Swan'ola

My parents have made their own granola since I was a kid. I don't know what it is about this family and granola, but a few years ago, Grandma gave me her recipe. I've since made and given her granola to several people. I've made my own little changes to it, but it still gets rave reviews. This year I branded it Swan'ola and Darron and I made some to give for Christmas. Darron thinks it should be Swa'nola instead, to make the post-apostrophe portion as long and as close to the word 'granola' as possible, but the jury is still out on that (why don't we call it Sw'anola then, hmm?). Anyhow, I suppose I could have called it Boydola or Yamamotola, but Boydola sounds like an Italian dish, and Yamamotola reminds me of a cell phone. Beside its rhyming with 'granola,' Grandma used to be a Swan anyway, so I took Head Chef's liberty and went with Swan'ola. In any case, I think somewhere she must be pleased that her granola has made many people smile. So here's to Grandma, always making people happy - even when she's not around!

Happy New Year, everybody.

Omen?

So, as a sort-of response to my dad's question: over the Thanksgiving long weekend three things happened in four days.

On Wednesday, my classmate had a first-time grand mal seizure during our final exam (see previous blog). Definitely out of the ordinary.

On Friday, I was on the freeway when a car ahead of me caught on fire. It's common enough to see a car with smoke coming out, but this one was actually on fire, and it was under the engine so the driver didn't even know he was flaming. Very rare. I don't think I've ever seen a moving vehicle with flames that wasn't part of a prop. I pulled over, though there was little I could actually do for him without a fire engine or even a fire extinguisher.

On Saturday, just after dark, I was on my way to Darron's and I happened upon an accident and a near-hysterical 18-year old in an intersection. I lit my trusty flares behind each car and quickly checked the girl out, although she was just "shook up" and not hurt. I waited with her and a couple other Good Samaritans until PD and fire came, then took off. Not so rare, but taken together with #1 and #2 in the previous days, highly unusual.

I've had enough off-duty incidents during my active firefighting days to know these things happen from time to time. But that's just it, they happen from time to time. Three in four days is a bit freakish. I felt like Nancy Drew, whose life is conveniently one event after another. I tend to think it was happenstance: if I had made life-saving split-moment actions or decisions in each of these cases, I would probably be really freaked out. But things would have turned out all right whether I'd been there or not. Still, things sure happened close together all in a flurry, and I just happened to be there.

What do you think? Something subtly reinforcing my career choice, or mere coincidence? Perhaps it was a reminder that I need to do some ride-alongs with the FD because I clearly noticed that my thought process has slowed down quite a bit. After two and a half years of not doing emergency response, I'm definitely out of practice. But I still love it! And perhaps that's the most telling omen of all.

Something To Be Thankful For

Thank God It's Over.

The worst rotation yet. I may have to retake the final exam again, because I just wasn't into it and didn't study that much. But on the bright side, I won't have to do another psych rotation again for the rest of my life. Thank god! That's what *I'm* thankful for this Thanksgiving.

The exam itself wasn't much fun, but we had an "unusual testing condition": one of my classmates started screaming a few minutes into the test. At first I thought it was in frustration at a particularly hard question, and I inwardly concurred, glad I wasn't the only one feeling that way. Then I realized he was having a seizure. I guess my autopilot came in handy, because I found myself directing the students next to him to lower him to the floor and the proctor to call help. I don't even remember seeing him seize before I got there, it's just kind of an unmistakable series of sounds. Responding to an emergency as it's happening is quite different from what happens to medics on duty: you get the dispatch, you get on the rig, you pull on your gloves, get your equipment out of the engine, walk up to the scene, and then you're finally there. That's plenty of mental prep time. But it's quite another matter when you're concentrating on taking an exam and someone seizing is the farthest thing from your mind! It's a little rattling.

Eventually the FD came, and we turfed it to them. Ironically, the neurology department was having their grand rounds meeting in the conference hall right next door, so one of the fellows wandered over. He didn't do anything, which further confirmed to me that emergency physicians are the experts at the first two hours of anything - then they lose interest and hand it off to specialists who pontificate endlessly the etiology of the illness at hand, but don't like to get their hands dirty. To add further irony, while my classmate discovered during this rotation that psychiatry was his calling, he inadvertently helped confirm emergency medicine to be my thing. Anyway, it made for an interesting, albeit a little bit sad, conclusion to psychiatry.

Can't Make This Stuff Up

Excerpts from the psych unit.

36 year old female:
Me: So how's your mood today? (we have to ask this every morning, you'll see why)
Patient: My mood has been following me around.

26 year old male Ivy League grad:
"I started thinking, well, I call my family overseas and so maybe they're wiretapping my phone calls to intercept me. I think people are out to get me, to turn me into a terrorist. Sometimes I can tell myself, 'It's not real,' because I've never participated in any sort of terrorist activities, so why would they want me? But other times it seems they plant magazines and newspapers at newsstands to try to influence me, and the thoughts become so overwhelming that I can't convince myself that it's not real. So at one point I was in [foreign country] and walked into the embassy, because I was sure that they were trying to get me to recruit me into being a terrorist. And that's when this last string of hospitalizations began.

45 year old female who just tried to escape:
Me: So are you able to sleep well at night?
Pt: God comes to visit me every morning around 4am. I just push him away. But he changes his mind a lot. I'm not pregnant anymore.
Me: You're not? You were pregnant with twins three days ago.
Pt: See? He changed his mind. You know the "virgin baby?"
Me: Yes.
Pt: You're God's type, I can tell.

26 year old bipolar male:
"I just recently went through puberty. I found a way to arrange my sleeping bags into a cocoon, and in there, I learned freestyle masturbation, and that allowed me to transition into adulthood."

Asian male in his 40's, psychotic and barely speaks English:
Marching around the unit: White power! White power!

Nuts

I think I've effectively ruled out psychiatry. Even though it was nice to see a former patient today who had found a job since he left, patched up things with his dad, and whittled all his girlfriends down to just one that he actually liked. Even though he asked me when I was going to be a doctor so I could be his doctor. How could I resist, I don't know. I'm an impatient person to begin with, then you give me all these nutty people who are all over the place and can't communicate, and I just don't deal well. Perhaps emergency medicine really is the place for me so I can bring 'em in, patch 'em up, and ship 'em out. What good is an impatient shrink anyway?

Secessionist

I've long thought California should secede, along with a handful of coastal states and other blue states. Some news articles make me not want to share a citizenship with a lot of people "over yonder," east of CA. A lot of them are scary. So Darron and I have thought about taking a trip to better understand these strange gun-slinging, religion-clinging, abortion-denying, so-called fellow Americans, with whom I don't think I have an iota in common.

I came across this piece, which I have abbreviated slightly at the end. It sums up my feelings pretty well.
____________________________________

Dear Red States Cousins:

We've decided we're leaving. We intend to form our own country, Nuevo
California, and we're taking the other Blue States with us. Bye.

To sum up briefly: You get Texas, Oklahoma and all the slave
states. We get stem cell research and the best beaches. We get the
Statue of Liberty and Hollywood. You get Dollywood and Branson.
We get Intel and Microsoft. You get WorldCom. We get Harvard.
You get Ole' Miss. We get 85 percent of America's venture capital and
entrepreneurs. You get Alabama . We get two-thirds of the tax revenue,
you get to make the red states pay their fair share.

Since our aggregate divorce rate is 22 percent lower than the
Christian Coalition's, we get a bunch of happy families. Please be
aware that Nuevo California will be pro-choice and anti-war, and we're
going to want all our citizens back from Iraq at once. If you need
people to fight, ask your KKK members, your evangelicals and
your hockey moms.

With the Blue States in hand, we will have firm control of 80 percent
of the country's fresh water, more than 90 percent of the pineapple
and lettuce, 92 percent of the nation's fresh fruit, 95 percent of
America's quality wines (you can serve French wines at state dinners)
90 percent of all cheese, 90 percent of the high tech industry, most
of the U.S. low-sulfur coal, all living redwoods, sequoias and
condors, all the Ivy and Seven Sister schools plus Stanford , Cal
Tech and MIT. With the Red States, on the other hand, you will have to
cope with 88 percent of all obese Americans (and their projected
health care costs), 92 percent of all U.S. mosquitoes, nearly 100
percent of the tornadoes, 90 percent of the hurricanes, 99 percent
of all Southern Baptists, virtually 100 percent of all
televangelists, Rush Limbaugh, Bob Jones University , Clemson and the
University of Georgia. We get Hollywood and Yosemite, thank you.

