy.

God. Fuck. Damn. Shit. Cunt.

I'm so mad, I'm c-word mad.

2009-11-14T12:24:00.001-05:00

Pains of pooping.

General surgery taught me one poignant message -- trouble-free pooping is never something be taken lightly. The tortuous gooey journey food takes from the mouth to the anus is fraught with peril. The human alimentary canal (also known as the poop factory) can be up to 30 feet long in a normal human. Within that 30 feet anything goes. It can bunch up, pinch off, knot up, swell, shrivel, burst, bleed, telescope in on itself, detach, reattach, and erode.

A lot of these problems warrant surgery. If someone starts pissing air (pneumaturia) it means a hole has worn through their colon and bladder. Same goes for someone pissing poo (fecaluria -- you get the idea). Some of these problems happen because of a reckless lifestyle, but often people's bowels just turn against them. In a squishy revolt a colon will start wearing holes in itself and bleeding. The answer can be to remove it, connect the small intestine to the butt, bunching it up at the end with staples to make a new rectum. This new answer works OK, but it can get infected, and even if everything goes according to plan it leaves the patient with 6 - 8 poops per day that are the consistency of oatmeal on a good day.

So this is why we pester our patients about poop from post-op day one. Every morning I wake my patients and asked if they've pooped yet, or farted. Farting is a harbinger of poo, and is a good sign.

"Gas is music to our ears," we tell our patients.

When one of my patients had his first poop with his newly revamped colon post-op day 4, I stopped by and said,

"I've heard the good news sir -- two poops, amazing."

Poop means we can start a patient on solid food, it means that they are one step closer to getting out of the hospital. I've always thought pooping is hilarious and awesome, and now it is my professional duty (heh) to hassle patients about their movements. Surgery is the best.

2009-11-06T16:18:00.002-05:00

Used to be cool

Parent's photo albums are incriminating. Disco clothes, tight pants and shoulder pads are enough on their own, but there are the pictures of friends, bystanders. People who you can point to, say,

"Who's that?"

And spark a jog down memory lane with that one couple they always did Jager shots with before hitting the bars. A picture of a beach and Aztec pyramids syncs with a night of doing tequila shots out of the bottle in a limbo line. A picture of Dad and his band.

This stuff is enough for a teen to gather, and in a fit of frustration, scream,

"Gawd -- you used to be cool, Dad."

Door, slam.

Puberty.

Looking back in it, though, everyone gradually makes a transition from someone who is cool, to someone who used to be cool. The transition seems to occur sometime in the late 20s to early 30s, it usually precedes the first child, or happens during the first child's decade. I've never known how it would happen, and never given much thought to it. But today, I think, I started down the path of "used to be cool."

Chances are I'm already pretty far down that path.

Looking back at the past month, I've been going to bed before 11, I tend to fall asleep whenever I'm reclined for more than two and a half minutes, and today, to celebrate finishing the most brutal test I've ever taken, I drowned my sorrows in french fries (two orders) and then went to the library to check out neurology books.

The library.

Stress eating may be more healthy than stress drinking. As some (doctors, peers, women) may call me underweight, stress eating could be a blessing in disguise.

But it just sounds so damn lame. And the library of all places? People are supposed to smoke cigarettes, drink whiskey, fuck and shoot guns.

So, in some future, 25 will be the cut in the photos where my punk ass kid can look back and say, shit, Dad -- you used to be cool.

2009-10-23T17:39:00.002-04:00

CH4

Freedom is a gift and a curse.

Each kind of freedom carries different implications. Naturally there are many different kinds of freedoms -- just ask John Locke -- or John Denver (both dead).

The freedom I have been pondering is the freedom of free food.

The hospital where I am doing my surgery rotation feeds its students and residents for free. We are politely asked to keep each meal under $8, but this is not enforced. and more importantly, there is no policy for what constitutes a proper amount of meals.

I'm very close with the cashier who works while I usually sprint to the cafeteria between cases for second breakfast. But all this free food comes at a price. Not the price that it actually costs the hospital, but rather the price of methane.

There is something about the cafeteria food -- it all looks different. Each item has a different flavor, different concentrations of spices and salt, mostly salt. But absolutely every menu item has the fart-inducing power of 10 fat men after an afternoon at the Old Country Buffet.

All-you-can-eat will always be different than all-you-should-eat.

So as we leave a meal full of energy, spunk and farts, we carry those farts everywhere we go. Farts, being gaseous, are light as a feather, but perversely, little is as difficult as carrying a fart for a long time. Rounding on patients leaves numerous stairwells, corners and nursing stations were farts can be rapidly and discretely deposited. But the operating room is a horse of a more trying color.

In the OR there is the attending doctor, me, the resident and the scrub tech. That is only four people in close quarters, and a steady jet of farts will not go unnoticed as operating rooms usually smell like, well, nothing.

Moments to release farts in the OR are few and glorious, and you need to be alert and gaseous to make the most of them. There are the precious few minutes of open bowel when intestines are being hooked back together. It's a ticket to fartville, express train. The other time is for the discerning fartist. The cautery smell of burning hair and fat can neutralize a fart, but the fart must be precisely matched to the duration of cautery. Under-estimation can result in embarrassment, and possibly ejection from the OR.

Med students produce future doctors, and copious methane.

2009-10-16T23:21:00.003-04:00

Sewing class.

"Being a surgeon is great," this surgeon was telling me, "you get to joke around, and you don't get to go to the bathroom."

Another surgeon told one of my friends that once living human is cut open, you really can't leave until the job is done. Surgeons have big bladders. They don't get diarrhea. Also, a lot of them watch Fox News, which really, is the only thing that makes me raise an eyebrow when thinking about whether to pursue surgery.

The beginning of med school the baby you. Some lady sends two to three emails a week asking if we're okay, and instructing us to call her the minute we feel sad. We have tutors, professors respond to any emails, and most give us their phone numbers. The idea being, once you're in -- you're in. But with rotations begins the trial by fire. It's still nothing compared to residency, but while hours to study dwindle, the studying itself becomes largely motivated by fear.

Take suturing for instance. Regardless of what happens inside someone during a surgery, assuming everything works how it should, the only lasting memory a patient will have of surgery is the scar. They won't be able to see the incredible rejoining of cut intestines or arterial bypasses, rather they will just see those shriveled ghost lines. Old scalpel entry points.

There is a good chance those scars were made by medical students. During surgery we help hold open incisions, cutting sutures and occasionally tying off this or that and sucking up goop and blood. But in terms of mucking around in a wound, we only close skin, since the actual surgery needs to go well, but nobody ever died of four amateur stitches in the belly.

That said, my first time stitching a human, my glasses started sliding down my sweaty nose. I couldn't see the suture end through my fogging glasses. It was a disaster. I stitched at 1/16 the speed of the resident. So from there we practice. We practice so that we don't give real live humans ugly scars. And we practice on pigs feet, because they are the cheapest thing you can buy that has skin and isn't illegal. So I spend Sundays watching football, making lacerations and sewing up pigs feet so that on Monday I can make tiny scars instead of big scars. Approximate -- don't strangulate!

Today the patient woke up about 5 minutes earlier than one would hope. After two hours of struggling to breath and sweat less (mind over autonomics) I finally had the glasses fogging situation under control when the belly I was suturing started convulsing with coughs.

"Alright, you're just waking up now sir," the nurse anesthetist said in her Minnesota drawl, "your surgery is all done now."

The patient moaned and reached to swat me away.

FUCK. The nurse was full of lies. The surgery was done, but the patient's skin was still open.

Something like this doesn't matter as much as it seems. The patient won't remember anything. The important stuff was already closed, we were only suturing skin. The patient instantly got enough IV happy medicine to calm down a little bit. But being swatted and sewing something wriggly and moaning is fucking stressful. As this was not a situation I had studied for or really had any notion of, I froze and looked to see what the resident was doing. Did he stop sewing? Did he have a look of panic in his eyes? He was suturing like something possessed.

I put my head down and dug my needle in.

2009-09-26T18:11:00.002-04:00

It's my squishy, and I love it.

There are certain things we get to do in medical school that would be frowned upon in other fields. Not only frowned upon, but illegal and downright bizarre. In human anatomy you get a tactile feel for the difference between a nerve, tendon and artery. This is a skill that is not applicable unless you're career will carry you inside living breathing humans -- and medicine -- for better or worse -- does this from time to time. Some would argue it does this too often.

Splitting hairs is nothing more than that, and for our exploration of the innervation of the head and neck we had to come in from behind the skull and neck, remove the spinal cord and wedge the skull forard from the vertebral column so we can see the anatomy of the space between the spine and pharynx. The pharynx is great, it lets us swallow, eat, and shoot milk out our nose when taken by surprise.

I had my students get a feel for the spinal cord, the mother of all nerves. It has a texture a lot like a superball. Squishy but firm, and fills the spinal canal like crab meat sitting in a leg.

"It's weird," one student told me, spinal cord between her thumb and index finger, "that something so weird and squishy is so fucking important."

That -- is learning.

2009-09-16T18:59:00.004-04:00

Snap crackle scrape.

I'm good for about one major bike wreck per year. I tend to prioritize top speed over general awareness of my surroundings -- and that's gotten me into trouble a few times. It's also one of the reasons I love my helmet -- and one of the reasons I'm down one helmet, lots of skin, a fair amount of blood and a working right shoulder.

A good wreck is instantaneous. Time doesn't slow, rather, there is no time. There is an instant transition from happily spinning through the night to meeting pavement, face on. Someone left a cone where the shouldn't, or rather, Minneapolis set a bicycle trap, and it caught me.

I peeled myself off 3rd avenue, and slunk home, a twisted bloody mess. Handlebars twisted, streams of blood framing my vision. I stuck a paper towel to my face, noticed I couldn't move my arm, checked in the mirror for a blown pupil and fell asleep on the couch. Dealing with these injuries was a job for the Ryan of tomorrow -- Future Ryan!

Not the first time I've dicked over Future Ryan -- it's usually with small stuff like credit card bills or hangovers. This time Future Ryan woke up bleeding from the head, unable to lift his right arm and in crushing pain. I drove to urgent care.

Some X-rays, bandages and stitches to the head later, I started off anatomy lab by making my students diagnose me based on my X-rays (which I brought to class). So it warmed my heart when most of my students nailed the diagnosis. Only 6 weeks into med school, and already radiology whizzes.

Sarah tried to take care of me. I'm momentarily grounded from bike riding. Dependent on the MTC 2 bus -- the slowest and awfullest way between point A and B. The 2's passengers sit there like 400-pound gumdrops, stuck to their seats, muttering. It's full of people like that, and of the angry cripples -- like me.

This morning, I tried to dress myself -- surprisingly difficult when you can't raise one arm. I walked my right hand up the wall, dragging my arm behind it, and wriggled into a shirt, grunting more than Don Draper on a Saturday morning. I can still dress myself -- but this is closer than I'd like to the other side. The side of adult diapers and personal care assistants. That side is no place for me thank you very much.

My stitches itch like hell.

2009-09-03T10:23:00.002-04:00

Safety lectures.

Right now I am a teaching assistant for the new medical students' anatomy course. It's one of the elective rotations we can sign up for in medical school, and it is absolutely incredible. It gives us a complete anatomical review when we are actually equipped to understand how the whole body works and does not work. Unlike anataomy the first go-round, we actually have a context for all these various bits and pieces of the body. In addition to being a great review, it allows us to teach, something that is rare for those at the very bottom-most-bottom of the totem pole. And, we have five rooms full of fresh, wide-eyed, impressionable medical students which is priceless. I'm hoping amongst other things that my entire room will trade in their cars for bicycles -- which so far has gone fairly well. I've seen tons of my students biking into campus.

But then one day on a run I saw one of my students biking home with no helmet on. Medical school is a particularly volatile environment for risky behavior. Some risky behaviors are promoted -- such as drinking to excess. But others are viciously shunned -- cigarette smoking and non-helmeted bicycling among these. Perhaps cigarettes are a little more harshly spurned, but as a past non-helmet wearer, I've felt the harsh judgment of my peers many times before. After enough spills in the winter, however, I grew to love my Styrofoam hat, and now the two of us are inseparable.

Medical school is damn expensive, and damn time-consuming. Most everyone is living on loans, and there isn't enough free time to spend the money that you do not have. The sole thing that medical students spend ridiculous amounts of ca$h on, every day, are their big wrinkly brains. So it stands to reason that they ought to protect them. No huffing, no joining the GOP, and most of all -- wear a damn bicycle helmet.

The day following my discovery of my student biking un-helmeted I greeted my class the next day, telling them that I wanted just a few minutes to talk about bike safety.

"I don't want to name any names -- David -- but I saw one of your peers bicycling without a helmet."

Then I told them my spiel about spending money on their precious brains and then threatened them with five extra minutes of additional bike safety lectures for each time I catch a medical student without a helmet. This was a very real threat since lectures run long and dissection time is scarce. It's like threatening a librarian with impending disorder -- it works -- David started wearing a helmet, and I had my lab applaud him for it.

Yesterday morning I saw another of my students, pants rolled up, sweaty, and asked about his bike commute. His guilty face -- but moreso his perfectly gelled hair betrayed his un-helmeted ways. Busted.

