June 26, 2004
4th Year:
Whee! I'm a fourth-year! Whoohoo!
No more drudgery!... finally get to do what I want to do... learn for the sake of learning (how's that for a change?)... and kiss a** on rotations and my applications/interviews... whee!
Last OB/GYN Lessons:
Pre-nups. My attending finally got me to consider a pre-nup for my future marriage. I was pretty skeptical that he could convince me of its worthiness, but he did it. His take is that you can't know what will happen. His example was of one of his friends who was happily married for a number of years... until his wife became bipolar... apparently pretty poorly controlled, to boot... after three years, he's still working on the divorce... what a nightmare... So, it got me thinking -- what if I become psychotic while married? seriously. Unlikely, but that'd really suck for my wife... not like _I_ would know the difference if I really was psychotic... so perhaps, it would be a reasonable, even a responsible thing to do -- to protect my wife financially in case I go insane. Certainly it would make me very vulnerable, and also a number of people may assume that I would be endorsing divorce... but perhaps it's worth considering after all...
Calling vs Job. My OB/GYN attending confessed that he'd lost his calling to be a physician about five years ago, and it's essentially just a job now. Sad, he admits. I think a lot of his wrestling with insurance companies, managing his practice, and butting-heads with other physicians about financial issues has a lot to do with it... Still a bit discouraging to see physicians beaten down by their careers.
For myself, I think I have a realistic outlook on my career. I expect to hit big-time burnout and lose that sense of calling someday... I think that I've realized that I need to take whatever steps necessary to prolong that inevitable outcome for as long as possible. Fortunately, emergency medicine has a lot of those future options available...
Sucks to you England!!!!:
Thanks to a slip on the pitch and sending his shot into the stands instead of the net, Becks ruined my week off. Portugal beats England by shoot-out in the quarters of the Euro 2004. Instead of singing raucous songs of England football glory with drunk, displaced Brits, I am now resigned to spending my vacation perfectly sober, agonizing over my residency applications and manuscript write-ups... with my only companionship -- a computer screen in our window-less computer lab... and my substitute for human interaction -- that blinking cursor and MS Word autocorrecting a mispelled word... Thanks a lot, Becks.
June 21, 2004
Four days...:
Four days... four more days until it's over... pleeeeaaaaase make the pain stop!!!! aaaaaaaaaaaaaahhhhhhhhhhhhhhhhhh..........
Obituary: My Laptop
My laptop was pronounced dead around 600pm EST Sunday. It lived a good life. Five long years of companionship... through some of the most difficult times of my life... med school applications... statistics... traveling back and forth across the country... it lived well, good and faithful servant.
Well, my oldest bro wants to play with it and try to resurrect it from the dead. Nevertheless, I think I'm going to buy a new laptop (yay for the new toy! boo for my thinning wallet)... with a couple journal article manuscripts + residency applications to work on these next several months, I dunno if I can get by without a laptop as I'm moving around so much on away rotations... WiFi will be nice to use for once, too.
June 19, 2004
Sorry:
Sorry, been in a bad mood
for quite a while... thus all the moaning and b****ing. I'll try
to stop.
Scalpel:
Actually had a pretty good
day Friday. Cut with a scalpel in a surgery for the first time.
My doc assisted a surgeon all afternoon... the last one was an appendectomy...
after a couple of pretty complicated surgeries, this went fairly easily...
and to my surprised, I got handed the scalpel to chop off the appendix.
whee! good times. new toys always brings out boyish glee...
Seven Sisters Colleges:
Ha ha! I finally saw
the Simpsons episode where they make fun of them... ha ha!
Discipline:
"For example, the proper
diet and rest and the exercises for specific muscles are not a part of
the game itself, but without them the athlete certainly would not perform
outstandingly. Some of these daily habits may even seem silly to
us, but the successful athlete knows that his disciplines must be undertaken,
and undertaken rightly, or all his natural talents and best efforts will
go down in defeat to others who have disciplined themselves in preparation
for game time. . . . A successful performance at a moment of crisis
rests largely and essentially upon the depths of a self wisely and rigorously
prepared in the totality of its being--mind and body"
The Spirit of the Disciplines,
Dallas Willard.