Additionally, 38 percent of those in the Red states believe Jonah was
actually swallowed by a whale, 62 percent believe life is sacred
unless we're discussing the death penalty or gun laws, 44 percent
say that evolution is only a theory, 53 percent say that Saddam was
involved in 9/11 and 61 percent of you crazy bastards believe you
are people with higher morals then we lefties.

It's About Time

I wish people would quit saying Obama will be the first black president of the U.S. In fact, he will be the first biracial president of the U.S. And did you know, mutts are hardier, genetically? They can't have recessive diseases that are found in the purebred population, at least in the first generation offspring. Someday asking someone's heritage will be the same as asking what his favorite ice cream flavor is, just an interesting conversation piece, and not a loaded question.

Crazier Than the CPS

Excerpts from the psych ward:

36 year old female:
Me: So how's your mood today? (we have to ask each patient this every morning, you'll see why)
Patient: My mood has been following me around.

26 year old male Ivy League grad:
"I started thinking, well, I call my family overseas and so maybe they're wiretapping my phone calls to intercept me. I think people are out to get me, to turn me into a terrorist. Sometimes I can tell myself, 'It's not real,' because I've never participated in any sort of terrorist activities, so why would they want me? But other times it seems they plant magazines and newspapers at newsstands to try to influence me, and the thoughts become so overwhelming that I can't convince myself that it's not real. So at one point I was in [foreign country] and walked into the embassy, because I was sure that they were trying to get me to recruit me into being a terrorist. And that's when this last string of hospitalizations began.:

45 year old female who just tried to escape:
Me: So are you able to sleep well at night?
Pt: God comes to visit me every morning around 4am. I just push him away. But he changes his mind a lot. I'm not pregnant anymore.
Me: You're not? You were pregnant with twins three days ago.
Pt: See? He changed his mind. You know the "virgin baby?"
Me: Yes.
Pt: You're God's type, I can tell.

26 year old male:
"I just recently went through puberty. I found a way to arrange my sleeping bags into a cocoon, and in there, I learned freestyle masturbation, and that allowed me to transition into adulthood."

Gas Prices

This morning as I was walking into the hospital bright and early, I passed by an old man veeerrrry slowwwly inching himself down the hallway in his wheelchair. As I passed by him, he looked at me and said, "These gas prices are killing me!"

Salutations

I'm at the Veterans' Affairs hospital in Long Beach now. Things have a different feel than at the UCI Med Center. The elevators fly up and down compared to the UCI ones, and the big tower building housing the main hospital wards is nice and pretty and new. The rest of the buildings are a bit run down, as I thought the whole place would be. The people work slower, but they seem happier. Everyone seems to smile and wish each other good morning. Today, a nice old man saluted me. "Good morning, ma'am!" he said. I wasn't quite sure what to do, so I smiled and nodded and wished him a good morning back. It kind of felt like being offered crackers and grape juice in church, where I would sort of go along with some of it to be polite but not all of it because I didn't really belong to the group.

The banter in the multi-patient rooms is different, too. Actually, the fact that there is banter is different to begin with. More than the UCI patients, these patients seem at ease with sharing their room with three others and it doesn't faze them at all. So far I have yet to see a single female patient, and the banter reflects this pretty well. As we were finishing up rounding on one patient this morning, he said, "Thank you, guys." The patient in the next bed corrected him, "...and girls." The first one mumbled, "Yes, and girls," and the neighbor grinned, "See, I notice girls!" To which the first one grumbled, "I get in trouble if I notice girls."

Overall, it's not a bad place to be. It doesn't hurt that the seven-mile commute is on PCH right along the ocean and it's really pretty both going and coming from the hospital!

Gross

We have a patient who is so constipated that it's backed up all the way through his intestines into his stomach, which means he's vomiting poo. Gross!!! Now that's a bona fide potty mouth.

Gravity II

My bed must have extreme amounts of density, because I could not escape its gravity this morning. The sun was shining onto the bed, there was a pleasant little breeze ruffling my curtains, and I didn't have to go to work. I felt like a happy little kitten napping in the sun. My bathroom light died but it was light so I was able to see in the shower, did laundry for a change, and got some errands done. Now I get to study before I make my first home-cooked meal (vs. cafeteria slop) in a long time! Hurray for days off!

Gravity

Yesterday was my last day at UCI for the next month. Starting next week I'll be at the Long Beach VA, with a very different patient population.

This past week has been a week of serious patients who aren't going to make it. My team's workload of patients all of a sudden were rather young patients who were terminally ill. Other young patients we've had were chronically ill, but not on their deathbed. It's one thing to treat patients, make them better, then send them home. It's entirely another to know you can't help, no matter what you do.

One was a 36 year old woman with breast cancer that had metastasized everywhere despite a double mastectomy - her lungs, liver, spine, pelvis, and brain. There was so much cancer in her brain that she was throwing up constantly but still coherent and talking when we admitted her. By the next morning though, her brain had swollen so much that all she could do was groan and reflexively contract her arms inward, a very ominous sign called decorticate posturing. They call it "decorticate" because you can tell that the site of the brain injury was such that it essentially shut off her brain cortex functions. The neurologist happened to stop by while I was at the patient's side and he remarked that it was a sign she was about to stop breathing, and we'd better intubate her before she did. So much mayhem and excitement later, she was sent to the ICU, from which she will probably leave only in a casket. I met her children the first day; the boy looked around fifteen and the girl looked about eight. The girl didn't seem to understand that she was about to not have a mom.

Another was a 37 year old man who'd essentially drank himself to death's door. He was in the hospital with our team for over a week, a belly swollen with fluid backed up because it couldn't get through his too-damaged liver, looking like he was pregnant. He was so jaundiced that it looked like someone had taken a black-and-white photo of him and colored in his eyes and skin with a yellow crayon. Literally. I'm not even exaggerating. I was part of the team taking care of him, but he wasn't primarily my patient so I didn't talk to him much when we visited his bedside during rounds every morning. Still, we had a little ritual that kind of came about after seeing each other every day. He always had downcast eyes while we were there, but as the team left his room, I would wave and he would look up and smile. Yesterday he looked so sad, sadder than usual, but he did give me a smile at the end. It was dimmer than usual, but it was still our little ritual.

Another was a 41 year old man who found himself diagnosed with HIV a week ago. He had been mysteriously losing weight for a couple months, but had suddenly started going blind and had spots growing all over him, so he went to the doctor and that's how he found out. The tell-tale spots were surprising because those aren't seen anymore with HIV therapy that's available nowadays. He thought he got it from a tattoo he got in Viet Nam several years ago, because he said there they use the same needles for everyone. It was a very cool dragon, but to think it could have been the cause of his death diminished its luster. He started to cry as I was talking to him. Apparently he had been married a few years ago and he had always used condoms because the wife didn't want children, then she left him after a year. He was so sad and didn't want the burden of sadness in life anymore, so he started studying to become a monk. He completed his three years of studies and was set to go to Tibet to finish up, but ended up in the hospital. Can you imagine, studying to find eternal peace as a monk, and one day you find out you've got AIDS. He squeezed my hand when I asked him if he'd like me to try to find a Buddhist monk that he could talk to. I hope he gets reincarnated into something nice.

Even though these people are a few days away from death and no amount of medicine will cure them, I guess the one medicine they can benefit from is kindness.

Irony

One of the great ironies of medicine, from paramedicine on up, is this: even if you're a great doctor, if you're an asshole you'll get sued, but you can be a crappy doctor as long as you're nice to patients, and they won't sue you.

Following that irony, I received my first patient letter yesterday from a very nice young lady in her mid-twenties who's been chronically ill since she was a toddler. She's one of the calcifying patients I mentioned in an earlier post. In her letter, she said she's had lots of experience with doctors, but I stood out as someone who was so kind to her and her family. She's had all sorts of expert care and I know the least amount of medicine on my team of course, but it was simply that I sat down at her bedside and talked with her and her mother for about 20 minutes that must have made all the difference. Maybe it was also because I said, "Hi XXX" and addressed her by name whenever my team visited her, who knows? I certainly didn't do anything superhuman.

