Contaminating Information

Practice makes Perfect

2009-03-09T21:37:00.004-05:00

Today was my first day at Baptist hospital. It's only a mile from Vanderbilt. I'm on my OB/GYN rotation, and I get to spend 2 weeks there.

During a complicated operation:
The attending tells me to cut about 15 sutures exactly 1.5 centimeters from the knot. I proceed to do so, one at a time.

Dr.: Too long.Me: Ok

Dr.: Too short

Me: Ok

Dr.: Too short.

Me.: Ok.

Dr. Too long.

This continued until all were cut. He asked both my medical student partner and me, "why did I do that?"

My partner's response was, "Hazing???" The resident on the case gave her a funny look.

"No," he said.

"Perfection," I answered.

Surgery is a technical as well as academic skill. Perfection is an unatainable goal that surgeons strive for. So even after a lifetime of practice, one is always still improving, striving toward that goal of perfection. That's why they call it the "practice" of medicine.

It's just like rowing. I've rowed for many years, and taken litterally millions of strokes with the oar. As of late, I've been watching training videos made by an olympic gold and silver medalist, Xeno Muller. He's reached the very top of his profession, yet every day he continually tries to improve his stroke, reaching for that unatainable goal. And that's what makes an excellent oarsman, as well as an excellent surgeon. And I look forward to a lifetime of trying to hone my skills.

My first patient to die

2008-11-16T21:08:00.004-06:00

I knew it would happen sooner or later. Everyone eventually has a patient die. I'm sure other patients of mine had died before, but this is the first one I knew about. She had serious emphysema. You get that from smoking.

Anyways, she came in for an exacerbation of her emphysema. She could hardly breathe. And she was only 50 years old. We gave her breathing treatments. A chest X-ray suggested pneumonia. That would explain why she suddenly had trouble breathing. We treated her with antibiotics. She got better for a while.

The trouble with antibiotics is this: They wipe out ALL bacteria. This leaves room for bad ones to grow in the place of good ones. We all have C. difficile in our colons, but when you wipe out all of your normal bacteria, C. difficile can overrun everything. And the result is horrible diarrhea. Most people get over it.

But in some peple, this diarrhea progresses to something worse. She developed "Toxic Megacolon," where the gut simply is overwhealmed with the bacteria and ceases to function. This bacteria got into her bloodstream. The only option was to surgically remove part of her colon. However, she was in such bad shape that her mortality from this procedure was 100%. And without the procedure, it was 100%. There was nothing we could do, except let her die. And that is what she did, after a few hours.

I plan on going to the autopsy tomorrow. It seems right to see everything through till the last steps. The permanence of it all is stifling. From joking about her kids just a few days ago.... to this. I hope she did not suffer too much through it all.

My Backpack

2008-11-16T16:56:00.002-06:00

I'm going to Portugal in about a month. I always travel with my large camping backpack, a trusty REI Valhalla. I first got it in the 8th grade, when I figured it would be easier to carry everything with me rather than keep going to my locker. Other kids called it my "body bag" and suspected that there might be some dead person deep in there. After all, it was about as big as I was at the time.
However, after 12 years of service, it didn't look quite up to the trip. The stitching on the bottom was starting to come apart, and the waterproofing on the inside was flaking everywhere.
I remembered that REI has a 100% satisfaction guarantee. So I put it in the car and drove to a nearby store. I went to the customer service counter. The man was very nice, but he couldn't find the bag in his computer system (it was too old). So after a bit of discussion, he offered me a $60.00 credit. Sounded fair to me.
Then I went backpack shopping in the store. The salesman was very helpful, but when I inquired about one of the packs, he said, "Oh, no way. If you think a 12 year old bag is returnable, that won't be nearly tough enough for you!" Point taken.
So I shelled out a hundred bucks on a Kelty Coyote 4900. Hopefully it will last me many more years. And it too has a lifetime warranty! I'm keeping the receipt though.
But right now I'm really missing that purple REI bag. It went to school with me for years. Countless camping trips. Probably 10 times across the Atlantic. London, Paris, Rome, Nice, Naples, Avignon, Cambridge, Frankfurt, Montreal..... I kind of want to drive back to the store right now and get it back. Maybe I can sew it back together.

I become the patient

2008-09-15T20:21:00.006-05:00

I came out of the shower and dried myself with a huge white towel. Something caught my eye. What was that on my back? It was dark, but I couldn't get a good look at it, even with all the mirrors in my bathroom. I'd never noticed it before.

A few days later, I became more worried. Could it be the dreaded melanoma? I had recently seen several patients die of metastatic melanoma in the hospital, and they were terrible, slow, painful deaths. I was rather young for such a thing, and I tend to wear sunscreen and keep out of the sun when I can. But there was still a chance. And if it was the real deal, catching it early was my only hope. If it invades more than 1 millimeter into my skin, my five year survival (the odds that I would live longer than five years) drops off a cliff. I couldn't let this go.

Since I couldn't see it well, I took pictures of it with my digital camera. I saw that it met all the ABCD's of melanoma. It was Asymmetric. Its Border was ragged. It was comprised of two or more different Colors. And its Diameter was greater than a pencil eraser. Shit. This could be bad. Should have used more sunscreen. I suddenly remembered the blistering sunburns of my youth. That time in Saudi Arabia when my skin was peeling right off my back. All those times I went water-skiing without sunscreen. Those blistering sunburn drastically increase your odds of skin cancer.

So I went to the Dermatology department to try to make an appointment. They asked to see my insurance card. Then they told me that the first available appointment was in late November. Really? I'm supposed to wait more than two months with a time bomb on my back?

That afternoon, I decided to take matters into my own hands. I would not wait that long if I could help it. I left the pediatric neurology clinic in which I was working, and headed towards the derm clinic. I tracked down the doctor I was after, and introduced myself. "Hi Dr. B! I'm me. You worked with my dad a while back. I have this thing on my back, and I think it might be a melanoma."

He was so nice. He immediately took me into a room so he could look at it. He thought it was suspicious, so a few minutes later, he took a biopsy of it. He asked for my pager number so he could give me the results as soon as he read the slides (he's also a dermatopathologist). Now I have quite a few stitches in my back, but at least I know that I, and the little piece of my back, are in good hands.

The Nile

2008-09-08T22:01:00.005-05:00

A patient comes in today. Middle-aged man, slightly balding. He had headaches that just wouldn't go away. So we got a MRI of his brain. The official report hadn't come in yet, but the images were on the computer. So I glanced through them.

MRI is an amazing thing. With the click of my mouse, I can fly through cross sections of a person's brain, seeing it in exquisite detail. I can see, millimeter by millimeter, what makes you who you are.

As I flew through the cross sections, I started to see bright spots at the junction of the gray and white matter. There were ar least four to my untrained eye. I called over the resident (a junior doctor). He agreed. Lesions at the gray-white interface are pathognomonic for metastatic cancer. The patient's prognosis was dismal.

The resident and I went into the patient's room to tell him the news. His wife was there.

"The results of the MRI are not good," the resident told him. "We think you have cancer in your brain. The prognosis is not good."

He looked at us for a while, not showing much emotion. I tried to picture myself in his position, but couldn't. I had no idea what I would do or say or think.

He said, "Jesus will heal me!" "I'll be fine, 'cause Jesus will heal me!"

