Hearsay

I'm fortunate to have good friends, who understand my schedule, because I only know the following story from an account given me this afternoon. Apparently, yesterday evening, one of my friends called me up, and our conversation went something like this:

"So, Nathan, what are you up to?"

"I'm in my room"

"Uh, great, are you interested in coming to grab dinner?"

"I have to...to...get out of bed. Good bye." *click*

I have no memory of this conversation. None. Normally, when someone tells you something like this, you dimly remember talking on the phone, and some of the details come back to you. Here, I'm at a complete loss. I was positive that I was asleep from when I got home around 4 until dinnertime around 8, and then back to bed (It's been a long week) But apparently, I had a curt discussion with my best friend at school and I don't remember. I thought he was pulling my leg, but no, he's serious.

I wonder if this sort of thing happens in intership as well.

I think...

I think the definition of a mixed blessing is discovering the source of the strange smell coming from your fridge.

Deep thoughts

Far from being solely concerned with internet games, Donkey Boy has been thinking some deep thoughts about G-d here.

Whether or not God exists, one must still choose how he is to live his life. That is to say, God does not function, as most would want him to, as guarantor of one’s actions. Good is good and bad is bad, regardless of whether or not God exists. Put in another way, wrong did not become right because God proclaimed it so. There was, of course, the alternative position raised by Christian existentialist Dostoevsky that if God does not exists, then all is permissible. I, however, sided with Nietzsche who argued that even if God did not exist, human artists could invent the good by which we were to abide.

I would argue, as I posted on his site, that there is also the alternative that good is built into the world because of G-d's relationship to it: that it is an aspect of nature like gravity, and that your belief or denial makes no difference for that reason. You can know nothing of Newton and still enjoy lobbing water ballons off a balcony, as I did when I was young.

Reason #387

Not to get a tattoo:

Tattoo customers in 3 states get infections

ATLANTA - A worrisome superbug seen in prisoners and athletes is also showing up in people who get illegal tattoos, federal health officials said Thursday.

Forty-four tattoo customers in Ohio, Kentucky and Vermont developed skin infections caused by methicillin-resistant Staphylococcus aureus (MRSA), according to the U.S. Centers for Disease Control and Prevention...

...that I had such friends

I have a wonderful set of friends and family. To all those readers who understand, thank you, you're awesome.

Face Recognition

This morning I got an email from Donkey Boy (thankfully, not his real name) and perusing his blog, I found this fascinating website which lets you upload a picture of yourself, and in return, it shows a group of celebrities who look somewhat like you, based on facial recognition techniques. Though it didn't seem to work too well for my electronic interlocutor, my results were pretty good. The top choices for who I look like are apparently Franz Kafka, pictured right, and Brendan Fraser, on the left. I'm not about to publish an actual picture of me on here, but I actually think the software isn't too far off with Brendan Fraser. And Kafka? Well, maybe the eyes and jaw. But the ears? Come on.

Of course, it also mentioned Alexis Bledel as a possibility, showing that it's not perfect, but maybe you really are attracted to people who look like you after all...

Keane - Under the Iron Sea

When "Hopes and Fears" came out, I was a Keane apologist. Numerous reviewers compared them to Coldplay, and said terrible things like "derivative" and "guilty pleasure" about that album. I stand by my original assessment of it as a a wonderfully melodic album, and distinctive as a whole. Coldplay's albums tend to be largely ethereal, with an occasional hummable single like "Yellow" or the "Clocks" rising through the mist of sound, whereas "Hopes and Fears" is a whole album of singles. However, "Under the Iron Sea" is a lot like Coldplay. Imagine what the outtakes from"X&Y" sound like, and you've a pretty good idea of what this album is. The single everyone's playing, "Is it Any Wonder?" is a good song, a quite catchy and well written lover's lament: "sometimes I get the feeling that I'm/stranded in the wrong time/where love is just a lyric in a children's rhyme" but the rest of the album is largely atmospheric. In short, just like Coldplay.

I don't blame Keane for trying this formula, it garnered international superstardom for Chris Martin and his fellows. Chris even ended up married to Gwenneth Paltrow, and there are probably worse fates imaginable.

But the point is, I have to agree with earlier critics on this one and say yes, it's a good album, but you can't help but think of another band while it's playing.

Ha!

From S. Lee, who has gotten me into cycling, in response to a question about Aero Bars:

"Lance Armstrong needs Aero Bars, mere mortals need more training."

ATLS certified...sort of

So I passed the ATLS course, but with the little "congrats" sheet they gave me as I walked out, there is a fine print note at the bottom, which reads:

As a medical student, you are ineligible to receive a card for successful completion of this course until you graduate from medical school. You have successfully completed the course and will be eligible to receive a card after graduation.

