Thursday, March 30, 2006

I love The Onion

Alternative-Medicine Practitioner Refuses Alternative Method Of Payment

March 29, 2006 | Issue 42•13

PORTLAND, OR—Alternative-medicine practitioner Annabeth Severin, a Portland-area acupuncturist and holistic healer, announced Tuesday that she is refusing to accept anything but conventional monetary compensation from her patients. "I'm sorry, but there just isn't any sound economic theory to support the idea that bartering or visualization of payment has the same effect as traditional cash or check up front," Severin said. Her customers are protesting her billing methods, saying that removing money from their accounts would be financially invasive and spiritually upsetting to their karmic and bank balances.


"Our number one responsibility as doctors is to convince our patients not to take medicine"
-One of my teachers

. . .

I think I'm starting to pinpoint what strikes me as weird about peds, at least part of it. All doctors are sarcastic. And more than occasionally, they are sarcastic about their patients. There's even an article in the most recent issue of the New England Journal of Medicine discssing physician humor and how it is occassionally inappropriate. Tellingly, it was written by a med student. But that's an aside.

I was saying, doctors are sarcastic. And pediatricians are no different. But since I like kids, and think most of them are pretty cute, it is jarring to hear the sarcastic commentary I expect from physicians stemming from the cute 18 month old we just saw. Maybe, subconsciously, there's an element of "you deserve this because of your lifestyle choices" underlying the bitter humor on a medicine ward. I feel on peds like the disciples questioning Jesus: "Who sinned, this man or his father, that he was born blind?"

Of course, in neither instance is the dark humor justified. I'm here, after all, because it's my calling to care for these people, no matter how they got their hurts. Which is why military doctors in Iraq care for insurgents as well as American and coalition troops. It's our responsibility. But I think the dark humor is a release, a way of distancing ourselves from the sick, because though we may want to care for the sick, we don't want to be the sick. I don't know. I'm just figuring this out.

Matisyahu - Youth

It's a good day today. The sun is shining, I've just got classes to go to, and two songs from this album are running through my head.

Matisyahu is difficult to describe. He's a Chassidic Jew, who sings a sort of reggae/hip-hop amalgamation where the lyrics come from his deep religious convictions. This is his third album, though just his second studio effort. I've heard them all, and I'm actually going to see him in concert in a couple weeks. This is a more mature effort than anything he's put out yet. He deals more with social issues, and even touches on the powder-keg issue of Israeli politics here, in the song "Jerusalem." He emphasizes the importance of the issue:

"Don’t you see, it’s not about the land or the sea
Not the country but the dwelling of his majesty"

and with

"Jerusalem, if I forget you
May my right hand forget what it's supposed to do."

And takes a de facto approach to the question of Israeli immigration:

"They come overseas, yes they’re trying to be free
Erase the demons out of our memory"

Very melodic, powerful lyrics, overall an excellent song. The other new track which is most in my mind today is "Time of Your Song" a reflection on a life lived poorly. The narrator relates his downfall "I don’t mean to glorify/ Ate the apple of the tree and tried to lie, " and finishes with a warning to avoid his course. Fairly typical "don't do what I did" preaching, but quite well done, and the production, especially, is excellent on this track.

The album as a whole is good, and finishes with a new studio version of his hit song "King Without a Crown" sung a bit faster than on his previous album. I hesitate to be too effusive because there are more than a couple tracks that really drag the album down, but the excellence of the good tracks is impressive. Overall, I'd consider just downloading the three tracks I mention above from iTunes rather than spring for the whole. I'll have to revisit this one in a few days to make sure though.

3/5 stars, with three top notch tracks.

I found a great quote from a reviewer discussing his concert in the Chicago Tribune:
"Most impressive of all was Matisyahu's rapid-fire beat boxing. With guitarist Aaron Dugan providing melodic fills, Matisyahu sat on the raised drum set platform, legs crossed nonchalantly, and replicated a turntable on his microphone with stunning realism. If anything sounded more remarkable, it was the sound of a thousand jaws hitting the floor."

