Wednesday, May 31, 2006


I don't believe race is still a huge problem in our country, but I have noticed something really odd lately. My white attendings usually refer to black patients as "African-American" and to white patients as "Caucasian." However, my black attendings usually refer to black patients as "black" and to white patients as "white." I'm intruiged, since studies have shown that dark-skinned Americans descended from sub-Saharan Africans prefer the label "black." I wonder if this is just a generational thing, since I always say "black" or "white."

And the descriptor itself doesn't make sense. I've white South African friends who call themselves African-Americans as a joke, just to point out the absurdity.

It is equally absurd to refer to white patients as "Caucasian" for two reasons. One, real Caucasians (Georgians, Chechens, etc.) are usually a bit dark skinned, and two, almost none of the white population of America is from anywhere near the Caucasus. It would make only slightly more sense to call white people "Alpsians" or "Pyrennesians" (staying with the mountain theme).

Just something I think is odd. And by perpetuating awkward politically correct descriptors, I think we stall the final elimination of racism. Morgan Freeman said recently that "the only way to eliminate racism is to stop talking about it" and further that "black history month" was offensive. I think he's right on.

Tuesday, May 30, 2006


I realize my love affair with C. arabica has gone too far. This morning, taking my first sip of hot water percolated through the ground roasted beans of that heaven-sent plant, I felt like a shade was lifted off the world, and a sense of peace and bliss much like the Saint of Avila must have felt descended over me.

I promise there's nothing but coffee in there...

Monday, May 29, 2006


I used to think I was a big fan of the rural environment. But now, living in one while finishing my family practice rotation, I'm changing my mind. I'm sitting in the one place in town I can access the internet for free and actually use it. This is the only place I can access this site, for example, since my hospital blocks it. The problem is this is an "internet cafe" contiguous with a gas station convenience store. So the air is redolent with hotdog grease, cigarettes, and petrochemicals. At least there is internet access I guess. And that alone means this isn't truly rural. But I'm not going to split hairs there.

Mostly I'm in a bad mood because I just got a speeding ticket. I'm convinced it is only because I have out-of state plates on my car, and I'm having deep, philosophical musings on the fascist nature of traffic cops. I actually asked the cop why he didn't pull over the guy who was passing me, and he said "he was going 2 miles slower than you." Now, I didn't major in physics, but if someone is passing you, they are, by definition, going faster than you are. The other driver was fortunate to have in-state plates though. Grrr. However, life is unfair, and I was speeding. So whatever. I can't wait to return to the metropolis, where 10 miles over is 5 miles too slow.

Sunday, May 21, 2006

Oh come on

Family practice so far has been like Internal Medicine-lite. Less sick patients, and fewer of them. And though I know I'm supposed to be sympathetic to all, sometimes that's a bit tough. Some of the residents seen this situation as it is. I was in clinic, having a pretty slow day, when a walk-in patient came up on the schedule. His sign in sheet said "trauma to left hand," so the resident and I were getting ready to actually do some good.

I should take this aside opportunity to say that this resident, Dr. Sard, is my kind of doctor: a bit sarcastic, though not about sick people, with a good sense of humor. The radio had been on in his office, and interposed with the typical pimp questions I'm getting, e.g. "what's the first choice antibiotic for community acquired pneumonia?" he's tossing in things relating to the songs we're hearing like "Cher is possessed by Satan. True or false?" So we're getting along fabulously. (The right answer is yes, by the way)

And this patient walks in, having hit his thumb with a hammer while doing some light construction. Yes. He hit his thumb with hammer. We looked at it, and saw nothing broken, nothing seriously injured at all. So Dr. Sard pulls me outside, and we have this conference in his office:

"So, Nathan, have you hever hit your thumb with a hammer?"

"Yes sir, I have."

"So have I. Did you go the doctor for it?"

"Um, no."

"Neither did I. Let's give him a bandaid and some encouragement.

I can't wait to retire."

So that's what we did. Unfortunately, that's a lot of what I've seen. Sniffles, headaches, minor injuries. The sort of thing anyone with a mother should know how to handle. You definitely don't need an MD to tell someone they have a bruise on their thumb, or that Tylenol does actually do what the label claims. Lest you worry, we also got an x-ray of his hand, which was completely unnecessary. Perfectly healthy hand.

I don't think primary care is going to be my strong point.

Final Round

I'm now in the second week of my final rotation of my third year. And if anyone was actually checking in here wondering if I'd ever post again, I should explain that I'm at a new hospital, whose network admin guys take a dim view towards anything that isn't strictly related to work. I can't even log onto some of my favorite news sites because they are "Politics/Opinion" sites and are banned.

So, I'll be trying to post regularly, but for the next three weeks, updates will be a bit sparse I think.

Friday, May 12, 2006

Gallon challenge?

You know the challenge to see if who of a group of people can drink a gallon of milk within an hour? Bah! A classmate of mine came up with a better idea: the Go-Lytely challenge. Everyone gets a double dose of Go-Lytely and last one standing wins. Standing. Literally.

Before you click on that link, I should say that this is one of those gross medical humor moments.

