Trivial Pursuits

2008-01-12T21:53:00.000-08:00

Me: "I hate Foleying women. I always catheterize the vagina"
Dave the RN: "That's why you always bring two Foleys. You leave the one in the vagina and the other one will be in the right place."
Me: "But some women can fit more than one Foley."
Dave the RN: "This is true. Some, probably a couple."

2007-10-08T17:41:00.000-07:00

Ironically, months of sustained inpatient care has made it more difficult to separate my own judgment of meaningful care from the care currently decided on. Ideally, as we are taught (albeit subconsciously), we work up ever minute problem, sustaining livelihood at the expense of practicality. How many patients stay on endlessly in the hospital, accumulating, rather than resolving problems, until they become virtually lifeless, forgotten by their families, trailed only by a stack of excess charts documenting the person they once were and their slow deterioration into a meaningless existence. But it is precisely those words which I feel compelled to censor, though at times it feels to be a tacitly understood sentiment, both by those who make the decisions, and those family members whose common sense have not been superceded by feelings of love, guilt, or worse, expectation. In my ability to only palliate, and not to cure, as was promised to me in my formative years, I have become perfunctory in my actions, limited by my futility. No one ever warned you that inpatient medicine does more to discourage enthusiasm than to feed the desire for knowledge. In my brief career as doctor, I have already become so jaded.

2007-09-23T19:12:00.000-07:00

Today, a day replete with anxious family members and arguments about petty electrolyte supplements, reminds me of the banality of our purpose as residents. To dangle false promises of imminent discharge, to report artificially saccharine prognoses to family members of those without prognoses at all, to direct the anxious mothers and wives away from the forest and toward the trees. Yes the cancer has invaded his liver, but today his sodium is up to 133. To this end inpatient medicine is an endless cycling of those trapped in the limbo between life and death, whose so-called livelihood consists of a constant shuffling between the hospital and nursing home, whose bodies, with each hospital admission, become petri dishes for increasingly tenacious organisms, who, not unlike saprophytes, effect bodily erosions no masochist could even dream of. And of dealing with family members who readily testify to their neglect with their inconsistent appearance, whose presence is characterized by so much misdirected anger, whose guilt is as latent to them as it is blatant to the observer. Moreover I am frustrated at how our medical culture advocates the superiority of meaningless life to dignified death, thinking of death only as failure, and not often enough of the relief that it inevitably brings. Such that our quest for the optimal potassium becomes paramount, and our respect for these poor persons become secondary.

2007-05-20T14:13:00.000-07:00

Every day Mrs. M has the same set of complaints, only in various forms. I know that the minute I enter room 563, the same script will run - where I yell into her 96 year old ears at the top of my lungs, asking her how she's doing, whereupon she informs me in which direction her bowels are misfunctioning on that particular day. Diarrhea prevented her discharge last Thursday. "What if she has C. Diff?" (says her octogenerian idiot attending, totally ignoring that her diarrhea has been idiopathic, recurring, and in large self-limiting in the past month we've kept her.) "We can't send someone out who's sick." These past few days it's been constipation. I honestly can't remember if I have her ON the senakot or off. Always is this nausea, and this weakness. In the beginning I have tried to placate her by setting up her meals, bringing her to the bathroom, cleaning her bedside table. But now all I want to do is get out of the room.

The cynical part of me has begun to think of patients as perpetual complaint-manufacturing machines. Ask for complaints and you shall receive. Some complaints you will fix, only to generate a new set. And some complaints you can't fix at all. I'm tired, I'm weak, I'm bored, I'm dizzy, I hate blood draws, my neighbor is noisy. As if they expect a pill for everything, and are suspicious you are purposely depriving them of it. I have stopped thinking of my hour of rounding in the morning as a valid clinical experience. I have become a wastebucket for complaints. Like a concierge, a hostess, a pin-cushion. (How was your night madam? How can I make your stay more comfortable") By the eight O'clock hour I am already worn out. It is like as my precepting attending says. Some patients take a long, thick swirly straw, drill it into your head, and suck all your brain matter out, slowly and painfully. This is the life of in-patient medicine.

I would like to think of myself as still-compassionate. But what good is compassion if you cannot relieve suffering? The revelation I have come into is that so often, their suffering is inevitable, incurable, and self-perpetuating. It will drown you if you continuously seek to dowse it - if you take your failures to the heart. Far easier to turn a blinded eye, fix what you humanly can, and send them to rehab. (I have become so callous).

2007-04-02T16:26:00.000-07:00

Me: That patient in bed four has that Jabba Look. She has those mean eyes and she's always frowning. When she talks it's like [deep voice] I'm hungry, feed me, grunt grunt. And I swear when she opens her mouth there's a thread of mucus that connects the two lips.
Resident: And do you write Christmas cards too?

2007-02-09T13:35:00.000-08:00

Medical Term of the Day:

Extracorporeal Hydration (ECM). def - When the IV line has fallen out of the vein and the IV fluid is wetting the bedsheets.
ex. Dr. Wang wondered if the continued deterioration in kidney function, despite 125cc/hr IV NS for the seventh straight day could be due to extracorporeal hydration.

2007-02-09T08:21:00.000-08:00

A few months ago a fellow intern/friend ended a brief courtship abruptly, after several dates which she had described to me as wonderful. He was, on all accounts, on par with her intellectually, professionally, and religiously. It seemed infalliable. But without warning, she, who advised me never to cry over a boy, was crying inconsolably.

And only until recently do I understand the circumstances that led to the end of the affair; can sympathize, rather than empathize. It seems, when initiating courtships, we as the fairer sex are treading on thin ice. And not entirely of our own doing, of course. I have traced this problem to that nefarious word -"expectation", or the fear thereof. And although we may not (albeit consciously) be exerting the pressure of expectation, its presence is felt - ubiquitously, unequivocally. And it is met with terror, amplified to disproportionate magnitude, and becomes reason to abort mission, no matter how successful the take-off.

And this is what I believed to have happened in her case, and is occurring, recurring in my own melodrama, like a movie stuck in a loop. It is the curse of this age, this stage in our lives, that women are expected to want to settle, while the thought of "expectations" renders their unwilling suitors veritable deers in headlights, that they feel compeled to begin courtship with a series of disclaimers.

And to add insult to injury, they justify their said disclaimers with their own self-proclaimed fear of "hurting you", perhaps not realizing that, by the very act of agreeing to invest time, intimacy (the very acts which have largely been performed previous to the disclaimers), we have already positioned ourselves in the line of fire, that there is no way to dodge ths bullets, no matter how well-meaning the other claims to be.

I do not mean to be bitter. I trust that these are good people. But to some extent this sort of behavior is nothing short of cowardice. While it is acceptable to wish to wade before one dives, it is unrealistic to expect that, because one did not wish to hurt (honestly, who does?) that hurt will not happen, that these sweet disclaimers will curb the disappointment and that one can remain inculpable.

2007-02-02T14:23:00.000-08:00

Sadly I have been negligent of my poor blog, to such an extent that writing here seems awkward and strange. Perhaps it has been the lack of complaints, and that 3 weeks of vacation/clinic has taught me how it is, again, to be rested.

2006-11-21T20:05:00.000-08:00

I wonder if there is not that element of amusement as we [perhaps] unnecessarily ponder the seemingly trivial decisions that we make. As if, by ruminating over all the aspects of an otherwise banal occurrence we make it somehow relevent. Simply put, I like drama, and though it makes me miserable to some extent, the lack thereof makes me irrelevent, a far worse circumstance. And I wonder this now, in retrospect, hours after our exchange yesterday morning, where in our post-call delerium we reiterated all our aforementioned fears and expectations (and on his part, lack thereof), and question if this entire situation would be best served in black and white, or if these nuances of gray merely provide a means of escape from our quotidien doings. It is rare, finally, to meet someone with as much complexity of thought as I have; I am still debating whether or not it is healthy.

2006-11-14T20:48:00.000-08:00

Four more days, oh only four more days left. I don't think I have yet recovered from the few attempts to straight cath old diapered ladies for urine samples, or how after so many years I can still mistaken the clitoris for the urethral opening. (Nurse, why won't the catheter go in?) With the modern advent of the practice of showering, we tend to forget that our scents, accumulated, is bestial at best, putrid at least. And to think of the glorious future of gasteroenterology ahead of me. I can hardly wait for my first code brown.

2006-11-01T19:29:00.000-08:00

There is something surreal about the pronouncement process; how to reconcile the austerity of the hospital environs with the silent sense of tragedy. You wonder if those rehearsed words from your lips mean anything to the grieving family, or if they would remember your being there at all.

The motions seem almost absurd. Putting the stethoscope to his chest to hear only the friction between the bell and his hospital gown, feeling the pulse at the wrist only to feel the warmth ebb from his body, shining the light into his eyes to see the pupils unyielding. And above all, the distinct look of death. The gaunt, yellow, sunken look that sets in only minutes after death. I remember sealing his eyes shut with my gloved hands, grateful that they remained closed, and squeezing his hand one last time, goodbye.

2006-10-10T18:05:00.000-07:00

What I am supposed to be doing is completing my module on hepatitis. But what I have actually been doing all day is reading back issues of New York magazine, Maureen Dowd editorials, Gramophone CD recommendations, perusing itunes, deciding that I really must have that compilation of ALL mozart symphonies, and deciding if I want to incorporate vegetables into my evening meal (I did not). And now the need to update my forsaken blog has superceded all other tasks. I guess I should feel a little guilty that I'm actually getting paid for all this. Life is good.

2006-09-28T15:01:00.000-07:00

Sometimes when I look at my older patients, lying lethargically in their fetal position, sheets rumpled about them, IV lines abound, and bruises covering their bodies from all the recent blood draws, failed IV sites, heparin, insulin shots, I imagine myself in 70 years, in the same position, and the thought scares me to no end. I cannot fathom wanting to be kept alive in such pain, sadness, in such chaotic surrounds devoid to diurnal cycles, of life and health. I think so much of medical technology in the latter years serve to prolong suffering rather than to deliver relief. When I look at my intact skin, lean limbs, bruiseless, scarless chest and abdomen I cannot help but feel dread for the inevitable process by which all this will be marred, maimed, slowly, until I am but a wrinkled, purple lump in a hospital bed.

Always in my preceptor's office I feel the stares of the 40-50 year old daughters of the patients on my legs and skirt. While I, equally as surreptitiously, observe their varicose veins, protuberent abdomen, non-existent waistline, and feel that same dread. That I need not 70 years to lose what I have. The inevitable will be reality in mere 20 years.

I think being young in this profession, while having the luxury of being pristine, has the added disadvantage of seeing the future at its worst. When the accumulation of toxic habits result in the illness of being old and helpless. And it is far from an encouraging sight.

2006-09-23T15:18:00.000-07:00

(Me and my favorite resident on his last day)

Tomorrow marks the end of my first floor month in the most scutty unit in the hospital. If only I had a nickel for every patient that was admitted and discharged on the same day. And those like Mr. L who still cannot leave because of unresolvable social issues.

But still, not all was a loss. I learned to speed through paperwork like never before, learned how to speed-round before the 9AM hour, how to bargain with patients over dosing of pain meds, how to beg for consults with no clinical indication what-so-ever, and how to drop NG tubes like it's nobody's business.

Last week was hell, and at this point I am so burnt out that one more day will make me seriously contemplate changing careers. But still, I know that the next month of repose will make me yearning for more of this madness. Because in the end, I can still feel justified being called doctor.