Tuesday, March 28, 2006

First day

First day on the pediatrics (hereafter referred to as "peds", which is pronounced with a long "ee") ward. I'm not real sure what I think of this environment. On the one hand, everyone is really laid back and pretty nice. On the other, they are very strict about some ways of doing things which seem slightly silly to me, coming off of medicine. And this hospital is entirely computerized, so I no longer have to write out my progress notes by hand. I'm not sure that's easier, actually.

Today had a bit of an eventful start though. I was supposed to be at work, normally 30 minutes drive from my house, at 630. Later start for the new guys, it's all good, right?

I woke up at 6:09.

I managed, by blending in with the crazy drivers I usually avoid, to be in place with my team at 42 minutes after six, but it was still a hair-raising experience. And thankfully, everyone else, including my intern, was late. But I'm going back to the "Chemical Brother's Greatest Hits" as my alarm.

One of my patients is less than a year old, but she has congestive heart failure, an ailment which is much more common to 70 or 80 year-olds. But walking into her room, and playing with/examining (they're the same thing here) her today, you'd never guess she's anything but a normal six month old, instead of a six month old who probably needs a heart transplant. It's strange, but I find it difficult to be sad about a patient who doesn't look sick. Or maybe it's because she is so young. I don't know. I actually a bit mystified by my reaction.

Monday, March 27, 2006


I started my pediatrics rotation today. My orientation began with a great quote from Osler:

The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head.

Indeed. And my first two weeks of the rotation will be spent on the wards of one of the largest referral centers in the world, which means I'll be seeing a lot of very, very sick kids. My preceptor, Dr. Imphi, said it is pretty tough, and tougher on people who have kids themselves. I guess it's a good thing I don't. She also said "if it ever gets to be too much, give me a call and we'll go out for lunch. We don't want you to lose that concern, that care. It hurts sometimes, and that's a good thing." I think she's going to be great.

Sunday, March 26, 2006

Odyssey complete

For now anyway, I'm back home, 1600 miles and two days from where I started. That's a long drive, even for someone who likes driving.

Saturday, March 25, 2006


I've been driving all day, from one hospital to another, halfway across the country. And as I watch mile after mile go by, I'm struck by how amazing this country is. We truly have anything and everything that could be humanly desired. Forests, mountains, beaches, and everything in between. Cities, farms, huts. Take your pick, you can find it here. How amazing it is to live here.

In other news, I got the chance to meet a fellow blogger and another member of a message board I've posted to since college in real life as I passed through their hometown. Wonderful hospitality from two people I've never seen before.

Wednesday, March 22, 2006

Pieces coming together

Though I haven't interviewed for a position yet, it looks like getting into residency at this hospital shouldn't be a problem. I'm pretty excited about it: the house staff are great, the attendings enjoy teaching, and I have friends who live in the area. Not to mention it's one of the best hospitals in the country for internal medicine. Since I went to college around here, I have a church lined up, and the music director asked me to play flute with them on Sunday mornings should I end up down here.

I think I might actually pull off honors in this rotation though. My interns really like me, and my resident said (behind my back even) that I was functioning at the intern level despite being a third year. Pretty flattering. Now I just have to make sure all my scheduling is lined up for next year, and get ready to enjoy what's supposed to be the best year of medical school.

Saturday, March 18, 2006

Interesting endpoint

A patient on my team is getting better. We know this because she woke up this morning and was quite rude to the nursing student. Her exact words were "get out of here and go walk the streets, you prostitute!"

Ahh, the pleasantries of the eldery.

Ironically, her room is right next door to a man who had a similar habit. He would moan at the top of his lungs, and if you appeared in the doorway to ask what was wrong, he would launch into a stream of vulgar invective that proved his past as a sailor beyond any doubt. His nurse was (only half-jokingly) begging the doctors to write him a prescription for haldol.