Denial ain't just a river in Egypt.
-Mark Twain

Crazy People

2008-09-08T21:37:00.002-05:00

Mr. T came to the hospital to detox for his sixth time, and he was only 25 years old. He was taking large amounts of Valium, booze, and opiates, as usual. So we detoxed him, giving him meds that would make him more comfortable while he withdrew from the drugs.

He would come up to me, seemingly from nowhere, and beg for more. He said the withdrawl was unbearable. He hadn't slept for days. He was anxious. He was sweating. He felt like he was crawling out of his skin.

And then he started to pee blood. A lot of blood. Oh shit. And on top of that, he had a urinary tract infection. He had a history of kidney stones, which can cause bloody urine as they pass through. And he described in perfect detail the exact location and excrutiating pain a kidney stone can cause.

He wanted opiates for his pain. If it were anyone else, we would have given it to him.

So we got a consult from Nephrology. They said that the bacterium cultured from his urine usually didn't cause UTI's. We started him on antibiotics. A CT scan confirmed that there were stones in his kidneys, but unless the stones actually pass through, they shouldn't cause any pain.

Then we got a Urology consult. They said his bloody urine was almost certainly due to "self manipulation." This translates to him shoving a coat hanger into his penis, all the way through his urethra, and then into his bladder, and then whirling it around. All to get opiates.

We discharged him a few days later. He was supposed to go to an inpatient drug treatment program the very next day (we had set up everything for him). But he relapsed, again, and nearly died, again. So now he's detoxing at yet another hospital.

At first I was furious. Furious that he had misled us. That we had wasted thousands of dollars for needless tests and consults. Money that could have probably saved several lives elsewhere in the world. All because this idiot was a druggie.

And then I felt sorry for him. Genuinely sorry. I wondered how a person would have to feel to do such a thing. To fake kidney stones with a coat hanger just to get some drugs. Never before had I realized the power of addiction could be so strong. So strong as to take over everything that you have been, or ever will be.

Death

2008-08-22T21:15:00.004-05:00

The thought of death is terrifying to me. You would think, being a medical student, that it would be natural... In some ways it is. But in almost all ways it's not. The permanance. The feeling of never feeling anything ever again. The emptyness. The abscence of anything. That scares me. I will be zero. Just a memory in someone's mind.
It really came home today when one of my professors, in Neurology, said it quite plainly: We are only future cadavers.
In many ways, I had only dealt with death superficially. It happened to other people. My job is to help prevent it, or if I can't, I am to make it as comfortable and palatable as possible.
Now I understand why people want children so badly. It is their way of cheating death. The one way of outliving one's self.
But still I can hardly imagine myself dead. The stagnation of it all. I would think it boring, but that implies consciousness. I can only hope that the purpose of my life is to provide comfort to those who need it the most. To those who have nothing else. To those who know the end is near.

Coxing while intoxicated?

2008-07-13T15:59:00.002-05:00

So this saturday, I got up at 6 in the morning so I could be rowing at 7. The only problem is that our coxswain was half an hour late. Her mom dropped her off at the lake. She said she was really sorry, and that she had had a late night (going to bed at 5 in the morning to be exact). She said she was still drunk from the night before, after having quite a few drinks with her friends. And from the way she coxed the boat, she still clearly was. The smell of vodka on her breath was still strong. We joked weather she could get in trouble for coxing while drunk. But all was good, and we had a good row, even if I got quite sunburned in the process.

I spent most of last night and this morning figuring out how to replace the battery in the cox box (the thing that amplifys the coxsain's voice). I went to wal mart and found some RC car batteries, which were perfect (600 Mah NI-CD's). After a lot of soldering, the cox box is working again. Yay for saving a few hundred bucks.

So much has happened

2008-07-11T17:46:00.003-05:00

So I spent this summer in England, studying for Step I of the NBME examination (the first step to becoming a licensed physician). This was probably not the best decision I've ever made, since there were plenty of distractions and other stuff to do.

We went to the Isle of Man for a vacation. This cost a fortune (as everything does when the dollar is so weak) but it was well worth it. We stayed at the Wicklow Hills hotel, which is within a half hour walk of the ferry terminal. A guy was waiting outside, and greeted us as we walked up to the place (at 1 in the morning). "Mr. and Mrs. XXXXXX? Welcome to the wicklow hills!" He showed us to our room, and told us that we could arrange payment the next day. Fucking amazing service.

2008-07-09T22:50:00.002-05:00

Wow, so much has happened since I last posted. I went to England to study for my step I board exams, and that seemed to go fairly well. While in England, I went to the Isle of Man, went to the Cambridge Beer festival, got chased down an alley by a drunk guy bent on hurting me, and had a jolly good time overall.

I got back to the US. I studied a lot. I took the boards exam, and think I did ok. And now I'm starting the third year of med school.

Wow, I'm half of a doctor already. Who would have known?

MedWars

2008-04-03T00:18:00.003-05:00

So let me tell you about MedWars. It's an adventure race with a medical theme to it. This year it was held in Augusta, Georgia at an army fort there.

We left Nashville an hour late because V screwed up her schedule. We got there late, but I slept like a log on my wonderful thermarest.

The next morning, we registered and got everything ready. V hadn't brought a pack with her, but by some miracle, I decided to bring two, just in case I wanted to use a larger one. Then I saw V in jeans. She was the only one there with jeans on. I tried to get her to put on my spare north face pants (which would have fit her fine) but she refused. "If my jeans get wet, I'll put on my other pair of jeans!"

The race started at 11 AM. We got slightly lost, but not too bad. Three hours in, we had to cross a swamp - and the only way across was to wade (swim) through. I was up to my neck in water (and I'm 6' 2") and decided it would be easier to swin than to try to keep my pack dry by holding it over my head.

Afterwards, V changed into her spare jeans. I simply took off my shirt and hopped around to keep warm.

And then it started to pour. And it got much colder - into the 50's. V forgot to bring a jacket. All she had were her soaking wet jeans and a tank top. I gave her my jacket to keep her from serious hypothermia.

And then her hip started hurting. She walked slowly, and would sometimes simply stop and sit on the side of the trail. I ran in place to try to keep warm. At this point, I was shivering constantly.

At the last checkpoint, me missed the time cutoff my 15 minutes, and were disqualified. It continued to rain constantly. We walked back to the campsite. The tents were soaked. M had no clothes, so I put her in my car and warmed it up. My hands had trouble gripping anything.

And after 7 hours of driving, we were finally home, and I got to bed at 3:30 in the morning.

Purgatory?

2008-03-25T21:10:00.002-05:00

I was talking with a few med school friends the other day. One had just recently gotten divorced after six months, because his wife was a giant bitch (anyone could have told him that). He said "I think I need to find a new church." I said, "What do you need a church for; it will just cost you time and money."

The girl in the group scoffed. Like I had said something heretical.

The conversation went on from there. The girl said how her grandmother kept a bottle of holy water with her, and splashed it on every kid she saw so they would not have to go to purgatory.

I said, "I thought they got rid of purgatory."

She said, "I guess she didn't get the message."

Music

2008-03-08T18:32:00.002-06:00

Have you ever discovered a new song on your computer, one that you had never heard before? Has it brought you joy - a feeling of happiness and euphoria that you haven't felt in a long time.