I was actually very inclined to be nice to her because I had met her before my internal medicine rotation began. She didn't remember me, but as part of a different rotation two months ago, my group was assigned to fan out around the hospital to look for patients with interesting physical findings. One of them was her, on her prior admission. About eight of us crammed into her small room, checking out her body parts, himming and hawing, staring, talking about her, but she was very gracious and talked about her disease course with us, let us poke and prod, and answered our questions thoroughly. At the time I kind of thought it a little distasteful that we were marching in huge groups into patients' rooms to stare at them, even if UCI is a teaching hospital. So when I discovered that she had come back and was assigned to my team, I guess I wanted to make amends, or at least show appreciation. I never told her directly why I was being so nice, so I feel a little bad, like I tricked her. In any case, one day she asked the attending if she would be able to have a baby some day. He gave her a general positive answer, but somehow I got motivated later that night and found an article. It said that women with her condition should be monitored prenatally as high-risk, but that there was a good chance she would have a healthy pregnancy. When the attending gave her the article the next morning, she said that it was the best news ever. It took me only about an hour to research the article, and about 20 minutes of extra conversation to apparently make a big difference in her life.

As we discharged her, I wished her a happy fourth anniversary with her boyfriend. She had told me she wanted to be home by Monday so she could celebrate it with him. I hope she has a long and happy life with as many healthy children as she wants.

Long Call (again)

I hate long call. It's very long.

Days Four and Five

So Day Four is called a "regular work day" where you just monitor the patient, try new things to make them better, or send them home. No new patients. Day Five is "pre-call" and is much of the same. The best case scenario is that you've discharged all the patients you got on long and short call, and are ready to start long call the next morning with no patients left over! Yeah, right.

Changing gears:
Today marks an interesting day. 9/11 has for several years now been the epicenter of intense politics, but to me it carries a different meaning. Every year as 9/11 approaches, I groan inwardly, knowing that people will get all worked up about this day, but then completely forget about it the rest of the year save for the politicians who continue to evoke it to their benefit. If this day just passed every year without anyone noticing, I'd be okay with that. It's like Valentine's Day - you're not supposed to love your significant other only on Valentine's Day, you're supposed to every day. Yet the commercialization and superficiality that is synonymous with V-day is pretty nauseating. Inasmuch, those who sacrificed their lives to save others should be remembered privately all the time, not staged once a year into a political tool.

I woke up today like any other day. Of course, I was aware that it was 9/11, but it didn't compel me to do anything differently than I would any other day. However, I was driving along PCH to go study at my favorite Starbucks this afternoon, when all of a sudden, there were hundreds of firefighters on motorcycles driving north. As I continued south, there were local fire engines parked along PCH, waving at the motorcycles. It was a huge, noisy spectacle, as cars and motorcycles honked and firefighters stood atop their rigs with their emergency lights flashing, waving at the motorcyclists as they thudded by.

I suddenly became really "homesick" for my fire family back home up north. How many other professions do this? Can you imagine hundreds of CPAs rallying together on a giant motorcycle ride to remember their own who were killed in New York seven years ago? Firefighters are pretty unique, along with the few other professions where you must live together despite your differences and sometimes rely on each other with your lives. I never had any Backdraft moments of falling through the roof into a fire, but there are countless less sexy or dramatic times when my ass was saved by someone I worked with. I haven't forgotten what it is to be a firefighter. The job and the landscape where my firefighter self was born, trained, lived and worked, has changed me for good.

I wish everyone could experience such a tie to their brethren - known and unknown - sometime in their lives. The world would be a better place for it. And that would be the best way to pay respects on such a day like this for those who gave their lives, unarmed but for rescue tools, surely terrified, but still answering the call for help.

Short Call

This is Day Three. Short call means we take new patients from 7am-4pm, with a cap of four new patients. Sometimes you get all four first thing in the morning from the "night float" resident, who is there to admit any new patients who come after 7pm when the long call team stops taking admisssions, and to make sure the rest of the patients don't die in the middle of the night. Other days you get the four dribbling in throughout the day.

I was assigned one of the new patients today, a young lady whose skin is calcifying. It's a very sad disease. She can't open her mouth completely because the skin at the corners of her mouth are calcified, and she walks with a limp because she can't bend her leg due to the calcification. Patients with her variation of this disease supposedly have no reduction in life expectancy, although it's a restricted and not-so-fun life. However, patients with the diffuse form of this disease have a very poor prognosis owing to organ involvement in addition to the skin problems, and most often die because their lungs lose capacity to expand and contract. There's no cure for this disease, so we do all we can to give supportive care. I hope my patient doesn't go from her limited end of the disease spectrum to the diffuse end. She seems really nice and I hope she can leave soon. There was another patient we had recently who had the diffuse form. It came on suddenly a few months ago when she had her baby. She was otherwise healthy, but has since developed calcified skin and organs everywhere, and her skin turned nearly black everywhere too. Her baby isn't going to have a mommy soon.

Anyhow, after we finish rounds in the morning, we work up our new patients and treat and monitor our old patients. It's not as long a day as long call, because we only accept new patients until 4pm, then we are generally able to interview the new patients, admit them, order some labs and studies, and finish their paperwork by 8-9pm. We even got done early enough today for me to hang out with Darron and try out his neighborhood Japanese restaurant. He liked everything we ordered! I'm so proud of my newly Japanophilic baby!

Okay... off to study up on skin-calcifying disease.

Library Books Sarah Palin Supposedly Tried to Ban

A Clockwork Orange by Anthony Burgess
A Wrinkle in Time by Madeleine L'Engle
Annie on My Mind by Nancy Garden
As I Lay Dying by William Faulkner
Blubber by Judy Blume
Brave New World by Aldous Huxley
Bridge to Terabithia by Katherine Paterson
Canterbury Tales by Geoffrey Chaucer
Carrie by Stephen King
Catch-22 by Joseph Heller
Christine by Stephen King
Confessions by Jean-Jacques Rousseau
Cujo by Stephen King
Curses, Hexes, and Spells by Daniel Cohen
Daddy's Roommate by Michael Willhoite
Day No Pigs Would Die by Robert Peck
Death of a Salesman by Arthur Miller
Decameron by Boccaccio
East of Eden by John Steinbeck
Fallen Angels by Walter Myers
Fanny Hill (Memoirs of a Woman of Pleasure) by John Cleland
Flowers For Algernon by Daniel Keyes
Forever by Judy Blume
Grendel by John Champlin Gardner
Halloween ABC by Eve Merriam
Harry Potter and the Sorcerer's Stone by J.K. Rowling
Harry Potter and the Chamber of Secrets by J.K. Rowling
Harry Potter and the Prizoner of Azkaban by J.K. Rowling
Harry Potter and the Goblet of Fire by J.K. Rowling
Have to Go by Robert Munsch
Heather Has Two Mommies by Leslea Newman
How to Eat Fried Worms by Thomas Rockwell
Huckleberry Finn by Mark Twain
I Know Why the Caged Bird Sings by Maya Angelou
Impressions edited by Jack Booth
In the Night Kitchen by Maurice Sendak
It's Okay if You Don't Love Me by Norma Klein
James and the Giant Peach by Roald Dahl
Lady Chatterley's Lover by D.H. Lawrence
Leaves of Grass by Walt Whitman
Little Red Riding Hood by Jacob and Wilhelm Grimm
Lord of the Flies by William Golding
Love is One of the Choices by Norma Klein
Lysistrata by Aristophanes
More Scary Stories in the Dark by Alvin Schwartz
My Brother Sam Is Dead by James Lincoln Collier and Christopher Collier
My House by Nikki Giovanni
My Friend Flicka by Mary O'Hara
Night Chills by Dean Koontz
Of Mice and Men by John Steinbeck
On My Honor by Marion Dane Bauer
One Day in The Life of Ivan Denisovich by Alexander Solzhenitsyn
One Flew Over The Cuckoo's Nest by Ken Kesey
One Hundred Years of Solitude by Gabriel Garcia Marquez
Ordinary People by Judith Guest
Our Bodies, Ourselves by Boston Women's Health Collective
Prince of Tides by Pat Conroy
Revolting Rhymes by Roald Dahl
Scary Stories 3: More Tales to Chill Your Bones by Alvin Schwartz
Scary Stories in the Dark by Alvin Schwartz
Separate Peace by John Knowles
Silas Marner by George Eliot
Slaughterhouse-Five by Kurt Vonnegut, Jr.
Tarzan of the Apes by Edgar Rice Burroughs
The Adventures of Huckleberry Finn by Mark Twain
The Adventures of Tom Sawyer by Mark Twain
The Bastard by John Jakes
The Catcher in the Rye by J.D. Salinger
The Chocolate War by Robert Cormier
The Color Purple by Alice Walker
The Devil's Alternative by Frederick Forsyth
The Figure in the Shadows by John Bellairs
The Grapes of Wrath by John Steinbeck
The Great Gilly Hopkins by Katherine Paterson
The Handmaid's Tale by Margaret Atwood
The Headless Cupid by Zilpha Snyder
The Learning Tree by Gordon Parks
The Living Bible by William C. Bower
The Merchant of Venice by William Shakespeare
The New Teenage Body Book by Kathy McCoy and Charles Wibbelsman
The Pigman by Paul Zindel
The Seduction of Peter S. by Lawrence Sanders
The Shining by Stephen King
The Witches by Roald Dahl
The Witches of Worm by Zilpha Snyder
Then Again, Maybe I Won't by Judy Blume
To Kill A Mockingbird by Harper Lee
Twelfth Night by William Shakespeare
Webster's Ninth New Collegiate Dictionary by the Merriam-Webster Editorial Staff
Witches, Pumpkins, and Grinning Ghosts: The Story of the Halloween
Symbols by Edna Barth