It is odd, but recognized in at least the four hospitals I've worked in so far, that the cantankerous patients do the best. For some reason, the nice, sweet, old people die much more quickly than their rude and abrasive peers. Maybe it's G-d's way of giving them a last chance to mend their ways.

Thoughts on Music, part II

Adding to what I said below, I think it is important to note that goood music, written by a Christian, will be good music that happens to be Christian. Explicitly Christian art of all kinds has its place, which is why there are hymn writers, and icon painters, and church architects. But what I am referring below to is music intended for popular consumption, music for listening to in the car on the way to the mountains for a weekend of camping, or playing during surgery, or while fixing the car in the garage. Music you play softly while healing a broken heart, loudly while playing volleyball at the beach.

We use music as the soundtrack to our lives, to accentuate emotion, to understand experience deeper, to unify cognition and emotion in the spiritual whole that makes us human. It aids our search for truth. And truth is not painted in the colors of Candyland, it is not always sweet, it is not always pretty. There is great sadness in this world of our destruction, no matter how much beauty waits beyond. And by telling that story, the whole story, of love and loss and pain, an artist shows us ourselves, in a way we cannot.

But I'm reasoning myself into a corner. If music is so deeply affecting, why should it not be explicitly focused what matters most?

I think it has something to do with the reason that every man is not called to be a pastor. For the world to continue, we must have janitors, bus drivers, factory workers, even doctors. We cannot live lives secluded. But does that necessity for interaction require music of the kind I am describing?

Friday, March 17, 2006

Thoughts on Music

Music is surely among the most baffling of the arts in its power to move people profoundly whether or not they have any technical expertise or intellectual understanding of it. If a few combinations of pitches, durations, timbres, and dynamic values can unlock the most hidden contents of a man’s spiritual and emotional being, then the study of music should be the key to an understanding of man’s nature. Music is a code in which the deepest secrets of humanity are written...
-Nicholas Cook

I'm quite sure I agree. And while listening to Sufjan Stevens and Over the Rhine this week, I was moved to write something on how frustrated I am with Christians who think that writing some trite, souless phrases about how much they love Jesus, and setting them to a few three-chord progressions is timeless songwriting. It isn't. Good songwriting is just that, good songwriting, and if a Christian thinks they have the gift of songwriting, they should attempt to write good songs, not songs which are explicitly Christian.

I was excited a few months back to find Jeffery Overstreet, a reviewer who thinks on these same lines. His blog is here, and here's a bit of what he had to say while reviewing the top albums of 2004 (ok, I was reading the archives):

"Many of this year's most impressive releases came from Christian artists composing music that the whole world is drawn to. Sure, there are still those fooling themselves, living in fear of what they perceive as "secular," and yet jealously plagiarizing "secular" styles and trying to "save" them with un-poetic, cheesy, elementary, propagandistic lyrics. But the wall is down now, and when compared to other artists easily identifiable in the mainstream arena, they're shown up for the mediocre and misleading "artists" that they are."

James Blunt - Back to Bedlam

I just picked up this album a few days ago, and overall, I'm pleased. He's good with words, and the music is pleasant, well-produced, and catchy. The second half of the album flags a little, and the closing track "No Bravery" is an awkward anti-war hymn, but when he sticks the the classic singer-songwriter far of love and loss, James is quite good. The single "You're Beautiful" which is getting some radio play now is a touching story of love at first sight, which, like most such stories, cannot be real. The speaker in the song realizes this, which gives the song a more real and less saccharine tone than other such works.
"Goodbye My Lover" is probably the most revealing song on the album. The title says a lot of what the song does, but James' high tenor and solo piano bring a lot of spirit to what could have been trite.
I'm impressed with his allusions too. Blunt quotes William Blake, and references Wilde intelligently. He's not terribly innovative, but solid, and I don't regret buying this one.