This happened to me today. "Prize Fighter" by The Velvet Teen popped up on Itune's Party Shuffle. I have not been the same since.

Ambulance

2008-02-21T00:42:00.001-06:00

I’m riding in the “box” of the ambulance. There’s a call for a 80 year old African American woman with "seizures." Doesn't sound too serious. Besides, an ALS (advanced life support) fire engine is on the way, well before we will get there.

Mid-way there, the driver yells back into the box "they're doing CPR." The driving gets noticeably more serious. We're running red lights like crazy now. Oh boy.

I rehearse what I learned over a year ago in my head. 30 compressions and 2 breaths. Or is it 30 and 4?

We arrive at the scene. The patient is lying on the floor, with a tube into her lungs. Someone is performing chest compressions. A woman cries in the corner. Another man looks forward, blankly, as if nothing is registering at all.

I see a big bottle of oxygen in the corner of the room, as well as a peak flow meter. She must have lung problems.

The paramedics flop her onto the blue backboard. They struggle to keep her lifeless hands from flopping to the side. Someone instructs me to turn the stretcher around, which I do. They place her onto the stretcher. The paramedic I'm with points to me and says "Start chest compressions!" I do. They load her into the ambulance with me compressing away. "Use the heel of your hand! Harder!" I continue compressions for about five minutes until someone else takes over. I’m exhausted. I could feel that some of her ribs had broken (not unusual). And there's no discernable heartbeat pattern on the monitor.

I hand someone a stethoscope. No left lung sounds. Must be a right mainstem intubation. They pull out the tube a bit, and it sounds better. They give her epinepherine and atropine through a needle in her neck. Someone asks me "Do you feel a femoral pulse?" I reach down there. "Um, maybe, yeah, I think so." Indeed, she now had a (slow) palpable pulse. God Damn, I was sure she was going to die. Wow. We saved her!

We arrive at the ER. The doctor looks none too pleased. He asks "how long has she been down?" "About 10 or 15 minutes, but she has a pulse." "Damnit! Well, resume chest compressions, then. We have no critical care beds!"

In any event, she will probably never leave the hospital.

ER tonight

2008-02-12T21:43:00.002-06:00

Radio says kid was shot in neck, point blank. Five minutes out. I'm there in the trauma bay, expecting the worst. He must be dead or close to dead. They wheel him in. I'm in full protective equipment, wearing what amounts to a garbage bag and face shield to protect me from flying bodily fluids.

The EMT asks him if he can move over onto the other gurney. WTF? He's conscious?

They examine him all over and take X-Ray films.

He's fine. The wounds are mostly superficial. The bullet is still lodged in his arm, though. To make it from the neck to the arm without hitting anything important is incredible. No one could believe it. If only everyone could be so lucky.

Plastic Surgery

2008-02-12T21:29:00.002-06:00

We went into the examination room. A woman was confortably sitting in a chair. I silently thought that she probably wanted a face lift or some such thing, even though she looked fine. This is plastic surgery after all.

How wrong I was. Ten yers ago she was in a car wreck, without a seat belt, and her face was smashed to pieces (the so-called pan-facial fracture). With some surgical wizardry, the plastic surgeon made everything look PERFECTLY NORMAL, at least to me. He still says that her maxilla is a little bit too big. Her only problem that day was that her nose itched a bit.

Damn. The thought that with your knife and skill you can make something look like it never happened. To give someone back their life, free of shame, free of self-consciousness and embarassment. Amazing.

John McCain

2008-02-02T17:10:00.000-06:00

I've never been to a political rally before, so I thought I would at least make the effort to walk across the street to my old highschool's gymnasium.

I got there half an hour early. Plenty of people were already there. A woman offered me a McCain sticker, which I affixed to my coat so I would blend in better. "This is my country" was blaring from the speakers by the stage. The backdrop was a huge American flag. I didn't see a single black or hispanic or asian person.

Interestingly, there was NO visible security. None. You would think they would at least check people for guns, especially for a guy who is about to be the Republican presidential nominee.

There were three throat-clearing speeches before McCain took the stage. One guy talked about how he took Sadam Heussein's blood pressure after Saddam was captured. Another read a poem about Tennessee, written buy a POW in the Hanoi Hilton who was in the cell next to McCain's. McCain's wife talked about the daughter she adopted without her husband's knowledge.

"Where's she going to go?"

"I thought she could stay with us, dear."

"Oh, Ok."

Then there was the pledge of allegiance. And then the national anthem.

And then McCain finally took the stage with a huge cheer erupting from the crowd. Cameras flashed from every direction.

He gave his well-rehersed stump speech. Promised to find Osama. Promised to make Bush's tax cuts permanent (I had to concentrate to keep my groans from being audible). Promised to reign in federal spending using the "veto pen that Reagan gave me." Promised to give better healthcare to veterans.

And then he walked into the crowd with his wife, and was immediately swarmed by people wanting an autograph or wanting to shake his hand or wanting a better picture.

It's too bad McCain is a Republican. He would probably make a great president if he weren't so beholden to the conservative right.

The thrill remains

2008-01-30T23:09:00.000-06:00

Hey L. You still owe me a dollar, don't you?

No, I gave you your dollar last Wednesday. You don't remember?

Oh. Well, I'll give you back that dollar if you go to Cadaver Prom with me...

Oh. Ok. Well, I'm watching a movie right now.

Ok.

I'll call you back.

I'm going to sleep in an hour, so make your movie quick."

L. calls back, and says YES, to my amazement!

Launry Detergent Thief

2008-01-26T12:59:00.000-06:00

Two months ago, I realized that someone was stealing the laundry detergent that I keep in the communal laundry room. Every week, another three loads' worth of detergent would disappear. My half-full bottle would be nearly empty when I needed to use it. So before I left for Italy, I took the nearly empty bottle of Tide Free and filled it up with vegetable oil. Looks exactly the same. That'll teach them.

When I got back, I was shocked to discover that 1/3 of the bottle was gone. This means that the person did MANY (like 8) loads with vegetable oil. They didn't notice something different about their clothes?

I filled up the bottle again with more vegetable oil. And when I checked it a few weeks later - the same thing. WTF?

I'm not sure if I should just keep filling up the bottle with vegetable oil, or if I should write on the bottle "You've been washing your clothes in vegetable oil for the last two months, you detergent-stealing asshole!" Thoughts?

Pro-Choice Rally

2008-01-22T18:18:00.000-06:00

Today is the 35th anniversary of Roe v. Wade. There's one student in my class, Student L, who is very active with Medical Students for Choice. In the hall today, she persuaded me to attend a rally that abortion rights proponents were having later in the day. At first I was non-committal, but finally agreed to (she's kind of cute).

So I showed up wearing my white coat. It was drizzling out and slightly above freezing. I was expecting a stage with a speaker and a bunch of people cheering. A rally, right? Wrong.

They were standing on the busiest street in town. As I approached, someone handed me a sign (I held the Roe part of the Roe v. Wade HONK!" sign complex). A woman advised me to stand as close to the curb as possible because anti-abortionists would probably come and try to stand in front of us. So I stood there, holding my sign and waving a flag every time someone honked, which was not that often in the Bible Belt. A woman came up to me and asked if I would be willing to be interviewed by News Channel 4. Sure, I said. More people showed up. My gloveless hands were already numb. The drizzle intensified.