I began lab by telling the tables that they may notice the handouts around the room diagramming proper bicycle helmet use. Then we started our first of what could be many bicycle safety lectures. I told them how to style their hair after a bike ride, gave them tips on what to do with a helmet if they're going to da' club. Pulled the recent offending student in front of the class and we demonstrated proper helmet technique. I gave statistics on helmets.

Most cycle fatalities happen to sober males, over 16 years of age, riding in summer, at a busy intersection in an urban area during dusk.

"Mike is all of those things -- except dusk," I told the class. And then Tyler and I, (the other TA) instated a helmet law in our lab. Several states and Australia have them, and now so does room 155.

2009-08-21T21:40:00.002-04:00

Tornado'd!

Tornadoes like rural areas. Like the elderly, they hearken back to a simpler time when fabric was rough and life was grainy. Usually you can assume safety living in an urban area, nearly enough to challenge the heavens -- tornado me you cloudy hillbilly!

And then, last Wednesday, the heavens listened and tornado'd the shit out of my apartment and girlfriend. I was in anatomy lab working with one living and nine deceased, while my girlfriend was pounded into the wall by miscreant winds.

The building shook, dust swirled in kitchen, falling from the ceiling as the sky peeled my roof back like a sardine tin, scattering bricks across our deck, moving 100-year-old trees, and giving me a new view of the interchange and metrodome across town.

I got home from lab to see our apartment wrapped in yellow tape. Tape I have broken through each day, and tape that is mysteriously repaired each day. A gutter was wedged against our rear door, and yellow tape was added as an afterthought. Neighbor's milled in the parking lot, sorting through the downed trees and bricks.

We got rubble, yeah you know us.

2009-08-18T01:56:00.003-04:00

Brooklyn zoo.

This is a pretty good summary of my trip to visit friend in new york city. That place moves. I never go there with a plan, I just go there with nervous energy, and this crazy synergy happens, and once again all is right in the universe.

And things that never occur to you in other places, for one reason or the other, seem like exactly the best thing to do on a very public, and very viewable roof deck. All the world is not really a stage, but really, this deck was.

So, we had some drinks, tried on a B-boy stance, and then Black Santa beat up this unicorn that was totally asking for it.

2009-08-02T20:06:00.003-04:00

The world gets a little cheaper when you're over 55 years old. It's a nod to simpler times -- when a metrocard cost $1, or hell, before metrocards even existed and coins were turned into tokens.

Nonetheless, things are cheaper -- it eases people into their twilight, and is the first birthday that means something after turning 21 years old. Between 21 and 55, there are no real milestones, but at age 55 you can order the senior special at Perkins, and by God, that must count for something in these awful times.

My grandpa adamantly refused to accept a senior special as long as he breathed this northern air. He coaxed a handful of hairs to cover his head, he drove a convertible, and he still went hiking in the rocky mountains even after some new parts and a pacemaker. The guy clung tenaciously to his youth, spat in age's face, yet always classy. I liked it. It drove my mom bonkers (why would you ever not accept free discounts!), and my dad thought it was sort of cool, that Scandinavian stubbornness defying time himself.

Grandpa divided up his last half year between the hospital and a rehabilitation nursing home, and as such was unable to drive. His car is a gold two-door plush Acura Legend, leather and loaded with a killer stereo. Grandpa didn't fuck around. He was by no means extravagant, but he wanted his everyday things to be exactly what he wanted, and so they were.

I defy the seasons with my inherited stubbornness. I bike everywhere, and every time, and this gave my grandma various pictures of me splattered on the grill of a truck, and also images of me never landing a girl, since this imaginary lady would have to sit on my handlebars all the time. So she combined forces with my parents to force me to borrow grandpa's car while he recuperated. It turned out to be a perfect match. The car bears some scars -- dings and dents from Grandpa's clumsy navigation in his later years. It's a killer grocery-getter, a great way to haul items and people, and it's my first car. I log 95% of my miles by bicycle, but there are some times that a car comes in handy.

While I was borrowing his car, Grandpa died, and Grandma asked if I wanted the car, strongly suggesting that my answer ought to be "yes." So now I have it, and I love it. A reminder of Chuck in the parking lot, carrying me near and far.

Grandpa's cane is in the trunk, and that's where it's going to stay, going wherever the car takes me.

2009-07-31T06:36:00.005-04:00

Drainage.

After we make big cuts, a lot of times docs put in surgical drains to encourage a wound, infection or incision to heal. The drain looks like a big floppy perforated rectangle connected to clear plastic tubing. The rectangle part gets buried in the wound while the tubing connects to a small clear plastic bowl that looks like a grenade. The plastic grenade then holds suction, whisking secretions from the wound into its belly, keeping the wound from backing up with goop, allowing it to knit back together.

Patients with long and complicated hospital stays can measure their progress by the tubes we pull out of them. Breathing tubes, chest tubes, IVs, central lines, wound drains -- the goal is to once again become a tubeless human. To wear something other than a gown and not have plastic tubing sticking out of various places.

So, when we pull tubes out, each removed tube is one tick closer to freedom -- to being better and to going home.

This is where I come in.

As a wide-eyed new member of the hospital team, grossly incompetent and largely incontinent, medical students don't get to do a whole lot when they first start. My job is picking out stitches and pulling drains. Pulling drains is satisfying, like popping a zit. The butt of the drain is slightly wider than the incision, so you have to really yank the thing, and then with one big whoosh you have a squirt of bloody goop, the drain pops out and you pop some gauze and tape on the wound.

End scene.

I pulled two drains today, the first went -- painfully. But I was better by the second, and I got a smile and a handshake.

The patient knew that with one drain out, he was minus-one-tube closer to freedom.

2009-07-25T17:53:00.002-04:00

Butt-face

Chewing tobacco is a bad thing to chew, it turns out.

We explained the procedure to the patient. We needed to take as much of the cancer out as possible to give him the best change for a cure.

This means cutting out over half of your tongue, the long way. We'll then open up your neck to take out all the lymph nodes to see if the cancer has spread to them. Then we'll take a section of tissue from your forearm, including all the subcutaneous tissue, sweat and oil glands, and all their blood vessels.

We'll use this tissue to reconstruct your tongue, and connect the vessels to arteries and veins in your neck and mouth. Then we'll take a thin section of skin in your thigh to patch up the hole we made in your arm. Finally we'll slap a banage on your thigh so it can heal on its own.

And we'll also stick a trachea tube in your neck, because your new tongue may swell enough while you're healing to block you're airway, so when you wake up, you won't be able to talk -- any questions?

The patient sighed, looked at us and said,

"Well, at least they're not making it out of my ass."

2009-07-12T21:21:00.005-04:00

Hoisting petards.

My last post -- see below -- I focused an unwarranted amount of vitriol against this poor girl, Rachel. She may or may not be a poor girl. Truth is, I don't really know a damn thing about her other than this:

She is tall (or was 10 years ago, in high school)
She could be Jewish
She is pro-life

I know that she is pro-life from the facebook, which was the whole reason I unfriended her. Then I wrote a nasty blog about her, delighted to have had a reason to unfriend someone (tired of receiving pro-life updates) and happy to vent on someone who, to me, is completely anonymous. So many great stories unfold in my life that I swallow and anonymize. I can't write about memorable patient encounters right now because with my limited experience, so far, the magic of patient encounters lies in the details and minutia. Those are the same details and minutia that can get my ass sued if write them for the general public.

Then, I'm also trying to be a doctor. The fact that I need to be presentable to national residency programs as a "good idea" makes a number of other stories dead at the gate. There are exes, flings, trists, walk-ins and drama that are all incredible, amazing and hilarious. But they're filed away for the future, when writing them won't get me ass in trouble or make going to the grocery store a living hell.

So, when I had one poor anonymous soul that I could vent all that pent up misanthropism on, I painted on my best dark smile and had at it. And don't regret a thing. Here was somone completely anonymous to me. Someone who, if they confronted me, I would defend myself, state that I neither know or care about her, and whistle dixie on my way.

Then I ran into her at dinner. Some girl I didn't know said my name and stood over her. My mind was occupied with making my girlfriend's family like me, so I ignored this girl I didn't recognize who was saying my name, figuring it was for some other Ryan. It's a common name.

It happened again, I half pretened a smile, said "hi," and stared blankly, waiting for a cue.

"Rachel, remember?"

I didn't.

"Sure!" I said.

Then I did remember. I remembered I had just written something nasy and mean-spirited about some girl named Rachel I didn't know.

Instantly, I was covered in sweat. Did she read it? Did she care? I'll cause a scene, I thought to myself. I'll defened the fuck out of myself. Impressions on girlfriend's families can wait, I've got unfinished business.

While my mind toched through possibilities, I stared blankly. Maybe drooling just a little.

"They have good burgers here," Rachel said, "nice seeing you."

She pointed to some guy with a beard, who smiled or something and she said something -- I wasn't really paying attention, and like that it was all over.

The '90s sure are a fucking crazy time.

2009-07-07T21:01:00.002-04:00

Un-friend'd!

I don't friend people will-nilly. In fact, you can count the number of times I've friended anyone on a drunk carpenter's paw.

I let people friend me, and after an aggressive vetting process, I accept. Or if I'm befuddled and need to accept to figure out who the bejesus this freak is, then I'll also accept.

Mark Zuckerberg's endless stream of gibberish updates has given me a window to the soul of depraved long-lost acquaintances, and more often than not, after a stream of updates, their remote e-idiocy pushes me over the edge. I have an even shorter temper for the conservatives, and the shortest temper for the vocal conservatives.

So, after the umpteenth update about being pro-life and having e-baby bumper stickers, Rachel Hill, consider your ass unfriended. I barely knew you in the first place, and am delighted I don't know you now.

2009-06-27T18:50:00.003-04:00

Swine flu.

Yeah -- 102.6° -- my body made that awful temperature, and it's no big deal. But let's not start there, let's start at the beginning. Let's go back to 99.7°. Not technically a fever at all -- but something for me, since I usually run cold anyhow.

It was late, I'd just finished my first day of clinic, and gone for a long run around the lakes. Stuff my face, cold shower -- bed -- and hopes to repeat. Children screaming woke me at midnights -- omens of tomorrow, a day when I'm scheduled to only take children as patients. But something wasn't right. These screams were aggressive. And even though I wanted to shout out the window like a crank, I was too cold to leave the covers. I was shivering. And sweating.

Only the sweating made since, it was still in the 80s even though the sun had gone down hours ago. Nothing clicked in my brain, so I lay in bed, happily shivering under my down comforter in the summer heat, listening to children screaming across the street.

The screams died down, and my brain fizzled in fits and starts. after a few hours of this, I took my temperature. It was 4 AM.

The morning was hell. Nothing worked. My brain wouldn't think. My legs wouldn't walk normally, my eyes wouldn't focus, my lungs wouldn't breathe. I took two aspirin, packed a lunch and headed into clinic. Clinic was a blur of children, incompetency and profuse sweating. Luckily it was a half day. By the end I knew I was fucked. I went home, napped, woke up and took my temperature -- 102.6° -- no wonder I couldn't think, bike, walk, stand -- do anything. I felt like I was operating my body with a clunky soviet-era remote control. I staggered around the apartment, sweating, hurting and coughing. Vaguely I thought that maybe I shouldn't see patients tomorrow.

I packed some dress clothes in case I had a change of heart, called the clinic apologizing for my immune system, and hit the interstate, trying to get to my parents house, thinking, if I die in my sleep, I'd at least like to be found the next day rather than discovered a week later by my neighbor Jerry because of the stench ...

"Medical student dies before his time, complications of H1N1" the headline said -- I shouldn't have eaten that bacon. I don't care what the CDC says about transmission of swine flu -- the bacon didn't help.

At my parents, I was safe -- for the time being. I loaded up on over-the-counter medications and started drinking cold delicious things like water, diet coke, cranberry juice and gatorade. Sweet, sweet gatorade -- so far advanced beyond puny water.

I crawled into bed -- curled in fetal position. Hot breath. Shakes. Sweats. Waiting for something to happen. Bizzarre fever dreams with crests, numerology -- stages of 12 and a need to traverse something. Waking only brought more of the same rude nonsense. Finally I staggered to the medicine cabinet. More pills and a change of scenery. The basement.

Rest.

Now, this is why people hate being sick. I'm finally done with chills and spiking fevers, and I still feel awful. I hadn't been sick like that since I was an eight-year-old. But unlike me as an eight-year-old, I have all the fun toys and knowledge-induced hypochondria of medical school. I regular listened to my lungs, stethoscope slung around my back. Charted my temperatures highs and lows. Did literature searches, reviewed H1N1 protocol, made a differential and narrowed down based on symptoms, patterns and durations.

And in the end, it eventually went away on its own, as silently as it came, leaving me a waxy shell of a man. Lethargic, downtrodden, moral low.

... but alive.

2009-06-22T17:32:00.002-04:00

Hermit crabs are fucking stupid.

My roommate is a grade school teacher. And a good grade school teacher from what I can surmise. Anyhow, as any good grade school teacher, her room has a few pets. But because our nations children grow ever more anemic, wheezy and atopic with ever new generation all creatures furry and creeping are banned from the classroom.

As are balloons (latex) and delicious food (anything that has touched / intermingled with peanuts).

So, this is where you have to get crafty.

Roommate introduced Herman, the Siamese Fighting Fish (beta, being the PC term) and he heroically fought through the entire school year, only to pass on to that great tiny fishbowl in the sky within the last weeks of school.

