"Goo-ood, goo-ood, goo-ood, good vibrations... goo-ood, goo-ood, goo-ood, good sensations..."

California, here I come! whoohoo!  can't believe it's been a year since I've been home...  kept on accidently flying to different continents instead of back to CA this past year... ha ha

gotta clean my apartment before I leave.  My floor is a HIPAA violation.  ha ha

Took my dumb Medicine SHELF exam and it went okay I guess... not going to judge by my impressions anymore since that's gotten me in trouble the last three times... but for what little it's worth, I thought it was easier than the family medicine exam... which probably means I got like a low pass or something.  =P  I know I missed at least one... didn't catch the characteristic temporal lobe lesion for herpes encephalopathy... =P

Also, just found out my shcedule for surgery -- I'm set to get butt-kicked when I return from break.  My schedule is Vascular-General-Emergency.  aaaaaahhhhh jeeeaaaah...  Two months of PAIN and then I can sort of relax the last month...

Next update probably won't be until I get back.  Merry Christmas, everyone.
 

December 16, 2003

"It's frickin' freezin' in here, Mr. Bigglesworth!" -- Dr. Evil

Taking a study break... took our OSCEs today (Objective Structured Clinical Exam? I think)... basically, a practical exam with pretend patients... kind of annoying, actually.  Hard to pretend that these perfectly healthy people have real problems when they're pretending to cough a lot or be fatigued... plus, they are so stubborn!  I swear you have to ask ridiculously specific questions before they volunteer any information, like,
Me:  "Do you have any history of significant medical problems?"
Pretend-patient:  "No."
Me:  "So, nothing like diabetes, high blood pressure, heart problems..."
Pretend-patient:  "Oh yeah, I do have diabetes..."
another one was, "Oh yeah, I have been urinating like 5-6 times at night recently..."
Give me a break... <rolling eyes>... I swear they'd never say they had terminal cancer unless you asked for the specific type, grade, and histological stage.  =P

Deep Thought of the Month:
So finishing the study of Romans put me in an introspective mood again.  I think in this past year, I've had a huge paradigm shift in how I approach my fundamental beliefs about Christianity.  I think a lot of it has to do with what Dr. Forney once described as appreciating subtlety... let me try to explain it as he did.  Take food.  When we were all young, our favorite foods were simple and ginormously intense flavor.  eg  pepperoni and cheese pizza ONLY, plain chocolate or vanilla, fries, hamburgers.  However, as we get older, our appreciation of subtlety in food increases (hopefully).  For example, different favors, textures, colors, balances, presentation, etc... it's no longer just about drowning a single taste bud with as much possible flavor as possible, but appreciating different characteristics... for example, I used to HATE alcohol, partially because its bitter flavor was absolutely repulsive.  However, after sampling some damn good ale in England, I've come to really like beer.  Also, living so close to Dearborn, I've gotten to taste a lot of Mediterranean foods and found a taste for stuff that I previously never enjoyed, like olives.  I just realized today how well olives really complement feta and roasted lamb meat. mmmmmm...  Anyways, enough about food.

In the same line of reasoning, I think I've jumped a bit in my spiritual maturity this past year or so in that it's not "simply" about memorizing doctrine, basic apologetics, and establishing a foundation of hermeneutics anymore... I think I lost my enthusiasm for that level of understanding years ago.  Now, after having that foundation of knowledge, it's about being comfortably open to challenging that foundation, exposing weaknesses, and appreciating the "subtlety" in scripture.  Romans is a pretty difficult text.  Objectively going through certain passages exposed a lot of doctrinal premises that I held almost unconsciously and caused me to reject (or at least reconsider) a lot of those premises.  As a result, I've shifted from the Armenian to the Reformed side of the spectrum.  (Interestingly enough, to a lesser degree than me, BP shifted in the opposite direction because of our study.)  In all, learning straight-forward answers really isn't satisfying anymore.  Instead, what has been satisfying has been the process of (re)formulating my doctrinal beliefs...  I remember specific moments as recently as a couple years ago, where I simply wasn't interested if someone were to ask me a question about scripture.  I think, if they weren't open to correction, I pretty much wasn't interested in the discussion... perhaps, I was even a measure insecure about my own depth of knowledge and level of intelligence.  However, I think if I were to be placed in those same situations now, the objective of those discussions, personally, wouldn't solely be of correction, but of personal growth as well... and for the intrinsic value of such critical thinking... and I think I'm at a place now where exposing weaknesses isn't as threatening to my faith or ego anymore (but, even if it isn't now, it shouldn't be after I survive three months of surgery hell!).

I think, in part, this change has to do with where I am in my medical training.  The first two years are ALL memorization... but now, in my clinical training, although there's quite a substantial amount of memorization to do, we start to transition out of that type of learning into more of an application-driven/critical-thinking type of training.  In fact, the practice of "pimping" is kind of Socratic in nature, where instead of stating facts, the instructer asks questions to expose deficiencies and provide guidance in knowledge, understanding, logic, and wisdom..........