2006-09-09T23:10:00.000-07:00

Yesterday Urology came by and placed a foley catheter in Mr. L. I could not watch; I left. It was too much. As he yelled out "Oh God Kill me now," I began to feel like a partaker in some vicious crime, a bystander who watches passively as a man is getting mugged, stabbed, kicked around. And I can only watch.

I should backtrack. Mr. L came to us last week after he fell on the wet ground outside his apartment complex. No heart problems causing syncope, no seizures, no tight carotids, no stroke, no blood loss. Just tripped and fell. His good neighbors brought him to the hospital to fix any broken bones (there were none) and make sure there were no internal bleeding (again, none). And from the ER he came to my unit; this is what we call a "social admit" - bringing in someone who we think cannot care for him/herself and trying to involve social services to bring home care.

All this was seven days ago. This past week has been filled with consults with hematology/GI services to help fix his anemia, failed attempts to install him into a subacute rehabilitation facility (thank you, Medicare), frustrating meetings with the case manager about what we CAN do for him (nothing), and trying to explain to him why we think it's necessary for him to be here (he does not) and that we are doing the best for him (which I do not believe). Every day I hear him pleading to God behind his curtains to take him out of this prison, his voice getting more and more desperate by the day, and recently, his asking God to end all this. And I just feel so guilty I cannot even look at him. I could tell he is not trying to be difficult. He is trying to maintain his dignity, and moreover his sanity. But in a place like the hospital, as many will tell you, this is a futile task.

I would like to think this is a system that is altruistic and generous, a system that accurately identifies those in danger to themselves and helps them get back on their feet. But more and more I see this as imposing our will on others, even if they do not want it. Somehow our sense of obligation deafens us from hearing what the patient really wants, because somehow we think all others are devoid of judgment.

How many times have I taken blood from an unwilling patient, subjected them to countless radiological tests, downed gallons of putrid radiocontrast dye, told them they cannot go home because WE do not think they are ready to take care of themselves. Meanwhile, longer stays inevitably lead to illness, until finally they cannot leave, and the only direction is down.

I want to send him home. I would drive him, if I could. Not because I believe he is capable of caring for himself ( I do not), nor that he is not a danger to himself (he is). But because I feel that everyone with the mental capacity to make decisions, irrespective of our approval for these decisions, should not have others' wills imposed on them, no matter how well-intentioned these wills are. I hate that our hands are bound by medical-legal obligations that we become automatons that systematically ignore what we feel to be the best thing to do. I hate that despite all this, not everyone is on the same page; while we are pulling all the strings, Medicare still insists they will have no part in it, and will not foot the thousands of dollars in bills that this hospital stay will cost.

Some days I feel more like a guard in some prison that makes a regular practice of torturing its inmates, working under the pretenses of beneficence. Three months ago I made a vow to do no harm. I am having a hard time fitting that into this system in which I work.

2006-08-23T17:10:00.000-07:00

grrr... boys... grrr. You think by 30 years they would have learned a thing or two. Just thought I'd throw it out there.

2006-08-21T17:37:00.000-07:00

Saturday calls have the feel of putting out small bush fires. Although most of the sixty plus patients you are covering will not bother you, the good twenty or so that will are enough to make you contemplate a career change. I remember those idyllic medical student days, when I would never write an order for pain without checking and examining the patient. At the end of your first 24 hour float call, you are pushing narcotics like any street criminal. ( IV Morphine .... ahh ... my panacea for pain/agitation/putulance/insomnia. How I love thee. Let me count the ways.) The trouble is explaining it to the team the next morning.

You begin to hate the words "What is your name?" when a nurse asks you at the end of a page. Because then they can put "MD Wang made aware" from which point any calamity can be pinpointed to you. And at times, MD Wang was not made aware. Figures. With 60 patients to cover, they definitely figure they can slip a fast one by you.

This is when you realize that so much of intern year is not about learning. It's about keeping your head out of the water, gasping for air when you can. When you realize there is no sympathy, that everyone wants something right then and now, and all responsibility falls on you, as soon as you are "made aware". And that MD is not as glamorous as you thought it was on graduation day.

Expired

2006-08-14T18:15:00.000-07:00

Our favorite euphemism for patient death is "expire" - suggesting people become no longer suitable for use after the printed date, after which they mold, curdle, become rancid, dessicated. I always think of a person exhaling out that one last breath of air, after which they lie motionless. Without commontion, emotion, serene - "expire", unlike "death" which is fettered with morbid connotations, of treachery, violence, grief, is more like the natural course of things. I have never seen anyone die, but this is how I imagine them to do so in the hospital, so many of the time - expectedly, quietly, into the night, on this - their expiration date.

2006-08-10T03:58:00.000-07:00

On Tuesday I ran into my old patient from the CCU Mr. M down in Medical Records. Or rather, I ran into his back. He was hunched over a form, slowing scrutinizing its contents, and, happily for me, incognizant of my presence. I slipped in and out of the room, thankful that my reappearance in his life remained anonymous.

I first met him with a nonrebreather on his face - the first sign that this patient may be a keeper. A coronary cath, a ream of EKG's, a few grams of lasix, two pneumonia antibiotic courses, and a mone marrow transplant later, he was little better. True, he no longer needed the face mask, but his face, arms and feet becaume elephantine from the water rentention and corticosteroids, his arm mottled with a patchwork of bruises after we stuck him day after day for labs, and his cough worsening from the URI symptoms that plagued him from the start. Every morning he would be up at 5 in the morning, wearing his blue pajamas and forest-green robe, headphones on, listening to the walkman that sits on his bedside table, nestled amidst the stacks of used tissue, plastic cups, and apple juice boxes. And when I would sit down to listen to his heart and lungs, to examine how bad his edema was getting, I wanted to tell him his symptoms are improving, and that he was ready for home. But I know this is not true; every day in the hospital makes his cough worse, his legs more elephantine, and his mood more forlorn. The best I could offer, could ever offer - after four years of intense study- is apologies.

No one teaches you about this guilt that pervades the beginning of your intern year. This is because I suspect not everyone has it. What they do teach you is that sometimes you'll have a rough day, and patients give you a hard time, and you're supposed to go home, shake it off, and leave work at work. This is easier said than done.

All this is independent of your clinical acumen; I have seen both the callous and the caring amongst the most brilliant minds. But the truth of the matter is that what the senior residents tell you at the beginning of residency is true - if you stop to do right for everyone you will wear yourself out. At the end of call, it takes all my energy not to snap at that patient with irretractable nausea, who is interrupting my getting information together for rounds. Those stone-cold doctors I vowed never to be like became that way out of adaptation. Not unlike boot camp.

I know at this point, the best thing I can do for my sanity is to not take so much to heart; one only has a limited capacity for heroism before driving oneself to lunacy. But I guess in the grand view of things, this guilt may be my savior from being that callousness that I hate. A sign that, at that particular point in residency, I still have to potential to be a good doctor.

2006-07-27T14:59:00.000-07:00

In concordance with the scientific tradition of standardized quantification, the medical profession has devised the pain scale. But first, let us have some samples.

This is the one on the nursing flow sheets I see. I think that guy seems a little too happy with hurting just a little bit. Number 8 is what I look like after a nurse yells at me. Number 10 -- the attending.

A stupid page to D/C a Boost drink order can easily tip me over two points.

Here is a one for infants. And look how cute they use decimals. I feel 0.46% today!

Ever stop to think if patients really in pain can't figure the scale out without the pictures?

2006-07-10T21:56:00.000-07:00

Today my petulant 60 year old GI bleeder allowed me, for the first time, to listen to his heart. Whereas my presence was previously greeted with a grunt, a demand for food, or a tirade on how this hospital system resembles a fascist regime, today it was none of these.

Just now, going back to take out the Foley catheter which he surprisingly let us put in today, I felt a pang of sadness -- seeing him, I think for the first time, not as someone determined to make my call-days miserable, but as a patient, an once-able person stricken with illness and who finally, finally resigned to his fate. Seeing him, head propped up on his pillow, his gaunt, bony features, scarcely more endowed than a skeleton, asleep, I almost wished for that angry man that swatted my stethoscope away just four nights ago, that refused to drink his contrast, that told me what a horrible doctor I am. As unpleasant as his temper was, his resignation was worse; it was so devoid of hope, so lifeless, that I felt as if I have failed him somehow.

It reminds me of how, sometimes I prefer the bitter, angry patients to the calm, complacent ones stricken with terminal illness. I think their placidity a manifestation of their acceptance that fighting for their life is futile-- a stolid declaration that our ability to cure has failed them, and, despite all the fancy medication and machinery, so many of which I cannot begin to comprehend now, we are still weak, ignorant of the monsters that infest and pervade our well-beings so readily, clinging on while we hopelessly watch on.

Perhaps he will again be frustrated at all our tests and attempts to keep him without food for further tests. Perhaps he will not be convinced, still, that all our mean attempts are really meant for his own betterment. But until then, I am stricken with guilt -- that I had felt frustrated at him previously, that I have though ill of his disposition, but moreover that I have nothing more to offer him.

Overheard

2006-07-04T19:08:00.000-07:00

Nurse one: Have you seen Memoires of a Geisha?
Nurse two: I heard of it! What's a Geisha.
Nurse one: Oh, you don't know? A geisha is a Chinese prostitute.
Nurse two: Is that so?
Nurse one: Yes. It's a sad story! They get sold as young girls and they train to be prostitutes so they can pay their master back for the money that he bought them for.
Nurse two: Is it still in theaters? I should see this!

Almost...

2006-06-30T06:34:00.000-07:00

Yesterday I tied up loose ends. Brought over the last of my furniture from home, said goodbye to my lab, and finally told a boy I've been crushing on him for the last fifteen months.

Because tomorrow I am a doctor. And while it will be following orders and writing notes I barely understand myself at first, finding the balance between intimidation and self-assurance, I cannot but be filled with irrepressible anxiety, trepidation, naked fear. No amount of verbal felicitations or wishes of luck can subdue the monument that stands before me at this juncture.

I remember those early mornings that I swam laps in the town pool as a teenager. With my feet dangling at first in the pool water, anticipating the shock of coldness into which I will soon be submerged. Knowing that the best way to fight the urge to turn back is to dive, without thinking, head on.

Things Learned from ACLS class

2006-06-10T17:00:00.000-07:00

1) You feel pretty stupid continually while shaking a dummy torso, asking him "Annie Annie are you OK?" and asking your imaginary friend to get the AED and call 911.
2) CPR will give you carpal tunnel if you do it long enough.
3) Doing the Heimlich on someone who does not need it is a poor way to make friends.
4) When given Adenosine, sometimes people go into asystole before they convert into sinus rhythm. (cooooooooool!)
5) You still feel pretty guilty smacking a dummy baby, for about 5 minutes.
6) Apparently we do not give mouth - to - mouth the way Zack did it to Kelly on Saved by the Bell. The face mask gets in the way of the tongue.
7) Surprisingly, those people in the training videos are pretty decent actors. That mother really looked panicked that her plastic baby didn't have a pulse.

Saving lives, people!

2006-06-01T10:55:00.000-07:00

Me: So the topic is "what propels people to change." Can you think of any examples?
Student: Umm. Sometimes when you're stuck in a bad situation you have to, like, adapt and live with it, and stuff.
Me: Well, good. Adversity promotes change. Can you think of an example? From your own life, if necessary.
Student: Well one of my friends went to college and found out her roomate was like Black and she called me freakin out...I mean she wasn't racist or anything, she was just like "um...I've never lived with a Black person before."
Me: No I would not use that example.

sighhhh two more weeks...