Roommate's classroom also has two to three of the lamest fucking pets ever -- hermit crabs -- and because these crabs did not die, they will be summering with us. And because my roommates are currently on my vacation, they are my responsibility.

Now, I'm not mad because of the responsibility. We have plants, and I feel like plants are both more difficult to keep alive and infinitely more rewarding than hermit crabs. I just thing hermit crabs are the worst animal ever. Here is a list of why hermit crabs are fucking stupid.

1. They don't even have their own shell, they borrow shells from snails and other animals that do not suck, unlike hermit crabs.

2. They don't move. A dead hermit crab and a living hermit crab look and smell exactly the same.

3. They bury themselves in the sand. So even if, on the off chance, one was going to do something remotely interesting, no one would know, because it is fucking underground.

4. As a young wide-eyed youth, I wanted pet hermit crabs, and my mom never let me. Now that I finally have the change 20-odd-years later, I see what she meant. Her main reason was a fear that they would die and smell.

Well, those fuckers smell bad anyways, and still have yet to come above ground, so on the hermit crab issue:

Mom - 1, Me - 0

2009-06-01T12:18:00.001-04:00

Buyer's remorse.

Like anyone else with half a brain, I'll bet GM sure regrets buying that Hummer in 1999.

2009-05-26T22:15:00.002-04:00

Brain my damage.

There are a number of ways to assess brain damage in adults, and one way is by the appearance of what are called "primitive reflexes." These are specific reflexes shared by healthy infants that generally go away by one year of age, and reappear later in life if you have a coma, a stroke, a traumatic brain injury or other brain disease.

One of these reflexes is called the "Babinski sign," and refers to the big to sticking up if you scrape something pointy along the edge of some poor guy's foot. Or a baby's foot. Not too exciting. But the next reflex, the "moro reflex" involves startling a baby. Or a grown up suspected of brain damage. The patient throws its limbs out, and voila -- the moro reflex.

The most important reflex is the "rooting refelx." This defines nipple-seeking behavior. So, if you stick a baby in a pair of boobies, it will go for the nipple.

Just like me -- and I don't even have brain damage!

2009-05-06T09:48:00.003-04:00

That's not a nipple -- it's a space station.

Probably one of the greatest shocks about aging is realizing that I know seemingly normal people who pay real money to put personal ads on the interwhatsit. There are a few problems with this. First, facebook is essentially the same thing as e-harmony, it's just free -- and the rejection rate is higher.

Secondly, there's this thing that's a lot like the internet, and is full of single aroused lonely folks -- the earth.

Semantics. A friend was telling me about a guy she met through J-date (match-dot-com for the chosen people). As she said, the internet's answer to making sure the chosen people keep passing on cystic fibrosis and Tay-Sachs disease. One thing you learn in med school is that there is a preponderance of weird genetic disease in people of Ashkenazy heritage.

Nonetheless, her parents, who she noted to be a lot more concerned about kids and marriage than she, signed her up for a free J-date account -- the rest is history. It turns out I know the guy she is J-dating from high school. It also turns out that I know he has four nipples. I also know that he plays the cello and likes soccer, but four nipples. The extra pair don't have areolas, and mostly just look like prominent dark moles -- but their perfectly symmetric placement, in line with his original nipples, about 14 inches below bilaterally -- tell tale accessory nipples.

Four nipples, that's the kind of stuff you don't put on a J-date profile. I know this because I asked. I also know exactly how far these dates have gone since my friend did not yet know her J-date has four nipples. My shoulder angel told me not to tell her about the accessory nipples. When the time is right, when there is a bond of trust, that's when he can lift up his shirt to her, my shoulder angel said.

But holding in the accessory nipples was like holding in diarrhea. Sooner or later something is going to blow. So I texted Reeny, a third party.

he has 4 nipples can i tell her plz help k thx

Reeny responded that I must.

It's on the third date where you tell someone you heard from a high school friend that he has accessory nipples that are not capable of lactation.

2009-04-24T17:05:00.002-04:00

Mommy?

Stockholm syndrome describes a psychological phenomenon in which hostages begin to feel a sort of loyalty to their captors. The term dates to an early '70s bank robbery in which the robbers held several hostages at a Swedish bank.

Give us all your fish -- yah?

And so, after two years of straight science lectures, my last day of class forever behind me -- looking into a future of patient care, I can't help but feel a little twinge of something toward the medical school administration.

Perhaps most apparent is how green we are. Sure we can take test after test, scribble in dots with number 2 pencils until we get pressure ulcers on our keesters -- but when push comes to shove, I still feel helpless. Today, after biking for mile after mile in the warm spring wind, my left eye got swollen and gooey. Where there is normally a green penetrating eye, there was now a pink oozing lumpy thing. The only thing my left eye could really do was make more eye goo.

Even though I know the cellular mechanisms and immunological response that produced my oozing shapeless eye, despite knowing exactly how to treat it, my first instinct was,

Call Mom -- she'll know what to do.

2009-04-20T17:21:00.003-04:00

The event that never was:

Poster designed by yours truly. Likely this is the last free poster I'll make.

For a long time I've been hoping to get Valentino, the protagonist from Dave Eggers' What is the What to come and speak to the students at the University of Minnesota. I even designed a really amazing poster, probably the best poster in the history of posters for literary speaking events. This was something new -- I was letting the public meet a protagonist. Meeting a protagonist is confusing. Isn't his written life fake? What implications does this hold to the fabric of reality?

Valentino becomes a vessel for the real tales of multiple people in the diaspora of the Lost Boys of Southern Sudan. So who better to talk to about the situation, about his experience and the rebuilding than Valentino himself.

I sent emails, I noted connections, I signed off with signatures to let people know how important I am. Not only a medical student, but hey -- this guy's in charge of some stuff! I used business-savvy language, aping the styles I remembered when applying for jobs.

I wheedled my way into a tour date, a time slot, confirmed. I made friends with local organizations, wrote a grant, got the grant, made partenerships, room reservations -- all these things I've never done before, all these things that people normally get paid, a lot, to do -- I did with ease.

I held meetings -- I led meetings. I fucking hate meetings -- but these were exciting -- something was actually going to come of them, something I was invested in, and had gotten others to buy into.

Nearly a year in the making I scraped together funds from tiny groups, derailing budgets to make this event happen and secured free printing for glossy beautiful posters.

And then, after confirmation upon confirmation, The Valentino Achak Deng Foundation canceled the event with no warning and for no reason. In an instant, all the ethereal time-consuming work that felt so good because I was making something happen was for nothing, now just a heavy embarrassment. Everything collapsed -- like finding you've spent the last three hours looking at internet porn. It was fun while it lasted but that's time you'll never get back.

So, for the first time, I was angry. I've never been done a great injustice before. I've broken my arm four times. I've had a bike stolen. But all that stuff, all those nuissances seemed random -- not injust. This time was different. The invisble face behind "Camela," Valentino's corresponding e-agent, just dicked me over, and I didn't know how to respond. How do you politely fight back when you're right, but it's not safe to swear. I needed to channel my anger the way really mad parents do -- the "I'm not mad -- just dissappointed" act.

I took a minute and cooled off, and wrote Valentino's e-agent back, telling her just that -- and not to burn people. Not to mislead people, and not to trifle with my time or reputation, that I'm two frighteningly short years from being a doctor so that things like my time and reputation mean a lot to me at the present moment.

To wit, I was more measured and less emo in the letter.

And to wit, I don't know how to properly use "to wit."

Then I wrote a heartfelt email of staggering genious to my co-sponsors, apologizing, thanking them for their help and generosity -- and forwarding Camela's email and contact info.

It sucks having to hide behind a "don't shoot the messenger," especially when it's true.

Writing this, I wanted to vent about how disorganized, self-centered and rude the Valentino Achak Deng Foundation was -- and more importantly, I wanted to show off my poster that won't get used, because it is really good, and I'm really good at making posters.

2009-04-16T14:38:00.002-04:00

Mask!

Medical school exists in three sections -- (cl)ass time, the boards, the wards.

The first two years are class time, where you learn that stasis causes clots to form in your legs while you sit still in a dark room taking notes for four hours at a time.

Next, you take a summative national test of the past two years that gauges how competitive a doctor you will be.

Then there are the ward, two amazing years of rotating through the different specialties in medicine, seeing patients, learning procedures, making diagnoses. During lectures we here snippets of these years as a cryptic shangri-la.

"And you'll see this on the wards," a professor will add. It becomes code for, "this is important."

Because going from listening to doing is a big deal, we have a transition day, 8 hours of priming us for the next two years of being proto-doctors which ends in a happy hour. Usually, when something big gets dropped on us, we get free beer, they've found that calms us.

The medical school administration can be needlessly cryptic, and the latest was an email regarding transition day, telling us no smoking 1 hour, and no drinking 12 hours prior to the test. Test? Next, we were told that our beards had to fit the respirator mask. Respirator? Then, the school official signed off with a quote that silent gratitude isn't much good to anyone.

I think they are used to silent gratitude.

2009-04-13T20:15:00.003-04:00

Max P. Fish
? -- April 13, 2009

Max was a stranger in our land. His heart only had two chambers, but it was always full of love. He came to Minnesota in August of ought-eight, age unknown. We can only speculate about his life prior to his time with us at DP Estates -- but over his past 18 months with us, he settled into a life of dedicated bachelorhood.

He leaves behind two rocks, many pebbles, a vase and some food. He is survived by me.

He was a stickler for routines, pellets for breakfast, blood worms for dinner -- every day, or else he'd flare his gills. He loved flaring his gills, and making bubbles.

Holding his bowl, I walked to the bathroom and gathered my roommates.

"He was a good pet," Melissa said.

"His name was a good name," Joel said, "for making nicknames from."

"He always liked making bubbles," I said, pouring him into the toilet.

Water flushed him away.

2009-04-08T14:17:00.002-04:00

Glycogen!

I told her that I had to go and study biochem.

"Do you know what glycogen is?" I asked.

"No," she said, adding that she didn't care what glycogen was, since she doesn't use it.

"You use it every day!" I said. It's true, she does.

She told me that she still didn't care then, as long as it was working.

And then she ended the phone conversation to go write a poem about glycogen.

2009-04-02T07:59:00.003-04:00

My gas-powered bicycle

I'm house and dog-sitting for my parents while they vacation / college-tour my little sister out east. One of the perks, if you're weird like me, is the commute. Minneapolis is a set up perfectly, and I can get to the med school by taking just under 10 miles of bike trails nearly the whole way.

The main trail, a bike highway called the greenway, connects the remote western suburbs to the outskirts of downtown. Today, I will be stinking up the greenway, riding in on a farty cloud.

2009-03-28T11:44:00.003-04:00

I'll let myself in the back way, thanks.
I spent a month in the most remote city in the United States. Dutch Harbor, 4000 people, also known as “the rock” bobs in the Baltic Sea some 800 miles west of Anchorage, Alaska.

I was there at the clinic, seeing patients. The clinic there is the first and last line of healthcare for the residents as well as the 60,000 odd workers for construction, fishing, crabbing and other nautical business who pass through the island annually.

When a waitress at the Anchorage Airport asked me where I was going, and I said “Dutch,” she looked me over and told me to order a stiffer drink.

Billed as a family practice clinic, the clinic at Dutch Harbor has to wear a lot of different sets of scrubs, from ER to OR to detox to

Endoscopy Suite.

While in anatomy, our professor leaned over our dissection and noted,

“Don’t nick the colon – and if you do, call a code brown.”

I asked what a code brown was, and the professor replied,

“That’s where I run out of the room.”

Back to Dutch Harbor, we were about to enter a couple dozen colons, this time attached to living people, take a look around, and if the situation warranted, take a souvenir back with us.

“It’s a shitty job,” my boss told me.

When you look in the colon, there are three main problems:

1. It is full of shit
2. It is twisty and moving
3. Patients are awake

The first problem is solved easily enough, patients drink a foul concoction that cleans them out. Occasionally we would congratulate a patient on a job well done.

“Looking inside your bowel Mr. Johnstone, we can tell that you really did a great job with the prep.”

This means that, looking inside the colon, we don’t see anything, which means that the patient has spent the last 24 hours glued to the toilet. There is only one way to empty a colon.

The next problem gets tricky. In school we only see the guts of the dead. They are grey lumpy tubes full of cadaverous poo. In live, they squeeze open and shut. Furthermore they twist around, so as we navigate a thin scope around tight corners (getting around the spleen is a real bitch) the bowel bunches up on the scope like a curtain on a rod – only to unhitch and suddenly slide by, giving the impression of scoping at light speed. NASCAR through the anus.

As the bowel lurches and collapses, we puff jets of air in to prop it back open. Air in the colon = farts. And if those trapped farts aren’t set free, the equal pain. Our first scope was on lone from Anchorage and had a number of loose parts, leaky seals and a short in the AV cable. My job was to jiggle the AV cable around so that the docs could actually see what they were doing, some two feet up some poor sap’s rear.

The shitty equipment mandated a longer stay up the rear. Bowels don’t particularly like being entered, so after a certain length of stay, patients involuntarily start trying to poop out the scope. To hold position, we needed to puff more air into the bowel, and plead with the patient to not let that air out.

First we would warn the patient,

“You’re going to feel some pressure.”

Then the patient would feel the pressure, saying,

“Ooo – you’re right!”