Student L as well as several other med students (including Student E) finally showed up, 20 minutes late. Making their signs had taken longer than expected.

Only a few anti-abortionists showed up. One guy stood behind me (I was right next to the curb), and constantly muttered something about the "value of life."

There were plenty of honks after a while. All (maybe 40) of us formed a line on the curb that was hard to ignore. One passenger in a car leaned over to honk the horn, causing the car to swerve. Another minivan drove by, all six kids emphatically giving us the thumbs down. Guess the parents didn't use birth control.

Student L asked me "Do you really think we're actually accomplishing anything?" "No," I said. "We're probably just pissing off the religious folk."

"Yeah, you're right," she said. "But that's ok by me."

"Me too... Me too."

Ears, Nose, and Throat

2008-01-22T12:18:00.000-06:00

The doctor looked into the medical student's ear. "Too much ear wax." She looked into the other ear. "Wow, even more wax! Who else wants to volunteer to be the patient?"

I rose my hand, sat down in the chair, and the doctor inserted the otoscope. "Beautiful tympanic membrane with almost no wax. Your ear canal is unusually straight. Ought to be perfect for demonstrating."

"Q-tip every morning" I said. "That's probably not the greatest idea" she responded.

Student E grabbed the otoscope, peered in, and said she saw the eardrum. Mission accomplished.

Student L then took the scope. She couldn't see anything, so her solution was to insert the scope farther with a quick jabbing motion, which evoked a sharp yelp from me. She appologized profusely.

Then it was off to the nose. The doctor inserted the speculum and peered in. "Hmm, slight deviation of the nasal septum to the right. Now you guys take a look. Just remember NOT to close the speculum before removing it, or you'll take out some hairs."

Student L took a look without complication. Then student Y did, but apparently forgot the doctor's instructions in the intervening 30 seconds. He closed the speculum while taking it out, taking five nose hairs with him. You could see them still attached to the speculum.

"Owww! Goddamnit" was my reaction. My right eye started watering. Student Y appologized profusely and got me a tissue.

I asked the doctor why pulling nose hairs caused tearing.

"It's called pain" she responded.

Natchez Trace

2008-01-19T19:31:00.000-06:00

Today I drove to the natchez trace and took a few photos. It was bitterly cold, especially on the bridge with the blowing wind. Normally I would have ridden my bicycle there, but it was just too cold today. Then I drove to Wal-Mart to buy some 3X5" index cards to study pharmacology.

Earlier today was parent's weekend at school. My parents and I got there at 7:45. I'll bet the school spent well over 100K on everything. There was a huge tent, zillions of servers, wonderful food, a lot of speeches, etc. The highlight was the "organ recital" that the pathology professors put together for the parents. They were shown lungs, kidneys, hearts, etc., all with varying stages of diseases. Tonight is a dinner for everyone, which I won't be going to since my parents can't make it.

Standardized Patients

2008-01-18T17:47:00.000-06:00

I was walking out the door when I ran into my psychiatrist neighbor. I said "I'm going to interview a standardized patient today!" He said "what's a standardized patient?" I was a little surprised. I said "It's an actor who's paid to pretend to be a real patient. We get to practice on him." He said, "I my day, we just interviewed real patients. There's plenty at the mental health cooperative that would be jumping at the chance to get interviewed for 15 bucks an hour." Hmm.

So I left for school. The patient was a 40 year old man. The presentation was so classic I almost started laughing. Unilateral headache, "shimmering" visual aura, slowly progressing, pounding pain, lasting about a day. Nausea.

A migraine headache. Case solved. I reassured him that he didn't have a brain tumor, which he was worried about. It was kind of thrilling actually. Putting all that I knew together and making a diagnosis, even though it was a fake patient. I even knew how he should be treated.

Hopefully the next one will be more challenging.

Standardized Patients

2008-01-15T20:54:00.000-06:00

Today I had my first encounter with a standardized patients. These people are actors who are paid to simulate real patients. They are given a list of symptoms, and act like real patients while we interview them. The first was depressed, the second had classical angina, and the third had carpel tunnel syndrome. It's great that we can interview these patients and hone our skills without actually having to deal with any real patients. If we screw up, it won't actually mean anything. Plus they can give us feedback on how we did.

Today I spent three and a half hours in the gym. I did cardio, lifted with Kam, and then played squash with him for a long time. He and I are almost perfectly matched.

Nupitals

2007-12-05T21:07:00.000-06:00

C. is his name. He's a short, balding man in his 40's, full of energy. He's been working at the condo for the last 8 years. He moved here from Wisconsin after he was "saved" by the Pentecostal church.

He lives 30 miles away in the country with his wife, who has a rare form of cancer that will eventually slowly kill her. So rare is the cancer that C. and his wife had to travel all the way to the Mayo Clinic in Minnesota because no one here could diagnose it. Here, they just wrote her off as crazy.

His son is getting married at the age of 20 in a few weeks. Weddings in C.'s family are a big affair. His wedding had over 250 guests, and his son's will have over 500 (basically the sum of two separate congregations and 100 family members). As such, C.'s family is in charge of the wedding shower. The big hangup now are the name tags that designate where the guests will be seated.

C. is a man of many talents, but computers are not one of them. But he's learning fast. A few weeks ago I taught him how to write formulas in Excel. He now manages the condo's check book and credit card with the program.

But tonight was a more difficult challenge. The name tags (not exactly tags, but pieces of paper that are folded in half and sit on a table) had to be exactly 5.5 by 8.5 inches, with the name printed in a certain font and in the exact right place. Microsoft Word just wasn't designed to do such things. An hour and a half later, we finally figured out how to make it work.

His next project will be to get hundreds of water bottles, carefully remove the labels, and then apply customized labels bearing his family name.

This is such a different conception of marriage from my own. I view marriage as a formality, merely confirming what already exists. And if you're confirming what already exists, what's the point? Do you need a ceremony to confirm that you love each other? To show the world that you're committed? Does anything real actually change afterwards? Britney Spear's 55 hour marriage is sacrosanct?

There is no need for pomp and circumstance. There's no need to invite hundreds of people, who come only for the free food and booze. After all, it's just a piece of paper. What's real and important lies far, far beneath that.

A Night in the ER

2007-12-02T19:42:00.000-06:00

Ten o'clock. I wasn't there for ten minutes until I heard a call on the radio. A helicopter was on the way. Major trauma. 15 year old kid riding his bicycle, hit by truck going 50-60 mph. Found him at the scene unresponsive. The nurses in the helicopter had already given him all the blood they had on board, and his blood pressure is still dropping fast.

They call the "trauma team." I counted 17 people in the room getting everything ready. Emergency doctors, trauma surgeons, an anaesthesiologist, nurses, a radiographer. The resident I'm with is in charge of managing the patient's airway. Everyone, including me, wears what amounts to a blue trash bag and face shield.

There's a tv in the ER that monitors the helipad, and another that monitors the dedicated elevators. We see a light appear on the helipad, the helicopter swoop down, the stretcher rushed to the elevator.

They wheel him into the room. 10 people simultaneously pounce on him in perfect synchrony, inserting needles into his groin, arms, legs - any place they can pump more fluid into him. The team leader stands at the foot of the bed directing everything. They examine every inch of him. The kid has a tube down his throat, another in his lungs. A nurse breathes for him with a squeeze bag. They give him medicines to relieve pain, to paralyze his muscles, and to increase blood pressure. Every drug is loudly called out after it's given. I look sheepishly from the corner of the room, and start to feel light-headed. I have to leave the room and sit down.

