When I need motivation

I AM FAT AND I AM UGLY.

My friend Erik taught me that mantra -- it's the remedy for complacency. Whenever I realize that a part of me thinks I've got this life thing sussed out, I just say, "I am fat and I am ugly." It also serves a dual purpose when one is in a self-deprecative mode.

I AM FAT AND I AM UGLY.

One out of seven deadly sins ain't bad

This photo of me was taken just moments ago as I reclined in my favorite tree. Seriously, I have become a sloth. I'm sleeping nine hours a night, taking naps in the afternoon, and finding it difficult to mount enough motivation even to perform basic chores such as grocery shopping. Well, I'm drawing the line... I will fight my slothfulness henceforth. So here I am, with my newly discovered will to strive (and, apparently, facility in French):

Painful television

I will have the dubious distinction of beginning my surgery internship shortly after the beginning of the new ABC program, "Grey's Anatomy," which is about a group of surgical interns. Initially I had high hopes that the program would help to illuminate for the general public what surgical interns actually experience. What a foolish little expectation that was! I only caught the last half hour of the show today, but it was enough for me to grow terribly dissatisfied with the veracity of the plot. First, the interns on this program appear roughly as competent as mediocre third year medical students. Second, at every turn the doctors on the program violated HIPAA standards and residency work hour regulations; please don't watch this show and develop the misapprehension that doctors shout to each other through a crowded elevator doorway the intimate details of a patient case, or that whole teams of interns still work 48 hour shifts before retiring to home! Those things don't happen anymore, thankfully. Also, interns don't salivate over the chance to stand passively in the operating room during a brain surgery -- not scrubbed in -- and then have an orgasm when offered a momentary opportunity to look into the microscope. "It was such a high; I don't know why anybody does drugs," said the main character, the intern Dr. Grey. Aack! Continuing the strong dialogue, the attending neurosurgeon (who also happens to be Grey's love interest -- hey, it's drama, right?) nods like a bobble-head doll and says, "Yeah." Way to contribute to the profundity, there, big guy! So in any event it appears that neurosurgeons don't undergo the longest, most arduous residency and work the most challenging hours in medicine out of a sense of professional duty and committment to their patients; nay, they do it 'cuz it's better than crack!

As for the actual medical content of the show -- well, I won't waste time pointing out the whole host of inaccuracies. Suffice it to say that there were plenty -- more inaccuracies than truths. Painful, painful, painful.

As much as I hate to face this fact, I actually feel compelled to watch "Grey's Anatomy" repeatedly so as to know the extent of the misinformation that will bombard the public during the next several months before the show gets canceled. I can't wait until somebody hears that I'm a surgical intern soon and asks, "Is it really better than drugs?" Yeah, it's like sniffing nose candy all day long. I can't wait -- I'm going to feel like Tony Montana sitting behind a foot-tall heap of yeyo, and I'm going to get paid for it! The world is mine!

What do I do? Oh, well I'm a high school english teacher.

I haven't even started my neurosurgery training, and already I'm tired of telling people what I'm going to be when I grow up. It seems that the range of responses of which people are capable when hearing the word "neurosurgery" in conversation is actually binary. Either they reply with a 0, which is machine language for "OH MY GOD! A neurosurgeon? You really don't ever want to know your kids do you? You'd better have a very understanding wife. Well, actually, I'm quite sure you'll have several. Man, you seem really well adjusted for a future neurosurgeon. I guess a lot of 'em must start out normal, though -- it must be the training that kills the personality. Well, I guess somebody has to do it. I'm just glad it's not me." Alternatively, they respond with a 1, meaning, "..." (awkward pause, jaw agape), "Wowwwwwwwwwww...that's awesommmmmmmmmmme. That's really hardcore. I can't even imagine what that must be like. So you're going to look at people's brains and stuff? Wowwwwwwwwwwww...that's awesommmmmmmme. Congratulations. Wowwwwwwwww... That's really hardcore."