Just One More

2006-05-25T19:42:00.000-07:00

Ok ok...TWO more. But I think singing in Carnegie Hall warrants a post...

A little dazed and confused.

Graduation Funness

2006-05-24T20:31:00.000-07:00

Despite the fact that dinner at the Waldorf last Saturday turned out to be such a bust, Leah and I still Looked great! Especially since that dress was bought one hour before our scheduled departure, with Leah and I running door to door through department stores.

Apparently we still live for last minute shopping.

Outside before the Senior Awards Ceremony. Five Girls. Five Cameras. Thank goodness for Annie and her ever-patient boyfr .... err... husband.

Minutes before the ceremony. Thank you Pia for fixing that stubborn hat.

My future prescriber of Viagra. It pays to have a friend in urology.

Kathy and I finally taking pictures that do not involve a webcam and a background of the office walls.

mmmmm MD sounds pretty damn cool... Yes it does.

2006-05-16T22:12:00.000-07:00

My GOD is apartment hunting a bitch. Someone just give me a cardboard box with heating already. I already know I'm going to be living at the hospital for most of my days. Well, this too shall pass. And we hope soon, because I am at the verge of a nervous breakdown.

Rude Awakening

2006-04-05T02:53:00.000-07:00

I now have a new favorite way of waking up in the middle of the night (well, discounting those night terrors I had as a kid), which is when all the lights in your room turn on at 2:47 AM after a power outage, and your printer, on reawakening, for some opportune reason, decides to groan and moan for a good five minutes or so. Gooooo New York Med, for taking 3 1/2 hours to fix the power. Me and my insomniac ways applaud you.

Match

2006-03-20T15:51:00.000-08:00

I think Leah has the flash on overdrive in this one, but it is the only picture from Match day I like. On the other one, my grin is so wide that I look like I have jowls.

But I have to gush just a little. On that particular Thursday, this nascent Long Island Jewish Med Center Intern became very happy. And I'm not just talking about the salary (oooooh Maureen the philistine.) The possibility of nice Jewish doctors excites me to (dare I say it?) lubricating degrees.

Why I love Ravel

2006-03-16T15:29:00.000-08:00

Most contemporary classical music fail to attract me for all the reason that I love Mozart, Bach and Vivaldi. The latter three are unfailingly calculated, symmetrical -- clean and unambiguous. No chord unresolved and no theme obscured. And so it seems incongruous that I should be enraptured by the antithesis - the imperfect dissonance and capriciousness of Ravel's piano music.

The best way I can describe a piece like La Valse or La Gaspard de Nuit is a theme trying to extricate itself from the dischordant sounds that overlie, and at times overwhelm, it. It emerges, like the head of a drowning body, at times. But this moment of clarity is tauntingly ephemeral, dying as quickly as its insidious entrance, flooded over by the shimmering trills and undulations across the keyboard.

To the listener, this seeming dysarthria of melody should be immensely unsatisfying. After all, do I not shudder all the way through most Charles Ives and Philip Glass? The latter two, fettered with discordance, asymmetry, sometimes fluid, sometimes staccato progression, leave me uneasy.

In the final analysis, I do not find Ravel satisfying. But this is precisely why I love him. His music is nebulous, dreamlike, haunting, and uncompromising in its resolve to disturb -- enthralling in its indigestive tendensies. Yet unlike Ives, I sense a profound yearning, an urgent desperation that is neither passionate nor fervent, but quiet, stiffled -- an internal, private brand of suffering that requires precipience to discern. It speaks of loneliness rather than despair. Not the quiet sobs reminicent of a Chopin Ballade or the poignancy of a Mendelsson Song. Ravel's loneliness intertwines with confusion, chaos, and intangible distance. It does not invite the listener into its psyche and evoke tears and empathy. Rather, it tells of a hopelessness and a void, and an ultimate sort of sadness - a limbo, nirvana.

Thibaudet was magical last evening; Thibaudet and Carnegie Hall together was perfection, and my bliss unsurmountable. It never fails to amaze me how music affects me, nearly to the point of tears.

Hmm?

2006-03-15T14:26:00.000-08:00

Why do I find this disturbing.

South Dakota can suck my balls

2006-03-06T15:29:00.000-08:00

An embarrassment, this.

Say What?

2006-03-05T15:02:00.000-08:00

The optimal time to get tongue-tied (my newest affliction) is when asking a standardized patient, during the Clinical Skills Exam, whether or not she had vaginal discharge. An re-enactment... slightly dramatized.

Patient: Doctor, do you think this is serious? Can you give me something to restart my period?
Me: Well, we would have to get to the bottom of the problem first. Let me ask you if you notice anything coming out of your vagina that's abnormal, like gray or sticky, or smells funny or unusual.
Patient: Looks confused. What do you mean. Like a small animal?
Me: I mean, what...anything out of the norm ... on your underwear...that you noticed, since the problem...I mean...
Patient: Um, no I don't have any vaginal discharge.
Me: OK then. Thanks for clearing that up. Let me just climb into this hole in the floor.

Thank goodness I'm avoiding the whole urology scene...

Life is good.

2006-02-21T16:03:00.000-08:00

Which is probably more or why I haven't updated my blog. Things have certainly picked since that last disappoint, and I am astutely immersed in the fascinating world of renal physiology, where numbers and urianalyses no longer frighten me. Plus there is the tutoring, brushing up on all the beautiful words I have not seen since high school. And most importantly, life has granted me another virile friend with benefits, the advantages of whom I like to think about on those endless consult rounds.

(And did I mention match day is in 3 weeks? It's SICK!)

For all my faithful blog readers, catch me on a rainy day.

Ecstatic

2006-01-26T14:58:00.000-08:00

I am selfishly writing this post as an exclamation of my extreme joy at having completed the only month of fourth year I actually dreaded. The most valuable outcome of the surgical subspecialties rotation is the confirmation that, of all the paths of medicine I could take, orthopedics would be the last one.

1,2,3 Fight!

2006-01-22T08:50:00.000-08:00

Item! Since I no longer watch Jerry Springer, I find the McLaughlin Group a viable alternative. The incendiary contensions flying between suited intellectuals. The title character interrupting heated diatribes with those of his own. It becomes a war of who has the loudest voice. I am still looking forward to the day John Mclaughlin puts Pat Buchanan in a head lock. What fun!

I think I'm paranoid

2006-01-21T12:38:00.000-08:00

Love me, like me,
Come ahead and fight me
Please me, tease me
Go ahead and leave me
- Paranoid; Garbage.

In view of the present circumstances I found these words so terribly touching, as I was churning out my 5th mile at the gym.

More thoughts in the OR

2006-01-17T15:56:00.000-08:00

It occured to me that surgery is a lot like flying.

Thank you for choosing Delta airlines, we will be flying non-stop from the first incision to the removal of your prostate. We ask that you remain strapped until after takeoff and refrain from moving your head too much as we attempt to intubate you. Feel free to use our on-board pillows and blankets; we have a wide array of sterile sheets and drapes in every shade of blue. During the flight, please enjoy your complementary peanuts and keep warm under the comfort of our Bair Hugger.

We are experiencing some onboard turbulence -- please fasten your seatbelts as we try to stablize your bleeding and give you more doses of propofol...

It is currently 70 degrees and sunny in FL, please remain seated as we make for a smooth landing and we gently extubate you. Please check that none of your baggage is left behind and your dressings are properly secured to your operative wound site. For your ease and comfort we ask that you dine at any of our fine airport restaurants and feel free to administer morphine as needed for your pain.

Again, thank you for flying Delta Airlines and hope you choose us again the next time you need anything removed!

Nice Day

2006-01-16T13:33:00.000-08:00

This is the view outside the Children's Hospital as I sat and waited in the foyer before the next urology case. It was a lovely day.

Write or Wrong.

2006-01-08T12:39:00.001-08:00

In my fantasy life I am a writer. And by writer I mean someone who writes well, by her own and others' accounts, or on an objective basis, if "well" can be so defined. But over the past few years I have been collecting reasons on why I do not write more. Observe:

1. I have a mild, perhaps subclinical, case of ADD (self-diagnosed, and unabated by my non-medically approved trial of Strattera) such that I have difficulty finishing the task at hand. I would like to point out that Da Vinci only completed eight paintings in his lifetime. But I have yet to write a treatise on painting that has revolutionized the art world. In time...

2. I don't know much. In fact, much of my good writing in college were based on biochemistry and biology -- relating them to real life. The one attempt to escape this ended miserably. We do not talk about that essay today, as I have eliminated all evidence. I keep hoping that keeping up with current events and trying to force an interest in history/politics/social studies will give me more material. It probably will. But reason 1 gets in the way.

3. I am neurotic -- a perfectionist. That said, I take for granted the fact that my writing will fail. To muster up the courage to write, despite the risk of disappointment, is still an aspiration.

4. I am a medical student. Enough said.

But these are excuses. I realize this. And perhaps all I require is inspiration (and the potential of fame; I am, after all a Leo). Who knows? I may find my muse yet.

¿De donde eres?

2006-01-07T16:01:00.000-08:00

Yesterday in eye clinic a bespeckled Asian man craned his head into the examining room where I was sitting to ask if I were Korean. I suppose I should consider this refreshing, given that all other queries have been based on the assumption that I was Chinese. What is interesting is that unfailingly, there is this look of immense satisfaction when I corroborate their conjecture. As if this in someway attested to their cultural competency. And if conversation continued, it would inevitably veer toward a discussion on which Chinese food starting with "chow" is truly the best.

Maybe I should try out this game sometimes. See how good my cultural competency is. ¿Tu eres mexicano? ¿Te gusta comer los tacos?

P.S. Can you tell?

My Knees have Eyes!

2005-12-31T20:54:00.000-08:00

Okay, so clearly we are still bored.

I heart Bloomberg

2005-12-20T05:09:00.000-08:00

"For their own selfish reasons, the TWU has decided that their demands are more important than the law, the City and the people they serve. This is not only an affront to the concept of public service; it is a cowardly attempt by Roger Toussaint and the TWU to bring the City to its knees to create leverage for their own bargaining position. We cannot give the TWU the satisfaction of causing the havoc they desperately seek to create."
- Michael Bloomberg on 12/20/05, Mayor, New York City.

This is why I love our Billionaire mayor. In the wee hours on 12/20/05, at the dawn of the first MTA strike in a quarter of a century, we see Mr.Bloomberg orating, in all his machismo with a twist of wry, standing in front of hundreds of hungry camera flashes, clad in a black mock-neck sweater that reads "I heart NY," after which he proceeded to walk across the Brooklyn Bridge, alongside hundreds of poor, cold souls, then joining the millions of other workers who must, somehow, get to their destination.

More indulgence

2005-12-18T18:31:00.000-08:00

Ah, heck. How vain of me -- innundating my blog with kid pictures. I guess the redeeming factor in all of this is that these are not even the cute ones. In this example, I am either a) constipated b) bored with Mom and Dad's dinner guests and their photo ops c) meditating.

Card me.