After 15 minutes, he's no longer actively dying. They quickly wheel him to the CT scanner with a nurse chasing after him, holding all the bags of fluid above him.

The table moves back and forth, passing the kid's limp body through what looks to be a giant donut. Within three minutes, I'm looking at a reconstruction of his entire body, slice by slice. We can see the full extent of his injuries - broken everything. Broken neck. Lung, liver, and spleen contusions. Broken ribs. Damaged major lung blood vessel. Shattered pelvis. Broken femur, etc. No wonder he's bleeding so quickly. Head looks ok though. I silently wonder if he was wearing a helmet.

They prepare an OR. The surgeons will be working late tonight.

Long Hunter State Park

2007-11-30T18:27:00.000-06:00

I took the dog to a park by Percy Priest Lake today. It was a good day for it - tee-shirt weather in late November. We walked 8 or so miles, seeing only one other pserson the entire time. Mid-way through, my parents called from Key West, Florida, where their cruise ship was docked for the night. They'll return to Miami tomorrow and start driving back home.

I think I'll spend tonight in the Emergency Room with my friend Kam. There's always interesting stuff to see on Friday night there.

Telephone poles at dusk

2007-11-28T17:10:00.001-06:00

Dr. F., as I shall refer to her, is rather uptight about some things. She has very strict rules on days that she brings patients to class (all common sense, I might add).

Rule #1: Do NOT arrive late. If you do, that's fine, just go and sit in the projector booth in the back of the classroom so you don't disturb everyone when you enter.

Rule #2: Do NOT eat food in your seat. Eating a Big Breakfast from McDonalds might seem disrespectful as a patient describes how his life was ruined.

Rule #3: Do NOT wear shorts to class. Looking like you just came from the beach is not a good idea.

Today we had a lecture about diabetes. Dr. F. brought one of her patients to class (an 11 year old boy and his mother), and he told us about his disease, how he was diagnosed at 2, how he checks his blood sugar 4-5 times a day, etc.

The day before, Dr. F. sent us all an email reminding us of the patient presentation, and of the rules. Right before class, she reminded us again about not eating.

About 15 minutes into the class, Veronica walked into the classroom, loudly opening the doors. She sat down, ruffled through her bag, pulled out a bunch of food, and started to eat it. I kind of wish it had been summer so Veronica would have completed the triad.

Dr. F. Looked like her head would explode. She walked behind the patient (so he couldn't see her) and pointed towards Veronica, shaking her outstreached index finger as she mouthed "Put it away! Put it away NOW!"

One classmate later described this as the scene in Indiana Jones where you look into the gates of hell and simply incinerate.

After class Dr. F. Pulled Veronica aside, and it wasn't pretty.

I didn't feel bad for Veronica for being a dumbass until I saw her crying four hours afterwards.

I find the black and white image creepy, yet beautiful for some reason.

Shot through a Celestron C90 1000mm f11 lens. The poles are at least a quarter mile away.

Moon

2007-11-27T22:28:00.001-06:00

This is what the moon looked like tonight, through a 2000 mm lens.

Cleaning the oven

2007-11-25T12:36:00.000-06:00

While baking the turkey last Friday, I spilled a ton of grease in the oven. Fortunately the oven has a self-clean mode where it heats up and burns up everything inside. There's a little vent on top where the smoke comes out.

A little drop

2007-11-24T16:14:00.000-06:00

I took the dog for a walk in the park again today. We did the red trail, which is about six miles long. I let him run without the leash (mainly because he chewed the thing into two pieces). Sometimes I wonder what goes through his head. He sniffs everything, and then urinates on every prominent tree he passes. He pees only a few drops at a time, spreading his urine over the maximum number of trees possible.

We passed by a waterfall. I got close and got this picture of a single drop of water falling.

Day after Thanksgiving

2007-11-23T17:40:00.000-06:00

I went to the store today and found an irresistable deal. A 23 pound turkey for only 30 cents a pound. That's less than $7.00 for something that will feed me for at least a week. It's in the oven as I write this. Smells delicious. In the future, my Thanksgiving dinner will be held exactly one day late - when the turkeys go on sale.

On the roof today, the sun was setting in one direction, and the full moon was rising in the other direction.

My Bear

2007-11-22T14:40:00.000-06:00

I took Bear for a walk in the park today - a three hour walk. He pulls me up the hills, and also down. A good way to spend Thanksgiving.

He's seven years old now. Time flies. I still remember how he chewed up every hose and extension cord in the house as a puppy. And how he got run over by a car. And how we found him that night, wimpering under a bush. And how we drove him to Knoxville that night so he could get his broken hip pinned back together.

Pictures after the storm

2007-11-21T17:11:00.000-06:00

A month ago, I bought a giant sack of potatoes for only three bucks on sale. I ate five of them, leaving about 20 that were getting moldy. Really moldy. I was shoving them down the disposal as fast as I could when one jammed, the disposal ground (har har...) to a halt, and smoke started coming from under the sink. So tonight I'll be bolting in a new one. Sounds like fun, doesn't it?

It rained hard for a few hours today, but after the storm was over, I lugged the camera + tripod to the roof and got off a few shots.

A tree at MBA.

Top of telephone pole across the street.

Walk in the park

2007-11-17T18:33:00.000-06:00

Today was beautiful, so I went to walk the trails in Percy Warner park, just a few miles from my condo, camera in hand. It's getting to be peak leaf season. Click on picture for full resolution.

Night shot from the condo

2007-11-15T22:40:00.001-06:00

Just playing around with the camera. 20 sec. ASA 200. F 11. 18 mm lens.

Neurological exam and a sunset

2007-11-13T18:32:00.001-06:00

We learned how to do neurological examinations today. The doctor forgot her ophthalmoscope, so she asked if anyone in the class could lend her one. I waved mine in the air, and brought it down to her.

Apparently this also meant that I was volunteering to be the demonstration subject. So for the next hour and a half, I was poked and prodded in front of the class.

Follow my finger with your eyes. Close your eyes really tightly. Smile as big as you can. Stick out your tongue. Wiggle your tongue back and forth. Say ahhhhh. Do you feel this pin as I poke different parts of your body? Shrug your shoulders. Wow, you have great muscle tone. You must work out. (Class laughs) This is how you check reflexes. You have beautiful reflexes. (more laughter) Now walk over there and come back. See how beautiful that turn is, class? A perfectly normal walk. (I consciously tried not to bounce as I tend to do.) And it went on...

If you're good at it, you can do a full neurological exam in under five minutes, briskly moving from one test to another. It's amazing to see the neurologists do it like brushing their teeth. Almost without the need for conscious thought.

I drove back home in the evening, and went to the roof of the condo to get some shots of the sunset. Click for bigger pictures.

IM UPDATE:

PF: she's was sooo into you

PF: i guess she's doesn't get to evaluate young guys much

PF: it was cracking us all up

james37027: all I wanted to do was lend her my ophthalmoscope

PF: she's like, "james, you're so toned. i can picture you working out..."

james37027: hahaha

PF: hahahah.so good.