Then the patient farts, giggles, we giggle, and then put in more air, and the cycle repeats. After too long a stay, the patient’s bemused giggles and farts turn into moans and groans, and eventually, an over-inflated patient starts belching. In through the butt, out through the mouth – it’s just one tube.

A few days later a newer scope arrived. That plus our learning curve spared long rectal journeys for the majority of the patients. I ended up being the co-pilot for most of the scopes, even driving for one. It’s sort of like having a learner’s permit. Only scope with a licensed professional, and no scoping after dark.

Finally, patients are awake. They are awake, and can see the same live video feed of their insides that we see. Some patients loved it. They encouraged us when to go around corners,

“Oh you’ve almost got it!” they’d say.

These were the types of patients who we would offer picture of their insides too.

"This is a picture of the inside of your colon, you can have a copy, maybe put it on your fridge?" I'd say.

Others wanted no part. The wanted valium and pain killers. Most, however, were about as uncomfortable as you would expect. Dutch Harbor is full of gruff working males. Many have been to prison. More are in Alaska so that they don’t have to go to prison. They have big beards and lots of the most functional alcoholics you’ll ever meet, who can only function in the unique atmosphere that Alaska provides.

Anyhow, we meet these guys, shake their hand, flip them over and go up their butts.

Several said “you’re not even going to take me out to dinner first?”

Har har.

We offered these fellows cigarettes after the procedure.

Haw haw.

Being in a town of 4000 that has three bars (counting the bars at the airport and the hotel) and two grocery store, you run into people. Filling up my mud-caked Subaru at the gas station, I saw a guy looking at me, trying to place me.

Last time I met him, I was almost 2 feet deep in this guy's bum.

So you're walking it off? How's the rear? Funny, I never saw this side of you!

Those are things that I did not say. A lot of unsaid information passed between us, culminating in a dude-nod, sup bro.

2009-03-18T22:46:00.003-04:00

Come on summer ... almost there.

Last summer, when I met this robot, he asked if I could send the picture to him. I can only assume he will know where to find this picture.

Because he's a robot.

2009-03-12T22:51:00.003-04:00

Coffee and poops.

My professor paused from didactics, looked to the back of the room, and, sighing, said:

C. difficile has really become the bugaboo of the whole diarrhea field.

This after admitting that diarrheal studies is one of his key points of interest -- I can't believe I was late.

And a little hung over.

Throughout all my life, I've been fascinated about the connection between coffee and defecating. Ever since I made the switch from bounding out of bed for cartoons to hitting snooze 5- 10 times to meet an unrecognizable creature in the mirror, I've been dependent on coffee. And ever since my love affair with that brown liquid vixen started, I've noticed her holding hands with pooping.

Cup of coffee, log of poop, a storied tale for the ages.

But why? I've got irrefutable anecdotal evidence that coffee makes you poo. And it's a fine sort of poo. Not diarrheal in nature, but rather, refreshing, normal, regular.

Alarm. Snooze. Alarm. Snooze. Alarm. Snooze. Alarm. Rise. Help. Coffee. Poop.

Back to class. Sitting there, discussing diarrhea with the world expert on farts, and even more incredible -- none of this is a joke. I saw this as a perfect opportunity to ask, why, why does coffee make you poop. So I did.

"I assume you are talking about yourself," my professor began. I blushed. I blushed and owned it, of course I was talking about me, I said.

All the evidence, he said, is anecdotal. Moreover, everyone drinks coffee, and everyone poops. That was that. Either a brushoff, or an invitation into one of the most accessible and inspirational clinical studies of our generation.

I was to be outdone, however, by a fellow student who is on a promising track to make scores of patients acutely uncomfortable.

Or confused.

"Excuse me," he chirped, "but how exactly do you you culture stool [editor's note: POOP!] for bacteria?"

He laid his hands on his desk, looking right at the professor.

Our professor looked right back.

"You mean," he began, "how do you get a guy to take a dump in a bucket?"

The student mulled this over for longer than appropriate. He also did not laugh. Earnestly, he pressed ever on, holding his eyes on the professor while cocking his head ever so slightly to the left:

Yeah, how do you do that?

The professor paused to gauge what the kid's question really was, and whether an answer still exsisted. There was a longer pause as the professor valiantly battled a massive non-sequitor. A dozen tired students sat, rapt, waiting to see his recovery. I held in my laughter and my poop

"Oh I see," the professor said to himself.

"We use many different containers."

2009-03-06T21:17:00.004-05:00

Grandpa-pie

As a kid I was never spanked as a punishment. One time my dad spanked me, and I was confused and upset. The audacity of it all. I had heard of spanking from my friends at school, and always counted myself lucky to be in a spankless household.

That was the one battle I won immediately with tiny fists, shrieking and angry tears.

At my grandparents, however, I got friendly-spanked. My grandpa attached the surname "pie" to everyone he loved. My family and I never thought twice about it, my sister thought it was something normal to do until she tried it in the real world. But every time I'd say 'bye to grandpa, he'd swoop me up, bellow "Ryan-pie!" and swat my butt.

I'd try to run, I'd try to juke, hustle, side-step, but he'd always catch me, holler, and slap my rear.

I hated it, and I loved it, and I told the story to a roomful of my relatives and family friends today over wine and beer after we buried grandpa -- our last day with him.

***

Grandpa died in his home, after a day of saying goodbye to his family, friends, children and grandchildren. He had been home for a few days, getting home on Thursday. He had a hard time breathing Friday, went unconscious Saturday morning, and passed away as the sun rose Sunday morning, while my Grandma, his wife of almost 58 years placed a kiss on his forehead.

His last breath and final minutes.

And that was the end. Breath, life, exhale, over.

The guy who told me every time to find a cure for him when I finish med school. The guy who swatted my rear and called me Ryan-pie. The guy who had never been happier when he found out that wine and dark chocolate are good for your heart.

And he was gone. I've seen a lot of dead bodies, and when Grandpa left his, that's all that was left, a shell. It's remarkable how lifeless a body is without life. But that all makes sense doesn't it? Ashes to ashes.

My dad, his oldest son, gave the eulogy, and saying that Grandpa was most comfortable on a folding metal chair.

Six grandchildren, aged 4 to 24, and up until he couldn't walk, breath or talk, he was at every recital, play, baseball game, football game, band concert, everything. It got to the point that I would decide to hide events from Grandma and Grandpa because I didn't want to stress their backs and hips by stuffing them into a cramped auditorium for three hours.

This is the first time where I've been an active part of a loved one's death and dying. Usually I'm away, so one minute someone is alive, and the next, they're dead. Living far from home, I missed the gradient between life and death. But here, being part to family meetings and health care decisions, and seeing grandpa's health go over the last few years, it made it easier to say goodbye.

But the problem is that after saying goodbye, and thinking everything is alright, there is the truth around the corner that you can't ever say hello again.

Grandparents are supposed to see the possibility in each new wriggly purple baby, and Grandpa did exactly that. All my relatives told me that he was so proud when he saw me in my white coat and stethoscope. He got to see a hint of what I'll be, and that meant a lot to him, and it means a lot to me, because I was able to show him what I was able to do with his support.

A brass band played "When the Saint's Go Marching In" as they wheeled grandpa's coffin out of the church.

2009-03-03T21:55:00.007-05:00

Classroom songs.

I have a friend who teaches fourth grade.

Teaching 4th grade is probably the best way to get an arsenal of stories that would make you an unstoppable force at any dinner party. 4th graders are hilarious. Medically, the girls are approaching puberty while the boys have yet to approach a thing. Hilarity ensues.

My friend teaches a class of mostly girls with a core of eight boys who do their best to drive their teacher crazy. Naturally, I am making up all the kids' names, both so my friend can keep her job, and because I have no idea what their names are. Everything else is absolutely true, which makes this the best thing ever.

Last week while the class was having a math test. Everyone's stubby little fingers working pencils. Derf raised his hand.

"Teacher, Bentin keeps calling me gay," Derf said, as Bentin silently mouthed

"gay gay gay" at Derf.

"Don't look at him," Teacher said, moving to Bentin's desk.

She asked Bentin if he'd been calling Derf "gay." He admitted. She reminded him that this is not how to use the word gay, while Bentin explained that his hands were tied because Derf was singing an "inappropriate song" that made him uncomfortable, and even though he'd asked Derf to stop, Derf kept right on singing. Teacher asked Derf to tell her the lyrics.

You have a big dick and I want to lick it.

Teacher went back to Bentin and asked about the song. Then she asked him to tell her the lyrics. He blanched and shook the head.

"If you can sing it to your friends in the classroom," she said, "then you can tell it to me."

He shook his head no.

"Then at least write them on this sheet of paper."

Bentin wrote the lyrics, confirming Derf's story. Morever, he implicated two more boys in the song, stating the he heard the song from them. Teacher confronted the other two boys who then pointed the finger at two more.

Teacher was able to piece together the pair who composed and distributed the "Big Dick Lick" song about her 4th grade class. Songs like this present two thorny issues.

One: it's hard to not laugh when seriously reprimanding these kids.

Two: (more importantly) they totter on the thin and dangerous line of sexual harassment. While not a problem for kids themselves, there is a legal boondoggle about allowing a sexually uncomfortable atmosphere to persist in the classroom. Because of that, each of the eight little boys gets a letter sent home to their parents.

"Your son, along with several other boys, has been singing a sexually inappropriate song in the classroom.

He will tell you the lyrics."

The song is totally gay.

2009-02-24T01:54:00.004-05:00

Roads made of ice are slippery.

One of the things I like about biking year round is the communication it gives me with the world around me. If it's windy, I see the wind's good and bad side. If it's sunny, I feel it warming my skin. If I see someone I know, I can stop and say "hi," -- though usually I'm faster than sound so this doesn't happen.

In the winter, several times I'll see a patch of road ahead of me, sheer and glinting, a perfect reflection. I know how that story goes -- my bike skids out from under me and I land sliding on my hip. Sometimes the left, sometimes the right.

Today the variation was that I had a bottle of wine in my messenger bag, on my way to meet friends for dinner. Instead of eating dinner I spent the night drying my notes and picking bits of glass out of my hoody and messenger bag.

Everyone has a balance of luck. I'm not talking about a higher power here, just luck. Luck concerns itself with the small things like whether or not you'll get caught by a meter maid or winning $10 on a scratch-off lottery ticket. You'd hope a deity would have better things to do, so that is why there is luck.

On Saturday I went to the vending machine to get a Salted Nut Roll. I rarely eat candy, because it turns my into a slobbering beast. When I punched "E4,", both the metal coil holding the Salted Nut Rolls and the neighboring coil (bearing Twizzler's) unwound at the same time. And though there was only one plop when my candy fell to the bottom of the machine, there I was with two treats. That was the first lucky thing that happened to me this week.

It snowed a ton on Friday, so much that Minneapolis declared a "Snow Emergency." This is an overly dramatic statement meaning that they intend to plow the streets. Important roads the first day, odd sides of wimpy roads the next, finishing up with the lowly even side of unnoticed roads on the final day. If you happen to park in the wrong spot on the right day, they will tow you and you will pay. I usually only drive to move the car to the correct side of the street as per snow emergency, and thought I was set. I was not. But luck smiled, and there was the car, happily burred in a snow bank, unticketed, untowed -- unhindered. That was the second lucky thing that happened to me this week.

During todays pathology test, I guessed at several questions, where I had no idea what most of the answers meant. Many of these guesses were correct. This was the third lucky thing that happened to me this week.

And that was the end of my luck, zero balance, wiped the frozen blood from my handbars, ready for a new week.

2009-02-21T10:38:00.000-05:00

Crazy phat.

The medical school sends its students out to different clinics ever Wednesday on "mini-rotations." The university sent me to an obesity clinic for my family practice mini-rotation.

There is a lot to say about the obesity clinic, or as my roommate calls it, The Fats. For one, the halls, rooms, doorways and chairs are all double wide. Which is great both for bigger people and claustrophobic medical students (me). The scale is equivalent to a scale in shipping and receiving. It is polished and finished to make it look like it was designed for humans, but its magnitude is staggering, and betrays that it was originally made for things that are much heavier than a human should be.

However, the novelty of the place soon wore off, and as I passed my days discussing diet, exercise, bad lab results, and asking how the patients liked their diet pills. I starved for something, anything not excruciatingly boring. The Fats was like the Biggest Loser, except that the contestants generally refuse to exercise, change their diets, or lose weight.

But there was one saving grace: for some reason, a lot of the patients were completely insane.

My eyes would glaze over as the doc explained pre-diabetes for the umpteenth time to the umpteenth patient. But then I would get sent into a room where a patient would start out just a little off ...

"You know I used to be a model," she said. "I had the fullest hair, and now look at me, it's coming out in clumps."

It was, and I told her that would be hard to deal with, losing something you identified yourself with.

She went on, asking me about my geneaology. I told her I was a mutt, and went on to ask her how she had been feeling.

"Your ancestors," she started, "came over to Jamestown with my ancestors. They were the medical founding families."

My real ancestors were starving in Ireland until the mid 19th century, and my dad is a writer. But I kept that to myself.

I asked her how she knew that, and realized, that for the first time in my rotation, something interesting was happening at the obesity center. She was acutely manic and psychotic and untreated. I knew she was untreated because she told me she stopped all her meds some time ago.

"Speaking of history," I said, "I'd like to hear a little about your past. Have you had any prior hospitalizations or surgeries?"

"In fact I have," she said.

As a child, she told me, she had her salivary glands removed.