Thoughts on intelligent design

I'm not really interested in starting a debate on this here, primarily because the debate is often fruitless, but I do want to preserve for myself, on this site, some comments I made at this blog. My closing point:

I agree that the driving force behind modern evolutionary science is a deep-seated conviction that naturalistic philosophy is absolutely true. But it is better science. (not great, but better) Evolutionists like Richard Dawkins and his intellectual progeny argue from observations backwards. Lacking any religious convictions, they trust their senses, and assume things we see on a small scale today (development of antibiotic resistance, variation in finch beaks, etc.) account for the large scale variation we see in the world.

ID unfortunately has a fundamental problem: they are approching from the other end. ID guys assume there is a creator and look for evidence of him/her/it. They insist this isn't the case, but the only defense they have of their actions if they truly aren't arguing from a first cause is intellectual laziness, a refusal to probe that black box on the empiricist terms set by modern science.

The difference between the two, and why ID will never win the debate, is that naturalists don't assume anything more than observation as a basis for their proposals. They may be wrong in their assumption, but they are based in a simplistic, empirical worldview. ID-ers must assume something outside the test tube, and in so doing, they make pure scientists nervous.

Oddly, perhaps, I am much more in the ID camp than the naturalist camp, but that stems from my religious convictions. I just am willing to admit that.

The key that the ID camp is missing is that they are attempting to win a debate on empiricist grounds, using rules defined by empiricists. What they ought to be doing, and what people like Philip Johnson do well, is attack that empiricist mindset, show the logical inconsistency of the rules as they exist. They can't win by saying it is science. What they can do is say that our perception of what science is must change.

Wednesday, May 10, 2006


In my meeting this morning Dr. Woodley, in his characteristic epigrammatic style, insisted that “with everything in life, we ought to ask ‘what am I getting out of this, long term?’” I don’t know that I can answer the question satisfactorily.

There is no permanence to things. But things (or the act of acquiring them) often pass for meaning. I read once that Andy Warhol's apartment was full of bags of groceries when he died, that he bought things merely to fill the void. The story may be false, but the essence rings true. Our lives lack meaning or permanence, so we buy things to fill them.

Today, on the way back from running errands, I dropped into Barnes and Noble to buy a P.G. Wodehouse novel. I’ve been told I should read him. The five pages I have read are hilarious. But something tells me I’m wasting my life if I’m not doing something with purpose every minute of every day. Probably I’m too young to feel this, and it’s assuredly a byproduct of the type-A personality that got me into medical school. Recognizing the source does not answer the question though. I’ve just bought a “thing” something with which to fill an idle moment.

So the question arises, what do I do with my life? Not the grand aim, I'll ponder that later. Right now, what do I do with the five minutes walking to lunch, or is walking to lunch all I need to be concerned with? What do I do with the twenty minutes driving home? The hour of free time between work and study and sleep? The sum of “spare moments” is the majority of life. I’m bothered how I’m spending mine.

Tuesday, May 09, 2006

Paper update

Tomorrow I meet with Dr. Woodley to discuss the paper we're going to write. It's actually quite a daunting prospect, as I've done far less review and preparation than I should. So this afternoon I'm reacquainting myself with an old friend. Between that and some articles I've been perusing since we last discussed the idea, I should be prepared. I hope anyway.

Monday, May 08, 2006


The best part of today was that Dr. Augur, one of the smartest people alive, and possibly the best lecturer since Demosthenes, was also involved in our teaching.

In the midst of a lecture on lipid control, he asked what we thought of a patient who was 5'11" and 170lbs. A classmate of mine responded that the patient was way overweight. Dr. A's priceless response: "are you running a concentration camp? That's fine! That's normal! Who are you?"

We all thought it was hilarious.

Maybe you had to be there. I'm glad, for your sake, that you weren't.

Saturday, May 06, 2006

Friday, May 05, 2006

Peds is Over

I can't say I'm sad, or that I'll miss the rotation. Hopefully I'll miss it actually, since if I failed the shelf exam today, I'll be revisiting this particular Slough of Despond next year.

Next up, Family Practice, which will hopefully be a good solid review before I take the first of four remaining tests between me and medical licensure. That should scare me more than it does, I think.

I'm celebrating tonight though, by giving myself several hours of uninterrupted mandolin practice, followed by a night's sleep that doesn't cease at 5am. The little pleasures in life mean so much sometimes.

No story, no ending

A few years ago, on an ordinary day, a young man put a gun to his head and pullled the trigger.

He survived, and now needs two anti-psychotics and one anti-depressant to stay sane.

I saw him in clinic yesterday for his yearly physical.

Tuesday, May 02, 2006


HEEADDSS is an acronym used in adolescent medicine. The assumption is that most adolescents are healthy, and it is more important to practice health maintenance with them than to spend a lot of time on acute complaints. So, at my clinic anyway, the vast majority of time in an interview with someone between 12 and 19 is spent asking a few questions from each of the HEEADDSS categories

Sexual Activity

Normally, and when done well, this picks up the primary ways teens are getting hurt, or setting themselves up to get hurt.

Normally, and when done well.

However, one of my classmates (you know who you are) made a faux pas while conducting this exam which is now legendary among the staff. Apparently, his rapport, or his style, or something, was a bit off (all right, all right, it was his first time too) but he managed to get through the entire interview and come out of the room to present the patient concluding that, though suffering from mono, the girl was pretty normal and well adjusted. Of course, when the preceptor came back into the room, the first thing he noticed were the multiple transverse unhealed razor cuts on the patient's wrists.

Observation is key.