Who's scared? I am.
Please Snopes at your convenience to verify.

Post Call

Day Two is the day after call, so it is appropriately named "post-call."  So I got there at 7am and left by 5pm.  Such a short day is hiiiiighly unusual!  Last cycle we were there at 6:15am until 10:30pm or so.  This is the day where you have done some initial workups of all your new patients the day before, so you finally get to present them to the attending (remember, he left at noon yesterday so he hasn't seen any of the patients who were admitted after he left).  Since he is such a scarce character but does the most of your block evaluation, you want to shine when delivering your report to this guy.  Additionally, the patient's been there overnight, so you get to see what effect your initial treatments had on your new patients... did they work?  Are the lab test values any better?  Any imaging studies that are done, with reports by radiology completed?  The answers to these questions get incorporated during morning rounds (keep up with the terminology here!) and help form your all-important Assessment & Plan.  Any Joe Schmoe can go find lab values and vital signs and report on them, but what they really want to see out of us is the ability to synthesize all this information and come up with a comprehensive "probable problem" vs. "possible other problems" list, explain how we can eliminate the possible problems, and how to effectively and safely treat the remaining most likely problem.

Usually this is a day of hard work but because we admitted so few patients yesterday, seeing that it was a Sunday, we had very little work to do.  Plus we were lucky in that a lot of our patients weren't sick enough to hang around for days and days, we were able to send a lot home after just one night in the hospital.

So next time you are hospitalized and hate the food and being woken at all hours of the day and night to have your blood drawn and are bored in your little room, just know that the medical team wants you to go home just as much as you do!  I, for one, came home, went for a short run and promptly fell asleep when I got back, since my body doesn't know what exercise or sleep is anymore.

Time to go scavenge for some food, then do some studying so I can be ready for Day Three!

A Typical Hospital Day

I'm currently doing my internal medicine rotation.  Internal medicine covers sick people who don't need surgery or aren't there on an emergency, and they can't ambulate in/out of their family doctor's office - they are the sickies.  Think congestive heart failure, heart attack, leukemia, those weird rare diseases that kill you... etc.

Whereas my work cycle in the fire dept. was a 3-day cycle, here at UCI Med Center Internal Medicine it is a five-day cycle.  The difference was, at OFD it was work-off-off.  Now it is work-work-work-work-work with a random day off here and there.  I used to have twenty days off per month.  Now I have four.  What the hell was I thinking?!?!  Well, I guess I might have been thinking that it's priceless to hear someone blame away their syphilis on a wet gym towel and know they are lying sack 'o bleeps.  Or that once someone develops a swollen belly from their boozing, you better say all your last thoughts because they aren't going to be around much longer.  Or that I know definitively how to end a life.  Although I won't use that knowledge, it's powerful stuff.  Those sirens that were Odysseus' temptation?  Sailors didn't throw themselves overboard to listen to them sing silly songs!  The sirens' "song" was actually knowledge - of the past, present, and future.  Knowledge is irresistable.  Many a brave Greek sailor went to their watery deaths trying to attain it.

In any case, this is Day 1 of my 5-day cycle, with an intro to my team:

1.  One attending.

He is the dude who makes the final call on treatments and plans for the patient.  He comes at 9am and leaves at noon, and makes a lot of money.  The 9-noon period is called "rounds" where first the whole team sits in a conference room and debriefs the attending on what new patients we have that day, or what the progress is on continuing patients since the day before.  Then we run around the hospital together, the whole team, so he can examine each patient, one by one.  On any given day in a teaching hospital, there are multiple teams flying in and out of all patient rooms.  It's hilarity to watch.

2.  One 2nd or 3rd year resident (aka "the senior").

She is the dutiful deputy.  She runs things before 9am and after noon, and makes sure everyone's verbal reports to the attending during rounds are delivered smartly, adding clarification or background as needed.  She is there at or before 6:30am and leaves after everyone else.  She coaches the interns on their treatment decisions, orders to nurses, consults with specialists, and teaches medical students in between. 

3.  Two 1st year residents (aka "the interns").

They also get there around 6:30 or before and start examining patients, checking lab values, etc.  They split the patient load in half and have the primary responsibility for the patients.  They consult with the senior throughout the day to keep her informed and bounce ideas off her.  They also babysit lost medical students who need help with menial things.

4.  One 4th year medical student ("the sub-I").

She has already rotated through internal medicine before as a 3rd year, but 4th years have to do a dry-run internship for a month or so (the sub-internship) before they graduate and actually become interns.  Optimally, she carries half the load of the interns, but is primarily responsible for patient treatment decisions just like the interns are.  Of course she consults extensively with the senior, but it's obviously nerve-wracking and hectic for her.  She's not responsible for anyone but herself, but she is the closest to us in experience, so she gives us good little tips and nuggets to help us navigate the behemoth medical system in the hospital.

5.  Finally, the two 3rd year med students.

We just wander around with perplexed looks on our faces.  We never know what we're doing, we just show up when told, and leave when told.  The saddest members of the team.  Don't know anything.  Nurses fart in our general direction, but it's a happy time in the day when unsuspecting family members address us or benevolent attendings introduce us as 'doctor.'  Of course the latter always clarifies that we are "student doctors," but it's still nice to hear!  We come in at 6:30 just like everyone else and write up our paperwork like everyone else, albeit a reduced load, since we're learning and slow at it still, but none of our work counts for anything.  The intern, senior, and attending will all repeat the work done, so we are actually useless on the team; rather we slow everyone else down.  However, we are the only members on the team (and the 4th year too) who are actually paying money to be present, so they have to tolerate us and teach us a thing or two.

Day 1 (long call)

Being "on call" means you admit patients up from the ER, down from the ICU, or from doctors' offices.  You can't just walk into internal medicine and say you want to stay in the hospital; someone has to determine you need to be admitted.  Admitting a patient takes a long time.  You have to go find the patient, spend roughly 30-60 minutes interviewing and examining and looking through the chart to see what's already been done to the patient.  The interview is basically detective work so you can start thinking, "what's wrong with my patient and how can I fix it?"  On long call days, we accept patients from 7am-7pm.  Each team can carry a maximum of 20 patients - eight per intern and four for the sub-I.  Med students generally get one to three patients, and our heads are spinning at that point.  We round with the attending at 9am-noon as usual for our existing patients, but throughout the day, whenever there's another that needs to be admitted, the interns take turns getting assigned.  At noon, there is "noon conference" which is just a fancy way to say "mandatory lecture on whatever and free food to guarantee your attendance."  At 1pm, we go back to work, ordering labs, consulting with specialists, sending patients to get MRIs, talking with family, coordinating with the case worker, calling the family or the convalescent home nurse for background info, etc.  It's an amazing amount of information synthesis that happens all day.  The last long call day I had, by the time I drove home it was midnight, just in time to change, eat, shower, sleep for a few hours, and get up to be back again by 6:30am.  Long call is aptly named!