"Did they give them to you in a jar?" I asked, digging for a laugh.

"No." She said. "They kept them. They kept them, and I later just found out they were saving them to clone from, and try and replicate the first medical families."

She paused, and looked at me. I nodded.

She only found out recently that this was why they saved her salivary glands. Naturally, she was upset, and raised a fuss.

"And that is why," she continued, "Bush had to ban stem cell research."

"What a ridiculous administration!" I said.

"I know, right!"

I continued the interview, redirecting often, and sifting through her garbled fancy for actuality, and realized that she loved herself. She loved being insane. She loved the rapid thoughts, the grandeur and the highs. It was just like my psych primer said. But seeing a patient who was completely unable to thrive in society and was perfectly happy to live on disability in her own quirky way was something powerful. I wanted to know more. I spent the rest of the time channeling my psychiatry professor until my preceptor returned and informed me that we needed to move things along.

From that encounter on, I was treated to a number of other psych patients who were at the clinic for weight loss. One manic woman had "only been a jail a few times, but was a lot better now." Another woman was furiously scribbling everything we said on the back of an envelope while rocking back and forth and emitting a powerful odor.

Finally I asked my preceptor about the patient population.

"I don't know where we're getting all these crazy people from," she said. "It's a recent thing too."

My next day at the clinic, my preceptor caught me.

"I found out," she said, "that the clinic director has been giving a ton of presentations to psychiatrists about our obesity clinic."

Anti-psychotic medications are notorious for their side effect of profound weight gain.

2009-02-14T14:19:00.002-05:00

I want to meet that dad

Applying to medical school is the worst. It is stressful, it is expensive, and it is expository. It is a year-long process of traveling to different destinations, dressing up and meeting a total stranger who point out and questions your weaknesses.

That said, it's behind me, and I couldn't be happier. There were a few catches along the way that, given a chance, I may have been able to smoother over.

One interviewer asked me to explain my B- in sophomore biology.

"I was under the impression that it was a fine grade," I said, which was not the answer she was looking for.

Before every interview, each medical school received a packet of essays, accomplishments and autobiographical data from each applicant which they then page through and decide if an applicant is worthy of an interview.

Part of the application is a form of information about parents. Their ages, jobs, education, residence, marital status, etc.

After this information, you check one of infinite boxes. Among the boxes are three choices:
_Living
_Deceased
_Don't know
For each family member.

When going through a long form of checklists, boxes and mindless fill-in-the-blank, it's easy to check the wrong box.

The first time my relation with my father was brought up was at my interview at Tufts University. It was innocuous, and I didn't think anything of it at the moment, but the interviewer, out of the blue asked:

"And how's your dad -- how are things?"

I told her that things were good, I like the old guy and that he's a write. I had no idea what she was getting at, and to me, neither did she. She moved on to more informative questions and I let the incident slide into the back of my mind.

But, when I interviewed at Temple University, things got weird.

The interviewer, a pleasant older man, was going through the getting-to-know you stuff. Siblings, home town, parents, things like that. After a little small talk, he looked right at me, and asked,

"So, your dad -- how is your relationship with your dad -- what was it like growing up with him?" He asked this softly, and looked right at me, tenderly.

I told him that it was very similar to my relationship with my mom, which seemed to alarm him.

"So where does he live, how are things going with him?"

I had no idea what was going on. I had heard of stress interviews, where the interviewer asks the applicant to open a window that is locked from the outside, and views how the applicant resonds -- but this was a nonsense interview, so I played my hand.

"I'm not sure what these questions are getting at," I said. "My parents have been married for a long time, and my childhood and family life have been remarkably stable. I miss my family at times because the live in Minnesota and I live in New York, but we keep up over the phone and holidays, but everything is fine with my dad, just like it is with my mom."

The interviewer hemmed, and then said that he had been given the impression that something strange was going on with my dad.

"Well, I'm not sure what gave you that impression," I said, maybe too defensively.

The interview changed direction, and a few weeks later I wound up on the waitlist.

Later, checking on application materials before another interview, I looked over my biographical data:

Father:
_Living
_Deceased
XDon't know

2009-02-10T11:09:00.005-05:00

Big heart, bad heart.

One of the glib paradoxes to heart disease is that a big heart equals a bad heart. Yet when the Grinch's heart grew three sizes sizes that day, Dr. Seuss was not saying that the Grinch had acute heart failure with right ventricular hypertrophy or dilated cardiomyopathy -- just that the Grinch had gotten a lot less grinch-y.

So maybe the heart isn't that great of a metphor after all, or maybe doctors should keep their thoughts to themselves when they read children's books.

Grandpa is in the hospital again.

Heart failure is one of the more self-descriptive diseases, and the long-term prognosis is equally self-evident.

Grandpa is skinny, covered in scabs and sores, and peeing out blood slightly slower than it is being dripped back into his veins. This is a small bright spot in a tough situation. Our generation has a new take on dying where we have somewhat of a choice of where and when to die. Now, we can keep bodies alive long enough that to give people a window of how long to live under what conditions. The only problem is that by the time most get to this point, their decision-making skills are blunted.

And deciding how much longer to live is not an easy decision.

***

Walking into the hospital I checked my phone for Grandpa's room number, got lost, got found, and found the ICU. I walked into his room, saw an emaciated old man hooked up to an IV, oxygen and more tubing in a room full of strangers. A sad matron and a guy in a snow-mobiling jacket I'd never met.

Most dying elderly men look the same from a certain distance, and I was absolutely in the wrong room. The man's family looked at me -- I smiled nervously, walked to the nurse's station and asked where my grandpa was.

***

Back in grandpa's real ICU bed, I talked with my dad and grandma while grandpa slept. I asked Grandma had any questions about his care. Scandinavian people tend to not ask questions of strangers, tend to not admit pain, and tend to not reveal their fears, so their medical management gets tricky. I knew the doctors had discussed Grandpa's end-of-life care earlier that day in a manner that scared the shit out of Grandma so bad that she phoned my dad saying the end was near -- and to hustle over.

The isn't as near as she thought, but it isn't that far either.

So we talked about quality of life, we talked about how isolating rehab nursing homes are, we talked about how Grandpa, a social homebody, has been sleeping by himself in various hospital beds since July 4th. We talked about things that no one wants to talk about, but things that are completely unavoidable. We talked about questions we needed Grandpa to answer before someone who looked like me, skinny, young, nervous, stuck a tube in his throat and he couldn't answer anymore.

I told grandma what intubation would mean for grandpa's comfort, and she said, that you get to a point where, when you can't walk, you can't eat, and you can't talk or breath on your own -- well ...

In situations like that, I am handling dangerous information. Toxic waste. Hazardous material that, I really wish I didn't know. I know that I have to present everything as evenly as possible for what it means to Grandpa and to Grandma in terms of the life they want. But even there its hard to not let a little of my bias slip in, because I'm making my very best guess about what they want.

Initially Grandpa thought that intubation was a quick procedure that would help him breath. Intubating somone that frail under those circumstances is not right, not informed, and techically, illegal. But at the same time, whether or not any of us think that grandpa ought not to be intubated, eking out a little more time as the expense of being completely mechanized, helpless and unresponsive, that decision is Grandpa's. It's his life, and no one is more qualified to make decisins about it, than he is.

The caveat is that it is infinitely easier to decide not to put the tube in over deciding at a later date when to pull the tube out.

Grandpa held Grandma's finger with his needle-worn hand. My dad asked him if he still heard music playing.

"What song, honey?"

"Oh you know," he said, "the old ones, like Paperdoll."

Then Grandma told us how the old men at the Lutheran group were supposedly organizing to sing Paperdoll and other old-timey love songs to their wives for Valentine's Day.

"I'll believe it when I see it," she said, "a bunch of old men singing in public what they've never once told their wives."

2009-02-08T23:38:00.006-05:00

Drunk doctors, fatty livers

Once every year, the medical school throws "Winter Ball," for all four years of medical students to get together. It is medical school prom. And like normal prom, people come arrive totally wasted.

Unlike high school prom, there is an open bar, and waiters run around with trays of stuff. However, in these harsh economic times and in my rapidly-increasing stupor, these moving plates of food -- fried eggplant, mini burgers, things with artichoke -- seemed sparse and were lovely to come by. This was something to stop a conversation for, forgo a make-out session for, even leave your place in the beer line for.

But maybe that's just me, I was really, very hungry. And these plates of light hors d'oeuvres were my white whale. My tiny, succulent white whales.

There are more reasons this is not like high school prom, or at least, why one could argue that this is should not be like high school prom. Every guest (discounting +1s) is going to be a doctor. This is an event full of future doctors. The night begins with mingling. People drink quickly, but talk evenly getting real information. Things about the best place for internal medicine rotations or who's who in neurology.

Minnesota's future doctors then take a second pass at the wine bar and start gossiping, pairing off, drinking their drinks in the line for more drinks, cycling back and so on. And at this point, Minnesota's future doctors are as drunk as a 15-year-old at his first kegger with the cool kids.

All the tension, all the stress and unrelenting long hours and steady paranoia about the future diffuses into strong and prolific drinking. Want an argument for why resident programs should have caps on weekly hours? Come to med school prom. You get a room full of people who know better, spitting on the face of all that knowledge and professionalism.

This, perhaps, is why medical students only get to wear short white coats.

At end of it all, this is really just an apology letter:

Dear Erik,

I'm sorry I threw up on your bath mat, I puked on mine later that same day,

<3
-RC

2009-02-05T23:46:00.004-05:00

If this lights a-flashin', I'm a-crashin'

This is the sign at Ballyhoo Road in Dutch Harbor, Alaska -- located 800 miles west of Anchorage, floating in the Aleutian Island chain. Ballyhoo connects the major shipping dock for the island to the rest of the island where all the people, fish processing plants and docks are.

Every day, ancient salt and mud-encrusted freight-container trucks run back and forth all day, from the docks to the other end of the island to the processing plants and industry and back again, each time crossing the entrance to the airport's runway.

The solution is the sign pictured above: if the lights are flashing, an aircraft is either landing and taking off, and its in your best interested to wait. The lights are engaged by pilots clicking their intercom at a specific frequency as the approach the runway, nestled in between a blown-out low mountain.

Last February, one of the container trucks blew through the "DANGER! LOW-FLYING AIRCRAFT" lights. The plane, a small propeller plane called a "goose," clipped the container truck with its landing gear, which snapped off in the truck leaving the plane skidding on to the run-way. Most of the eight aboard were dinged up a little, none severely, but no one was hurt more than the city manager.

"And after all this," he said, "the State is making us get a fancy rail-road crossing arm. It should cost half-a-million dollars."

"Typical government overreaction," he sighed.

Dutch Harbor is one of those rail places where:

a. A major road can run across a runway.
b. Residents would ignore lights warning them that a plane was landing
c. All involved are perfectly happy in this daily game of chicken.

These people are too harsh, crazy or [wanted] for the lower 48.

2009-01-31T13:03:00.004-05:00

Ghost in the AC

One of the best moments in talking to a psych patient is the moment they reveal themselves. A lot of people with psychiatric disorders can smuggle their mental illness into mainstream society and pass day-to-day activities without once betraying their crazy. But others can only keep it inside so long before it pops out. And right then, right at that moment, when someone goes from small talk to putting their hand on your shoulder and telling you they are in hiding from an international group of scientists conspiring to steal his life's work which is safely hidden overseas, that is when you realize you are really talking to a psych patient -- and that they trust you with their carefully guarded reality.

The world's that people's minds create are so dramatic, that being in on the secret is a hoot -- one professor told us that psychiatric illness is contagious this way.

One of my good friends is a therapist at a residential woman's rehabilitation center in Philadelphia, and has done a lot of group work with psych patients. One of her favorites received his auditory hallucinations in the form of radio sports broadcasts. During one group session this patient kept opening the hood of the air conditioning unit and sternly talking into it.

During a break in the session my friend walked over to the AC unit, opened the hood, looked in and said:

"Listen, you need to leave this man alone. We are trying to have a group session here, and you are being very disruptive."

She closed the hood and walked back to her seat.

"Thank you," the man said.

2009-01-30T00:41:00.003-05:00

Martin Luther King Breakfast Day

"We combined your eggs into our carton," my roommate Melissa told me. This was on Martin Luther King Day. It was perfect.

Finally brown eggs white eggs can be united in one carton, on this, Martin Luther King Day, 'ought-niner.

2009-01-26T15:36:00.004-05:00

Lady Parts

I'm getting this blog back on track -- back into the fast lane. It's cold as death outside, my bike got stolen, my car has a flat and I don't have a girlfriend, so I also happen to have a fair amount of by-myself-time at the apartment. -- So why not write? RC
As a part of our medical training, we go through half-day workshops that fall into two categories:

A. Fellas
B. Ladies

The school breaks us into groups of 4, sending us into exam rooms to take sexual histories and learn sensitive exams in a staged setting. Each group of four is assigned to one "standardized patient." Standardized patients play tons of roles. Their job is to patiently be interviewed, poked and prodded by medical students learning how to do exams. The conceit is that we ought to get our awkward shakes out in a controlled setting, and a lot less likely to traumatize a patient or anger a superior in the future.

When we are just doing physicals this is fairly innocuous. But when we are doing, say, prostate exams, each standardized patient will have no less than eight fingers in his butt before the sun sets. No amount of snack packs could bribe me into taking that shitty job.