2005-12-17T17:12:00.000-08:00

After much deliberation I decided in favor of sending holiday cards this year. I will submit that a part of me is disapppointed that I chose to partake in this exercise in kitsch. But in order to appear socially acceptable, one has to sacrifice some principles. And so begins this exchange of sacchrine greetings -- an attempt to convince each other that forgiveness for a year's worth of neglect can be bought with a 3x5 card, most likely promising some future meeting that will be postponed into oblivion.

I think myself too cynical for this season. But do not let this deter you from sending expensive gifts my way. Season's Greetings.

Mr. Isaak sings the blues.

2005-12-14T15:52:00.000-08:00

It was only time that I succumbed to that sexy voice (or was it merely that it reminded me so much of Mr. Phoenix in Walk the Line) and now I cannot stop listening to Wicked Game. Perhaps it was the romantic in me finally emerging, or my reflexive response to Adam's strange but mildly charming predilection to listening to country music during mad bouts of sex, or that it takes me back to that video with Helena Christianson on the beach.

In any case, Mr. Isaak has successfully seduced me, 15 years after my parents canceled cable after having seen his video.

Smile!

2005-12-12T17:14:00.000-08:00

I think growing up, I clearly had a dearth of cute photos. (I guess I just wasn't Gerber enough.) Especially between the ages of 4-6, where apparently I had that awful bowl cut.

Last week, I asked my sister to pick kid pictures for me for my yearbook page. She chose this one, of me, on the doorsteps of my grandparents' house in Shanghai, posing next to what looks like a can of paint and a chamber pot. Cheese!

(And No, I did not pick this one.)

I don't get it.

2005-12-12T13:56:00.000-08:00

This is where my ignorance on matters of world affairs turns into social embarrassment. 2 hours of the 146 minute-long Syriana was spent in utter confusion. As if the segmented and multifaceted storyline, with characters seemingly peripheral to each other, speaking in coded terms, wasn't obnoxious enough, the fact that my knowledge of the material was superficial at best frustrated me to no end.

And so Adam asked me the dreaded question -- what'd ya think? As much as I would have liked to express some profound insight into corruption and oil in the Middle East, I was reduced to it was good. I don't think I was all that convincing.

So much for being well-rounded.

My Chumps

2005-12-06T18:36:00.000-08:00

Oh good. Among those who have any inkling of good musical taste, someone has finally spoken for the rest of us. (Thank you Slate, as always)

Bottom line: I do not understand. Perhaps there are those who are moved by the music video whose depth is exemplified by Ms. Fergie's micro-skirted bottom (all that ass) gyrating across the television screen, or by the sheer inability to discern any sense of melody throughout the entire song (can we call it a song in the traditional sense?), or perhaps by the artfully disguised message insinuating copulation (but oh so subtly), as exemplified by the lyrics:

What u gon’ do with all that ass?
All that ass inside them jeans?
I’m a make, make, make, make you scream Make u scream, make you scream.

Oh the beautiful syntax, that exquisite poetic prowess.

I shudder to think how we've regressed to this. But then again, Mozart was controversial in his time.

Bliss (?)

2005-12-01T07:12:00.000-08:00

One always remembers the beginning of affairs with such fondness, recalling only the first kiss, the hand holding, the sharing of secrets, the cathartic release of sexual tension tantamount to the rush of orgasm. But only in experiencing it does one remember the composite side -- that which is laden with insecurity, with doubt, with this incessant fluctuation of emotions, with this pain that persists when the other is gone, and the anxiety that will not be quelled until the phone shows his name. Maybe it depends on the pessimistic versus optimistic nature of the person. But being one (unfortunately) always with a tragic outlook, more to prevent myself from potential woe, it becomes impossible to enjoy the moment. I will not trade this for the world, because I believe myself, for the first time, to be truly truly blissful, but faced with the fact I will not see him for a mere 4 days (maybe 5!) is pure torture.

The curse of my nature (and perhaps that of womankind) is this insecurity that pervades and extinguishes any attempt at satisfaction. You learn to dwell on the minutiae, that he dates often, has no qualms about having sex early in the relationship, is too good with women, forgeting that perhaps you have the same deterring tendencies. You want to know where this is going, but cannot ask, and continue to slowly simmer in this torture and agony. Being hurt before, unexpectedly, you want to avoid previous mistakes, with the caveat that you, having received little to no feedback, may be doomed to repeat them.

I know this is too early to make any conclusions. At the end of the day, he is surprisingly sweet, honest, and funny. As hard as it is, we can only expect to take one step at a time.

A Better Place

2005-11-24T19:14:00.000-08:00

And yet I find myself watching Laguna Beach last Saturday. Mere glimpses throughout this season sufficed to key me into the details of their questionably sordid liasons. Apparently the much-covetted boytoy of one blond bombshell kissed another in front of her, during a family function, leaving all involved in a state of confusion, anger, expressed so vividly by the blunted affect that afflicts these teenage youths, in their noble attempt to appear blazé and over it.

At one point in my existence I would have envied that their woes consisted of deciding which Fendi purse to purchase and which football hunk to fornicate with. And perhaps on that particular Saturday I had been none the wiser. On the same day I had ventured into the palatial Westchester Mall with my roomate, where at once the same blond prototypes surrounded us in clusters, replete with their phones, skin tight jeans, and theatrical makeup. I had wanted to be one of them, hating them only out of envy, because I had missed the youth as they experienced it -- blissful, superfluous, ostentatious.

But something was different that Saturday, whereupon I believed I finally experienced that much-needed epiphany -- that feeling of distance between me and them, and how such comparison is, in fact, non-sensical. For the first time, I fully appreciated my reality, and the beautiful surprises therein, that exist, and promise to reemerge, independent of whatever deprivation I have previously suffered. Then is when I realize that I am the one who truly can be blazé and over it -- because I am in a better place, where the ephermerality of glamour and fantasy no longer apply.

It is good to finally move on.

2005-11-13T09:06:00.000-08:00

I don't own a big boat.
- Lee Raymond, Exxon CEO. on the Wall Street Journal Report.

Oh sorry, all's forgiven then. Carry on, old chap. We'll just get back to sucking dicks for gas money,

Get Rich or Try Richie

2005-11-11T04:50:00.000-08:00

What I could do is tell you that I am trying not to judge, and perhaps submit that Ms. Richie is, underneath her vapid veneer, a spectacular writer. And that I strongly feel that I must read this book before I pass sentence.

But this would be to lie.

This bespeaks loudly of some megalomaniacal attempt to evoke sympathy for the hardships of our rich, fabulous counterparts. And yes there is a very real human beneath the bronze godess and my God is she an admirable one.

But the truth is that this, in the spirit of Laguna Beach, heralding the end of good sense in our teenage girldom, really brings me to tears.

But this would be to lie again. I really do not care that much. In the end, it's just a few more trees dying.

It's just the way that I love Paula

2005-11-08T16:57:00.000-08:00

For you kids, Paula was actually a singer before she was a judge! said the z100 DJ today.
And so my age was felt.
But 15 years after I bought my first tape of American Music (by Ms Abdul), I still knew every word to "Straight Up."
Which I sang in my car, loudly, on the way to Starbucks.
This made me happy.

Madballs for Lunch

2005-11-08T05:06:00.000-08:00

Watching VH1's I love the 80s (3D!) I was suddenly reminded of why madballs held particular significance to me. It was not a fan of aesthetically unappealing toys as a child, preferring barbies and My Little Ponies to their more obese counterparts, otherwise known as cabbage patch kids and the neon-haired wrinkled faced trolls. But this was somehow not apparent to my mother. (Somehow the time when I bit another girl because she was allowed to wear a dress and I wasn't didn't clue my mother into the fact that maybe I was a girly girl.)

So for my first lunchbox, instead of buying me one festooned with the likes of Rainbow Brite or My Little Pony, it was one, composed of flattering neon-green plastic, depicting madballs in all their wide-mouthed, buck-toothed, eyeball-enucleated glory, jumping out at a crowd of terrified school children. I was to scared to complain, and merely made it a point to press the pictoral side of the box to my body, hoping to fool my peers into thinking that some product-developer at Mattel was stoned enough to come up with a neon green Barbie box.

The idea of ugly toys always fascinated me. It seems to me that children should be revolted by such inventions as the madball, as I was. I never understood how prepubescent girls found those Cabbage Patch kids, with their cushionoid features complete with pin-sized eyes and obese habitus, appealing. One wonders if indeed advertising could be persuasive, as to catapult these terrible products en masse into public consumption -- and succeed! And if this were the case, how sad it is to think that the (assumed) good aesthetic sense of our youth can be led astray so easily.

Luckily, their attention span is often as ephermeral as their good taste, and such fads fade until VH1 bring them into our recollection, at which point they, all grown up, will scoff at their past temporary insanity, and continue playing with their Furbies.

Laguna Bitch

2005-11-06T08:47:00.000-08:00

Why do I feel like Laguna Beach is a part of a conspiracy to make 98% of the female race feel inferior in their station in life? The trials and tribulations of the rich and gorgeous. And I was wearing tapered Lees and Mickey Mouse T-shirts, taking the late bus home from Math Team during high school. One likes to imagine, albeit falsely, that some justice exists there.

Hurt

2005-11-03T18:20:00.000-08:00

Mired in a world of hurt, I find the internal discourse shifting away from narcissistically questioning the rejection of the other, and toward validating these feelings altogether in the grand scheme of things. There has been greater hurt, in response to greater spurn, but oh how the experience, experienced, precludes any rational stratification of woe and pain, such that a mere scratch, inflicted on one's own body, becomes tantamount to the genocide of nations.

And so in this I refuse to feel guilty, and indulge in my self-defined suffering. Judge me if you dare.

How do I love thee? Let me count the positions.

2005-10-26T13:55:00.000-07:00

It only takes speaking to my 16 year-old sister to realize that female sexuality is not only exonerable, but revered, it seems, at any age where members of the opposite sex realize the interlockability of their pubescent parts. One's desirability is measured by how many members of the opposite sex wish to bed you, such that "he told me he wants to hook up with me," becomes the ultimate expression of one's own worth.

It is not a world that I knew as a teenager, but it is also not one that I am willing to judge. Not because I embrace it, or even condone it. But because I understand it, and at times, even in my more matured years, fall victim to it.

Slate magazine quotes from a recent essay by a certain Dr. Kass of the University of Chicago, who blames the female sexual revolution on such forces as effective contraception, the notorious ephermerality of modern marriage, the de-romaticizing of sex in high school sex-ed, and the concomittent erotization of sex in media. But I believe underlying all of this is this basic desire to be desirable. And while quoting sonnets and picking flowers were the terms of endearment in the past, a sexual invitation, or even the insinuation of such is the modern equivalent. Who is to say that long stem roses speak more affection than an experienced tongue?

We lack an effective language to woo, and so we dismiss language altogether. Because while chocolates and flowers bear the potential to become hackneyed expressions, an orgasm never will. Yes, there will always be the admonishment that a dead goose lays no golden eggs, there is always potential for another one, mayhap laying platinum eggs, to come along.

Lost in Lohan

2005-10-25T14:48:00.000-07:00

Watching TRL I realize

what ensues when oversexed underfed

drama queens procure a soapbox

Thank goodness for Ashton

for bringing some sense back

to the inanity

Goodbye to all that

2005-10-24T19:43:00.000-07:00

"Dress more professionally," one attending wrote in my evaluation. Terse and Cold. I guess cleavage doesn't work as well in medicine as it does in real life. Guess I gotta stop shopping at H&M. Hmmm.

Differential Diagnoses: Worry, No Worry.