......... although it doesn't always feel that way... =(    ha ha, like the other day, SM (the other med student on my team) basically got asked, "What are every conceivable physiological manifestations of pancreatitis?" ha ha ha... sometimes it's really not that instructive. ha ha ha

Oh yeah, my fantasty football team choked on me.  I romped through the regular season undefeated, only to lose to NP in the first round of the playoffs... pretty satisfied overall though since I still will finish higher than all of the other MCO peeps who know a lot more about football than me. ha ha ha   eat my shorts TC and AP!!!! ha ha

I recently saw the Simpsons episode where they parodied the Odyssey, Joan of Arc, and Hamlet.  it was hilarious! ha ha
Lisa:  (something to the effect of) "Hamlet is about a morally troubled young man who ends up killing a lot of people.  You'll like it"
Bart:  "Okay.  But, does he at least get to sleep with his mom?"
Homer:  "That would be hot."

Anyways, that's it.  Did I mention it's getting REALLY cold out here?  Thank goodness I'll be back in CA Friday...
 

December 14, 2003

Where was I when...
...I found out that Saddam was captured?:  I was seeing a patient in the neuro step-down unit around 800am EST when I found it about odd that all the pt TVs were set to the same channel and I thought, "boy, they sure like Meet the Press around here."

Well, we'll see what happens.  I think in the big picture, it was a necessary but not sufficient step in establishing US legitimacy in Iraq.
 

Crazy Ivan:
There's a particularly infamously unhappy russian surgical resident here... he's a pretty funny guy, as long as you're not one of his medical students.  ha ha
Funny stuff --
1)  His take on Jehovah's Witnesses (who refuse blood transfusions based on a belief that the soul is in the blood):  Isolate the patient from the rest of his family and peers and tell him, "If you don't get blood, you gonna f***in' die!"  Apparently, it's worked for 5 of 6 of the JWs he's seen.
2)  One morning, I was writing a note in a pt's chart in one ward when he came trudging in... followed by his three medical students... all matching in their blue scrubs and white coats... each a couple inches shorter than the guy in front of him.  ha ha.  It was cute.  like goldilocks and the russian bear... or 'ivan' and his family of 'little ivans'... or a family of ducks... ha ha
3)  On being a surgeon and sleep -- "I don't sleep.  I just blink my eyes very slowly."
4)  One last observation -- the word "bulls***" seems to roll, wiith a seemingly perfectly natural ease, off the russian tongue.
 

Bible study:  Romans 14-15
Finally finished the book with BP last week.  hah.   it almost took us an entire year!  This last section on "disputable matters" was particularly poignant only because I think any Christian who's really been part of a church community or involved in leadership in any Christian organization can tell you a lot of pretty upsetting memories about disputes within these communities... that, in retrospect, probably weren't as important as they seemed to be... or at least, even if they were important, probably caused more disruption, anguish, strife, and turmoil than warranted.  After studying this section for the first time in quite a while, and reflecting on incidents in my past, I think I gained greater insight in how to approach these issues in the future.  The short answer:  to reexam my beliefs with humilit, great discretion and careful interrogation of the scriptures (ROM 14:22-23); to consider my Christian brother and his complaint with mercy, grace, and selfless love (ROM 14:9-12,15; 15:2-3); to consider that the cost of the implications a persistent dispute may outweigh the price of apparent correction (ROM 14:17-20, ROM 15:5-7).
 

December 8, 2003

Did I ever mention that it's getting pretty cold out here?  It's pretty sad when above freezing is a WARM day...

Passed:  Family Medicine
Well, that drama is over.  Look at this madness:
#1 time -- My score = 61 raw, 2% percentile.  Passing = 65 raw, 10% percentile.
#2 time -- My score = 63 raw, 21% percentile.
How dumb is that.  You'd think they might want to make these tests a bit more uniform, eh?  Well, I suppose if they go by percentiles, it shouldn't matter overall, but talk about a screwy test...

Road to the UK:
So, been looking into rotations in the UK during my fourth year.  I've got to apply at least a year early to get into these things.  Got some recommendations from my tentmate KD from Peru who's an anesthiologist in Scotland.
Ruled in:  Glasgow
Ruled out: King's College (London) -- too expensive (275 BP to apply!  Good grief!  That's more than a round-trip plane ticket to heathrow!)
Edinburgh -- pretty messy transition to a new faciility
Cambridge -- minimum 8 week rotation (dude, why woould I want to work the entire time I'm in Europe?  Bummer, I thought cambridge would be a pretty hip place to live)
To look into:  Newcastle, Manchester, Oxford, Peninsula...
 

December 6, 2003

FIFA WORLD CUP 2006

Preliminary round draw was this past week.  The US should fair well in the North, Central American, and Caribeean Zone.  With Howard, Friedel, and Keller as their goalies and the continued development home-grown talent in Donovan and McBride (who may transfer from Columbus to Blackburn in the Premier League) among others, there should be no reason that the US will take one of the three World Cup spots for the zone.