I've been at fault for trying
to exercise Christian attributes without having undertaken the lifestyle
necessary. For whatever reason, this analogy really resonates with
me... whereas nothing else I've read or heard about discipline really made
much of an impact for years... well, hopefully, this book will continue
to instill challenge and change in my life.
Dublin:
Just saw Rick Steve's
Europe: Dublin on PBS... ah man... gotta go... pubs crawls... real
Guiness... Trinity college... Yeats, Joyce, Hopkins.....
June 17, 2004
Getting S*** On:
I am continually being s***
on for wanting to do emergency medicine. This morning, after asking me
what I was going to do, the anesthesiologist replied in the typical, condescending
manner, "So, you want an easy life..."
I understand that getting s*** on is part of being an EM doc, but please, give me a freakin' break... you don't have to start FIVE years in advance...
So, I've decided that from now on, if someone asks what I want to do and I have idea that they're a pompous a**hole doc, I'm going to say, "Toxicologist." B/c no one has any clue (hell, I have only the faintest idea even though I'm strongly considering it) about what toxicologists do. So, they can't have any real opinion on it... and even if they do, since it's so unusual, it'll at least throw them off long enough for me to gain the initiative. I actually tried it this morning and that's exactly what happened... neither doc had any clue what that meant... both reacted with that characteristic slight, but obviously confused "uh, what?"-pause. ha!... a**hole.
Personal Statement:
I've been working on my
personal statement for residency applications for the past four weeks...
it's pretty lame... already totally trashed one attempt. This is, by far,
the most uncreative creative writing project I think I've ever done...
it's basically, 'I'm the greatest med student in the world and I rule and
I'm going to be the bestest, most hardest working resident on the planet
and D*** I'M UNIQUE!!!'... what a farce... I've concluded it's the most
useless thing on the residency application... I mean, come on. If a med
student's booksmart, it'll be on his grades and board scores. If he's hard-working
or had unique experiences, it'll be pretty obvious on his CV. Unless you're
super smart or super not-smart, I don't see how there's really all that
much of a difference between most med students... and I'm skeptical that
a personal statement can be that reliable a means to tell any meaningful
difference. Well, we'll see how unique I can make myself. I think I might
write about how my trip on the Inca Trail relates to how I'm going to be
a great emergency doc... and make it believable... ha! wish me luck.
Maybe It's Time When...:
One doc told me that his
father had a moment of revelation about his marriage. One night he started
having left-sided chest pain radiating to his left arm (classic symptoms
of a heart attack). He remembered looking over at his wife... and, at that
moment, he realized that he would rather lay there and DIE than to wake
up his wife and listen to her nag him about how it's his fault for not
taking care of himself etc etc...
Advice:
Today my doc told me, "Dr.
----- is through two marriages and workiing on his third. Derrick, I want
you to understand that that's why he has to work hard as he does."
June 16, 2004
D&E:
Recently, I had the opportunity
to observe a Dilation & Evacuation... woman had an early miscarriage
and wanted to get rid everything immediately instead of waiting for the
spontaneous abortion... this is the same procedure used for elective termination
of pregnancies. Although my doc said he didn't expect me to show for this
since it was early in the morning and a bit of a drive from the main hospital
we're based at, I decided to go since it may be the only time that I'll
actually observe the procedure.
I'll probably write more as I reflect on it a bit more... general impression is that it's not hard to extrapolate that it could be a fairly distasteful procedure with a later-stage abortion.
I will say that it's kind
of funny to reflect that participation and or training in elective abortion
was a hot topic in medical school interviews. I remember a handful of religious-affiliated
schools going out of their way to emphasize that such an experience was
absolutely not taught to medical students. It's kind of funny in that such
a big deal was made of it, yet after being in medical school, I find it
difficult to believe that such experiences could be anything but uncommon.
First, many teaching hospitals are religious-affiliated and do not condone
the procedure. Second, although I've never had reason to, it's never seemed
difficult to opt out of participating in procedures due to religious beliefs.