2005-10-17T06:34:00.000-07:00

There are two possibilities when you, on Monday-morning pre-rounds, in a state of ignorant bliss after a call-free weekend, find that another name plate adorns the door of a patient on your sign-out list. (1) They went home, meaning you've worked your magic and now they are singing your praises (move one space forward! Collect $200!) (2) They were sent to MICU. (i.e. good news: no longer your responsibility; bad news: you probably missed a fatal metabolic disturbance, causing them to code at 5AM Saturday night, and now you are a bad bad person -- Go to Jail!). Fortunately, on consult service there is none (ok, ok, less) of the guilt (I'm on GI! No PE for me!). But the forever inquisitive and studious academician you are, you decide to pop a visit to the good-old MICU.

And so I found her lethargic (which in medicine means something far graver than sitting, stoned, on the couch watching Road Rules) in the glass aquarium that is the Cardiac-ICU unit, family members around, and a panoply of tubes extending out of her. This is not good. I feel badly for her. (who wouldn't?) But I feel worse for the medical resident who was in charge of her care, who did not think her increasing shortness of breath was due to the small effusion in her pericardiac space, because her LV function had been perfect, because despite her horrible cancer history, her heart has never failed her, who did not think it likely that this effusion could have expanded to 500cc and effected a cardiac tamponade with resultant respiratory decompensation that drove her CO2 to the upper 90s and her blood pH to fall below 7.2. I feel for the resident. Because I have been there, with the scarlet insignia of C, (culpable), or of N (negligent), plastered across my chest. And you feel like the whole world is judging you.

It is a terrible feeling.

These are not isolated events. I remember the OB resident who, on the morning before a patient threw a pulmonary embolism, wrote "LE: no edema" without checking her legs, despite the fact that she has had a DVT that caused her legs to balloon up over the course of several days. Or of that time I, myself forgot to check the abdomen of one of my patients that AM before she developed an opening between her gut and her skin, causing her to require a colostomy bag. I could not face her that day. I felt as if I've failed her.

I remember one ER episode, when a man, dressed in a superhero costume, came in complaining of back pain. In real life, these complaints are a dime a dozen. You end up seeing so many cases that turn out to result from things you can't fix (i.e. vertebral compression resulting from an obese body exerting itself upon a skeleton already undergoing osteopenia, long-standing history of sciatica from a prolapsed disk, and worse - narcotic withdrawal from over-medication, and even worse - idiopathic.) that you tend to think yourself silly for thinking of things that you can fix, and really, for life-or-death matter, should (i.e. aortic rupture, as was the case for our Superhero friend, who eventually bled to his death).

As a clinician faced with a patient with a nebulous complaint, you have two choices : (1) Not to worry. (2) Worry. For the most part, I have seen more residents take the former path, and more attendings take that latter. I used to think, and in part still do think, that part of the reason is that the latter path requires one to order a myriad of obscure and costly tests that will not only throw the hospital into greater state of financial duress, but will also invite nasty looks to the poor intern, so often the innocent messenger for the attending, from those (i.e. poor nurses) who must carry out those orders (good example: testing for fecal fat, which requires you to collect 72 hours worth of stool and calculate how many grams of fat were not absorbed). And the attending, always able to walk away after rounds, never needing to explain his or her views on why this test is indicated, is exonerated from abuse.

There is more to this however. I am more inclined to think years of training will expose any physician to experiences akin to that OB patient with the PE or my lady with the fistula. So many that they become fearful, perhaps even petrified, of the small possibility that the one thing that was not checked, that afterthought of a differential at the bottom of the list, becomes the proverbial piece of straw. And I think more nefarious than the threat of suits and unemployment is this guilt that pervades. That you, entrusted with this wealth of knowledge, and the power to help those who cannot help themselves, ultimately fail to do so.

The reality is that you cannot check everything. There is only so much time, resources, patience. But I think in the end, the good doctor's top differential is always to worry, because it is a far nobler crime to oneself to live with the guilt of having done too much. But this is easier said than done, because of much of medicine training is weeding out the false positives. To learn, once again, to look for the zebras among the elephants, is indeed a difficult feat to accomplish.

Homesick.

2005-10-12T13:49:00.000-07:00

I am really starting to think it's all in my head. This inferiority complex. I can't help thinking that were my name tag labeled "Yale medical student" that I would be able to interact with people with more confidence here. It has been 2 1/2 weeks, and I must say this is the first time in my third/fourth year medical school career that I really do not feel like I belong. Partly because this is the first time on consult service (i.e. give a lot of advice, carrying out none of the orders) which in theory sounds pretty relaxed, but in actuality makes you feel pretty useless. I love it when I write in my consult note "c/w current care," meaning I have nothing more to add, and in fact, yes, I am pretty useless -- and even MORE so, since I'm just a temporary student here at Yale, from a medical school most of you probably put on backup, and didn't even bother going on interview.

I am literally counting the days I go back to Westchester, and eventually back to the City, knowing now, with unequivocal assurance, that I belong in NY, even if I do end up (somehow) in a program in which everyone thinks they are better than me (and are probably correct), because at least I can run off my troubles under the twilight of Central Park. Ahh. Bliss.

Belly pain, anyone?

2005-10-05T16:23:00.000-07:00

I think my patient hates me. The way his teeth are perpetually gritted. I feel like he is purposely trying to pit my attending against me. The way he asks for morphine while telling me he's never in pain. The way he does not put down his inane word-searches when we enter his room. I think I should be allowed to hate him. Or slip some Prozac in his Ensure. I know he is allowed to feel sorry for himself. But I wish it wouldn't keep me from honoring.

On Rounds.

2005-09-30T19:03:00.000-07:00

"Fourteen dollars, Costco," said the chief of transplant surgery, stretching out his arms to show off his blue pin-stripes, proudly even, as we sardined into the elevators to the S-ICU, white coats flapping, before the conversation turned, once more, into the use of chemo-embolization in hepatocarcinoma.

One of Them.

2005-09-29T19:08:00.000-07:00

He does not look up when I enter the room. It does not faze me. I have had my share of obtunded and intubated 90 year old women. But this was a 31 year old guy, with his eyes unmoved from Judge Judy on the television screen, some unidentifiable hip-hop blaring through his headphones. Usually patients like this offer at least a grunt. Not so much luck here.

I am probably the 5th white coat he has seen today. Except I am not really in white. I am in blue. Contact precautions -- the signs announce in front of his door -- alongside other such ornaments in multi-colored papers that read NPO, Fluid Restrict to 1500cc, Wash your hands. All this means is that you must put on a blue smock backwards before you enter his room. And you cannot feed him pizza and coke with your grubby hands.

Good Morning. Are you having any belly pain? No words. A faint shake of the head no. Any difficult breathing. Eyes still on the good Judge. Mind if I take a look at your belly? I drew up his hospital gown. He lets his hand fall.

It is still distended from the ascites, despite having been drained yesterday. Brown-yellow fluid, said the Interventional Radiology operative note. Fluid sent for amylase and bilirubin levels; rule out bowel perforation. Fluid cultures positive for mixed flora, despite days of the strongest antibiotics out there.

I note how his head seems to small for his body. Eyes nonresponsive. Transfixed on the television, to which he is not even listening. I would later tell my supervising fellow that he was non-verbal at baseline, but likely from unwillingness rather than inability. Although at that moment I was not certain.

I covered him again, listen to his heart and lungs. He knew the routine. Breathed deeply when I pressed my stethescope along his sides, and back to normal breathing when I auscultated over the heart field. He's been through this. Yes, my heart's still there. And if it's not, you might just as well put RRR no m/r/g, anyway. In fact, it's probably there already, in your pre-written note, even before you laid one finger on me.

I peeled off my blue smock, and said goodbye. And thank you for letting me examine. He remained unchanged. The judge still on the screen. Hip hop still in his ears.

And then I realized. I did not even tell him my name.

SIG E CAPS

2005-09-27T17:50:00.000-07:00

There was an article in the September issue of NEJM that talked about depression in medical students. It seems counterintuitive -- that the prevalence is higher in the clinical years than in the basic science years. One would think that the thrill and rapid change and novelty will excite and solidify one's love of medicine rather than bring on the blues.

Somehow this article made me feel better -- justified everything I've been feeling the last few months. It's difficult - because no matter how difficult the rotation, there is a sense of belonging once one finishes, that the thought of leaving and going into something completely foreign is unpleasant, at times terrifying. One month ago, on the subway to my sub-internship, I wished that the train would stop and I would never arrive. But now, two days into possibly the easiest elective I will do this year, I crave the hectic schedule that last month brought. I longed to wake up at 4 AM everyday to see my patients. Longed for the calls that told me my patient had a fever, and now needed cultures drawn. The admission papers. The daily progress notes. The disappearing temperature boards. The lack of clean utility. I miss everything. And now, bereft of my former setting, which I view both with contempt and fondness, it is hard to pull myself out of this depression.

But this is nothing new. Relationship are ephemeral in the time of rapid change, and there is the sense always of being lost, alone, never really belonging anywhere. You build your reputation one place, work so hard to impress yourself upon others, only to have to do it all over again. It becomes tiresome, and depressing.

I just wish there were some way I can pull myself out of this.

Needs vacation.

2005-09-24T01:39:00.000-07:00

One tends to think that things have a way of tapering down; that the way this subinternship month for me would end would be much the way it began -- a slow to medium paced chain of events, all of which lead to a happy conclusion.

But Of course, no.

Over the last 48 hours, I spent 4 hours with a patient going into and out of a seizure, during which time I found myself in negotiation with the interventional radiologist, who informed me that another patient is now on the OR table, but cannot be done because her PMD is an idiot who has no idea how to reverse anticoagulation, preprocedure, followed by the next day, in which two patients were bounced back to me, who, conveniently, both developed fevers and thus required the full fever workup, one of which is so cachectic 3 IV nurses failed to insert a line in him, the other so demented that he jerked his arm each time I stuck him, causing me to pop three veins, leaving me to constantly run back to the poorly stocked utility room where a fucking syringe is NO where to be found. And of course, this order needs cosignature, that order was lost, that order needs to be renewed, you need to add these labs, these orders are written wrong, we don't carry that drug. And then the demented patient's wife yelling at me because he was not given lunch.

Yesterday, at approximately 3 PM, I decided in favor of law school.

What frustrates me is the constant paperwork, which is not a big deal except that they need to be written in such a way, be cosigned; you need to call or tell who ever it is the paper's going to to actually do what it says, or they play the "i didn't get it" game, expecially when faxing is involved, and when it doesn't happen you have to run down and personally send it yourself, all of which involves running up and down the stairs, because the elevators have a mind of their own, and because the hospital is in the cro-magnon stage of computers in which, unlike any hospital I have worked in so far, orders need to be hand delivered and signed, rather than being inputted into the computer.

All this leads up to the fact that there is really no way to keep on top of things. You start to accomplish one task and can't even think straight because you're so anxious to get it done quickly before the next page comes, so that when the next page does come, you would have accomplished nothing.

And this is when you start being murderous. Those stupid family members that flag you and demand answers, even though the decisions weren't even made by you. The nurses who demand things be done now, because they, too are busy and do not personally care if you are running ragged (welcome to their world, darling). The stuid, slow-walking service people who hog up the elevaters to go from floor 3 to 1 (because their fatness precludes the possibility that they sustained any excercise in the past 3 decades.) The people that put you on hold AFTER you answer their page 5 seconds later, because for some reason they can't wait that long by the phone, that they are now wasting your time. All the while you have to smile smile smile, like none of this is bothering you, and your world is just peachy.