So maybe I can put in chest tubes, intubate, splint pelvic fractures and insert intraosseus catheters, but I can't prove it yet. Not for another 332 days. Somehow, this doesn't really put a damper on my mood.

In other news, I consider it a sad, bitter irony that the female surgeon who married another surgeon, and who assured my class in a lecture a year ago that it was entirely possible for two surgeons to marry and have a normal family with several kids, got divorced and remarried within 4 months. I don't think the guy is a doctor. I have no idea about her kids. The really odd thing about her talk back then was that she said, and I quote "the key is having a really good nanny who can move around with you." I think I'd rather not have children than have them raised by a nanny.

The Fourth year begins

Today marked day one of the fourth year of medical school. We're starting off by taking the ATLS course, so we can be certified in trauma care. The course is basically first aid on steroids. The Boy Scouts teach you rescue breathing and CPR, this teaches cricothyroid airways, chest tube placement, and the like. The aim is for physicians who aren't surgeons to take this course and be able to save lives long enough to get them to a trauma center. And it has been great so far, lots of hands on stuff, and input from a very fine staff of lecturers.

The crazy thing is that the entire course is crammed into two days, so we started this morning at 7AM and we finished today's stuff at 7PM. 12 straight hours of lectures and labs, with one half hour for lunch. Fire-hose learning. It's like first year, all over again.

Gnarls Barkley - St. Elsewhere

I bought this album because of the music video for the single "Crazy". It's like an animated Rorsach test, wonderfully inventive. And that song doesn't disappoint either. It's a driving, catchy song, which is great for working out to actually. The beat is perfect timing for push-ups. But it's definitely the highlight of the CD. The first track, "Go Go Gadget Gospel" gets things moving, and "Crazy" brings the album to a fine point, but it's a decline from there, into the downright creepy "Necromancer," which closes a paean to a dead girl with "man bet she was alright /when she was alive." The album is definitely inventive, production is top-notch, and the sound is unique, but except for the catchy single, I just didn't get into it.

New Tires

I replaced the tires on my car today. You know you're overdue for something like this when you bring the car into the shop, point out what you want done, and the first words out of the attendant's mouth are "Holy $#(^". My car is much happier now, and I found I had forgotten it's possible to accelerate on a wet road without slipping.

Scary?

337 days from now, I'll be able to write prescriptions. And I'll likely be right back in the clueless, more-danger-than-help stage I was at the beginning of this year.

Back Safe Home Again

Driving back yesterday, I noticed that the traffic picked up the closer I got to the city, despite the fact that the speed limit was unchanged. I was still a bit jumpy from my ticket, but soon I was just flowing with the traffic, 15 miles over the posted limit. Looking at my cellphone, I noticed that not only did I have more than one bar of reception (a first for this last month) I was maxed out. Getting off the highway on the way towards home, I passed several Chinese resturants where actual Chinese people make the food. And *gasp* a Japanese Resturant with the same story. And (dare I say it?) Lebanese, Thai, Ethiopian, Italian and Greek resturants, Farsi shops, Russian shops, and stores that stay open past 6pm. The Starbucks where I have yet to hear unaccented English, and usually hear none at all. Best of all, a good friend of mine called and came over to hang out a bit when I got back.

Metropolis, I missed you.

Destined to be a Flea

Internal Medicine docs, like I'm going to be, are called "fleas" because both are the last things to leave a dead body. That's obviously a derogatory term, but like "yankee" the term has been embraced by its targets. Fleas can be a pretty nerdy bunch, so I tend to fit right in.

I was reminded of this Friday. I saw a patient, whom I was convinced needed a colonoscopy, because her symptoms were strongly suggestive of cancer. My resident didn't want to order one. So our conversation went:

Well, if you don't want to get the C-scope, I don't know how sensitive the test it, but you could just culture her blood for Streptococcus bovis, since that's associated strongly with colon cancer.

Wow Nathan, you are destined to be a flea.

See, that's a pretty insubstantial footnote in the average medicine text, and an almost ludicrously wild shot in the dark, but I was trying to surmount obstacles with knowledge.

I love it.

My attending agreed with me though, and the patient got the C-scope. Good thing residents don't write my grade.

What makes a good patient

There's a sidebar with the title of this post in the May 1 issue of Time. The doctor writing it has some pretty keen insights:

"Few patients realize how deeply they can affect their doctors. That is a big secret in medicine - one doctors hate to admit. We think about, talk about, dream about our patients. We went into clinical medcine because we like dealing on a personal, even intimate level with people who have chosen to put their bodies in our hands. Our patients make or break our days.