June 15, 2004
Foul Mood:
I've been in kind of a bad
mood lately. Even with the great time I had in Columbus... I think the
anticipation of heading back to CA for 4+ months this coming academic year
is kind of heightening my impatience with everything... tired of OB/GYN...
tired of exams... tired of Toledo... BLEAH. Little things like not finding
anyone to head up to the Movement Festival in Detroit over Memorial Day
weekend and having to drive 2 hours to watch that Euro 2004 game just kind
of add up to remind me of how difficult it's been for me to make any sort
of 'home' out of Toledo... plus, just have this general feeling that I'm
kind of just biding/killing my time here until next June... After 4 years,
I'm really really ready just to move somewhere new and get a fresh start...
even if it's still somewhere in the midwest... just as long as it's not
here... ugg. Well, must be my time of month or something. blah.
btw, Men's Health Magazine
grades Toledo: Stress -- F. Sex -- D.
June 13, 2004
Gerrard Gaffe, England
Disaster:
Eriksson understatement
-- "'Our players did an excellent job, hhopefully it will not be too difficult
to lift them. If I played it again I would not do anything different but
the last three minutes what can you do? Put the ball into the stands
I suppose."
UGG!!! England loses to France 1-2 in extra time via two Zidane goals in a span of three minutes. Unbelievable.
Why does this keep on happening to me? First the Southampton equalizer in extra time at the Fulham match I was at last year in England... now this... ARGH.
Other than the last three
minutes, the game was a blast. Fado
Irish Pub in Columbus (notably, where the US
beat Grenada 3-0 in their first World Cup qualifier match). Packed
with transplanted, many drunk, Brits. Lots of singing. Laughing
at the couple France supporters (up until the end, at least). Had
draught Boddington's and Newcastle. Ate chips with curry. If
England advances (two
more prelim matches vs Croatia and Switzerland), I'll be making more
trips to Columbus with the semis
to the final match falling during my week off.
Sermon Message Sound-Bite:Living according to your needs, and not relative to your means.
Made use of my two hour drive down to Columbus by listening to some message tapes. This particular message didn't really cover anything I already knew, but it gave me pause for introspection.
I've realized that over the last few years, I've been fortunate to have received some unexpected generosity from my father at the same time that a certain financial liability disappeared from my expenses.... More significantly, I've been able to be almost completely selfish with my money... Which is in stark contrast to my post-college life between roughly 1999-2001, during which I lived a very spartan lifestyle due to this financial liability. For example, I think in the last two years I've tripled to quadrupled the # of pairs of shoes I have. Easily quadrupled, at least, the # of pants. Kind of stunning to think about it, actually. I have certainly benefited from and enjoyed this financial freedom... including a lot of personal growth from my multiple travel excursions all across the country and world...
However, reflecting on this,
I realize that when I start getting paychecks (and more obviously whenever
I have a new relationship), I'm going to have to reevaluate how I spend
and invest my money... and come up with some new balance between
my evolving lifestyle expectations and whatever long-term goals/objectives
I value... ie supporting missionaries? wedding fund? more world
travel?... which means if I think about this seriously, I've got
to figure out what kind of new car I can buy with a clean conscience...
man, I really want that turbo-charged Mini/Audi A4...
June 11, 2004
Delivered my first...:
Placenta today. That
was pretty easy... probably more fun than it should have been... only because
all I do during deliveries is adjust the lighting, hand off instruments
to the doc/midwife, and transfer sampled umbilical cord blood into a plastic
specimen container. yay. Was going out of my mind today because
I stood around for two hours waiting for this kid to give birth... what
a waste of time. Only stuck around for a while 'cause my doc expected
me to, but got sick of it after two hours and finally hinted to the midwife
enough that I needed to go home to study. Just sick of this standing-around
and observing thing -- it's only useful for the first couple times... becomes
a waste of time pretty quickly... kinda lame what some of my tuition money
goes to...
Should not be allowed
to be pregnant:
Whiny, obese 16-year-olds.
No offense to the pregnant... or obese... or teenagers... but, a BAD BAD
combination. sooooo whiny. less than zero pain tolerance.
complain before anything actually happens... I thought I was going to lose
it watching this...