Tomorrow... Day 2 (post-call)!

How much do you think the property tax is for one McCain property?

I officially started my time in the hospital proper.  Until now, I've been at the medical center, but technically I was assigned to the outpatient clinic of Internal Medicine.  Now, I'm on inpatient medicine of Internal Medicine.  These are the patients who are the sickest - CCU, MICU, ICU, etc., as well as the well-loved "wards" are all part of Internal Medicine.  Outpatients aren't as sick, because they can walk in and walk out again.  Inpatients are kept overnight, often for several nights.

I'm starting out responsible for one patient.  He is a man who's fallen on tough times.  He's a skilled worker in the civil engineering industry, but since land development has come to a screeching halt (though not evidenced by all the building going on across my street, darnit), he's been laid off.  Money woes caused problems with his family, and that made him more stressed out.  That led to an exacerbation of his illness, but he can't buy medicine because he doesn't have money anymore.  So he doesn't get better, so he can't get a job, so the financial picture doesn't improve his family relations... and it goes on and on.  In his hospital admissions interview, he cited finances were the thing that worried him most about being in the hospital.  Why can't people's biggest worries be about their illness?  And he has some serious stuff going on.  Why is it that in the USA, in the 21st century, a skilled worker cannot pay for the medications he needs?  Why is this so often the boring, dry topic of my blogs?  I wish I had sunnier things to post!  Or I could just content myself with telling funny stories.  But when you see patient after patient, concerned with or worse, suffering as a result of, the inability to pay for their health care, what do you do?  How can I meet patients like this day after day and not spout off every so often?  

Seems like it used to be that doctors had to bear the looks in the eyes of their dying patients and live with the guilt of not being able to save them.  Now, doctors scramble to do whatever they can to get patients medications and treatments so they will not have to look into their eyes, knowing they *are* able to save them, but having to weigh the cost.  What is the value of a human life?  According to one of my professors, the average cost the U.S. as a society has deemed acceptable to save a life is about $50,000.

I wonder if my patient is going to vote for John McCain.

The Lying Patient

A sample bedside conversation alone with a patient:

Me:  "Hi, how are you feeling today?"

Patient:  "Oh, just great.  Thanks for asking!"

Me:  "So you don't have any pain today?"

Patient:  "What pain?"

Me:  "The pain that brought you to the hospital."

Patient:  "Oh, that went away a long time ago, I took some medicine and it went right away."

Me:  "So you're not having any pain? At all? Are you sure?"

Patient:  "No, no.  No pain."

Half an hour later with the attending and the whole team watching:

Attending:  "So I hear your pain went away?"

Patient:  "Went away?!?!  My God, it's never been worse!  In fact, I think I'm having a heart attack right now!"

Patients are *notorious* for changing their stories, invariably making you look stupid.  As if 3rd years need help with that.

Hospice Reflection

Part of being a med student is visiting hospice patients. The really odious part is having to write our thoughts on it. An excerpt of my "reflections" at 1am:

"The most important thing I can glean from my hospice experience, if I can remind myself to do it often, is to enjoy life and appreciate the minor things I take for granted. If I were told tomorrow I couldn’t drive anymore, I would probably actually relish my commute. If I were to learn that I was going to be in an accident and I couldn’t walk anymore, I’d probably go for a good, exhausting run.  Stripped of a long life expectancy, a hospice patient may actually have an advantage most of us don't have – the hightened awareness to consciously appreciate and experience what is left of their lives."

Given that I whipped up over a page of these sorts of paragraphs in the last hour, as I sit blurry-eyed in front of my computer, I wonder, was my parents' hard-earned money for a liberal arts degree worth it?  (Let us also recall that my essay-writing skills have already earned me $271 in exonerated fines for a carpool land violation, plus hundreds more in savings from my insurance rates NOT going up as a result of that ticket.)

Empathy

First of all, I must say y'all are commenting like champs! I love watching That McNabster Guy vs. TGTAdventurenz - it's almost like watching the Olympic women's pole vaulting!

And on to today's depressing business. We were on task to find cool physical findings on patients today, so we were running around the hospital with our resident, dropping in on patients for a quick visit. Next up was a ptosis patient. (No, it's not an ailment unique to African click language speakers, it means "droopy eye" - why they can't just say "droopy eye" I don't know, but I think it has to do with keeping up with the lawyers and their secret language.) We'd already seen a girl with scleroderma, where the skin begins to tighten and calcify, and eventually you can't bend your fingers or open your mouth anymore - very sad; a patient who had an ablation to correct her irregular heart beat, but who ended up with a punctured lung- very unlucky; a patient with an old heart valve replacement that apparently clicks so loudly at night it keeps his wife awake - how exhausting; and other fun things. They were all supposed to be quick, in and out visits, but our ptosis patient trapped us!

He had just been diagnosed with leukemia and started on chemo. He was very angry. He let us know it. He was so angry at his primary care doctor for not catching it, he was gonna sue him as soon as he got out of the hospital. Can you say Stage One of the classical stages of loss? He went on and on and on, and in the end he was very appreciative of everyone at UCI because we had turned his life around (obviously it was our great work, since the four of us had never seen him before), but he sure let us have it. We were all very sympathetic and very professional and listened to him rant and rave for a half hour before we cut him off, but it just reminded me why I want to go into emergency medicine - so I don't have to deal with the same irate patients over and over.

The most depressing part was that I didn't really want to listen to him anymore, because I didn't care that much.

Times Are A Changin'

I scrambled onto the employee shuttle bus, the last passenger before the door closed, and made my way to the one open seat. As I settled in for the ten minute ride from the parking lot to the hospital, I noticed: every single person on the bus was a woman. From the med students and lab techs with the white coats and the nurses with their conspicuously colorful scrubs to the more loosely business-attired clerks and the bus driver in her uniform, some were carrying lunch bags, some carrying Coach purses; stilettos, tennis shoes, clogs; long hair, grey hair, messy hair, perfectly coiffed hair; lots of mascara, lipstick and rouge, but also some without... it was a feminist's dream.  

I wanted to snap a black-and-white with the morning sun streaming through the windshield and the faces at the rear of the bus in shadows, and title it something ordinary like "Off to Work," but display it alongside old 50's typical male work scene photos, you know, the kind where all the men have the thick-rimmed glasses and crew cuts and suits.  The best part? An entire shuttle bus of workers on their way to run a major medical center in a densely populated metropolitan area happened to be female, and no one but me seemed to notice.

Medical Ethics

If a patient came to you and told you his complaint, but then asked you not to document it because he was afraid of complications with his new life insurance policy, what would you do?

If a pharmaceutical company rep offered to bring you and your staff lunch so he or she could spend lunchtime telling you about a brand-new drug, would you accept?  A free nice dinner with just you and the rep?  Would you accept a trip for your family to go to Italy?  How about a Starbucks latte?  A pen with the name of the drug on it?  

If a doctor yelled at the nurses and a med student for not completing the overnight lab work as ordered because he felt the delay would adversely impact his cancer patient's surgery scheduled for that day, should he be punished for unprofessional behavior and creating a hostile work environment?  Or should he be lauded for advocating on behalf of the patient?

If you needed to learn how to perform a pelvic exam, and the young female patient was visibly uncomfortable but didn't specifically request that medical students not be present, would you stay or leave the room?  What if you had to perform that exam that week and have it signed off in order to complete your required procedure practice and pass the rotation? What if you later found out she had been raped in the past?  If the different scenarios changed your answers, how could you justify them?

If you were a nonreligious surgeon but a seriously ill patient wanted you to pray with herbefore the surgery, would you?  What about if the patient asked you to carry a "lucky charm" in your pocket as you performed the surgery?  What if you were atheist and actively did not believe in a god?