It is useful though. When guy parts was all said and done, it wasn't that bad. The exam is quick, dirty and easy. No one likes it, but prostate cancer is a lot worse than the errant gloved finger up the butt. On the heels of guy parts, I thought the lady parts workshop wouldn't be that bad either. It would be no holiday, but I'd survive it.

I survived it. We began by shoving speculums and fingers into a plastic disembodied practice pelvis. Our tutor was a cranky old OBGYN doctor who looked like John Voight.

"It's a little weird," I said, pointing at the plastic pelvis on the exam table, "seeing that without any legs or body."

"Legs just get in the way," Dr. John Voight said.

This set the tone.

I was chosen to take the sexual history. They have us practice taking fake sexual histories so we don't say things like, "well, do you think your husband is faithful," out of the blue. Which I did. Instead, we slip those nasty little questions in on the sly.

"Well, you've come in here complaining of a foul-smelling discharge Ma'am, would you feel comfortable with us running a gonoccal/chlamydia screen?" From there the patient processes that, why we are asking, and what the implications could be. It's a lot nicer than being confronted with infidelity by a complete stranger in a white coat.

But at the same time, interviewing a patient about their sexual history in a tiny exam room while three of my classmates and a professor stare at me, it's damn near impossible not to stumble, stutter and phrase things the absolute worst way possible. I'm mortified of public speaking, but pretty savvy at patient interviewing. Put me on stage with a patient though, and it balances out to an awkward, yet amiable robot.

"I see, so you are happy with your menstrual cycle and happily married -- do you have any other sexual partners?"

After the sexual and gynecological histories, we are instructed to rotate to the next room where we will each perform a pelvic exam in serial fashion.

"Well," our standardized patient greeted us, "this is the only pelvic exam you'll ever do where you're more scared than the patient. Who wants to go first?"

Then, pointing at me, she said, "You. You'll go first."

Gulp.

I washed up, gloved up and walked up to the exam table.

"I brought aloe for my own lube," she said. "I know my body, and this is what it likes, so, just spread some aloe on the speculum."

I did as told, and, with three peers and a professor watching in the tiny windowless exam room. Then, speculum clattering, I headed in. She instructed me to go down and to the left, so in I went, Cervix Town, USA. I got a glimpse of that little guy, but it was mostly obscured by vagina.

"Pull the speculum out a little, and then go back in deeper," Dr. John Voight said, peering over my shoulder and into her vagina.

"NO." The patient said, "just hang out there a while, and I'll cough. Maybe that'll help."

The disagreement hung uneasily in the tiny room while I hung out in her vagina, waiting.

*Cough*

Nothing. Just a little cervix.

"That's enough," Dr. John Voight said, "we need a longer speculum."

Next, I was going to aloe up my right hand, slide my fingers back into her vagina while pushing down on her abdomen with my left hand to feel her ovaries and uterus. It seems like some awful kind of torture, but apparently its also standard of care for OBGYN visits. So there I was again, on stage, knuckle deep in vagina when Dr. John Voight decided to pause for a teaching moment.

I stood patiently, listening to differing theories on the bimanual exam, acutely aware that I was very deep inside this woman's vagina.

"Push down here" Dr. John Voight said, pushing my left had deep into the patient's belly.

"Oof" the patient said.

"See," he said, "you can feel her vertebrae."

No light burns as bright as the spotlight when you're knuckle-deep in vagina. This is impossible to properly emphasize.

I wanted out. I wanted out so bad. Each asked me if I felt the ovaries as I pantomimed what I had seen in the teaching video.

"Sure," I lied, "they're so subtle."

Let me out, let me out, God it's me Margret -- let me out.

At that point I would tell them anything they wanted, I just wanted out.

And that, my friends, is why torture is not an effective means of getting intelligence.

Or teaching.

2009-01-02T17:53:00.005-05:00

Fucking sick.

I wanted to do some work and look cool at the same time -- so I biked to a trendy coffee shop and carried my laptop with me.

I also needed to get oustide the xbox 360's vile sphere of influence. It's taking over my life and gobbling up my minutes. xBox 360 is an insatiable time glutton. I never thought I would waste so much of my life hitting pretend people with baseball bats, and generally being a really bad imaginary person. I also have a terrible cold, and am leaking left and right.

I hope it looks cool to be sick in public.

2008-12-29T17:34:00.003-05:00

Real family.

My aunt and uncle on my dad's side have three children. The first two boys were created by my aunt and uncle, the youngest was adopted from Columbia -- we think largely because they wanted a girl and after two generally uncontrolable and gigantic sons, they were not going to leave anything up to chance.

This bothered my mom to no end, I think she saw it as some sort of Angelina and Brad Pittesque stunt. Furthermore, she carried the healthy skepticism of dealing with a country whose main exports are coffee, cocaine and human babies.

Nonetheless, Eleanor is here, she is 3 years old, and really short. She is a powerfully cute ethnic baby. I spent some quality time with my baby cousin on Christmas day when I see the relatives on my dad's side. Rather than make small talk with my uncle's weird sister's husband who is 84, deaf, henpecked and sleepy, I hung with Eleanor.

While Eleanor, my mom and Eleanor's mom were all sitting in the living room, another of my cousins' approached Eleanor's mother.

"Aunt Amy," she said, "If Eleanor was with her real parents, would she speak Spanish?"

2008-12-09T17:11:00.004-05:00

the schwinn caliente in all her icy glory

The winter of our arousal.

I fought last winter tooth and nail. Never had something seemed so cruel and unjust. Never had I felt so trapped and powerless. Just walking outside felt like the wind was peeling the skin from my face. And I took the bus.

The bus is the longest, slowest and most depressing way between two points.

Come February I took my life back and started biking. Every day. Slush, snow, whatever. There was no way in hell I was ever stepping on a bus again. I passed multiple buses each day on my commute, laughing in the deathly-cold wind.

But I was still cold. All the time.

Really. Fucking. Cold.

But I noticed that on days I did not bike, I was angrier, meaner and dumber -- swollen with ill-will.

This winter arrived and I made some changes. For one, a Minnesota summer with an easy job and no school made me stop hating Minneapolis, and actually come to like the little guy. Then winter stuck its wrinkly foot in the door, and I didn't even notice. I put big-ass tired on my road bike, fenders so I wouldn't get wet-but, and put on a polyprene ninja mask for the cold.

Suddenly winter is fun. Snow is pretty, the cold is a challenge, and I'm passing multiple buses while wearing a ninja. Instead of battering me and stripping away my autonomy, I'm taking control of winter. That's me, with the stilettos on winter's neck. Yeah, winter likes it, because winter is a freak like that.

Hopefully the poor commuters trapped in the bus glimpse a ninja biking past them and see freedom.

Today, however, I almost face-planted into a bus. Ninja-style. The bus did some nefarious shitty busdriver thing, as buses are wont to do. I squeezed my front brake and nothing happened. I squeezed the other for the same effect. I squeezed the front harder and the cable snapped.

Me, on a bike in rush hour, iced-over snow and no brakes.

So, thanks everyone for not hitting me today as I swerved down the middle of the road, in and out of lanes and cars and through stoplights.

Tomorrow, I'll have brakes again, promise.

2008-12-04T19:11:00.003-05:00

The Department of Natural Resources

My grandpa has been in hear failure for a long, long time. He has a pacemaker, an mechanical heart valve, an implanted defibrillator, two hearing aids, and fake joints and something wrong with his spine.

But if we were to rewind to, say, a month ago when Chuck was answering the phone, answering questions and able to swallow, were we to take the wayback machine and ask him about a DNR, we would say something like:

"What like the department of natural resources?"

My grandpa has intractable spinal pain from numerous back surgeries aimed at pain reduction. Instead the irritated and scarred his spinal lining, confusing the highway of nerves running through his spine and angering them. For life.

Medically my grandpa is frail and complicated.

Spiritually he is scared, depressed and stubborn.

So back to the Department of Natural Resources. When patients are in teeter-tottering states of health, their caregivers often discuss DNR/DNI, meaning: do not resuscitate / do not intibate. Legally it means that if a DNR/DNI patient winds up in the hospital septic, or with cardiac arrest or some other urgent situation, that they will be given morphine and love, and allowed to die on their own terms rather than languisihing on a ventilator with a tube up their nose, threaded down their throat and into their stomach.

My grandpa has been in constant denial over his health. He never even accepted a senior discount. Rather than come to terms with living with illness he expected to be fixed. Now he is a hobbling catalogue for MedTronic.

With his thin balance of heart failure medication, hypertension medication, diabetes medication and pain pills, it does not take much to tip the scale and send Chuck to the hospital. Early AM ER visits became routine for Grandma and Grandpa, until the last one where the kept Grandpa for a long, long time.

On top of his medication and preexisting health problems (essentially incompatible with life) he had developed a bad, bad pneumonia On top of that, he stopped talking to all of us. We would visit the hospital. I'd busy myself checking Grandpa's vitals as they beeped across the computer monitor. Grandpa busied himself by struggling to breath, not talking and sleeping.

This went on, and on and on.

We'd visit and see Grandpa, plugged full of tubes. Tubes to urinate, tubes to eat, tubes for medication, tubes to drink. Shriveled and sunk in a hospital bed.

I put my hand on his shoulder, wake him, and ask how he was.

"Oh. Pretty good," he says, and falls back asleep.

2008-12-02T19:35:00.003-05:00

Diarrhea.

Frequently we cover material in medical school that forces students into a fork in the road. The student can:

A. giggle.
B. roll his or her eyes at the gigglers.

I always opt for A, and more often than not it is a lonely path. Diarrhea is a side effect of most medications, and a symptom of most diseases, and I find its mere mention absolutely hilarious. I nudge whomever is nearest and repeat in a stage whisper:

diarrhea

This usually gets brief nervous laughter because people are unsure what to do with me.

Yesterday we had a lecture on rheumatoid arthritis. Incredibly, one of the most common symptoms of rheumatoid arthritis is

persistent morning stiffness

I asked everyone within a two seat radius if they experience morning stiffness.

Then the lecturer went on:

This morning stiffness lasts about an hour, and tends to resolve with activity.

Classic.

2008-11-20T12:29:00.002-05:00

No milk, no sugar.

We drink a shit ton of coffee at my apartment. A testament to our collective addiction: between the three of us we have an espresso machine, two french presses, and all three are often going at once. That's a lot of coffee.

Nearly as much as coffee, I love argument for the sake of argument, and as a corollary, I love to be right (this is less frequent, so I'm learning to enjoy mini-concession speeches). Nonetheless, while trying to settle whether you need to stir a french press (I say: no), I turned to the interwebs, and found:

RUMORS STIR FRENCH PRESS

Perfect, I thought, indisputable e-evidence that french-press stirring is a myth and a waste precious morning seconds. One click later I realized that the Times wrote a very clever headline about provoked French journalists.

PS: I drew that French press.

2008-11-01T12:43:00.003-04:00

Noah the drunk cow.

I fucking love Halloween. It's a time that pushes extremes, so you see people at their best, their worst, and sometimes (often) both simultaneously.

One great example is Noah the Totally Wasted Cow. In the midst of rowdy debauchery, a man in a crumpled plush cow suit staggered up to me —

"Hey, don't I know you from New York?"

He absolutely did know me, and was the nicest drunk cowman I'd ever met, but that isn't the point. Here it is: Adults who haven't yet jumped the transition to being real adulty slap two standard variations on their Halloween costumes.

1. + drunk.

So, going back to the example of Noah, he was a cow for Halloween, but also, he was a drunk cow for Halloween, a subtle, but poignant variation that takes his costume the extra mile. Sometimes this works wonders, and sometimes it kills the costume entirely. The Noid I saw who became an inebriated Noid made this work wonders. But sometimes, as in the case of a friend who dressed as a Christmas tree several Halloweens back, it does not work. There is something fiercely melancholy about a Christmas tree puking into a trash can.

2. + slutty.

This is the worst variation in the book. Slutty fireman. Slutty Little Bo Peep. Slutty bumblebee. Slutty pumpkin. Slutty person from decade that isn't this one. Slutty generic female superhero. The slutty twist is absolutely the lamest addition to any halloween costume. Don't get me wrong. I'll sit there drop jawed with every other perv on that first warm Spring day when the layers come back off, but just don't screw with Halloween, it is a time for excellence.

That said, there are a few times slutty could work, and these tend to be the only exceptions.

a. If it is hilarious. Slutty Janet Reno comes to mind.
b. If you are dating said slutty person and are totally weak of mind.

But back to Noah the Drunk Cow. He gets it. So did Steve Irwin, who had a home-made sting ray coming through his chest, or Liz, Meggo and Kelsey, the Jamaican Bobsled Team.

That, Charlie Brown, is what Halloween is all about.

2008-10-28T11:03:00.001-04:00

If nothing else, I'd like people to say:

"That Ryan character sure draws a mean toaster."

2008-10-21T10:12:00.003-04:00

Pieces.

My grandma was baffled that no one went to church last Sunday. Spiritual tumbleweeds blew through the austere suburban church Sunday at 7:30 AM, the mass patronized by the elderly and sleepless.

The church was empty because it was not Sunday. It was Saturday.

Things like this happen to everyone. Waking on a vacation day, running to the shower and packing a lunch before realizing its black Friday, things like that. But autopilot usually gets shut down before we exit the door.