Pet Peeves:
I actually lost it due to
something else... during communion last sunday. Was on a short pew
with two other people. This woman was fidgeting -- swinging her leg
nearly the entire service... so much that it SHOOK the pew... I couldn't
stand it. I couldn't concentrate. I felt like leaning over
and saying, "I don't mean to bother you, but can you please stop fidgeting?
I think I'm going to vomit." Luckily, self-restraint prevailed again...
So, after I got my wafer, I moved... Look, I know I'm a bit anal
about fidgeting (something programed into me by my parents), but please...
there are very inappropriate times to fidget... like when
people are trying to meditate on Christ's redemptive sacrifice, it's not
cool to be inducing nausea...
Representative Adam:
Another drawback of working
in an all-female office is that I am inevitably the representative Adam.
ie whenever someone b****es about their husband or a man in general, it
get directed to me in forms like "Are you listening?"... "Taking notes?"...
"Do you realize that we will help make your life a living hell if we find
out you do this to your wife?" (last one paraphrased)....
Psych SHELF:
Raw score = 84. Percentile
= 90%.
HEY... finally did
well on one... good grief. Well, as long as I got decent evals, I
should get Honors... which means, I'll be PISSED if I got bad evals...
hey, come to think of it -- this would be the first grade of Honors I'll
have gotten in med school... which means I'll be REALLY PISSED if I don't
get it...
Beat the Froggies:
EURO
2004 starts this weekend. I'm headed down to Columbus (yes, 2
hours' drive each way) to watch the England-France
prelim match on Sunday in an Irish pub with a lot of drunk, transplanted
Brits, singing songs... whoohoo! Actually, this is may be the funnest
thing I do between my friend's visit two months ago and when I go back
to CA.
On my way...:
LA sublet -- check.
Oakland sublet -- check.
Plane ticket -- check (flying
into/out of SD July 18-Sept 23).
Car -- still working on
it........
June 5, 2004
"Will you not revive us again,
that your people may rejoice in you?"
Psalm 85:6
Obituary: Ronald
Reagan
Quite a legacy.
Priorities:
We had a patient this past
week whose mother wanted the labor and delivery induced because if it wasn't,
she may miss out of the birth of her grandchild because she is leaving
on a trip... to Las Vegas... Right. Well, I guess the
bringing of new life into the world and welcoming of new family
members gets kind of dull after a while... and, hey... Vegas,
baby, Vegas...
Asian American Christians,
Responsibility and Shame in Relationships:
So this thought has developed
through a number of conversations over the last several months. In
Christian relationships, I think the male partner, assuming that he takes
the admonishments of Scripture seriously enough, feels a particularly strong
reponsibility for the well-being of his significant other. This responsibility
is not based on some inherent weakness in self-sufficiency, worth, or character
of a woman, but instead, is based on a divine plan and a loving stewardship
of a tangible gift/grace from God. This godly charge, augmented by
certain patriarchal Asian cultural values, is taken seriously and somberly.
Thus, not only do decisions and actions affecting their s.o.'s and families
carry a heavy weight, but real and perceived failures produce an
even heavier shame and guilt.
For Christian men who've already bought into this idea (there is a whole discussion about Christian men who don't, but we won't talk about that here), I think some common problems are 1) actuating this charge in an ego-centric instead of a s.o.- and God-centric manner, and 2) not allowing the perceived gravity of significant decisions and actions (good or bad) to paralyze themselves or their relationships.
For Christian women, from experience and observation, although I think this is an easy enough concept to know and see Scriptural basis for and even (at least superficially) support, I think women generally have difficulty having a full understanding and appreciation of this glad burden of Christian men. I think this, coupled with the inevitable mistakes that men make in this area, can easily lead to misunderstanding of the intentions of their s.o.'s, causing unnecessary, bilateral resentment and conflict.
Ah... what a headache.
June 4, 2004
WELL...:
Including last weekend,
this was an eventful week. I can't recall the last time I was being
driven to prayer so much in such a short amount of time... oh boy...