What would you do with a patient who is elderly, just feels "done" with life, and can't wait to die?

How would you react if you found out your patient was doing or has done illegal drugs?

Playing Doctor Can Lead to Uncomfortable Social Situations

I was walking out of Starbucks today when I caught the eye of a guy studying at a table.  I had a flash of recognition, he had a flash of recognition, I briefly hesitated in my step, and my hand was dangling in the air in the start of a wave, when it suddenly hit me why I recognized this man.  I had just been party to examining his testicles last week!  The wave already launched, the hesitant step already cut short, my body already half-turned toward his table, my brain screamed, "Abort!!  Abort!!" but it was too late.  Crap crap crap, I cursed myself and my recognition-betraying reflexes, but it was too late.  I forged on.  He had put down his pen and was standing up to greet me.  In as quizzical a voice as I could muster, I furrowed my brows and said:

"Don't I know you from somewhere...?"  He laughed and said, "You don't want to know...  when I met you I was naked."  The other patrons sitting at the nearby tables were getting quite an earful.  He could have just said he met me at the clinic, or he was a patient, but nooo.  At least he had a sense of humor.  We were about the same age, so that made it all the more awkward.   I felt a lot like those people in the Southwest Airlines commercials: "Wanna get away?"  As I left, I remarked, "Well, it was nice to meet you fully clothed this time!"

Such is the peril of practicing medicine close to one's home, apparently.  I wish they had put THAT into the "Clerkship Survival Guide" Chapter 13:  How to Engage in Social Situations with People Whose Testicles You've Examined.  I could have used a bit of guidance today.

You People

I write passionately about health care coverage, and I get a trickle of comments if any.  I write about assholes and all of a sudden I have six comments in two days.  I see what sells to this audience!!!  ;)  And yes, fear not, I will have more and more stories as the year goes on.  I'm not above pandering.

The Things People Tell Their Doctors

I am now seeing patients.  Patients trust their doctors, and seemingly, the med students that come tagging along.  The trust patients have for their doctors is quite a powerful thing, and a serious responsibility.  It also leads to surprising conversations.

One worried patient brought a litany of minor complaints.  She went into detail about each one, even though she was an otherwise healthy young woman.  She was a PhD candidate in humanities and didn't have medical lingo at her disposal, but nevertheless, went on with her descriptions with the vocabulary and manner of speech expected of an academician.  When she was finished, I summarized everything, then conscientiously asked, "Is there anything else you'd like to discuss today?"  She hesitated for a moment, then replied, "This is a little embarrassing, but..." and continued in the gravest of manners, looking straight into my eyes with no trace of humor, "can you take a look at my asshole?"

Are You Underinsured?

There is much attention (well, of the attention paid to health care, anyway) on the uninsured in America.  There are currently about 47 million uninsured Americans, and rising.  But what about the underinsured?  According to this article there are about 25 million underinsured Americans, adding up to a total of 72 million inadequately covered Americans.  That's staggering!  These are people who have insurance, but not enough.  They pay for health insurance, but when it comes time for the insurance company to cover their expenses, they get shafted.  I consider myself in this group.  How do you measure up?

Learning

I'm back to learning things, and not just stuff out of books.  The month of June we have workshops and lectures to prepare us for being in the hospital starting July.  Last week, we learned how to do pelvic, rectal, and testicular exams on real people.  I always wonder about the people who voluntarily subject themselves to ubernovice examiners.  I've heard they get paid $100/hr for an afternoon of pelvic exams, or $25 per poke for rectals.  I have to say, I personally price my orifices much higher than that!

Thoughts on DC

• The White House was a lot less impressive than I thought it would be.  Granted, I know there is a LOT more than meets the eye, but all I saw were two bored-looking cops keeping an eye on two bored-looking protester types with a few bored-looking tourists idly snapping pictures.  I wouldn't have minded seeing a bunch of nattily dressed Marines doing tricks with their rifles.  I mean, come on!  I think I should get something for all those federal taxes I pay.  Is a little entertainment when I visit the capitol too much to ask???
  
• Allergens in NY/DC are pretty bad.
  
• When the vice chair of the department you want to eventually succeed in tells you that partying with them is going to have a much bigger impact on your career than any presentation you could make the following day, you do as he says.
• The best way to reduce performance anxiety when presenting research is to party way into the wee hours the night before so you are too exhausted to be nervous.
• I got a lecture on Eritrea from a taxi driver at 3am, who declined payment because I seemed so interested in his country.  
  
• I really should travel to Africa someday.
  
• The Metro in DC is pretty nice.  Not as expansive as NY's Subway, but more similar to BART, except they have plastic seats.  I like the design of the stations.
  
• Sometimes you can get really good hotel deals by staying on top of "travel deal" e-newsletters.  I got a fantastic hotel for a fantastic deal, which was my treat to myself for giving this presentation.
  
• I felt a little ill on the day I was going to spend at the Smithsonian Museums, but after a couple of hours there I was so engrossed that I could have spent many more days there.  And that was just one museum!

NYC

I'm writing this post from somewhere in New Jersey I think, while riding on Bolt Bus, an awesome new service from NYC to DC. I didn't reserve my seat early enough for the $1 rate, but I did get a $10 ticket for a 4-hour ride. It's a very sleek, new, nice, nonstop bus, and it has a free internet connection! How cool is that?? I saw Juliann and Karen off to Boston at the Chinatown "Lucky Star" bus stop yesterday, and I have to say by far I think I got the better end of the deal! One might think a week in Manhattan/DC might be pretty expensive, but between being partially subsidized by the dean for it being a partial business trip, staying with friends, free conference-related dinners and lunch, and getting very savvy advice from an almost autistically intense travel expert former roommate, it's not turning out to be as bad as it could be. What a great way to re-enter the world of the living after my academic hiatus!

Manhattan is very cool. I've been to NYC a few times now, and I actually feel very comfortable in it. It's convenient, things work well, and I found lots of friendly people there. I'm sure DC will be just as cool. I'm reading about Scott McClellan's outrageous memoir "allegations" (which the rest of us know as "I knew it!"s) against George W. and the White House response just as we cross the border into DC. It'll be great! Okay, gotta turn off the 'puter and see the DC sights!

Fun? What's That?

For better or worse, I am once again free - however momentarily - in just a few days. I plan to read a book or two while traveling to the East Coast. Any good suggestions? Nothing medical!!!!!!!!

I See Why

doctors kill themselves cuz this lifestyle sure does suck.

Crunch Time

I've entered what I've been told is the "suckiest time in med school." It is the few weeks preceding the Step 1 of the U.S. Medical Licensing Exam. Step 1 encompasses everything we've learned out of books in the first two years of med school. I'm currently taking an Intense Prep course for the exam, run by a private company, Kaplan, who does nothing but prepare students for professional exams. So far, we cover the material of a 4-6 month course in an average of 1-3 days. We are in class 6 days a week. Little did I know that when I "escaped" from the Japanese academic system, it was really jumping from the pot into the fire!

So why am I blogging, you ask? Because my brain is ready to explode. It was a medical emergency, for which the only treatment is mindless entertainment!

The Happiest Place on Earth

I don't know when the last time was that I went to Disneyland. Over ten years ago, I think! It was cool to go back again. Darron had the Monday off for his last day of spring break, and I had another day to relax before real studying for the Boards begins. We got there pretty much at opening time and stayed until the end, like little kids. Space Mountain was my favorite! Since the upgrade, you can no longer see the track in the dark, so that made it especially great. We both felt they over-emphasized Johnny Depp in Pirates of the Caribbean, but it was still neat. I didn't like the Finding Nemo submarine ride at all, even though we waited the longest for it, because it was a total movie tie-in, too. There were quite a few people there, probably the last wave of spring break-ers. But we still got to do everything we wanted to, including eating at the Blue Bayou! Mmm, it was sooo good. We even got to return for a second time on some rides!

What a great finale to a fun spring break! Now it's back to work...

Some Facts on Health Care in the U.S.

Uninsurance: Currently, about 47 million Americans are uninsured.

Underinsurance: Millions more are underinsured, meaning they are just a car accident, heart attack, diabetes diagnosis, or baseball-to-the-face away from a financial meltdown. As one reader recently commented, losing one's job also puts you just two steps away from that catastrophe. 