That's just about all I get. And so far, no groupies. Somebody should have told me ahead of time there weren't going to be any groupies, because that's a bum deal. Come to think of it, though, not even the neurosurgery attendings seem to have much of a following. Even when their legs are soaked to the knee with blood and cerebrospinal fluid, and they're finally getting out of the OR at 9pm, and they're on their way to their office for a teleconference with their attorney about the latest frivolous malpractice suit, they still don't seem to have any fans hanging about, nor even any paparazzi vying for an unobstructed photograph. Hmmm...I guess all the rocket scientists get groupies, though. DANG IT! Too bad I didn't have any rocket science skills.

So anyhow, I'm thinking of renaming my blog, "Not American History," and writing about my imagined life as a high school english teacher. What do you folks think?

An apolitical post about Terry Schiavo's case

Wow, I can't sleep. I just spent a while reading a blog by a radiologist, who offers his opinion of the Terry Schiavo case. I couldn't resist adding a comment on that site. Meanwhile, I have resisted using this blog as a forum for my personal opinions regarding the case. Honestly, I don't know enough about it, and neither, I believe, do 99% of the people we hear blathering on about it on the news. In any case, I would like to offer some basics of medical ethics -- the ideas upon which this case is founded.

After the horrors committed in Nazi Germany in the first half the 20th century, the international medical community developed four overarching principles of medical ethics to which all physicians must adhere when making medical decisions. These principles are, in no particular order: 1) Beneficence -- the physician must try to help the patient; 2) Non-maleficence -- the physician must not try to harm the patient; 3) Justice -- the physician must consider the impact of the patient's care upon the society, both locally and at large (e.g. using limited resources on exhorbitant treatment for a dying patient is unjust if it deprives other patients of their opportuninity for treatment); 4) Autonomy -- the physician must respect the decision making capacity of the patient, and must not administer treatments against the patient's will. It is this latter ethical principle that comes into play in the Terry Shiavo case. From the standpoint of medical ethics, it doesn't matter if the family wants Terry to live, or if Michael Schiavo wants her not to live. The ONLY issue in question should be, 'What would Terry want for herself?' That is the principle of autonomy in action. We must respect what Terry would have wanted. That is the reason why Michael Schiavo has won every court case to date regarding Terry's treatment: he offers testimony (whether you believe it or not) as to what Terry expressed to him she would want done under such circumstances as she now faces. It's the only thing that matters.

Also, we have this large problem of having to remove a feeding tube in order to allow Terry to pass away. Some people see such an act as tantamount to murder; she was alive, then the doctor did something to her, and then she began to die. However, a well-established precedent exists that the withdrawal of treatment is no different, from a medicolegal and medical ethical standpoint, than never offering treatment in the first place. So taking the feeding tube out -- even 15 years after its placement -- becomes a question of whether or not Terry would have wanted in the first place to undergo an invasive procedure in order to obtain nutrition that would maintain her in her present state. The issue becomes more thorny because the court order Michael Schiavo recently obtained also contains prohibitions against Terry receiving anything by mouth, such as food or even water. I must admit that I'm a bit out of my depth in dealing with that particular issue -- perhaps the family could be allowed to care for her, sans tube, as a compromise that still respects Terry's autonomy? I just dont' know.

In any event, this case has become a terrible conundrum (gee, Ian, thanks for that insight). The take-home point, though, is this: make sure that your loved ones understand your wishes if, God forbid, anything should happen to you. Making clear, illustrative statements such as, "I do not want to have any medical treatment if it means living in a persistent vegetative state," is a good thing. Better yet, capture those wishes in print in the form of a living will that provides guidance for your loved ones. Better still, if you know of an authoritative figure who can make well informed, dispassionate decisions on your behalf, obtain legal documentation to appoint that person as your durable power of attorney should you lose decision making capacity. For example, many physicians have a fellow physician as a proxy decision maker. The idea is that this person would be educated about the pertinent issues and would not let emotion stand in the way of faithfully representing what you would have wanted. Moreover, certain pitfalls associated with a living will can be avoided, because written documentation is by nature static and finite, and cannot delineate exactly how caregivers should act under an infinite number of circumstances. Whatever you do, remember that it's never too early to think about this sort of thing; Terry Schiavo is a prime example.