Tiananmen Square Massacre
15th
Anniversary:
Today.
Graduation:
Went to graduation
today, to give my congrats to all my buds... soon (or already) departed
from this barren land...
What I learned today:
1) Graduate graduation
is just as boring as undergraduate graduation.
2) Since I'm going
to be a dual-degree person, I may be leading the procession down (a MD/MS
did this year)... plus, I'll get introduced completely separately.
Whee! I like being special... although I won't have anyone to chat
with, really...
3) Even with a once-in-a-lifetime
event, I'm still not a camera-person. Brought my digital cam,
and met up with everyone I meant to, but still didn't get any pics
of anyone with my cam... have to hunt down some copies from people later...
oh well.
4) In one year I will
be Doctor Derrick for the rest of my life. cool.
5) I covet
the emergency medicine award. I don't think I'll get it, though.
6) I thought I might
get an additional stripe or something on my hood with my MPH, but I don't...
in fact, nobody with a master's got anything but some generic thing...
7) Overall, it was
good to see a lot of old friends off. Even to give my congrats and
wish luck to my ex-apartmentmate, with whom I had a disagreeable living
arrangement... Since I probably won't keep in touch with most of them (besides
a couple-few + fantasy football), so kind of nice to have a bit of closure,
albeit brief, with these people... still a bit weird, though, that they're
all moving on, and I'm stuck in school another year... But, not too
sad, since I've seen less and less of them over the past year...
Catty Women:
The office is Tiffin is
kind of scary. Lots of catty women scheming against each other.
Lots of whispering and slandering... I'm trying to stay out of it,
but inevitably I'm being used as an unsuspecting catalyst to irritate specific
people... example, apparently, one woman's pet peeve is the load paper-shredder
while she's on the phone. I didn't realize this, and while shredding
some stuff while this woman was on the phone, another woman in the office
used the opportunity to shred a bunch of stuff. Err... it's kind
of uncomfortable. Hard not to make certain generalizations about
women.... ugg.
Stupid White Kid:
Some stupid white kid in
my apartment complex in Tiffin, called me "Kawasaki" or something a couple
times... I tried to lead him to self-realizing his idiocy, but I think
he was too dense to figure that out (ie dumb smile + "huh?")... too
bad it's not appropriate to kick his a**.... if he does it again,
I think I'll be more blunt.
Sort Out the Propaganda:
Featured on the McNeil/Lehrer
News Hour a couple nights ago, factcheck.org
seems like a pretty reputable website that sorts out a lot of the claims
on campaign tv commercials. Since Ohio is one of the critical states
in the upcoming elections, we've had commercials for a couple months now...
May 30, 2004
There have been some strange
and very sad turn of events over the past week involving people I know...
although none involve me directly, they do affect me indirectly.
I'm not quite sure if any of it is appropriate for blogging... so as things
continue to progress, and I try to make sense of these events and my complex
feelings in response to them, hopefully I will be able to publicly share
something meaningful in the near future.
May 29, 2004
Life's Calling?:
One fair criticism that
the aforementioned surgeon gave during his little lecture -- basically,
that ER docs skirt (if not totally cop-out from) the essence of the patient-physician
relationship in the profession of medicine. Eg shift work,
no long-term or continued care, minimized patient-physician relationship.
People go as far as equating emergency med with other "NPC" (non-patient
care) fields as pathology, dermatology, anesthesiology, etc...
I can appreciate this omission from emergency medicine. To a significant degree, I do have a sort of high idealism and romanticism of the profession of medicine. And, in that, I'm even drawn to the personal, life-long sacrifice that epidomizes the profession -- a commitment of one's whole person to, not a job or career, but being a physician. In what other job is the professional expected to drop everything at a moment's notice for the needs, objective or subjective, of their clients? Personally, some of the appeal of being on a DMAT team in the future is due to this aspect.