Death by denial: Every year 10,000 Americans die preventable deaths because they were denied care by insurance companies. To clarify, these deaths are DIRECTLY caused by denial of claims, e.g. a patient needs cancer drugs and the insurance company says "no, your policy doesn't cover those drugs because they aren't approved by our administrative board" or "we've discovered you have a gene that predisposes you to this type of cancer, so we are canceling your policy for failure to disclose a pre-existing condition."

Insurance company practices: Currently, what insurance companies do is "cherry-pick," meaning they only insure the young and healthy who won't need much medical care, and deny insurance to older people and those with pre-existing conditions.  This can include people who are otherwise quite healthy, but weigh too much, or have a gene that could cause disease in the future.  The thing with genes is they don't always turn into disease.  Genes are like words in a dictionary.  They might be in the book, but that doesn't mean that every word gets looked up in the lifetime of that book.  Similarly, not every gene is expressed in a person.  In fact, many genes don't get expressed.  So denying insurance to someone simply because they have a particular gene is very shady.  But that's all par for the course because insurance companies make their profits by denying medical care, not by paying for it.

Insurance company costs: When the sick but uninsured finally get sick enough to need care, where do they go? The ER. Emergency care costs way more than preventative care. And guess who pays the ER doctors and hospitals to treat people who don't have insurance? You. It's called taxes. It's also called "out of the ER doctor's paycheck" because they never get paid for the services they render. And insurance companies get away with not covering those expensive individuals by pawning them off to the ERs-->ER doctors/taxpayers. Even the insurance that is supposedly paid for by employers, do you think they are really paying extra? No, they're taking it out of money that would otherwise be included in your paycheck. Let's not kid ourselves. Employers don't pay for our health insurance, they merely play middleman. Covering all Americans under a Universal Health Care plan would widen the pool and spread the risk/cost of insuring the very sick onto everyone, so each person's health spending burden is decreased. That's more money in your pocket from (the cost of insurance your company no longer has to pay for you) + (the money in taxes you no longer have to pay toward emergency care for other people). And let us note: insurance companies' administrative costs run 31 cents to every dollar you spend buying a policy from them. If a family is paying $1000 a month in premiums, that's $310 that goes toward hiring people to fill out a dizzying number of forms, put you on hold for half an hour before hanging up on you, or mailing you cryptic "coverage checks."  Why not choose a system that puts that 31%, or at least a good portion of it, toward paying for your medical care?

World rankings: Even though the U.S. is ranked #1 in money spent on medical costs, we rank #37 in the world - between Ukraine and Costa Rica - in terms of overall health, measured by several standard variables. Our infant mortality rates are the highest, and our life expectancy is lowest of any developed country. We are the only developed country that doesn't have a universal health plan for all its citizens. To be sure, American medicine has amazing drugs, technology and procedures. But guess who gets that great care? It certainly is not the uninsured or even the underinsured.

Other systems: Some of the best systems in the world - Britain, Japan, France - perform much better on most, if not all, heath indicators for less expenditure per capita.  They cover everyone.  And last I checked, they were not scary communist or socialist countries like many are afraid we'll turn into if we insure everyone.

Match Day

On one day every March, thousands of medical students across the country gather 'round for Match Day.  Yesterday was that day.  

Match Day is when 4th year med students find out what residency programs they matched to.  This is important information, because even when you graduate from medical school and are technically an MD, your training is really only beginning.  Without a completed residency, no one in their right mind would hire you as a doctor (you could work as a consultant for a biotech company, but most med students actually want to be doctors).  Around January or February, you create your "match list" where you rank various residency programs you want to go to.  Each residency program does the same for its medical student applicants.  Everyone submits their list, and the day before Match Day, a central computer uses an algorithm to spit out nationwide match results that pair up students and residencies who have ranked each other high on their respective lists.  It's a lot like pledging a fraternity or sorority, only obviously waaaaay more respectable.

At UCI, Match Day is such a big deal that everyone in the School of Medicine gets the day off, all the deans come out, they serve breakfast in the courtyard, set out chairs for the family and friends, have balloons everywhere, and put up a podium where the dean calls off a student's name from a randomly ordered list.  When the student approaches, he or she hands the dean a dollar.  The dollar goes into a pile for the person who gets their name called last, because it's such a stressful event that no one wants to be at the end!  Then the student gets his or her envelope, takes the podium, opens the envelope and reads the result to the crowd.  It's kind of like the Oscars.  Watching the 4th years yesterday, there were a lot of smiles, shrieks, and joyful dances as most people matched to their #1 choices.   But one girl opened her envelope, then silently left the stage in tears.  Her husband caught her as she ran off, and led her away as she buried her face in her hands.  It turned out that she had matched to the best orthopedic residency in the country, but it was not her #1 choice because her husband was already a maxillofacial surgery resident somewhere else.  

This sobering scene illuminated the sacrifice that med students make in order to become doctors.  They give up their childhoods, their young adulthoods, their comfortable surroundings, networks, friends, all that potential free time, their childbearing years, and sometimes their families and significant others to pursue the doctor dream.  Is it worth it?  Many primary care physicians say no, they would not repeat their career if they could go back and do it over again.  They get paid so little in relation to their sacrifices: the insurmountable educational debt, mounting costs to practice, dwindling Medicare reimbursement rates, minimal patient-care time, and unbelievable malpractice premiums.  It's no wonder physicians in America are trending toward high-paid (read: costly) specialists just so they can recoup in their adulthood all the sacrifices they made earlier in their lives.  However, that just leaves the rest of the populace with ever-decreasing access to primary care physicians and ever-increasing costs of health care.

Match Day.  Luckily it's a joyful occasion for many.  But it's also a time to reflect on the 4th years' achievements and sacrifices, wish them much luck in their residencies, and strengthen one's resolve to overhaul America's broken healthcare system.

Positively Black

My friend Nancy sometimes gives me blogging inspiration, as you see in a recent post. Here's the latest, thanks to her blog. I actually wrote this over a week ago and saved it in my draft collection for release during my own inner Writer's Strikes.  But now that Barack Obama has made his speech on race, it's serendipitously relevant to current politics!

Sometimes people say "dark" or "black" are associated with negative things. Here are some positives:

• What is oil known as?  Black gold. 
  
• The universal desirable male type?  Tall, dark and handsome. 
  
• Quality chocolate?  Dark.
• Time when people spontaneously get lovey-dovey?  Blackout. 
• Necessary item in every tasteful woman's wardrobe?  Little black dress.
• Most well-loved children's horse book?   Black Beauty. 
  
• Attire associated with power or achievement?  Dark suits, black gowns (graduation, judges).
• Symbol of highest achievement in martial arts?  Black belt.
  
• Color you want your finances to be in?   The black.

May the racial healing begin.

Health Care

It's been over a month since Lobby Day. So, what was Lobby Day all about?

Lobby Day was held to support the health care bill (SB840) that Senator Sheila Kuehl (D-Santa Monica) hopes to pass. Not all of us present that day necessarily believe that a Single Payer Universal Health Care system is the way to go about achieving affordable health care in CA or the U.S. But all of us know that the current system has to change.

I could quote a bunch of facts about health care, but all the argument over facts won't change the opinions of someone whose basic values are different from mine. As a doctor-wannabe, I may be a sucker for suffering and death, but I think health care should be a right. If one is sick, one is not free to pursue liberty or happiness or much of anything else. But some people think health care isn't a right. They think it's just fine for us to attack the rest of the world, tooting our righteous horns about democracy and liberty, while we stand by and let our own people die of simple, treatable diseases in our own streets. People recoil in horror and stick their noses in the air when they see a photo of a dead Afghan/Kenyan/Brazilian kid on the side of the road, and think, "Oh my God, how barbaric! How indecent! I'm glad *I* live in a civilized country!" And the kid in their own town dying of athsma? Not a thought about that. It's not catchy news. The Republican Senator (or Assemblyman?) for North San Diego told our med students he flat-out thought health care isn't a right. If you are poor, stupid, lazy, unfortunate or old enough to get sick, then gosh darn it, you better pick yourself up by your bootstraps and get a job to pay for your medical bills. Otherwise you don't deserve health care, and can die in a gutter for all he cares. And guess who's paying HIS ample medical insurance bills? WE are! The taxpayers! Irony knows no bounds. I wonder what he would think if a person who was refused medical care, due to his politics, coughed on him at the neighborhood Starbucks and gave him drug-resistant, incurable tuberculosis. You think he might have wished he'd invested a little of his politics into helping others be healthy?