When incidents pile up for your average, say, 88-year-old, however, tiny red flags flap in the breeze. I wanted to rationalize parts of it.

"When I'm 300 years old like Grandma," I'll tell my mom ...

She spent 60 years of life living with her husband, my Papa, the last few of which she was essentially a home health care aid and loving wife. When Papa died, so did 99% of the activities that occupied Grandma's mind and day, so it only seemed natural for her to come a little unhinged.

We made it through income tax season with Grandma by the skin of our hearts, it was not easy. She talked to each of us separately worried that the other was trying to change the wills, curry favor and moneygrab. Her fears had this lining of crazy and meanness that didn't fit.

During one of Grandma's countless invented financial emergencies my uncle went over to calm her down.

"How am I supposed to take care of myself with all these taxes?" she demanded, gesturing to a pile of open envelopes on the dining room table. The envelopes were for utilities.

***

As far as I can remember, Grandma was always super old compared to me. When I was 5, she was still really old. Now that I'm 24, Grandma is also real old -- that essential dynamic has never changed. But she used to be cheery, snappy and witty. Now she seems muted. And I am reluctant to talk to her now because I am afraid of picking up more and more scraps of evidence that Grandma's brain is not doing what it ought to be.

2008-10-13T16:17:00.002-04:00

First blood.

My name is Ryan and I have a mouse problem.

Last year the mice came, the pooped, they conquered. My roommates and I responded limply -- we emailed our landlord, who emailed some lady who had a meeting and called an exterminator. A month and more poops and furry encounters later, the exterminator came and told us that we had mice. He then proceeded to dump poison in most of our nooks and crannies. The body count rose, the weather warmed and we no longer had a mouse problem.

This year the mice came back early, and they've been getting bolder. I was puttering around making coffee in the early evening and a fuzzy bastard circumnavigated my kitchen, diving behind the pantry. I had to get proactive.

I went to the hardware store, straight to the killing small things aisle and picked up four old school mousetraps. Mousetrap technology seems to be at a relative standstill, taking the "if it ain't broke, don't fix it" mentality. A wooden plank, some metal crap, a spring and a snap. While the rest of the world has moved forward, even giving unchanged technologies cosmetic makeovers (IE: the toothbrush) the mousetrap is purely functional. A tiny death machine.

I dabbed chunky peanut butter on each trap and set them in places that had high yield for mousy activity.

While in bed last night I heard a SNAP followed by mouse screams, and the sound of tiny claws dragging a mousetrap across the floor.

Shit.

"Bide your time," I thought, "it will die."

The mouse went on wailing and clawing. And screaming. Mice squeak and squeal, but, when in pain, they scream, helpless screams with mouse voices. The mouse didn't die, meaning that the trap did not kill, meaning that I had to kill. My shoulder angel told me to end the mouse, quickly and decisively. My bad shoulder angel was less convincing. I wanted to believe that the mouse would die as soon as I threw it in the dumpster, or that a three-story drop off my deck would be more humane and decisive. But I couldn't drink the kool-aide I had to off the mouse.

I pushed the couch back and saw little grey paws frantically pull an overturned mousetrap across the living room and back under the couch. I grabbed the trap and saw a grey mouse, all ears and eyes tugging on his smashed and splattered leg caught under the trap bar. He looked me right in the face.

I eat and poop, but no one (that I know of) is actively pursuing my life.

But then again, I don't poop in my cupboard.

I grabbed a plastic bag, dropped the screaming twitchy mousetrap into the bag, brought it outside and whacked it with a shovel.

The hard thwump of humanity.

2008-10-06T12:41:00.003-04:00

My couch.

My family used to have a little dog -- Pip. In his own way, Pip was both completely unique and incredible while simultaneously confirming every small yip dog (some say "kick-me") stereotype. I could go on about Pip, our fuzzy black dustmop of a tiny wolf.

But the important thing is that Pip, at 22 pounds on a good day was easily moved. Pip could not hog the sofa, for instance. It was just an anatomic impossibility.

Presently my family has a big dog -- Ralphie. Ralphie is the opposite of Pip in most ways. Most obviously, he is big and long, and he hogs the sofa. Physically moving Ralphie out of the way is similarly successful to physically moving a human being. They do not like it. He resists moving from his sofa spot (also the best spot to see the TV from), and he resists with muscle.

But he is just a dog. So there are a number of tricks that work every time. I usually jump to my feet and run to the front door. Ralphie ensues, and I take his spot.

2008-09-28T14:12:00.002-04:00

The poop deck

Some 20 years ago the fishing boat above caught on fire in the harbor around Unalaska, Alaska. The crew was evacuated and everyone thought the boat would sink into the underwater landscape of the Bering Sea.

Instead the fire burnt out, and the smoldering hull drifted to shore, becoming part of a different landscape.

2008-09-20T14:08:00.003-04:00

Is this my masterpiece?

2008-09-07T23:29:00.002-04:00

Internet shopping -- or -- How I Ordered Over $100 of Discontinued Hair Product
When my hair is not buzzed it grows into a matted curly creature that perches awkwardly on my head. It dangles where it pleases, grows in depth rather than length, and doesn't look messy in a cool way when it's "mussed up."

My normal solution is to buzz my hair, making my style essentially white space -- the absence of style. Something a newspaper layout editor would appreciate for its daring do. But my hair, like all the cattle and creepy things, grows. Over the past I'd tried many different products to try and give my hair some form -- any form. Some worked, some did not, but nothing ever made it easy to put my hair into any real shape or form.

Then, randomly one day, I saw a little plastic canister on the bottom shelf of Duane Reade for about $4 and thought, why the hell not. Since that very day, my <3 affair with Dep Sport Sculpting Clay has been in full throbbing thrust. It's this white tacky stuff that makes my hair stay wherever I put it. It withstands Minnesota headwinds. It is really cheap. For a while I would order cases of the tubs of the stuff on the internet. Now I'm down to my last two, and so I went online to try and get another shipment in, only to find that it had been discontinued.

Looking for close-out deals, I found a small internet community of other messy-headed folks trying frantically to build up a stash of the stuff before all was lost. No more bulk buys. Online dealers doubled the price and were only selling single tubs, one at a time. Panick.

Then, I found a deal -- buy 11, get 1 free. Nevermind that the new price is a soild 4 X greater than the initial bulk rate, I clicked frantically. We'll see how long this stuff lasts.

2008-09-03T23:28:00.003-04:00

Dr. Clay

I am a medical student, but I've been one for a while, so I'm starting to get medical questions from friends.

Most lately, my buddy Mark sent me this:

"Hey, you're basically a doctor right — will a bunch of hairspray kill a wounded cockroach?"

2008-08-09T19:13:00.002-04:00

Unbelievable Unalaska

I've just finished my first full work week at the clinic serving Dutch Harbor (the port) Unalaska (the city), Alaska (the state) -- all of which is curiously within the United States. I am on an island of 4000 people located between several island volcanoes (currently spewing ash, with one earthquake this week) working here treating and diagnosing patients. If we can't help them here, then we MedEvac them to Anchorage by a small turboprop, which is the most reliable way to fly out of Dutch Harbor since commercial flights are delayed by fog and volcanic ash advisories more often than not.

The town has one long stretch of paved road that runs between two islands, Amaknak (where Dutch Harbor is) and Unalaska, where the clinic is, across a small bridge. The city is currently building a second bridge a few meters higher because the first bridge has a nasty habit of clipping the attenae and radars on small fishing vessels when they pass under at high tide. The town is also home to a horde of vicous ratty bald eagles. They eat normal eagle stuff (fish, souls) but also take down cats and small dogs. They also have a habit of dive-bombing cyclists and runners.

After one year of medical school I have extensive lecture hall experience, which I carried with me to Dutch Harbor and realized how useless it really is in vivo. After one day of shadowing (Monday), I've been turned loose to do exams, histories and small procedures. I've given a steroid shot, helped suture a small fluffy Pekanese's rear leg, and looked a host of boils, bumps cuts and bruises. It's amazing what people will work through, and our patient's biggest concern tends to be when they can get back to work. Our patients are coming from the fishing boats that put in here, and the four different processing plants in town, as well as dock workers and other tough jobs. They work through the flu, boils, infections, pneumonia, broken ankles, displaced vertebrae and only come into the clnic when they reach a breaking point. This is one of the ways you can have a 40 year old who looks like a 60 year old, or a twenty-something who looks middle aged. It is not an easy life.

At the same time, everyone who comes in is so damn nice. You get these gigantic dudes who look like testosterone posterboys. Prison tats, old scars, big rubber boots and an unshakeable brine scent. Time and time again, though, these guys are Mr. Manners in the exam room. Amazing.

And I am going around learning by doing, and so far it seems to be sticking. I made my first daignosis -- influenza, and made my first reassurance in broken Spanish that this wasn't a death sentence, just a pain in the ass and exremely contagious. An extremely contagious virus that makes work impossible for a few weeks is no good when you have a ship full of people in the wet, wild and frigid Bering Sea for weeks at a time.

The different fishing and processing companies pay for all health probelms discovered while their contract workers on the job, so we examen everyone who comes in to see what all we can treat, because otherwise the workers, a group of immigrants and people who couldn't make a go of it in the lower 48, are not generally on Medica or Bluecross Blueshield.

And generally, it seems sustainable. People work out here until they break down, we see them, force them not to work for X number of days, and their contractor covers the medical fees. The process repeats, and there we have it.

Holy shit I've never learned so much in one week of my life ever.

I also know how to pull up, rebait and set King Crab pots, as well as how to clean those big ass delicious alien critters.

2008-07-28T22:00:00.003-04:00

The cruising dock.

I couldn't sleep last Thursday night. Sleeplessness hasn't been a problem for me since my angsty teenage years, so whenever I get a rare bout of sleeplessness, it isn't that frustrating. I accept that fate has christened me at that very moment to be an awake person.

I woke up at 4 AM to the whir of fans, and Sarah's tiny snores. Each tiny snore marking off another few seconds that I had been awake. I puttered around on the internet, looked out the window, and at sunrise took my bike out for a few circles around the lakes. It was one of those mornings where the world has a hard time getting going. Fog and mist hung over the lakes, the heaven's soft underbelly reluctant to get up and get to it. Cycling through the mist and clouds, the atmosphere along with my own sweat coated me. I took a break to walk out to the base of a T-shaped fishing dock to look out at the sky touching the lake.

An older guy puttered up to me and said hello. He had a thin mustache, was wearing a bell-helmet shaped like a turtle shell, and was shaking uncontrollably. Each movement was plagued with hundreds of jerks and twitches in every direction. The fact that this guy could ride bicycle was a miraculous protest of everything his body was doing to him.

We made small talk, but it seemed more like an interview, with my twitchy interviewer getting all the more kinetic with each further question.

Was I from Minnesota, how old was I (he was 51), what did I do, did I like bicycling, did I come here often ...

I asked back, what did he do for work.

"I'm retired, on disability," he said.

"That's pretty cool," I said, instantly realizing that not only was this entirely the wrong thing to say, but that I had no idea nor any desire how to make small talk with a crippled middle-aged man who was hitting on my before 6 AM on a Friday morning.

Then he went for the money $hot:

"Are you married or single."

Apparently the misty dawn of weekday lake Calhoun is a cruising spot for gays in their twilight, and I was stuck in the dank thick of it. It would have been flattering if it weren't for the fact that I consider myself light years out of a creepy middle-aged guy with a neurodegenerative disease's league. Anyhow, we all get sucker-punched back to reality at some point, and this was my sock to the gut.

I replied that I was happily in a relationship with my lady, to which he said, "so you really like that single life huh?"

His response miffed me. I sized him up. A little man, his bike jerking back and forth, his voice soft and a quavering with each syllable, he had a hard life. He was in a subsection of a subsection. He was a sexual minority from a time when it was a lot harder than it is now to be a sexual minority. He has a terminal disease that makes things as simple as opening a peanut jar impossible. Immediately I thought back to myself -- he must have such a hard time dating that he just goes after anything. He is self-actualized, and really doesn't give a flying fuck about who is gay, straight, ambidextrous, in his league or not. I felt my dating stock rise again, and then he said,

"So you're straight, huh?"

I nodded.

He went on,

"I like guys, you know, it starts with 'G'."

I hadn't heard someone be so openly closeted. What a weird contradiction.

"That's cool," I said, not knowing or caring what to say. Then, unsure what more to make of it, I added, "is it fun to be gay in Minnesota? I used to live in New York. Gay people there seem to like it."

There was no end in sight to this conversation, and I was not making it any better with my incoherent nonsense. The whole scene was just so damn weird that I was caught completely off-guard. I had no idea what would come next in the cascade of awkwardness.

"It's very hard for me to find other's of my species," he told me.

I assured him that I was sure he would find someone,

"There's tons of gay people," I said, "don't worry," I added, closing with, "well, time to get to work."

I biked off, leaving him twitching in the misty dawn.

2008-07-27T03:29:00.002-04:00

On June 15th I got stitches in my ankle (seven) as the silly result of trying to ride two bicycles at the same time. Being in a health care setting, I set out to make lemonAIDs out of ... and anyways, my doctor and I hit it off. Everyone loves a menteé.

In addition to the regular sutures in my ankle, we had to suture a tiny artery in my ankle that was angerly bleeding a little too much. My doc used a stitch that was supposed to dissolve on its own.