Okay, I'm sleepy now. Hopefully I kept this post relatively free of opinion, restricting it instead to background info and general advice.

Bored, bored, bored

A friend of mine who reads my blog (my only non-Internet friend who routinely reads it) was a bit confused by my last post, which is probably because I was not clear about the origin of the poem that I trashed. I think that's understandable, because nobody in his right mind would actually take something he created himself and criticize it so sardnonically, right? Well, sometimes I like to mock myself in order to ensure that I'm not taking myself too seriously. It works for me; I find it difficult to remain in a melancholic mood for any length of time if I consider myself a buffoon who worries himself to death over trifles.

Anyhow, I spent today (well, yesterday, at this point) expressing how completely burned out I've become on my steady diet of medical school this and medical school that. I tried to read a few pages in American Pastoral by Philip Roth, but then I got bored and stopped. So, I moved on to Sons and Lovers by D.H. Lawrence, but then I got REALLY bored and stopped. Next I tried to do some writing, but about two hours and forty words of composition later, I realized that it just was not going to happen today. So, I acquiesced to my urges and drove off to the casinos, where over the course of four hours I succeeded in losing $100 playing limit Hold 'Em. It's no big deal, though -- I just won't eat for a week or so, and I'll make up for that lost money, no sweat. Eating is overrated anyhow.

So is sleeping, by the way.

Esa poema es terrible

As I remain stricken with intense blogger's block, I decided to post some more old poetry rather than leaving my blog blank for another day. This piece (of ____), written about three years ago, is a particular favorite of mine, as it calls to mind what a room full of chimpanzees might produce if they were provided a typewriter and a thesaurus, and then given abundant time -- oh, say, twenty or thirty minutes. Oh, and they should be nihilistic chimpanzees. With hemorrhoids. Okay, so we're limiting our candidate pool -- one nihilistic chimpanzee with hemorrhoids will do.



This chimp should do.
Originally uploaded by Ian D..

"By the Campfire"

By the side of the fire he lays his head;
The remnants of his dinner still adorn
His plate -- fresh caught fish and canned corn.
He relishes lying where other feet don'€™t tread.
Gazing at the starry night, a wistful thought
Encroaches. Could he stay? Let his absence
Spill and blot out all the words of nonsense
That ruefully define the diction of his lot?
His mind ascends on a blissful gust, as he
Ponders the wonders of a hermetic home
Here, devoid of the paragraphs in the tome
Of his life, written so peremptorily.
Yes, he will stay! O joyous evening away
From the painful truth of his reality among
The Others! Here there is no truth slung
Gravely upon his neck, but only day after day,
And time stretching endlessly before him while
The guileless rain washes off the caked history
Of society and leaves the indelible mystery
Of Nature to curl his wayward lips into a smile.

Then, a baleful epiphany clatters over the hills.
He must return. The firm dictate of a Nature who
Will not have him here: he must wade through
The fetid mire of what he was granted, as God wills.



Wow! Great job, Coco! I particularly like how you threw in that line about the canned corn so as to preserve your simplistic rhyme structure. Nothing says poetry like canned corn. Now, was that creamed or whole-kernal?

Anyhow, Coco, you have done yeoman's work with that thesaurus we gave you. In fact, learning only the vocab words you forced into this little poem would be sufficient to ace the verbal portion of the SAT! And as we all know, the key to good writing is to cram as many inkhorn words in there as can possibly be made to fit. You've really outdone yourself here, Coco. Hey, are you even listening to me? Put down that typewriter -- that's not food! Bad Coco!