So even if you think people should earn things in life (which I generally agree with), it still makes sense to cover everyone so they don't spread disease around or drain the rest of our pockets by getting very high cost emergency care as their only form of health care. Prevention is so much more economical than reactionary interventions, but as a nation, we're not getting it. Cutting insurance companies out of the picture is the only solution. They are only in it to make a profit, and they make profits by denying care. Single Payer Universal Health Care makes the most sense because it does just the opposite - it replaces all insurance companies with a government agency that reimburses private doctors and private hospitals. This is not Socialized Medicine that everyone is so afraid of. Even if it were (and it's NOT), let's think about the effects of a socialized agency. We currently have socialized firefighters, police officers, highways, EPA, Medicare, schools, and libraries, to name a few "Scary Socialized Institutions." They aren't so scary. But I digress. Single Payer Health Care ISN'T socialized medicine; doctors and hospitals would still remain private. Single Payer health care would simply cut out insurance companies, because corporate greed just has to go.

Coming soon:
1) For you business types to mull over and comment on - why the "free market" won't improve the American health care system.
2) Some facts about the state of health care in the U.S.

Little Things

I read an article about a person who impulsively bought a cute little purse that her oversized life had no use for, and suddenly she found herself unloading all the unnecessary stuff she'd been hauling around. It began with having to think about what she truly needed that day and what could fit into the tiny handbag. One day, she realized she had become more organized and productive - all stemming from that impulse purchase. She somehow had made a large positive change in her life without even knowing it. The point of the article was that it's the little shifts in our everyday habits that eventually beget large changes; changes that we ordinarily fail to achieve when we set out to achieve them in one fell swoop, like "losing weight" or "becoming happy." One little change causes another, then another, then another, until eventually something big and positive has happened and it was no effort at all!

Reflecting upon this, I discovered that I've done a couple of things like this. The first: I spent last summer keeping busy, and I didn't study at all. A week before school started again, I looked up something I couldn't remember. Once I'd brought out the ol' textbook, I read a little bit each day until classes began. I actually enjoyed looking at old material because it wasn't as confusing in posterity. And now that second year is coming to a close, I find that I've gamely, if not eagerly, studied nearly every day this year. Last year there were many times when I was unable to make myself sit down and study, but this year I haven't been fighting it. Even though there's more material and the testing schedule is harder, I strangely enjoy the process a little bit. My grades show it, too.

The second thing is my cloth bag. A couple months ago, I bought one to haul groceries in so I won't have to use those plastic bags. Unlike other similar efforts I've made before, I actually remember to bring it into the store with me now. This is probably because I'm pleased with my bag and I think it looks cute, regardless of any environmental good it does. It has an understated, tasteful logo (just the fruit/clock part, no words) from a new grocery chain called Fresh & Easy. The bag has since started conversations with checkers as they load my food into it, and I even had a woman stop me in the parking lot to ask where I got it! So I think my little change is already having a bigger impact than I set out to make. Actually, I must attribute the origins of my cloth bag change to Darron's dad. He gave me something a few months ago in a heavy-plastic Fresh 'n Easy bag, and commented that it was built to reuse. So when I saw an ad for "a new Fresh 'n Easy coming to your neighborhood," it caught my eye. I noticed the cloth bags they had for sale in the picture of the new store, and had been wanting one ever since. So this change is actually a little shift that Freeman started - see how nicely that works??

So (to take a page from Nancy's book - or blog, rather), let's hear it in the comments section: What little thing have you changed in your life recently that works for you?

Cardiac Petrification Disease

There was recently a report that medical students have a hardening of the heart during medical school, particularly after the first/second years. It seems medical school sucks away their human spirit, rendering them less empathetic and more cynical. I just finished taking my umpteenth set of exams today, and I certainly feel like an empty shell of a person. Or maybe that's just because allergy season is now fully upon us, and I'm just feeling empty because I've blown all my contents into tissues. Still, I wonder what happens if one is already jaded before even hopping onto the bottom rung for the long climb up the prestigious medical ladder? Does it get worse?

Blue Cross Encourages Doctors to Snitch

Blue Cross encourages physicians to snitch on patients about their pre-existing medical conditions so they can deny even more people insurance.

Aetna Wants Colonoscopies Without Anaesthesiologists

Just another example how health insurance companies want to stick it up your bung-hole.

Good Karma Day

I watched a sappy romance movie last night with my friends as a post-exam celebration, and got SO sappy that I paid Darron a surprise visit afterwards to give him lots of hugs and kisses! I think today I must've gotten good karma because of it.

I got to see the sunrise this morning because I got up really early. It was so pretty! Then I checked my email to find a message saying morning classes were cancelled because the professor retired. What luck! How often does that happen?! So I took advantage and went back to bed until really late. When I woke up again, I took a shower by daylight only, not using the fluorescent light (my bathroom doesn't have windows, so it has to be late enough in the day that the sun can shine through my bedroom and then into the shower). It's such a nice, pleasant, natural-woman thing to do! I had a nice leisurely breakfast/lunch, and it was a gorgeous day so I enjoyed my bike ride to class and back home in the sun - not too hot, not too cold, just right. It was so nice that I wore flip-flops and a tank-top with my New Zealand fishhook necklace, and got some nice compliments! And then I got a nice little present in the mail from my mommy and daddy on their trip to Hawaii last week! =)

THEN I came home to find an email saying my summer research had been accepted for presentation in May at the Society of Academic Emergency Medicine Annual Conference in Washington, DC. The funny thing was, I thought the doctor who I'd done the research for had submitted the abstract for the Regional Conference. UC Irvine is hosting that one in March, and it'll be a more local, laid-back atmosphere because it's run by my department. But the DC one is the biggie, and I didn't even know we were submitting for that! So imagine my surprise at the email... and a little excitement and a little nervousness.

Oh and another good thing: I got an exam score back today, and I did even better than I thought I did! THAT never happens.

What a nice day! At this rate, I should give Darron lots of hugs and kisses more often. =)

Drinking and Driving

Our EMIG (Emergency Medicine Interest Group) pulled off a major DUI prevention event at a local high school yesterday, in an effort to keep little teenage drunkards from killing people. It started with a mock car crash, then an auditorium presentation by a doctor, then breaking the 400 students into small group discussions led by med students. Ironically, we were hoping to get good media coverage but they were all at Cal State Dominguez Hills for a report of a gunman on campus - big teenage sociopath trying to kill people. Maybe next year we should involve the Psychiatry Interest Group and have a mock shooting spree to talk about the dangers of being under the influence of psychosis. But, as it turned out, it was an ROTC student carrying his nonfunctional rifle out in the open to class. Daiiiii!! Even without the paparazzi though, everyone had a good time. You can imagine how much I missed my job that day!

Click here for pictures.

Lobby Day in Sacramento

So you might be wondering what I do with all my free time.
See for yourself - I'm in the very back row.

Quantum Physics

You won't believe it! Somehow, after my karate meet, I was accidentally transported to the delta quadrant via this time portal! Darron was there with me for some reason, and it turned out we landed on a hospitable planet, so we didn't burn up or die of oxygen deprivation. We found a wormhole to come back through within a few days, but when I got back, I discovered that the Darron I was with was an anti-Darron! He existed in the delta quadrant in what we understand as an "alternate universe." When I got back, poof! he disappeared, and suddenly I found myself in a Star Trek exhibition in Long Beach. It also turns out I've been gone for nine months and the real Darron has been here the whole time. I don't know how this happened, but I should have suspected something was up because the anti-Darron was always cleaning and wanting to go shopping.

So anyway, that's why I haven't blogged for so long... to you, although it was just a week ago for me when I last posted. I'm just glad I got beamed back in one piece! Literally. They had to try a couple of times because my signal strength was so weak during the Cardassian ambush, but you can see me arriving safely home here sans equipment - they stole it during the attack!

Click here to see it!