PF: she was playing doctor with you

PF: mmm, his deltoids are so defined

james37027: ha

PF: well for better or worse she made all the girls in the class wonder what your arms felt like.

james37027: really...?

PF: we were talking about it after class

james37027: they are pretty ripped, I must say

PF: good to know. keep it up. as much as girls don't admit it, we love that stuff

Ride today

2007-11-03T22:46:00.001-05:00

Today was beautiful. Mid 60's and sunny. I had lunch with Alan, and then went for a ride with C.

C. is my new riding buddy. She is a former runner who has discovered the low-impact wonderfullness of bicycles (three knee surgeries later at the age of 23).

She is now incredibly fast. Like really incredible. Especially up hills. She simply dances on the pedals, all 120 pounds of her. And on a steep uphill, I'm working really hard to stay with her. If I really try hard, I can still pull ahead, but this is damn impressive, especially for someone only riding for a few months.

I can still make up huge distances on her down hills, where she still has the habit of braking to keep from going too fast, and my 205 pounds pulls me down quicker.

Today we meant to do only 30 miles, but I got us lost, so we did close to 40.

Condo Association Meeting

2007-11-03T20:51:00.000-05:00

A few weeks ago we had our annual condo homeowner's association meeting.

I arrived neatly dressed, since I was the youngest one there by about 25 years and wanted to appear not too unlike the residents. Scott, the association president, called the meeting to order.

A brief word on Scott. He lives directly below me. Occasionally he will go out on his balcony and smoke, and if I have my window open, I can smell it. He started a computer company in the early 90's, made a TON of money, and then retired before the age of 40. Now he does a lot of charity work. He is on the board of directors of several organizations in Nashville, including Nashville CARES (raises money for AIDS), as well as a charity for the homeless and an organization that helps people suffering from substance abuse. That's all I know about so far.

When "new business" was brought up, my neighbor Kevin proposed allowing pets in the building. Apparently we are only one of two condos in Nashville that do not allow pets, and allowing pets will add approximately 20% to the value of a condo.

This proposal caused the "old timers" of the building to go ballistic. And not in a nice way. Scott, to his credit, maintained order.

Man: "Wait! This is crap! Think that....."
Scott: "As association president, I will determine the order of who speaks. Please wait until I call on you."

BS story from old woman: "My friend lives at a condo that allows pets. This woman had a dog, and when she got on the elevator with the dog, the dog's leash got caught in the door. The dog's head got pulled off, and there was blood everywhere! Is that what we want here?"

Man: "Kevin just wants to get this passed so he can sell his place and leave us in piles of dog poop!"

And so it went on.

I stated my desire to allow pets, and even tried to force the measure to a vote, but Kevin (wisely) decided to withdraw the proposal in the face of such ardent opposition. Maybe next year...

My proposal to change the lights to compact fluorescents was warmly received, helped no doubt by the significant amount of money that the association would save per year. So now at least some of the lights will be changed to fluorescents.

Lawnchair sudy

2007-10-29T17:22:00.001-05:00

My Adirondack chair in late afternoon. Best light I've seen in a long while.

Fen Ditton part 2

2007-10-26T06:57:00.001-05:00

My friend finally had to go to class, so I walked to Fen Ditton by myself, about a six mile round trip.

I found this old church. I walked all around it and didn't see a soul.

Just some old gravestones.

It would be cool if this picture were from the church, but it's from a pub that I passed by on the way home.

Fen Ditton

2007-10-22T13:38:00.001-05:00

Today we walked along the river to a nearby town, Fen Ditton. The morning started out on the cool side, but then the sun broke through the clouds, and it was perfect walking weather.

The swans are beautiful. (click on the images for their full gory. This may be the best picture I've ever taken.) I understand the necks. And the webbed feet. But what selective pressure would cause them to be as white as new snow? (it doesn't snow here much).

I decided to get friendly with the swan pictured below. Like petting a cat... I kneeled down by the river, camera in hand, and extended my finger. The swan swam up and BIT it, thinking that it was a bit of food. Thankfully their teeth aren't too sharp. I actually thought it was kind of an honor to be bitten by something so beautiful.

We also walked by a several heards of cows. Apparently in England you can have your cows graze on any public lands. They were quite friendly, and did not mind my petting them in the least.

And the culmination of our walk was lunch at a riverside pub/strangely posh restaurant, watching the row-boats and swans go past.

Grantchester part 2

2007-10-22T13:30:00.000-05:00

Apparently one trip to Grantchester is not enough, so we went there again the next day, walking this time. On the way, the colleges were having a cross-country race by the river. Scores of exhausted-looking people walked and ran past us.

This time we actually got to go into the pub, which was bustling with people (on Sunday).

Grantchester

2007-10-22T13:15:00.000-05:00

Yesterday we rented a canoe to explore the river on the way to Grantchester, about two miles away. We arrived at the town, but couldn't find any way to tie up the canoe. So my friend went to the pub, got three different beers in plastic cups, and we had an in-canoe picnic on the way back to Cambridge.

Schopenhauer

2007-10-16T20:41:00.000-05:00

Arthur Schopenhauer, The Art of Controversy

When we come to look into the matter, so-called universal opinion is the opinion of two or three persons; and we should be persuaded of this if we could see the way in which it really arises.

We should find that it is two or three persons who, in the first instance, accepted it, or advanced and maintained it; and of whom people were so good as to believe that they had thoroughly tested it. Then a few other persons, persuaded beforehand that the first were men of the requisite capacity, also accepted the opinion. These, again, were trusted by many others, whose laziness suggested to them that it was better to believe at once, than to go through the troublesome task of testing the matter for themselves. Thus the number of these lazy and credulous adherents grew from day to day; for the opinion had no sooner obtained a fair measure of support than its further supporters attributed this to the fact that the opinion could only have obtained it by the cogency of its arguments. The remainder were then compelled to grant what was universally granted, so as not to pass for unruly persons who resisted opinions which every one accepted, or pert fellows who thought themselves cleverer than any one else.

When opinion reaches this stage, adhesion becomes a duty; and henceforward the few who are capable of forming a judgment hold their peace. Those who venture to speak are such as are entirely incapable of forming any opinions or any judgment of their own, being merely the echo of others’ opinions; and, nevertheless, they defend them with all the greater zeal and intolerance. For what they hate in people who think differently is not so much the different opinions which they profess, as the presumption of wanting to form their own judgment; a presumption of which they themselves are never guilty, as they are very well aware. In short, there are very few who can think, but every man wants to have an opinion; and what remains but to take it ready-made from others, instead of forming opinions for himself?

Since this is what happens, where is the value of the opinion even of a hundred millions? It is no more established than an historical fact reported by a hundred chroniclers who can be proved to have plagiarized it from one another; the opinion in the end being traceable to a single individual.

Quite interesting, I think. I too am guilty of recycling the ideas of others.

In the end, the "norms" must be ceaselessly questioned relative to the evidence at hand. It is evidence and reason, not superstition or faith, that must guide our evaluation of truth.

Do not simply guide your actions from the distilled opinions of others. Form your own from the raw evidence. Look through an impassionate and objective lens.
What you have been taught since birth and what you currently believe may be only a manifestation of others' ideas - not your own. So think, where is the preponderance of the evidence? Is global warming happening? Is evolution real? Sticking your head in the sand and relying on the opinions of others is an insult to your innate intelligence. Review the evidence for yourself.