P.S. In looking for a picture of a chimpanzee I happened upon this little fellow, who is apparently buggering himself. Somebody actually painstakingly sculpted this thing.
Ahem...what, exactly, is that right hand doing?

P.P.S. Upon further review, it appears that the right hand is actually involved in the wholly innocent endeavor of clutching the right thigh, and that I in my idiocy have mistaken the chimp's foot with his hand. That's not to say he hasn't developed certain talents with his right foot, though.

P.P.P.S. And besides, he's a cute little fella, even if he is abusing himself.

Oh, by the way, I believe it was just last night that I swore off these 2am posts. Just ignore everything I say; it'll be better for all parties.

My mood swings have put me in a bad mood

"Drying up in conversation
you will be the one who cannot talk"

I've been feeling out of sorts the past few days. I'm not sure if it's because of the recent Match that signifies the impending conclusion of my medical school training (and the inexorable advance of the next seven year phase of my life), because I will likely sign a contract on a ridiculously expensive house tomorrow, or because my girlfriend departed today for her three week trip to India. Whatever the reason, I have felt rather leaden. My blog has suffered, as you can perhaps surmise from my recent uninspired and laconic posts. On the plus side, though, I seem to have installed a new time sink into my life: Blogshares. Somehow becoming a mogul in fake blog stock has struck me as more important than reading or writing anything substantive the past few days. Well, I intend to readjust my priorities tomorrow and spend my time in a more constructive fashion. That's not to say I won't strive to increase my net worth in B$, but I will at least spend a few hours tomorrow writing. Perhaps getting my sleep schedule back in order wouldn't hurt either! (Sorry, no more 2am posts).

Blogger's lassitude

I could write a nice little blog post this evening. Or I could just sit here and stare at my computer screen, my wall, my feet, and any other random thing that happens to catch my eye. Yeah, I'll do that. G'night all.

Pervasive nausea

Having mentioned a particular medical supply (heretofore indicated by the initials V.S.) a multitude of times in recent posts, my infernal Google ad bar has become a one-stop-shopping alternative for all your pelvic examination needs. Though I must admit to some curiosity over the extent of the damage done, I cannot gather the guts to run a Google search for a V.S., lest I find that my blog has actually occupied a high station. Ugh. Time for some Zofran.

What? On what?

Search used to find my blog through Google:
"cystic on man's balls"

Sweet. The search, that is -- not the balls.

Feeling ill

I just noticed that the Google ad bar I placed on my blog some time ago in a fit of poor judgment has dealt me a formidable blow. Yes, indeed...I am now advertising vaginal specula on my blog. Come one, come all, get yours while they're still cold! Special price for you today! Get your vaginal speculum here!

I must make this feeling of nausea go away, but I'm so dumbfounded that I can't decide whether to use my finger or the back of my toothbrush to gag myself. Any suggestions?

Ch-ch-ch-ch-changes

Not feeling like writing any content for my blog tonight, I decided instead to fiddle with the sidebars and add two new features. First, I have a column called "My Published Writing," which at present contains the only story I've ever published: one that happens to be published in my school's literary journal, which probably amounts to exactly nothing in terms of the gravity of the accomplishment, but at least it's a start. I hope to add links to more published stories in the near future.

I also borrowed an idea from L and added a drop-down menu with links to some of my earlier posts of significance. If you feel like browsing, these represent my attempt to cull the wheat from the chaff, so to speak, saving you the trouble of having to wade through multitudes of inane posts about online quiz results and the like.

Anyhow, thanks for reading, and to all, a good night.

To this chapter, a conclusion

Yesterday I finished the second stage of my medical board licensing examination, meaning that I will now be able to practice medicine as an intern come July 1st. More importantly for me in the short term, though, is the fact that I can now go about the practice of life in an unencumbered fashion, reading and writing what I want, when I want. It's a nice feeling. Of course, nagging issues will arise and demand attention, such as ongoing student government duties and the detail of a graduation speech I have to prepare. However, those things will not seem too terribly painful now that my time is my own once again.