4/5 stars

Drug trials

It has become worldwide news that six unfortunate men in England are suffering from the side effects of a drug trial. If you haven't heard, the basics are that a German company, TeGenero, in cooperation with a British company, Paraxel, was conducting the final stages of investigation into a new drug. What, exactly, it was supposed to do is somewhat unclear from the lay press, but it seems it was an immune modulator, which are pretty widely used in cancer chemotherapy and in rheumatology for treating autoimmune arthritis. Anyway, the six test subjects suffered from some deleterious side effects, and two are apparently still in an ICU with multi-system organ failure.

My first reaction to this story was "wow, I'll never be a test subject in a drug trial." This was folowed shortly by sympathy for those involved and their families. But reading some of the articles, I started to get a bit angry. There are already lawyers involved, threating or discussing lawsuits and getting even. Which is probably understandable, but when uninformed people start making grand pronouncements about how a drug company was negligent or liable for an unforseeable circumstance, I worry.

Drug trials like this go through huge amounts of development before a human gets near the pointy end of a needle. And I refuse to believe that this company intentionally put people in harm's way. They may still be in the testing phase, but it has already been run through thousands of in vitro studies, and thousands of animals, and the investigators and their oversight are convinced it is safe for people.

Second major point of contention: these people signed up for the trial. They are knowingly ingesting, or having injected, an unknown substance. That's the whole point here. No one knows exactly what it will do, which is why they are testing it on healthy volunteers. And while no one enjoys such drastic reactions, they are part of the risk you say you understand on the consent you sign.

Now if the company willfully concealed evidence the drug was dangerous, then sure, they should be hung out to dry. But otherwise, I think those slinging hyperbole ought to step back and realize that the test was well planned, believed to be safe, and performed on willing volunteers.

I just get tired of the drug companies being the sterotyped bogeyman. Saying "drug company" in a TV show or movie automatically connotes "bad guys" and this is unfortunate. Sure, they make money off of people's health. But if they didn't, they wouldn't make the drugs they do. And millions of people would die.

But discussing drug companies in general is probably too much for tonight. I need to get to sleep.

Wednesday, March 15, 2006

Germs and Jokes

I'm taking care of my first patient who might have TB. So before walking into her room, I put on a special mask, pass through an isolation room, and into her own negative pressure accommodations. It's funny how aware you become of the tiny variations in the contour of your face when you have to mold a mask tightly around them.

It sets people on edge, bringing starkly into relief how dangerous this job can be, even though TB is not the worst thing we deal with. And I think that's why medical humor becomes so morbid. I asked her nurse for the patient's chart, and she joked "only if you're not going to write any more labs on her. I swear I have TB already, running in and out of there like I do." That's probably not funny outside of this group of people, but we both laughed as if she were Eddie Izzard.

OK, maybe not that hard.

A better example was a few months back, while I was getting blood work done following a needlestick injury. I was pretty stressed, but attempted to shrub off the tension by telling the lab tech "I guess it's just an occupational hazard." He came back with "then I suggest you take up prostitution sir, the pay is better and there's no overhead."


This may be silly, but I'm probably due for another non-medical, more lighthearted post, given the tenor of the past few. I'd like to add before I start that Sufjan Stevens is amazing. I just got Seven Swans and Illinois. Both excellent albums.

On top of that, I'll say that I'm surprised at some of the results here. The Chemical Brothers being my top played song, for instance. But I think that's due to the fact that I've set them as my alarm. If nothing else will, a drum set and angry dance beat coming loudly from the next room will awaken a tired medical student at 5 AM. Even if it takes two tracks. Wow, the neighbors must love me.