But on July 26th, I found out that said stitch did not dissolve on its own. This is because every bit of my ankle had healed except for an angry red circle circumscribing a small pit of dry skin spitting out a string appeared on my ankle. With each tug on the string coming out of my ankle, I noticed only more string, and more pain, came out.

I snipped this mess with a nail clippers and learned not to small-talk my doctors unless absolutely necessary.

2008-06-15T11:52:00.002-04:00

I'm a patient too!

A month ago I got a bicycle custom built to all my likings. It is a single-speed racing bike, the Schwinn Caliente, ready and hot as the day is long. Part of the deal is that I get a free tune-up after a month of riding from the wonderful Sunrise Cyclery, where my bikenstein was conceived. But this has a dilemma -- if I ride my bike to the shop to drop it off for repairs, how do I get back? I got this idea -- bike there with a second bike, that's my ride back. So, I would have one hand, the left, on my handlebars, and the second hand on the seat of the bike I was brining for my ride home.

My mom, somehow was involved in the decision process.

"I don't understand how you are going to ride two bicycles," she said, "we can just pick you up at the shop and drive you back."

"Don't think about it," I said, "it's harder to explain than it is to do."

They say that hubris fells many a tragic hero.

I started pedaling our of my parking lot, so far so good. I stopped at the exit to the road, looked, and bump-bumped from the parking lot on to the road. Like that one little tile missing from the space shuttle, this was something my expedition would never recover from. The second bike I had my hands on is a mountain bike, built much lower with pointy handlebars. The bump shifted me, so I put more weight on my hand that I was holding the mountain bike still with. This shifted the mountain bike toward me on my racing bike. The bikes handlebars stuck into my handlebars, twisted my bike inwards, and slammed me into the pavement.

Pride bruises before skin, or at least before people feel pain. I limped back with my two bikes and failed idea, and noticed I was sliding around in my sandals. Looking down to see what I had stepped in, I saw that it was my own blood, spurting from my ankle. I checked my phone to see a missed call from my mom. I called back.

"We just wanted to tell you that it's stupid to ride two bicycles, we'll drive you," she said.

2008-06-04T17:30:00.002-04:00

She's like Jason from Friday the 13th.

Hillary is holding out for a time machine ...

Or she is playing the sabotage card. Classless, powermongering and narcissistic.

2008-05-26T23:18:00.002-04:00

The herpes virus has two distinct forms, HSV-1 and HSV-2. HSV-1 used to be called "above-the-belt," and HSV-2 used to be called "below-the-belt," but now-a-days those distinctions are no longer clinically relevant. HSV-1 and HSV-2 now share the workload for genital and oral forms of the viral outbreaks, reflecting a shift in sexual practices during the '70s and '80s as felatio came to be a common sexual practice.

This is especially important when one considers how astronauts feel about herpes.

They hate them.

2008-04-22T22:39:00.003-04:00

Perhaps gun-toting uneducated racists aren't representative of most democrats?

2008-04-16T20:12:00.003-04:00

How to tell someone he is dying.

This was my first time really being in the hospital, and already I felt the difference. Seeing patients at clinic is not dire. There is not a sense of urgency. And though going to a cancer clinic is not going to be anyone's ideal way to kick back and put their feet up, just compare it to the hospital.

Hospitals are interesting. From the outside they could be anything. Some look like castles, some like malls, other like labs. But inside, the hospital interior swallows you up. People talk disparagingly about "hospital white," but even without the stigma, the effect would be the same. Windows do not reach the middle of the hospital. People are dressed strange, professionals in pajamas (scrubs) and sick people in gowns that don't close. There is a chorus of beeps, boops, and flashing call lights.

The other thing is that the sick people in the hospital are very, very sick. And the people who are not sick, the civilians who are neither health providers nor sick people, but are visiting the sick — they look sad, sad and scared.

And the sick people are scared

Because, at clinic, cancer patients are always able to get back in their car and drive home. They may have diarrhea. They may feel like shit. They may not be able to get up in the morning. They may no longer care to eat, but they are able to go home.

Whenever we see a patient, we have to make a split-second diagnosis: sick /not sick. It's easy. Look at posture, gaze, color, animation. Then after the first diagnosis comes the second call: hospital / not hospital. And hospital looks very sick.

So, back to the hospital, we were in the center of the cancer inpatient floor. Everything was beeping along, and so were we. A patient who had been a long-time clinic patient was now a hospital patient, and on top of cancer, this patient had gotten even more sick. What is not fair, is that the sick people are even more likely to get more sick. So, as different illnesses layer on like an onion, the likelihood of peeling away the accumulated disease to get back to the first problem gets to be a race against time.

And time tends to be measured by people's organs, and a good organ can only take so much abuse. A sick organ can take even less.

In this cloud, we entered the patient's room with our dramatic irony. We knew there was a chance the patient would never leave the hospital, and we knew that chance was pretty good. The patient did not know this. The patient was completely alert. The only problem was inside the patient, in the blood and tissue. But on the outside, and so far, in the patient's brain, everything was ticking along as it should. When someone enters the hospital as a very sick person they are walking on very tenuous ground. Any step, right or wrong can send the patient reeling on a steep, steep slope to the mortuary. There is not any logic to this stepping are far as life choices, but, medically, there is a logic to it in the progression of an illness.

At the juncture before the next step that could be the last is the time to present the patient with options. And the option is the DNR / DNI order — Do Not Resuscitate / Do Not Intubate. This means that, in multi-system failure, health care workers should not give "Heroic Life Saving Care," because, the life that would be saved has been evaluated by the patient, and is no longer livable. Following the directive is easy. But for a completely alert and responsive patient who thought they were going home eventually of their own power, contemplating why they are being asked to consider DNR / DNI is not so easy.

And that is where I come in.

I was aware of my heart beating. I felt it beat in my stomach, in my head and in my neck as I walked into the patient's room. My mentor sat down, and relieved, I followed suit. I looked at the patient as his tenuous condition was explained to him, and the DNR / DNI option was explained. And the patient reacted. He reacted like anyone would react when they did not consider dying as a looming possibility, he got upset. He didn't believe it. Then he did believe, and he felt worse, and something inside of him sat back down, and he had a conversation with us.

I concentrated on what to do while this happened. I heard everything that went on between the doctor and the patient, and I nodded when appropriate. Then something clicked inside me and I realized what should have been obvious at the first step I took into the room, as soon as I pumped the hand sanitizer into my palm. My thoughts in that room did not mean a fucking thing. What happened in that room was about the patient, absolutely all about the patient. And the reason I was so quiet, and should continue to be was because this was his stand, his battle and his life. Beyond being their as a caring and receptive ear, I had no function. And when that clicked in me, my heart settled down, my stomach felt like it ought to and my hands and feet stopped drenching themselves, but I was no longer thinking about that.

I listened to the patient, my brain on the bleachers, and let him consider his life.

2008-04-01T01:50:00.003-04:00

Harvard Chastity Club

Their founder, Ms. Janie Fredel is a virgin, makes sense to me. Yikes.

Cheap shots aside, after reading about her pseudoscience, homophobia and fundamental misunderstanding of what being human is, there is one positive aspect to college abstinence clubs: the yahoos that join them are not reproducing.

For one, their is a belief that oxytocin, the hormone that stimulates milk ejection, uterine contractions and smooth muscle contractions during orgasm is a deep-rooted love hormone to be shared only within the confines of marriage. Does that make the pituitary gland, the shy secretor of oxytocin (along with some other hormones) the little love bean of the brain, high atop his Turkish Saddle?

Is it really more human to go and work out whenever the sexual drive comes along? Were that our true nature, we would have gone the way of the dodo many moons ago. There are a lot of weird things about humans (hairless, bipedal, fatty) but one of the stranger things are the subpockets of us who fight tooth and nail against making babies.

2008-03-29T11:38:00.003-04:00

Project time.

It's not like I'm going to do a whole series of the different vagisaurs, except, that is exactly what I am going to do.

2008-03-21T00:06:00.002-04:00

Yikes!

Today, for the first time, I was sent in to give brief physicals on my own.

I needed and probed my fingers from the jawline, following the curve of the neck down to the collar bone and then across the collar bone to the shoulder, poking around for any lumps or bumps. The skin moved between my fingers, pulling tight around a lump here, an egg-shaped mass there, a jelly bean below. There are a lot of lumps and bumps in an oncology clinic.

I found something that wasn't described by the C/T scan, so I closed out all my senses. It was just my fingers and a little rubbery bead tucked behind a clavicle. I pushed it this way and pulled it back, captivated.

My patient gasped and yelled "Boo!"

She scared the bejesus out of me. My fingers were out of her collar bone and out the door, along with my composure. I was laughing the hardest yet since wearing that white coat.

"I'm new at this," I said, "and do you know how many patient's have done that to me?"

"No?" she said innocently.

"Just you," I said, and she smiled.

2008-03-19T15:48:00.002-04:00

Togetherness.

More than ever, our country is fragmented. We like to think that America is more than the sum of its parts, but over these past two presidencies we have been moving more and more toward just that — that sum of our parts. When you take all the potential, all the diverse experiences, views and ideas that could form something incredible, unseen and progressive, and split them into alienation and fear, we become even less than the sum of our parts.

Barack Obama has been chastised for being just a slogan. He is too likeable, too attractive, too polished. For years the republicans have coasted to victory with just that — slogans. When America needs to pause and think it turns to the democrats, but heavy thinkers and and big spenders like Mr. Carter and Mr. Mondale leave bile creeping back into America's collective maw.

But for once, there is someone, slogan or not, that is able to unite the states behind a message of hope. Hope is ambiguous, and so is change, but just like the rising tide of hope and unity that rose and fell in the '60s, people finally came back into the streets and cared about something. And right now, they are doing just that. Hilary Clinton would be a wonderful president. But looking at the effect she has on people, on our gut reactions to her — it makes me wonder whether she would be able to pull ourselves together.

And while Mr. Obama has our attention, and has people around the country getting behind something that they may not understand, we finally have someone who does have the nation's attention. While he keeps us tuned in, Mr. Obama can make us think, and feel and analyze. He makes us acknowledge our country's elephant-in-the-room hang up on race, and it is time that someone who understands the complexity and sadness that created the current racial climate today steps up as our leader.

2008-03-08T11:31:00.002-05:00

McCain Grow Testy

The New York Times has a storied relationship with Mr. McCain. While McCain doesn't make it any easier on himself by denying before an allegation is even made, the Time certainly knows how to poke the old bear with a stick.

The latest headline "McCain Grows Testy on Question ..." refers to Mr. McCain throwing a temper tantrum instead of answering a Times reporter. What seemed very poignant about this story, especially in light of Senator McCain's time in the service, is the first part of the headline,
"McCain Grows (a) Testy ..."

2008-03-03T09:12:00.003-05:00

The gift shop

When I was a little kid, the highlight was the gift shop. But the gift shop was also where my heart was broken. After a dry trip through a museum I would be captivated by plastic representations of what we saw. Neanderthal figurines, reaching claws, space food. Somehow, NASA thought it important enough to send the real food they make for astronauts to the center of the country. Probably for me.

Each pass through the gift shop was justly rebuffed by my parents. I had dinosaur toys, I was tall and didn't need a reaching claw — those were for grandma Audrey, and no laughing matter. As for space food, my mom told me I was better off with real ice cream.

***

A couple years ago some friends and I were at the Museum of Natural History in New York, looking at dinosaurs. While we were trying to leave, we naturally were forced to walk through the gift shop. Charles bought some space ice cream, and it tasted terrible.

2008-02-29T17:23:00.003-05:00

Predictive text sometimes predicts something greater and more perfect than I can every imagine. I'm working through the foibles of my new phone's predictive texting, and found today, that it selects "gaspy," as the word more likely than "happy."

Gaspy birthday struck the right cord for me, and so that was what I sent to my friend Remy.

Remy, gaspy 24th (or 6th) birthday.

2008-02-26T00:46:00.002-05:00

Ear wax spoon.

Dealing with earwax is a day to day toil for any ENT doc.

Tomorrow we begin our physical examination class, and the first unit is ear, nose and throat. So before we poked around in each other's orifices tomorrow, I wanted to do a little preview work.

I remember a while ago, someone asked me what the scientific term for ear wax was. Boogers are mucous, poopie is feces and so on. But was was ear wax? Well not only did I not succumb to Wiki's siren song, but I was steadfast in my ignorance. Today I learned that the medical community knows "ear wax" as the almost sensual "cerumen."

Cerumen sounds like a pre-coital skin oil, which, considering how a nibble on the ear lobe can be a wet button topic, perhaps that isn't all that far from the truth.

Nonetheless, our text instructs us on multiple techniques for getting around an earwax road block to the tympanic membrane, otherwise known as the holy grail of the middle ear. There are a few was to poke and prod the wax out with the scope for looking inside the ear, but probably the most extravagant measure is the cerumen spoon.

Also known as the ear wax spoon, this long slender spoon is like an ice cream scoop for heavy ear wax build up.

Big heaping bowls of cerumen please, with a cherry on top.

2008-02-15T12:50:00.004-05:00

I can't stop drawing Narwhals, perhaps the cutest, most ridiculous whale ever. Whenever I feel down, thinking back on the simple fact that these unicorn whales exist warms my bitter heart.

Also, let me remind you that my super awesome wit and drawing skills are also on display with my brother's super awesome wit and drawing skills at Preston and Tread, our super amazing daily comic strip that you all must read.