But this teaches me one thing this month. That to begin this profession is harder than I ever thought imaginable. That I still have mountains to learn. That there will be more nervous breakdowns and doubts and fears and anger like I've never known.

But moreover, that I can do this. And maybe one day I'll actually like it.

Delirious

2005-09-18T15:19:00.000-07:00

Today my bitter flamboyant friend allowed me to draw his blood. I suppose I ought to construe this as sort of an honor -- after all, he did refuse the third-year resident on the day he was admitted. When I penetrated the first vein, and nothing but fizzles seeped up into the tube, he told me, not entirely mean-spiritedly, that I really out to practice on my boyfriend. I smiled at him, trying to hold back saying what I really wanted, that I had no boyfriend in the picture, and moreover that I had been up for nearly 30 hours, with about a 1 hour nap between 5 and 6, in the cold intern's lounge, without blanket, with my body pressed up against my pager, barely able to close my eyes for fear that it would alarm as soon as I become unconscious, and that I was beyond tired -- that what I felt was this trippy light-headedness, a sort of delerium, where I wandered, sleep-walked, almost ghost-like to my next destination, at times wondering how I ended up in a certain spot I had no intention of being in. I did not want to heighten his anxiety anymore, the way he was heightening mine. He had amazing veins. Bulging from his lean, white arm -- ideal for even the most amateur of phlebotomists. But, even in my altered state, I felt this overwhelming need to impress him -- this person that greets me with a dismissive "hello, little girl" each day that I come to examine him. And as expected, nerves got the best of me.

So this was my ending to possibly the longest day I have ever spent. When two minutes before I was about to leave to rest in my warm bed at home, the nurses call me to tell me that he who was minutes away from being discharged, had, now a fever of 101. And my attending, with all the habitus, and none of the charm, of Archie Bunker, gruffly told me that of course I needed to culture. Kiss my bed goodbye. I forsaw that before I were to attempt to sign off again, I would receive another page. They never fail, these nurses, at predicting when the least convienient time would be for you, and page right at that moment. Ahh, medicine. How beautiful that sound of the beep.

And to think; in less than 12 hours I will be right back where I started.

Crash and Burn.

2005-09-15T17:58:00.000-07:00

There is no way to prepare for this moment. When the patient is lying there, oxygen mask on, an aspirin, a nitroglycerin, and 20 milligrams of morphine later, eyes wide with fear and in irretractable pain, when all the cardiac workup has been negative, when all eyes are on you and you don't know what the hell is wrong with her, and what the hell can raise her pulse from 70 to 140, her systolic pressures rise from 110 to 150 in a matter of minutes -- it is like a train about to crash, with you driving, and you suddenly realizing you didn't know how to drive, all this time.

When all you want is to curl up and cry, this same sick panic you've been feeling everyday for the last week, when you're feeling like you really don't belong here, and that you're no good for this. This feeling of incompetance. Wanting people to know that you're only (for God's sake) a student who can spew out the molecular mechanism of coumadin without knowing why the hell someone with an INR of 3.96 could still extend her pulmonary embolism and suddenly be in respiratory distress. And even if you did, not knowing what the hell you can do about it, short of holding her cold, shaking hands, looking into her tearful eyes, and apologizing for her pain, her suffering, her terror, and your helplessness.

This feeling. Of not being ready. I don't think I have ever questioned my career choice as much as I am now.

Cry me a river.

2005-09-12T16:41:00.000-07:00

I am allowed to dislike a patient. Although so much of my medical training has ingrained in me the fact that countertranference is a reality that must be overcome in order to achieve empathetically rapport, I think that's bullshit written up by some hippie freak who never had an asshole as a patient, or was too oblivious to diagnose the assholism.

Now, what is ironic to me, is that most of the cheeriest, most affable patients that I have met are oncology patients. This is perhaps due to the fact that I have met so many later on in the disease, either when they have already achieved remission, or when they are so far advanced that they seemed to be at peace with their future. For the most part, I have noticed them to be stoic, strong, with a complacency that I, myself, even envy.

But there is the other extreme. Luckily, he is the first one of this prototype I have ever encountered, but by no means the last.I liken him to a cross between Jack McFarland and Simon of American Idol. With a Frasier-like snobbery, a biting sarcasm, all atop a cloud of blazeed flamboyancy. So that you can imagine him mauling away at your self-worth, flinging your insecurities in your face, all while sipping tea with a raised small finger.

"Oh look, new residents. How tedious," says he, as my resident and I enter the room. And when I introduce myself as the sub-intern, he retorted, dismissively, "oh I figured as much." Not to be outdone, I replied that I only looked young. "Don't worry, I won't last," this he replied.

I imagine that he fancies himself more intelligent, more respectable, and above all this -- the hospital, the nurses, the house-staff. Moreover, I imagine that he feels, because of his illness, that sense of entitlement. That all the world should pity him and that he is justified in accepting this pity with scorn, sarcasm, and blatant rudeness.

I could understand this mentality. When you, being terminally ill, become so inured to condolences, so many of which are forced, dealt out of necessity, pursuant to social decorum, rather than from sincerity, when you become so weary of the helplessness of those most capable of help, when you are so depressed, anxious, even terrified of your fate, and all anyone has to offer are drugs that ravage your immune system, make you sicker than you already were, render you bald, cachectic, and weak, at the end of which you hear no happy news, but rather more "sorries" and "how terrible" accompanied by stupid mylar balloons and kitschy cards filled with inane Hallmark-sentimentality. I cannot imagine how that must be like.

But at the end of it all, you are the one that decides how to respond. Whether or not you choose to spread your embitteredness to others, because you suppose their pity to be a byproduct of social conformation. I will not say that it is wrong, because that is a personal value judgment. Rather, I will say it is unjust; it is exploitating your condition, knowing that no one dare challenge your cruelty because their own conscience cannot allow it.

I hate that he chooses to be cruel, and that I feel reservation at resenting him, because I feel this need to understand his point of view, without his being obligated to consider mine. Because he is with condition, and I am without. And that he feels, in some sordid way, that fairness can only exist between us if he is allowed to be vicious.

Perhaps in the course of his stay, we will reach an understanding. That my goal is simple -- to help and not to impose. But somehow I think his years of hard-experience have already numbed his sensibilities, and that he has already transcended the reaches of human compassion. And here left is this hard shell of a being, devoid of human emotion, cold, practically dead.

Doctor's orders

2005-09-10T15:17:00.000-07:00

Yesterday I wrote an order for Percoset 5 times. And spent 20 minutes figuring out how to order Colchicine without the nurse being on your case about overmedicating. I am beginning to hate the page that begins with "Hi, are you covering for [insert name]? I have an order for...". It's never good news. Once you start writing the order, the cascade begins. Change the IV infusion rate. We don't carry this formulary/dossage/form. We don't give it at this frequency. Change your dosage. You can't crush the pills. Patient is NPO; order the IV form. You will kill the patient with this dose. This does isn't strong enough.

Writing orders is an art, one which I will not master any time soon, most likely.

Documentation nazis.

2005-09-08T15:09:00.000-07:00

I have a new favorite beep. These people call themselves documentation experts; gestapo is more apropos. They have a sense of what possibly is the worst time to call, and then attack. Like in the middle of director's rounds, when I am crammed in a tiny room with 20 other people, listening to a case presentation, and I have to squeeze through 2 chairs and 5 people to get to the door, B-line it to the nearest nurses station, find a free phone, and call.

Excuse me, it looks like this patient is just here for a foot infection; can't they just put him on something at home? You need to document the real reason for admission.

Believe me, lady Nazi, I would be more than happy to send these people home. But truth is, I probably have less say than you. Barking up the wrong tree, you are. Why don't you page the admitting doctor at work, and see what nice words he has for you.

And why don't you document that, bitch.

That infernal beeping

2005-09-07T12:40:00.000-07:00

I am scared of my pager. That devlish flashing. Those insidious digits. That piercing, obnoxious, persistent, caustic beeping. The feeling of urgency, of panic that it brings. Like the sound of your mother calling your full name after your baseball flew into the window, the jerk forward after you have been rear-ended, the gutteral sensation a millisecond before a free-fall, the sight of a nurse holding a needle. Panic. Pure and simple. It is like a phantom, following me everywhere. WIth each passing beep I hear, on the streets, in the stores, I clutch my left chest, where my white-coat pocket normally is, and feel for that wretched plastic box, realizing that it is safely tucked away in my locker. I live in constant fear of the beep. Scarfing down my food, racing for the nearest elevator, lest it summons me at my most inconvinient moment. It has made a nervous mess of me, always in a state of impending panic, alert, vigilant, petrified.

Here is a list of some pages I have received in the past 1.5 weeks. From least to most malignant. Beep beep...

1. Hey, It's Liz; let's get lunch.
2. Hi pharmacy here, we can't carry out this order ... can you run up 5 flights of stairs and write it again?
3. Hi, 16 E here, are you taking care of Ms. _________? Oh she vomited/had diarrhea/ got constipated/ leaked her colostomy bag/ developed a fistula again.
4. Hi 16 E. Are you taking care of Ms. __________? She received Lasix at 10 AM but still has not urinated. what do you want ME to do? Well [nasty voice], I think she needs to be ASSESSED, don't you?
5. Hi, Vickie, Case manager here, about Ms. ____________ - so why is she still in the hospital?
6. Hi, this is 16E. Ms. ________ just had a temp of 100.8. You need to poke her impossible veins and get blood cultures. And did I mention two sets?
7. Hi, this is 16E. Ms. _________'s daughters and son are here to bitch you out.
8. Hi 16E. Ms. _________ is in respiratory distress; she's desating to the mid 80s. What should we do?
9. Hellloooo, this is Adam (my resident). I know it's 15 minutes before you get to sign out, but boy do I have a great admission for you.

It is like the Clockwork Orange; the beep is my Beethoven 9th. I have the rest of my life to become insane, as well.

I just need a fucking PRN.

2005-09-01T19:39:00.000-07:00

Excuse the poor writing. For I am frustrated.

Just when I thought I figured out how to beat the system that seems to thrive on bringing me down, it strikes. There's no avoiding it. This inefficiency. The bureaucracy. It's like a den of wolves. No matter how you try to arm yourself, you will get mauled.

And it'll just get worse.

I mean, it was just a skin infection case right? Easy. But of course he had to have the resistant strand. Of course, we needed Vanco. And when I saw him taken out of the Xray room, the Vanco infusing, and he is scratching his head desperately, turning red from the medication, of course I knew how impossible it would be to get a nurse to give me a stupid PRN Benadryl.

Don't you know how to treat this? Do you know anything? The resident's face read this. Of course I know. I know a lot of things. I know to store butterfly needles, bandaids, gauze, tape, IV needles, down to fucking alcohol pads in my pockets. I know to store every possible form in my personal folder so I do not have to run 10 flights of stairs to get a lab slip. I know to write the orders early, as soon as the nurse asks for them to cajole them. Even if it's for something tomorrow. I know to smile, smile, smile, even when I feel like I have to be on floors 7 and 11 at the same time, when I can't think straight, when there is 100 things to do and I don't know where to start, and I find myself on floor 11 wandering around when I realize my patient is actually on 16. I know. I know.