The iTunes Game

How many songs: 8560

Sort by song title...
First song: ...which was the son of... - Arvo Pärt
Last song: Zulu War Chant - Afrika Bambaataa

Sort by time...
Shortest Song: Flip Sting (SFX) Kill Bill (Volume One)
Longest Song: Dies irae Verdi: Requiem Robert Shaw Festival Singers

Sort by album...
First Song:El Canelo - Los Lobos - (Just another band from East L.A.)
Last Song:Satellite - Collective Soul - Youth

Top 5 Most Played Songs...
Voodoo People Remix - The Chemical Brothers
Let Forever Be - The Chemical Brothers
Girl Inform Me - The Shins
Stars All Seem To Weep - Beth Orton
Seven Story Mountain - Railroad Earth

First 5 songs that come up on Shuffle...
For a Man to Be Alone - Don Francisco
Say Yes - Elliott Smith - Live at The Black Cat
Little Orphan Girl - Doc Watson - The Essential Doc Watson
Good Times Gonna Come - Aqualung - Strange and Beautiful
No More - Elliott Smith - Either/Or Demos

1. "Sex"--How many songs come up: 1
2. "Death"--How many songs come up: 81
3. "Love"--How many songs come up: 189
4. "You"--How many songs come up: 474
5. "love" and "you" --How many songs come up: 41

Sunday, March 12, 2006


At dinner tonight, I realized what an odd group medical students are. As third years, we're talking a lot about specialties and who is going into what, and whether or not that's surprising. Usually, it isn't. Specialties seem to pick their aspirants, as aspirants their specialties.

Medicine takes so much of our time and effort that all our conscious thought is structured around it. When there are five of us out at dinner, we don't talk about the weather, or whether it's a good thing that Milosevic won't face temporal judgement, or even about sports. Favorite cases, interesting occurrences, even our gossip is related to the hospital. When the conversation does drift away from medicine, it is never more than a few minutes before it comes back.

Only with friends I made before this tribulation we've inflicted on ourselves began to affect us can I relax and talk about music, or faith, or nothing, just sitting there in blessed silence. My bent towards introversion is accentuated: not only am I overwhelmed with human contact already, but the humans I can contact only talk about a topic I find exhausting.

The only way I can survive is escape. My escape is usually music, or art. In the simple concerns of line or note, "what is more than human in me [finds] its solace and its hope." Without poetry, without faith, without music, medicine is pointless, for why save a life which is not special, and why dedicate so much effort to a cosmic accident? It would be worse than pointless, it would be cruel.

Thursday, March 09, 2006

Elvis may never again leave the building

Elvis is back, and it's not a good thing. He suffered a severe complication of the disease we thought we had treated and required emergency surgery. The prognosis looks pretty grim. Though I'm not on surgery, I found out about what had happened, and I went by to see the family. There wasn't anything I could do but give Scarlett and their daughter a hug and tell them I'd be praying for them and him.

I was impressed that when I said I was very sorry to see him back in the hospital, Elvis' response was "well these things happen, and the L-rd has a plan, I know." Stirring faith in someone denied the debatable blessing of unconsciousness as the end approaches.

Monday, March 06, 2006

Going Home...for how long?

The Lady With the Sad Eyes has gone home. Her death sentence has not been commuted, and given the complications she's endured in the past two weeks, it has more likely been moved up. The cancer which is killing her has invaded her brain, and her personality has changed as a result. She is no longer sweet and endearing, but tired and occasionally snappish. She didn't recognize her own family when they visited.

How much of what we are is dependent upon the chemical reactions in a few cells? How does faith matter when something so little can change it? Is our soul a mere by-product of biology, a "ghost in the machine," a machine we don't understand, and merely inhabit on the way to an uncertain doom?

Saturday, March 04, 2006

Elvis has left the building

We figured out what was bothering Elvis. He and Scarlett were grateful, and Scarlett gave me a hug on their way out of the hospital. I am so glad to see him improve.

Wednesday, March 01, 2006

Nerdy medical joke

If you get the following quip I made today, you might be a medical nerd:

My attending:
"So, in addition to RFA, what other localized treatment is there for HCC?
Anyone? Come on guys.
**long pause**
Ok, you might not have heard of it before, it's ethanol"

"Is that PO?"