Lessee... in 2006, I'll be in my 1st-2nd year of residency... which means I'll be getting my butt kicked... but, I should have 4 weeks of vacation time... maybe I can make it this time... hmmmmmm.......

I did look into heading to the UK for a month elective my last year of medical school today during a prolonged study break.  Although I still need to set foot in Africa to see if I'm being called to doing international missions there, uh... it can wait.  At this point of my life and medical training, experiencing Europe, pubs, mad soccer matches, and Scottish women with their super-hot accents wins.  =)
 

Recent physician-patient conversation:
Setting:  Morning rounds.  Seeing one of two 70+ year-old women in a room, both a little loopy.
Physician:  "So how are you feeling?"
Patient #1:  <coughing with mucus>  "I'm going to need a bucket."
Physician:  <gesturing around his chest>  "Oh, you mean you've got stuff coming up?"
Patient #1:  "Not thaaat way... the oooother way..."
Patient #2:  "That's a good one!"
Patient #1:  "We're going to be gooood friends."
 

couple more 'firsts' this past week...
1)  First Arterial Blood Gas (ABG) -- whee!  got to stick a sharp needle into some guy's wrist and suck out some arterial blood.  Got it on the first try.  Gotta love sharp objects...
2)  First Malignant Physician -- went to speak with the head of undergrad surgery education to get approval to switch my upcoming ER rotation at MCO with one at St. V's (typically reserved for 4th year students only) basically in order to work with physicians I've known since 1st year and to reduce the redundancy of doing two ER rotations in Toledo.  So, besides rejecting my rationale with succint statements (with an understatement of entirely invalidating the field of Emergency Medicine), he did seem to indicate that the 'conversation' was over when he stopped making eye contact about a minute into it... by picking up and reading a journal.  I suppose it wasn't that bad... at least he didn't openly ridicule me.
 

December 3, 2003

FHM US Magazine movie preview:  The Last Samuai
"Continuing the fall's trend of white people fighting like samurai, this drama finds Cruise as a Civil War hero in feudal Japan.  Once there, he has to fight off an army of enraged Asians who want their damn genre back."

It's been a long time... Pretty much just been lazy.  Take Thanksgiving break.  Was stuck here.  Since I had nothing to do and the impending doom of my next exam hadn't hit, I became super-sloth sleeping for like 8-10 hours a day, playing PS2 for 4-6 hours a day, and basically sitting on my ass.  But, it was great sleeping in for 4 days in a row... didn't realize how much life cardiology sucked out of me until I had the chance to recover from it.

Medicine has been pretty uneventful.  My team is really good.  Fairly tough waking up at 500am, but otherwise I've gotten off work around lunch the last two days only to pass out for a couple hours trying to study.  Also learned that alcohol withdrawal is pretty crazy s***.  Admitted this dude the other night and besides his bad teeth and grimy clothes and uncontrollable fidgetting, he seemed pleasant enough.  Today he was having some crazy hallucinations and had to be tied down to the bed.

Otherwise, I'm finding myself simultaneously excited and jealous for my 4th year friends... a lot of them are getting GREAT interviews.  one's going to match in neurosurgery.  Another got himself Emergency Med interviews at Denver and Minneapolis (both considered among the top 10 programs in the country).  another just came back from Emory for pathology.  I've actually got to start arranging my 4th-yr electives (ie 30-day interviews) within the next couple months... crazy, it's actually frightening to realize that my 3rd year is just a couple weeks from being half-over.  Crazy.  I still feel like a deer in headlights.  Man, if I still feel this way after surgery... I'm in some deep kim-chi (ie some pretty hot s***)........

I should find out if I failed that crappy family med test again this week sometime.  whee.

Ego-booster:  Talked to an almost random woman at a coffee shop last week.  Thought she was attractive, recognized the EKG book she was studying and just decided that I'd try starting a conversation.  Embarrassingly, she was actually an ex-classmate who took a couple years off and I just didn't recognize her.  But, to redeem myself partially, that was the first time we had ever talked.  Ended up chatting for like an hour or so.  So, yay for me.  Ex-classmates now, hot nurses later.  ha ha

Lesson of the week:  Life is never as bad as I think.  So turns out I know the older sister of this 21 year-old Univ Toledo student who was at the Toledo-Pittsburgh football game earlier this year when Toledo beat Pitt.  When the students were tearing down the goalpost, either the goalpost or somebody on the goalpost landed on him... and shattered his L3 vertebrae into hundreds of pieces.  He's a paraplegic now.  All for a freak accident.  No sensation or muscle use below his waist.  What a s***ty deal.

well, hopefully I'll be able to update this page over the next couple weeks.  Got to start cramming for the exam and have my research project to work on before I head back to sunny CA for winter break.  man, I haven't been back to CA since last winter break... wow.  can't wait.

I think s*** is my word for the evening for some reason.
 

Dates:  November 24 to December 19, 2003

Current Rotation:  Medicine Team B, General Medicine at St. Vincent's Mercy Medical Center, Toledo OH
Best thing about this rotation:  lots of free food