Take the compliment. Our career choice means we really do think that you - with your aches and pains - are more interesting than trading hot securities, more fun than a courtroom full of lawyers. Massaging the ego is the key to manipulating responsible types like doctors. When we feel your trust, you have us.

The most compelling reasons to be a good patient are selfish ones...You'll get more of the mind that you came for, a mind working better because it's relaxed - recalling and associating freely, more receptive to small, even subliminal clues...But you should try to be a good patient for unselfish reasons too. We worry about you 60 hours a week. We gave up our 20s for you. Why not show us some love?

Good patients answer questions completely, and accurately. They ask questions too...

Any good doctor knows when you're too sick to be polite and will let it roll off his sleeve. The squeaky wheel we don't like is the one playing a dominance game. That big wheel is likely to get a shorter, less sensitive examination and more tests, and then still more tests to follow up on the abnormalities in the first tests, followed by extra consultations with specialists - anything to relieve the doctor's responsibility for a bad patient..."
Scott Haig, MD

I love my job

"Nathan, have you read The House of God?"

"Yes sir, I have"

"And what does it say about taking temperatures?"

"One of the Laws in the House of God, is "if you don’t take a temperature, you can’t find a fever."

"Yes, now give me your hand so I can slap it."

The idea behind the law is, if a patient isn’t feeling sick, they probably aren’t. Therefore, medical intervention, which ethically obligates action upon abnormal findings, isn’t going to help them.

This is usually correct.

So today, when Mr. Seneca, 60 something, with no health problems, showed up for his annual physical feeling fine, I probably should have just left him alone.

I couldn’t though. I listened to his heart and heard a rhythm more like one of Billy Martin's creations than the normal lub dub. And feeling his pulse, I heard "beat-beat-beat-beat-beat *pause* beat-beat-beat-beat-beat *pause*" for several cycles.

Not good, right? No rocket science there. But Mr. Seneca feels fine. He’s actually just complaining of low back pain, and hasn’t even tried aspirin for it, because it’s so mild.

But I am a medical student, and I care about my patient, and of course, about my learning. So, I order an EKG. And that looks, for all the world, like Mr. Seneca is having a heart attack. PVCs, ST segment elevation, just general electrocardial craziness. This triggers pulling of old EKGs, a cardiology consult, a discussion with the inpatient medicine team, and two hours worth of work admitting the very last patient of the day.

My resident was not too pleased, but the leading conversation here was between me and my attending. He was thankfully, mostly kidding.

It’s maybe a bit morbid, but I was excited. A break from sore throats and well baby checks is always welcome to me. I didn’t even notice the time pass.

Mr. Seneca may be fine. But I might also have saved his life with that EKG.

That’s why I’m here.

Too far, I think

Some things are better advertised without smiling, plush, stuffed characters. Like anything Fleet makes, for instance.

Vexing

“I never cease to be amazed at the reproductive efficiency of this community.”

My attending was baffled. In the community here there has been an outbreak of a treatable disease, and we’ve been using the opportunity to test our response capabilities in case something truly terrible, like a lethal flu epidemic, comes around. So we’ve been trying to track the sick kids and their families. What provoked his response was the fact that quite a few of the families were unable to tell us where their children had spent the previous night. “They were at someone’s house” was such a common refrain, we were getting exasperated.

It is remarkable, but no matter how many kids you have, I would think you might keep track of them, right? This isn't just medical training breeding arrogance and maturity into me?

Ah, clinic

A new marker has been reached in my search for unique individuals. Today I met a woman who, I'm convinced, was capable of talking while inhaling through her nose. There is literally no other way she could have accomplished the remarkable feat of talking, without a break, for twenty minutes straight. If I hadn't been overwhelmed by the demands of an insanely busy schedule, I would have let her keep going, just to see how long she could keep it up. As it was, I kept waiting for her to take a breath so I could interrupt, but she never stopped. I finally had to apologetically cut her off mid sentence.

And another contender for the “most embarrassing moment in med school” has been reached, right up there with performing my first rectal exam on the teacher/model who had an ‘fro 2 feet across, a beard rivaling that of Billy Gibbons and who lectured in the most lisping, stereotypically homosexual voice ever, and who managed to critique my technique mid exam. But I digress.

I don’t know if anyone else has had this problem, but sometimes, it’s tough to tell if a baby about 6 months old is a boy or a girl, right? Now picture your doctor, or at least, the med student pretending to be a doctor, walking in, and making that mistake right off the bat. I knew from the chart it was a girl, but the appearance of the kid shocked me enough to cause me to revise what I was saying, just in time to embarrass myself. That probably makes it worse, but I can’t help it if the kid looks like a boy, right?

Probably unfair. I think I should be excused, since the kid was stripped down to her diaper and had an androgynous name, but mom didn’t really forgive me.