Brain exam

2007-10-16T20:18:00.000-05:00

I just finished my Neuroscience exam. I think I did really well, mostly because of my new study partner.

Kam is from Kentucky. He went to UVA and majored in economics. We've been friends since the beginning of school, but we've only recently begun studying together. We take turns going to each other's places, although today we studied together in the library.

Kam's parents own a restaurant in Kentucky, "Great Wall." So Kam loves to cook. Stews are his favorite. The other day, he put a pork scapula in a pot with some greens, and then sprinkled in a little MSG. "Adds to the flavor," he says. Two hours later, he poured the stew over some rice and had dinner. I politely declined, saying that I had already eaten.

Kam is a die-hard Kentucky basketball fan. Two nights ago, Kentucky had it's first day of official practice.

Who cares, you ask? Well, 25,000 people filled the stadium to watch. It was a huge media production, and Kam and I watched it on TV. Apparently even the first practice is a big deal in Lexington.

Radnor Lake

2007-10-14T15:16:00.000-05:00

The weather here has been beautiful lately. High in the mid 70's, partly cloudy.

In the last few months I've been biking more and more with C, a girl in my class. She recently got a road bike because her knees are shot from running so much (she's had several surgeries to try to correct the problem). At first she was pretty slow, getting used to riding. After just a few months, she's become much more comfortable and confidant on the bike. She climbs about as well as I do, and on the flats, I break the wind while she drafts behind me.

We ride about three times a week. Mostly in the park, but recently we've been venturing further. The last ride we did was well over 30 miles, all the way to Radnor Lake and back (generic picture of the lake attached).

Gustav Klimt

2007-10-09T19:48:00.000-05:00

I just got a poster of Gustav Klimt's "The Kiss." I don't know what it is about this painting that makes me want to stare at it for hours.

Maybe it's the way that the two bodies blend into one. The way snow falls in the background. The masculine squares on the left versus the feminine circles on the right. And how bright and beautiful and golden the moment is.

Contest

2007-10-09T19:15:00.000-05:00

A radio station in town is having a contest of who the sexiest medical professional is. Several people in my class have submitted entries. I'll bet this guy, Dan, a former pro body builder, wins.

Sandy

2007-10-02T21:38:00.000-05:00

About a week ago, Sandy H. Came to pick up some stuff that his sister had left with me. Namely a bunch of mason jars, a few books, and two wooden xylophones that he had made years earlier.

He arrived in his usual beat-up pickup, complete with the plethora of bumper stickers on the back. He was wearing on old tie-dyed tee-shirt; I don't remember what it said on the front.

Sandy lives in the hills of eastern Tennessee. There, he works as a carpenter, waiting for capitalism to self-destruct.

He comes to Nashville from time to time. He brought me a pumpkin (or squash, I can't tell which). I put it in the oven, and it was good.

We talked for a long time on my porch. About almost everything. Economics, diet, asthma.

He's a remarkably intelligent and likable person, much like his sister.

I hope he comes by again.

Making my day

2007-10-02T19:54:00.000-05:00

I bought a bicycle this summer to replace the one that was stolen in DC. It's a 1981 Schwinn World Sport. Nothing special by any means.

The red paint was starting to flake off, so I went to the store and got a can of blue spray paint. I spent hours stripping off the old paint with sandpaper, and then painted it in the storage room downstairs. Then I got some fake Colnago stickers on Ebay (Colnago makes super-nice, super-expensive Italian bicycles) and put them on, kind of as a joke.

So riding to school today, some guys rode past me (I try to ride slowly so I'm not covered with sweat when I get to school). One of the guys admired my bike, and then promptly offered me 500 dollars for it.

I was taken a bit off guard, and then told him that it was actually a Schwinn that I had repainted. Damn. Could have had 500 bucks.

Rug Day

2007-09-29T23:21:00.001-05:00

So I woke up this morning and looked on Craig's list for stuff. I've been looking for a rug for my dining room table for months. I found a much smaller rug that would fit nicely in my hallway. So I called the guy to inquire, and ended up driving out to Bellevue to one of those brand-new cookie-cutter subdivisions.

Turns out the guy imports rugs from Iran and uses craig's list to drum up business. One thing led to another, and I ended up with a 10 X 13 rug from Kashmar. Huge. Takes up pretty much the whole living room.

The rug guy, Shawn, is from Iran, and has a bachelor's degree and two master's degrees, and was an engineer until he figured out that he could make more money basically selling rugs out of his house. The rugs come to New York on a container ship, and then get shipped via DHL to his house, where he sells them to rug stores in town and to people like me on the side.

Update: The thing was just too large. So I had the brilliant idea of giving it to my dad for his birthday (Oct. 1). Turns out it fits brilliantly in the living room, and he loved the thing. My mom and I both took credit.

Party night

2007-09-29T23:17:00.000-05:00

So tonight was supposed to be party night. We were going to play Risk or watch a movie. It's two weeks before exams, though. I should have realized that, because nobody showed up. Well, to be exact, three people canceled on me, because of legitimate family problems, and I had to tell the rest not to come (all 2 of them) because no one else was coming. Fuck. So I spent Saturday night, by myself, watching USC play Washington.

Natchez Trace

2007-09-20T22:12:00.000-05:00

Last Saturday I rode 75 miles on my bike, mostly hills on the Natchez Trace parkway - perhaps the most beautiful road in the world. When you get on it, it feels like you're in the middle of nowhere. The road curves and winds through the countryside until it ends up in Tupelo, Mississippi. On my way, I went across a bridge that was as narrow as a 2 lane road, but suspended several hundred feet in the air. As I rode close to the edge, it actually felt like I was flying.

On the way back home, I went through a Starbuck's drive through, where they were quite surprised to hear me ask them to fill up my water bottle with an iced latte. I must say that after guzzling all that sugar, caffeine, and fat, I felt like a million bucks.

Mullet Festival

2007-09-18T20:44:00.000-05:00

I toured the Jack Daniel's distillery a few weeks ago. It was pretty amazing. The people on the tour were even more amazing. I managed to snap this photo of one man on the tour, complete with his "29th annual Mullet Festival" tee-shirt.

Neurology

2007-09-18T20:37:00.000-05:00

So this evening I studied a bit of neurology on the balcony. A kid's soccer practice at my high school was going on across the street. It looked like they were in the fifth grade or so. You can see my new Birkenstocks in the picture, as well as the beautiful pilsner glass that I later knocked over as I repositioned the chair.

The church, again

2007-09-18T20:32:00.000-05:00

This is what the church looked like this evening.

Williams College

2007-09-16T21:38:00.000-05:00

Watching the end of the Red Sox vs. Yankees game tonight brought back a flood of memories for some reason.

The announcer mentioned a crisp autumn night in Massachusetts with a low in the 40's, and I remember exactly how that felt. I miss college. I miss Williamstown.

Looking at the colors change from my room in the Greylock Quad. Warming my hands with my breath while rowing on lake Onota. Running up Mount Greylock for another year. Snuggling underneath my down comforter while watching a movie. Riding my bike to Vermont and back.

Candle light

2007-09-13T20:53:00.000-05:00

Tonight I decided to study by candle light. So I lit every candle I own, and read. I took a few pictures to capture the scene, and here they are. Click on the pictures for a better view.