The exam was another exercise in attrition. I had to see twelve patients, performing a thorough history and physical exam on each, and then summarize my findings in a medical record note. It wouldn't have been so bad were it not for the unrealistic time constraint imposed upon us: 15 minutes to interview, examine, and counsel the patient, and 10 minutes to write it up. The latter time limit I could handle, but 15 minutes to see a patient borders on absurdity. Oh, sure, doctors do it every day in their clinics (we've all likely been on the receiving end of all-too-brief care, seeing a blur of a white coat move into the room and steamroll us with a mechanical diagnosis and treatment plan), but they do so with the aid of pre-printed patient history forms filled out in the waiting room, saving them the effort of asking about Aunt Clarice's psoriasis and other minute details. Nevermind the fact that practicing physicians have...well, years of practice, which tends to expedite the process of clinic visits. In any case, 15 minutes proved vastly inadequate for me to feel comfortable in creating a quality patient encounter. Yet, that was the scenario presented to me. So, for eight hours total (we had a couple of breaks, hence the failure of the math), I plowed through patient after patient... Oh, wait. I can't really say any more. See, the first rule of the Clinical skills exam is you're not supposed to talk about it. And the second rule of the clinical skills exam is you're not supposed to talk about it. Seriously. I could get in trouble. In fact, I may just burst into a smoldering pile of charred bones in an instant if I divulge any more details. Suffice it to say that I feel tired and worn, but glad to be finished. Now it's time to gather the scraps of my life, and during the next three months, paste them together into such a patchwork that, though it will not likely resemble the real thing, it may serve as a suitable substitute. So bear with me.

And thanks to everyone for persevering during the great Blogger comment famine. My trip to Chicago left me unaware of the turmoil, but I was pleased to find a couple of emails waiting for me upon my return. Thanks to KarbonKountyMoos for the great postcard, and sorry to Extreme Unction for the delay in providing apt medical terminology for toes. It's good to be back.

Sapped of production capacity for tonight

Initially I felt like writing a decent blog entry tonight, but upon sitting down at my computer I found my mind wandering to stories and themes I would like to explore in depth at a later date; nothing sprang to mind that would suit a quick blog post. Besides, I'm tired from studying and generally overcome with evening lassitude, so here instead is a poem that I wrote about three years ago. I don't write poetry, by the way. Let's just get our excuses out in the open beforehand.

Tender is the breath that blows
The fine powdery dust from the stone;
What words there linger on the slab
That marks a passage to a lasting home?

Carved in the granite, defying the flow
Of time with an ebb of the infinite,
The words bespeak the works and days
Of a tireless body and the soul within it.

Words to sum, words to conclude --
What do they say, those sentinels
Of a singular history? What ink did
This life score in the world's annals?

Ah -- a closer look reveals that
The space for summary remains yet blank;
So still I can choose: what grave words
Will encapsulate me once my corpse is cold and dank?

I'm like a speculum...

speculum
Originally uploaded by Ian D..

...that's how many medical examinations I have endured. Though, hopefully, most women don't bristle at the sight of me as they do upon glimpsing that bad boy.

Once again, a board examination detracts from my enjoyment of my final months of free time before I begin residency. This coming Saturday I'll take the second part of my USMLE Step II board exam, this one consisting of 12 standardized patient encounters that will demonstrate my proficiency in patient communication and the diagnosis/initial management of some common diseases. Alas, this test pretty much blows, and I am loathe to devote ample time to preparing for it. But I must. So, begrudgingly, I spent a few hours today, and I'll spend the rest of the next three days, studying like the obedient little student I am.

I wrote a long rant about the exam, its premise, and its implementation earlier today; however, I decided against publishing it, both in the interest of avoiding a needless increase in the negative Karmic energy of the world, and in the irrational fear that somebody from the National Board of Medical Examiners would come upon what I wrote and decide to fail me out of spite. Well, the latter is not really a concern for anyone not suffering from a paranoid delusion (thus not a concern for me!?!?), but in any case the rant served its purpose by providing a much needed catharsis. Now it's gone, deleted, and I'll hear no more about it, understood?