But I don't know how to find help when I really need it. When I am stranded, in the middle of the ER, with everyone flying around me, intubated patients rushed in and out, and random patients yelling at me for their pain. Because I have this white coat. It feels like a disguise sometimes. For someone who can do something. Clearly, all I'm capable of doing is packing order forms and supply room equipment. There are only rocks and hard places. And I don't know who to go to. And I just want to cry.

Spike!

2005-08-29T16:59:00.000-07:00

Truly destiny, this. With the finishing line in sight, a well-deserved respite to follow. That then a call from the nurse. Fever. 101. And guess what. She is neutropenic at 180 white count.

This is where pessimism comes into play. When one spends most of his/her life contemplating what one must do in times like this. Of duress, of disappointment, sometimes almost of despair.

Did you want to culture? Nurse Ellen asked. Of course. And I'll run to the lab for fungal culture. I called the resident. Both of us trying to mask the frustration that was understood in both of us. It wasn't hard, I imagine. You cannot survive being a resident long, always hoping for a surprise-free day.

So looking at 2 hours more than I expected. But this was what I expected. Perhaps I would have felt wary had there been nothing of the sort. That there was an overcast sky, and I didn't know when the rain would strike. And so it had, today. Not at Katrina level. More like Ithaca weather. I mean, I needed to learn this any way, this massive attack we call the sepsis workup, so often of which turn out to be something akin to a search for mythical WMDs.

But somehow, I felt better walking out today. Better today than I had felt all of last week, sitting in my apartment with nothing to do. I felt useful. Contributory. In a strange way, it was a good day. Because in this career I am, and need to continue to be, the eternal pessimist.

Massive

2005-08-27T02:53:00.000-07:00

It was more than I could have imagined, being there in Avery Fisher Hall, listening to the divine concoction that is Mozart's Mass in C. I have listened to the CD dozens of times, while reading, studying, but still the vibrato of the soprano and the sparkling of the strings dring the opening Kyrie made me shiver like I never had. Perhaps it was the excitement of my virginal visit to Lincoln Center, or my love of Mozart and his masses, but I was transfixed, nearly moved to tears. I could not have imagined anything this beautiful.

And the thought came to me - how, by not being a subscriber to organized religion, I will never understand the profundity to which the love for an intangible being can motivate such powers of creation. Faced with religious fanatics, I am filled with skepticism. But faced with such resulting beauty, I am filled with envy. Will I never know such drive that evokes genious, creativity -- that elevates them to a plane of superhuman capacity.

This music. It moves me with its majesty. I doubt it will move me toward belief. But it convinces me that to some, indeed this love is real, and is something I can never fully understand.

Maureen Who?

2005-08-26T08:05:00.000-07:00

I love this picture. I would like to use it, as if I had something to prove. Allow me to explain.

Three weeks ago at the Islamic art section of the Met, I ran into my high school friend Seema who I have not seen for one or two years, however long ago our five-year Amity Class reunion was. We had a pleasant enough conversation, talking our about our final year as medical students, our impending subinternships, (and the additiveness of friendster).

Call me crazy. But after than encounter I was filled with disappointment over the fact that she recognized me so easily. Ever since I graduated, changed my hair, my clothes, lost weight, plucked my eyebrows, I had this Romy and Michelle-esque fantasy that 10 years from being that frumpy geeky senior I used to hate, that no one would recognize me. That someone from my old school (preferably someone I used to crush on) will turn their head as I walk by, not realizing that they had once shunned me. (Admittedly I was disappointed when, during my high school reunion, my crush-of choice, Joe, greeted me by name.)

But let me lay it out like this. Mine wasn't the story of the typical nerd being picked on, made fun of, and hated. Mine was the story of non-existence. I could not join clubs, having to watch my sister after school. I did not have many friends. I spent lunch periods volunteering to clean the rat cages for our Biology teacher, because so often my friends would not be at our designated lunch table (and how horrible it would be if Joe or Chris or Fouad or any of the others caught me alone with one or two other estranged souls.) My club of choice? Math team. This was my claim to fame. Glamorous.

I never believed the being smart or successful necessitated, or is facilitated by, being a non-entity in high school. In fact, the girls who were ahead of me in class rank, the people who got into schools I could not get into, were popular, sat at lunch tables with hoards of people, all while having talents far exceeding my own. I hated them. Not because they were better, but because they were better AND popular. They showed me that my unhappy social status was not a sign of my introverted genious, but rather an intrinsic weakness I cannot overcome.

To some extent I have not outgrown this. In most social circumstances I still feel overwhelmingly inadequate. But now, after years of trying to change myself, inwardly and outwardly, I realize I cannot. And perhaps the reason that I cannot is that most of my attempt at change is focused on the outward. Because this is easy. You can buy the nice clothes, makeup, and run off the pounds. You can learn to make the mirror and the camera love you. But something else needs to happen. (and I don't know what it is.) Until then, when you are standing around in a chic lounge with people you barely know and are trying to impress, you will still be that math team geek that cleans up rat feces during lunch period.

So this as good as it gets. I am not as unhappy as I was. Having passed high school, college, and most of medical school, I am farther away from the societies that, by their emphasis on fraternizing, force me to face my own insecurities.

Job huntin'

2005-08-20T17:44:00.000-07:00

There is hope for me yet. Once I got started on this residency search thing, I finally proved to myself I can make good process. But I am not certain whether getting started does anything to allay my nerves. The real problem comes in finding the truth about the programs -- somewhere between the buttered up versions resplendent with shiny happy residents featured on the program websites and the disgruntled rants on residency review sites/forums. I would love to see these program websites feature someone like Rich, the first night-float resident I met during my medicine rotation at Greenwich, who greeted us at sign-out every morning with hair tussled in every direction, chin grizzly with stubble, and the eyes of someone about to head-bob his way into REM. True, this is not the universal face of an IM intern, but it will be my face, minus the stubble of course.

As the impending doom draws nearer, I become more reluctant to enjoy my fourth-year bliss. In my head is the perpetual nag that chastises me on not filling my days with competitive electives, sucking up to big names, and rubbing shoulders with influential house staffs. Why am I sitting home reading novels when I should be running around gathering lab data like a true MS scut-monkey?

Some think of medicine as a life-calling, some as a steady income. I think of it as an inevitability. Because there is one track for me. As sure as I must eat, sleep, drink diet soda, call my mother on Sundays at 9PM. These are non-negotiable parts of my existence. Some ask me if I love medicine. I say love, whether it exists or not, is inconsequential.

Perhaps this plays into my procrastination, even avoidance of this application process. It leads to guilt, which I fully anticipate, but somehow am unwilling to overcome. Because it is inevitable as well. I think the guilt comes not from procrastination per se; rather it comes from the fact that I believe I am living falsely, but am unwilling and too fearful to truly find what will make me happy. Again, happiness is inconsequential, as is love. Necessity supercedes.

But I am not doing so poorly. I finished my comparison chart for the programs I plan to apply to. Happily my desire to remain in the city and its proximities narrows my choices for me. The personal statement is, for the most part, complete. The next step, I suppose, is finding the place that will make me the least unhappy. (or dare I hope, most happy.)

East Siiiiide

2005-08-06T05:54:00.000-07:00

Boy this internet addiction is worse than crack. I come back to Valhalla today for my week of Anesthesia fun in the WMC and have just spent 2 hours in front of my computer, basking in the glory of LAN-pleasure. My temporary roommate Kathleen has not yet been able coax the cable guy from coming until two Wednesdays from now. She and I, suffering together, will have to wait another 11 days.

Yet the past week has been somewhat of a vacation. With an easy rotation in rehab and virtually no studying to do, I did my share of explorations I have meant to do during all these years I attended this school. Of course this taught me that a) the expensiveness of the city is inevitable, no matter how hard you try and b) I need better shoes. The latter conclusion came after I developed multiple blisters on both my feet, and, lacking the sterile and sharp equipment needed to eliminate them, proceeded to pop them with a) rubbing alcohol b) a tissue and c) a pushpin (and d - my tetanus booster 5 years ago).

Pain nonwithstanding, putting my legs to good use outside of the gym was readily welcome (despite the >95 degree heat and humidity). I discovered (well, with the guidance of my fellow classmate and tourguide Freddie) the bike trail along the East river, though questionable in its scenic appeal, serves an excellent (and cheaper) alternative to the gym. Admittedly on multiple occassions I desperately wished I were male and could thus make do without the shirt and sportsbra. The hosed down look is not terribly flattering on me. Maybe I need to invest in some waterproof mascara.

The camera my family gave me came to good use this week, mainly to take more pictures of myself (vain vain person!). But now, instead of my cramped and clustered room, I have as my background my sublet, graced by the quaint stylings of Kathleen. (Oh what I could do with some patience and some money. Patience, mainly.) Taking self-photos has been an addiction, and happily I feel less silly and self-conscious with each photo shoot.

But last night I took the first ones not of myself. Atop the rooftop at the Met, my 3rd or 4th favorite part of the museum. Despite the humidity and the hoards of people, cocktails in hand and appropriately chic for the occassion that is Friday night, it was charming.

Here's a piece from the LeWitt exhibit on the terrace. Appropriately reflecting the city skyline. Boris and I agreed that it was LSD like. (Which I informed him later was quite the safe drug.)

So I will be back in one week, to enjoy 2 weeks of freedom and NYC.
I thought I shouldn't deny my adoring audience one more picture, though. (Cheeky)

Pro-CRAS-tination

2005-07-28T16:00:00.000-07:00

So I haven't gotten very much further on the personal statement thing. There seems to be no way to avoid the lameness that will ensue. Maybe I'm not really much better than this. I just like to think so.

So I have spent the last two hours sitting here, in my underwear, in front of my computer, thinking of how much I need to write this, and how good life will be once it's done. But I have not yet convinced myself to do it somehow.

I did, however, come up with some choice phrases last night. The brilliance that is me. Here are a few of the nifty quotables I plan to insert into my masterpiece. (Don't copy. That's called plagiarism.)

"I honestly thought "'tarry' stools was pronounced 'terry'. " (It's tah-ry).
"I almost said "Bun" during my first case presentation."
"I can't believe my attending noticed that stye on the woman's eye!"
"I hope to one day be able to palpate a Fallopian cyst."
"I enthrall in the humanistic and integrative nature of internal medicine -- seeing it as much as an intellectual challenge as a .... (suggestions??)"
"Someone once told me a patient often looks upon a doctor as a mystic with a crystal ball." (This is a lie. But it sounds damn good.)

I could tell this one's going to be a winner.

Let's get personal.

2005-07-27T12:21:00.000-07:00

This is me warming up before the kill. I am starting with pen (my signature Pilot Precise V5 0.5 mm extra fineroller tip) and paper. This means something serious is about to be written. So far I have written "I need." Indeed. What do I need.

Admittedly I have procrastinated long enough. It's just that I loathe writing personal statements, with all of my heart and soul. It is because I love writing. I love the honesty, the non-judgmental face of an untarnished blank white surface. But personal statements are not about creativity; they are not about honesty. However, I do not write to sell myself. I write to expose myself.

I do not say this to appear virtuous; I have never considered genuine humility to be a part of my nature (rather, I too often exploit the fact that I seem so humble). I am saying there is something in my nature that forcefully resists accentuating the positive. It is like a reflex to think of the negative -- to find my own faults before someone else does. I live in fear of lacking introspect in anything I do. Because people, abiding by the tenets of social decorum, are functional liars. So it is up to oneself to correct foibles before they become visible, or worse, irritating.