Today in Psychiatry, we interviewed our first psychotic patient. She was a middle-aged woman who claimed that she had walked to Memphis while picking up trash to make the world a better place. When we asked her where she slept at night, she said she went back home to Nashville. Every night. She said she was picking up government papers and putting them in a trash bin. She didn't say why.

After that, the psychiatrist told us about catatonia - a state where the patient is like a statue for prolonged periods. He told us that he saw a woman who would lie on her back with all four limbs in the air, perfectly still for hours. You could go up to her and position her limbs any way you wanted, and they would remain in that exact position for hours. And every once in a while, she would snap out of her state, and in a burst of activity, run down the hall for about 5 seconds, only to freeze into another statue-like form. This continued for two days. The cool thing is that the doctor gave her some drug, and after one minute, she sat on her bed and told him what the past two days were like for her.

The most amazing thing of the day is that a good third of my class still does not believe that schizophrenia is a brain disorder.

2007-09-11T18:55:00.000-05:00

I spent an hour on my balcony this evening, just sipping a beer, watching the traffic go by, and admiring the lighting on the church down the street. It rained all morning. But when I came out of the medical center at 5 or so, it was perfect outside. The air was cool and had that post-rain smell, and the sky was a bight blue with thin wispy clouds.

So the balcony it was. There were lots of people running by on the sidewalks. More than usual. Sometimes it seems like half of Nashville runs by.

Then the firetruck left from the station, sirens blaring. Soon after, five emergency vehicles went by, in what can only be described as a flying-V formation, with three police cars forming the V, an ambulance in the protected position, and a fire SUV bringing up the rear. Must have been a big accident somewhere down the road.

Technical difficulties

2007-09-11T18:32:00.000-05:00

Today I woke up early (6:30), did my usual morning routine, and then left the condo. Just as the door closed behind me, I had a feeling of "oh fuck." I reached into my pocket, and realized that my keys were sitting on the kitchen island. I was locked out. I went down to the lobby and opened my neurology notes and started studying, with several residents giving me quizzical looks as they went to their cars. The maintenance guy would show up soon, and he could let me in.
An hour and a half passed. I called him. Apparently he was having "technical difficulties with his car" which is entirely understandable because it's a Dodge truck older than I am. He gave me directions on how to break into his office (with a hidden key) and open his key box.
Now, all the keys in his "key box" have a letter code, only decipherable with his computer, which I also had to start. But he screwed up the code somehow, so I simply took all 60 keys with me and tried them until one finally worked. And I had to explain the whole story to the lady across the hall when she came out to find a giant pile of keys on the floor, me trying one after the other.

Then I drove to the dentist, where my favorite dental hygienist scraped on my teeth for an hour. You know that feeling when somebody plays with your hair? I like that too, but I get the same feeling when somebody scrapes plaque from my teeth. I just close my eyes and relish every moment. Ahhhhhhh...

measure twice...

2007-09-08T08:37:00.001-05:00

Yesterday as a study break I decided to put some speakers in the living room's ceiling. I got them on Ebay for cheap, and they came a few days ago. I measured the diameter of the speaker, putting one end of the tape measure on 1 inch, and reading the other. It's more accurate that way. The plan was to subtract that one inch. That was the plan at least. Now I have a BIG hole in the ceiling. A 12.5 inch hole to be exact. For some cool photographs, visit http://www.jamesbrittin.com

Birkenstocks

2007-09-01T20:26:00.000-05:00

My birkenstocks were looking pretty dirty today, so I washed them in the kitchen sink. Since they are basically the only shoes I wear, I wanted the dried quickly, so I put them in the oven at 190 degrees (not that hot, right?) Well, the soles shrank to half their original size, and came off the rest of the sandal. Fuck.

Engaged?

2007-08-27T17:21:00.001-05:00

So I posted some pictures of my last party on Facebook. One of them had a friend of mine sticking his ass in another girl's face. The catch is that this guy's engaged to another girl. A hot one I might add. And he didn't want his fiancee to see him having fun, so I had to take down the picture.

But all of this seems strange to me. If your girlfriend/fiancee is going to get mad at you for something like that, are you sure you're with the right person? After all, you are who you are.

Today's trauma surgery story

2007-08-26T22:15:00.000-05:00

Last night a man got piss drunk at a party. So drunk that his friends ask him to leave. This infuriates him to the point that he decides to kill himself. He gets his gun and calls his friend. "Hey, which side of my chest is my heart on?" he asks. Thinking quickly, his friend says "It's on your right." The man shoots himself and ends up in the ER, where, according to the trauma surgeon, he was "hopping mad that he wasn't dead."

Crazy people

2007-08-22T16:27:00.000-05:00

Have you ever thought about killing yourself? Have you ever tried? Do you feel undeniable urges to do certain things? Has all of this destroyed your life?

Today in class, a patient from the psychiatric hospital visited us. A psychiatrist interviewed him for about an hour in front of all 100 of us. I couldn't believe it. He told his story in exquisite detail. How he bought $18,000 of gold for his friends in Cancun. How he lay in bed for weeks at a time thinking only about how miserable he was. How he needed to pound his chest with his hand, and if he didn't, how he felt that his head would explode. How he jumped off a roof to try to kill himself. The horrible car accident of his youth. How his father died a slow, drawn-out death from cancer. How his mental illness had caused his till-then perfectly normal and successful life to disintegrate. And most recently, how he slit his wrists, only to awaken in the hospital.

And yet, with all our medical advances, there is only a limited amount we can do. Drugs have helped him greatly, but not enough. There is still much to do.

This is your brain...

2007-08-22T16:14:00.000-05:00

A few days ago, we started dissecting brains. Ours was in a large plastic bucket underneath the sink in the lab. I brought the bucket to the table and then opened it, releasing the all-too-familiar stench of formaldehyde. Then I reached in and took it out, let it drip for a while, and then put it on a blue cafeteria tray. I took some tweezers and slowly peeled away the membranous covering, revealing every little indentation, gyrus, and fissure. My group worked for an hour, trying to identify different lobes and areas with fair success. Then I put the brain back into its bucket, and scraped all the little pieces we had picked off into the same bucket. This was important because all of these pieces would later be cremated and returned to the original body.

At the time, I didn't think much about it. But later I wondered... Were this person's memories still in there, encoded in the connections between the neurons? What would they think about having perhaps their most intimate organ being poked and probed like this? And how can something so small define all of who we are?

3:30 A.M.

2007-07-30T23:07:00.000-05:00

The other night, I was sound asleep when I heard a screeeeeech...... BOOOOOM! Both of us woke up. Naked, I pushed the blinds to the side to see an upside-down car across the street, steam rising up from it. I tried to find my phone. I looked around for maybe 30 seconds, and then threw on some pants and ran downstairs to call 911. When the lady answered (what is your address and the nature of your emergency?) , I sounded like I was calling to conform an airplane reservation... talking as precisely and clearly as possible. But the adrenaline rush was intense. Turns out they had already received a call on the accident. Then I looked out to see two fire engines arrive. Good thing, because I was going to run out there right after calling.

In the end, 3 firetrucks, three police cars, one ambulance, and one fire SUV arrived, along with two news trucks arrived. And I watched it all unfold from my balcony, while trying to calm down and eat watermelon.