Well, I'm off to bed and then back to the books. I'll try to post intermittently for the next few days, then return to our regularly scheduled programming next week.

Me too

I saw a link to this quiz on The Meat of the Matter, and I ended up getting the exact same result as he did. I guess it's reassuring, somehow.

Your Brain is 33.33% Female, 66.67% Male

You have a total boy brain Logical and detailed, you tend to look at the facts And while your emotions do sway you sometimes... You never like to get feelings too involved

What Gender Is Your Brain?

Lessons from The Jacket

I watched The Jacket this evening, a new film starring Adrien Brody and Keira Knightley. This is what I learned, whether or not I wanted to learn it (WARNING-- MAY CONTAIN PLOT SPOILERS, especially #7):


1) Time travel may or may not be possible
2) Presenting time travel on film with an internally coherent plot is patently impossible
3) Apparently -- I had never noticed this before -- one's memories actually appear on the retina as if cast forward from a movie projector located (I would guess) somewhere just posterior to the optic canal
4) Keira Knightley's breast development is roughly Tanner Stage III
5) Keira deserves respect for showing us that one need not have 500cc saline bags implanted prior to exposing one's breasts on film
5) Adrien Brody's maxillary teeth are in fine order, whereas his mandibular teeth are all over the place
6) When observing extreme close-ups of the mouth, one gains greater appreciation for Eliot's description, "her teeth were only accidental stars with a talent for squad-drill"
7) Wretched, ill-devised, cruel, medieval psychiatric treatments are not for everyone; side effects may include PTSD, time travel, and -- if one has already sustained a severe scalp laceration leading to profuse hemorrhage -- death from unabated continuation of said hemorrhage

But at least I learned something.

The best laid plans

For the past couple of years of med school, during which I have studied until my mind was dull, I often thought how fun -- and how easy -- it would be to write. Alas, I rarely found the time to write, as my studies and/or clinical duties demanded my attention anywhere from 10-24 hours per day, but I always thought wistfully of how blissful such a pursuit would be. A recollection came often to my mind of an article I had read which stated that Stephen King, one of the most prolific of contemporary writers, could produce as many as 1500 words(!) per day; yet that total struck me as rather mediocre. I knew that I myself could write 1500 words in a couple of hours, so surely I could produce at least five times that much in a single day! Hmmm...

I'm working on a short story at present, and I must admit that my previous conceptions of the writing life are proving far askance from reality. Don't get me wrong, I've written many a short story before, so the realization of the difficulty of writing comes as somewhat of a shock to me now. Though I cannot say for sure why I have begun to suffer this newfound difficulty, I suspect that my medical training has had a sure influence: whether by instilling in me a greater appreciation for economy (as all medical communication places a priority on being succinct), by making me more intently focused on the quality of my product, or even perhaps by robbing me of some of my basic literary facility, med school has made it exquisitely more painful for me to write. In any event, my goal of writing a novel before beginning my residency on July 1st may prove daunting indeed, and will surely require me to eliminate needless distracions from my daily routine. Hence, I may pass on addictive but time-sucking activities such as Texas Hold'Em. Man, I'm gonna miss Texas Hold 'Em.

Meanwhile, with this resolution fresh in my mind I just spent an hour on my girlfriend's couch watching America's Next Top Model. Way to go, Ian. That's time well spent, buddy.

P.S. More acurately, I spent an hour coughing, sneezing, hacking, wheezing, and generally making the world a snottier place to be, all while watching America's Next Top Model on my girlfriend's couch. I am tormented by millions of organisms that don't even meet the minimum criteria for life. Humbling, indeed.

On receipt of a parking ticket

A great benevolent

Force

Protects

the

innocents

On even dated Wednesdays

So

Do not fear