So, in having to sell myself, I would have to let my guard down. The ideal would be to find a balance between my harsh honesty and whatever good I see in myself, so that I would not be compromising my instincts as an exposer, yet not playing muckracker to my own soul. And I have failed each time in the past. For the college essay. For the medical school essay. It is a source of frustration. Knowing I have the capacity to write. But having the capacity being stifled by the demands and goals of the assignment.

Part of it is, as always, the lack of passion. As trite as it seems, without this drive, any amount of work would produce something as lack-lustre as the will that created it. And this is not something you can forge - this passion.

Better,I suppose, to fill this empty page with the usual fluffy drivel and cocktail-banter than to procrastinate. Some of the saddest moments in life are when you have to sacrifice ideal for practicality. I will sell myself, and will probably succeed in doing a mediocre job of it. But it is difficult - this creation of something so detached from yourself.

Drosophilae. Part Deux.

2005-07-23T16:50:00.000-07:00

This is what they look like when they're dead. I learned that in Genetic 256. It's what happens when you choloroform them for too long. Between that and having them rise from their inebriated state and fly away. To the time-pressed pre-med, needing to breed white-eyes with white eyes for the sake of getting into a good medical school a female escapee is worth crying over.

This is a classic example of desensitizing a fear of insects. The 4AM visits to the underground dungeon they call the fly lab. The smell of fly-fodder and choloroform. The chipped ceramic bowls of fly soup; unused and discarded corpses crowded in a thin layer of soapy water. And flies. Everywhere. Your skin crawled. Like formication in an alcoholic undergoing withdrawal. And under your microscope - every detail of the intoxicated, the sedated, the dead, and the smeared. Really you get used to it. That's the scary part.

And so they return. For round two, but this time in my kitchen. Drain flies - they call them. And surely they must be because there is no other source for them. I have taken out the trash, scrubbed the floor, poured 2 bottles of Draino down the sink. But they still return. Whence do they come? What do they want?

They have nearly driven me to insanity. Such that killing them has become a sport. Like darts. Or racketball. It has become an art. Some advice from them much-wizened? It is preferable to wait until they are on a surface, then come upon them quickly. When you catch them between your hands in mid-air, you must smear your hands together, to make sure they do not escape between the fingers. And the feeling of satisfaction at watching a dead fly roll off your hand and into the drain. Exhilarating.

According to the exterminator website they will leave by winter. But they've already mostly gone. Maybe then I'll take up rat-trapping. Stay tuned.

3 more days

2005-07-19T08:17:00.000-07:00

Vicious
Originally uploaded by Daisy72580.

This is like the classical case presentation of kidney stones - a young patient (usually male) complains of blood in his urine and sudden back pain radiating to the groin -- he cannot get into a comfortable position and is writhing in pain. 3 days before the 2nd biggest exam of my life I don't know what to do with myself. I can't study well because the words are just flying over my head, and I throw a fit whenever I get a question wrong. It becomes traumatizing to keep doing these practice tests at this juncture. I can't relax because - hell, the test is in 3 days. I can't sleep, I am loaded on caffeine, I have intermittent subclinical panic attacks; every small thing irritates me. I just can't get comfortable, no matter what I do.

I am not one to get nervous over tests. And nor am I one who usually does unexpectedly poorly. Logically, there is no reason to worry. But this is where my neuroses come into play. This daisychain of what-ifs. What if I fail, don't get matched, and end up scrubbing floors in the hospitals intead. What about my loans? What if I have to sell my body to get rid of them? (Is the Bunny Ranch hiring?) What if I end up having to practice medicine in Wisconsin. What if my nerves kick me into PSVTs during the exam and I have to retake it? And why the hell can't I ever get those antibiotics right? Damn penicillin resistance. I never get those pneumonia questions right.

Bottom line. I don't know what to do with myself. Please someone shoot me up with some Ativan (or maybe pot) before I drive myself crazy.

Pascal, Katie and the kids

2005-06-28T21:02:00.000-07:00

Pascal, Katie and the kids
Originally uploaded by Daisy72580.

Sophie (right) and I were making a circle of her plastic array of animals, insects, and automobiles - setting up for a game she has yet to explain to me, whereupon Adele (left) walks up and taps Sophie on the head with the beak of a small plastic airplane.

That wasn't very nice, Adele. Sophie says. Matter-of-factly.

Adele steps back, ruminating over having being chastised, pondering her next strategic maneuver.

She advances once more, taps Sophie again with the plane, and then kisses her on the head. Loud smack.

The absurdist play that is Pascal's Children. I hope they never grow old. (well maybe I do)

Austin, Baby

2005-06-28T19:48:00.000-07:00

There something amiss about Real World. How every season, unfailingly, the two best looking people (in the conventional sense) become a couple (one of whom inevitably is in a (often shaky) relationship already). And the show proceeds to portray their romance as something miraculous, fateful, and as inevitable as R&J. There is the necessary banter about "feeling each other from day one", or "feeling a connection." Maturity and class nonwithstanding (the girl did moon 2 of guys AND made out with another girl in the hottub on the first day, and the guy, not to be outdone, nabbed a zygomatic fracture worthy of surgery during a drunken brawl on the first outing), they are a match made in heaven. Ahh, destiny. Who is to mention the obvious, that they are pretty boys and girls, and this is what pretty boys and girls do -- mess around, cheat, and fling it out in front of the cameras, pretending as if there were more substance than the mutual discovery of pretty-ness -- as if more meaning were to be derived from the most primal kind of lust that brews when you put several fuckable persons of similar age in one house.

Here is to making meaning out of frivolity, as only MTV can. I am officially addicted to Austin.

Normalcy

2005-06-18T22:29:00.000-07:00

Each period of respite that follows a intense marathon of study brings with it a certain restlessness, laden with more anxiety than the one preceding. It is, at best, irritating and at worst, suffocating. Like a drug-induced state of formication (note the m rather than the n in the previous word) it is unresolvable, persistent, and unbearable. As if normal life has become phenomenon rather than baseline. The mundane - esoteric and intensely disconcerting.

I make of it best I can, telling myself, nearly obsessively, that there need be no reason for guilt. That this hiatus is well-deserved and necessary. (Though playing dual roles as both pathetic defendant and cynical jury proves to be somewhat of a challenge.)

But I have manged to distract myself today from these neuroses. A lovely 6 mile run with the sister, in which we trespassed into the idyllic corporate park of Hubbell. Began reading electroman's copy of What's the Matter with Kansas (having my father wonder of this sudden interest in American politics). And picking up the third movement of Bach's Italian Concerto, for the 5th time (maybe this time I will learn it in its entirety).

It felt like summer vacation -- strangely anachronistic, albeit beautiful. I run the risk of becoming addicted.

Need for Speed

2005-06-18T02:20:00.000-07:00

I can no longer wear high heels - for the mere reason that they impeded my speed. Over this last year I have progressed from speed walking to scurrying, perhaps as an adaptation to being on the floors. Miss a beat and the resident you're supposed to follow is nowhere to be found, leaving you with a handful of notes and orders to be signed, because without that MD after your name you are utterly and pathetically dependent.

But it is not only in walking. My love affair with speed, although present my entire life, has really accelerated to torrid extremes. I can no longer read, wanting to reach the end upon starting. Anticipating the end of movies. Racing up escalators. Pumping up the treadmill. I have become a fan of bullet points, newspeak, and the 5 minute man. But for good reason. The need for study. It seems like the entire goal has become to reserve time for that which I need to do above all.

So it comes to be a problem now, when in between studying, this need for speed can no longer be justified. And I realize now this obsession is really not functional, rather pathological - when pleasure is derived only from efficiency and completion, and never process. Even without necessity, I have become, at baseline, impatient, anxious, neurotic, and on caffeine.

It makes waiting the bane of my existence. Because unlike a book, I cannot turn to the last page and see the outcome (which incidentally is why I never finished Great Expectations). And so I sit here, tortured, things out of my control, waiting, with pessimism, no less. I'd really rather be studying.

The Big Chill

2005-05-22T20:00:00.000-07:00

There was one Bewitched episode in which (if I remember correctly) someone, probably Darren, was in the midst of raving about some great invention, to which Sam retorted "Yet you still haven't got a cure for the common cold." (or something of the like). In my quest for sugar-free cough suppressants today, I took a minute to marvel at the impressive display before me: racks of lozenges, sprays, instant-melt strips, rubs, vapors in every flavor. No, we still haven't got the cure, but we sure are compensating well. The utilitarian (and confused shopper) in me wished there were just one generic lozenge, THE Lozenge, with its appropriate dose of menthol and benzocaine for my consuming pleasure. Flavor not needed. If I really wanted watermelon, I could have got me some Jolly Ranchers, thank you very much.

Finally in line with my stock of store-brand lozenge, tissue box, and chicken broth, my eyes bloodshot and nose erythematous from the irritation of paper towels upon them, I thought of how appropriate this sudden onset of illness was. In fact, it was years overdue. Years of running in the rain, walking out with undried hair, tempting fate, only to succumb to the strange viruses that plague children on the pediatric ward. I am reminded that I do not play the sick role well, trying to overcome illness by running six miles rather than four, thinking that surely exercise would boost my immunity, continuing to go to work, blowing my nose out during morning rounds. Lovely. We thought sick people were supposed to stay in the ER, awaiting the mercy of the triage nurses.

But I indulge in this new role, sublimating it to the best of my ability. (when that maculopapular rash begins, will it be centripetal or centripedal?) Loving the feeling that my call home this week will not be laden with uncertainty and silence, because illness is the most interesting topic of all. Mothers will take every opportunity to reassert their role. Loving the ability to validate 6 hour naps during the day when I ought to be studying.

I should do this more often. Hopefully before a cure for the common cold finally gets out.

Mumsy.

2005-05-08T19:24:00.000-07:00

Mumsy.
Originally uploaded by Daisy72580.

The usual scene this morning, moments before I get into my car to drive back to Valhalla. My mother got up at 7 AM this morning, probably in hopes of being downstairs first, so she could have all my care-packages in neat plastic bags (and directions for use, no less).

The vacuum sealed salmon must be eaten within 3-4 days. Remember to refrigerate the squash. (No I like rotten squashes). Why do you eat so much squash? don't you want some shrimp?

I would like to remind her that I'm 24, and was perfectly capable of eating squash 3 meals a day, 7 days a week if I wanted. But I did not have the heart.

Yesterday she completed the best sewing project, in the history of her sewing things for me. Amid legions of pants cropped to the mid shin (before capris were fashionable), or dresses made sizes to large, there is now, the perfectly sleeved white coat; dirty hems neatly hemmed away. When I sat down to write my notes today in the ED, I did so with remarkable ease.

I think of how her personality so often gets in the way of her good intentions. Unashamedly dogmatic and vociferously judgmental, she is locked and closed to persuation. And when pushed further, she explodes. And so I've learned to take it all in. And implode. Distress where the rest of the world cannot see. Because I am afraid to fuel the fire; suffering in silence to avert the massacre. But ultimately I am happy I do. Because it would only be fair to her that I follow her rules. Behind all of them are good intent, unwavering. She does not want me to eat rotten squash. Is all.

This becomes most obvious to me when watching her getting smaller from my car window, waving in pantomime.

I think it might be then when I miss her the most.

Picture 014

2005-05-02T15:20:00.000-07:00

Picture 014,
originally uploaded by Daisy72580.

Test Blog. His Name is Curly.