However, as I get older and progress further through the medicine track, I am realizing that my tolerance threshold for bearing a cost (personal, economic, etc), is dropping rapidly. I think about career options that might be more 'acceptable' to people like that ortho doc -- cardiology, sub-specialty surgery -- and I realize that I don't want to bear the cost of having a career in such fields. The cost of time -- years of added training (5 total for cardio, 7 for something like vascular surgery vs 3-4 for EM)). The economic cost -- continuing to be poor, making a residdent's salary for those extra years. The personal cost -- busting my a** for more years. The diminished rewards -- getting into cardiology or any surgical subspeciality is no lock, by far. The happiness cost -- being stuck for 3-5 years doing work that I do not enjoy just to possibly get into what I really want to do.
I think, perhaps if I was a couple years younger or had a distinct calling to long-term medical missions, I might have been willing to bear these costs... but, after so much sacrifice just to get to this point already, I think I'm unwilling to do so now. I'm unwilling to postpone the monetary, personal, and career rewards that med school promises much longer. Why should I?... if I'll be able to enjoy my work next year?... if I'll have easier access to 'more respected' fields, if I choose to do so, like academics or toxicology?... if I don't have to postpone and make more difficult a real end to my financial debt?... if I don't have to give up having a life until my mid-thirties?...
I don't think that I fit into this generation's 'lazy and selfish' med students... in fact, I'd get pretty damn pissed if anyone were to connote such... but if I must be, for being realistic and honest about my personal goals and ambitions, I guess you can lump me into that group.
Medical Acronym of the
Day:
T. F. BuNDY = Totally
F*****, But Not Dead Yet
British Beer in Tiffin:
I forgot to mention that
one good thing about Tiffin is that there's a really neat, little home/kitchen
appliance store called Ralph's that has a pretty decent selection of wines
and import beers. Really friendly people. I ended up chatting
with the unofficial beer-person of the store, and took some of her recommendations
for beers. This woman was more knowledgable about import and micro-brew
beers than the few people I've talked to in Toledo. I left the store
with a six-pack of John Courage Amber (haven't seen it at the Anderson's
or Joseph's in Toledo), and two Belgian beers that I can't recall off the
top of my head. So, I actually violated my no-drinking-alone policy
to have a John Courage last week... oh well. ha ha Anyways,
a pretty good English ale... had some draught in San Jose's Britannia Arms,
actually... think I still like the Scottish ales better (eg McEwan's and
Tennant's) and Fuller's... This Ralph's place also has cooking classes,
but their next series doesn't start until when I'm nearly finished with
my time there... oh well. that would have passed the time there nicely.
Making a Migrant Worker
Laugh:
My doc sees a number of
migrant workers at his practice in Tiffin. It's pretty embarrassing
for me to try to speak Spanish... even though I've just had a year of JC-level
Spanish, it's actually plenty sufficient to communicate basic commands
and questions during a history and physical. But, since I have so
few opportunities to practice in Northwest Ohio, it's really a struggle
just to come up with basic sentences that are not only correct, but are
pronounced in a proper and intelligible manner. With one patient
and her bilingual relative, I was explaining my embarrassment at not only
my terrible vocabulary -- I had gotten a couple quisical looks at things
I tried saying -- but my even more ridiculous American accent... so I said...
"Um, how do I want to say this?... uh... Hablo como los gringos."... that
got a pretty hearty laugh from the two of them. =)
May 28, 2004
Movies:
Just rented a couple of
Sundance Festival films... All the Real Girls and Dopamine.
Just watched All the Real Girls, and I have to think about it a
little more, so all I'll say about it right now is that I liked it and
identified with parts of it. Also, my most-true-blooded-of-hockey-friends
didn't like Miracle at all. Oh well, I guess I'm a sucker
for melodrama sometimes... ugg.
Medical Liability Crisis:
The American Medical Association
recently put together a couple of pages on its website that provides interesting
anecdotes and plenty of information regarding the medical liability crisis.
It has a cute,
interactive map -- is your state in crisis? I can say
that from my conversations with docs around Northwest Ohio, I can validate
a handful of those anecdotes under the Ohio section by second-hand confirmation.
Career Advice:
As a prelude to a series
of personal anecdotes, I was told recently by an Orthopedic Surgeon, "I
haven't met an ER doc yet that knew jack-sh**."
Apparently, I will be getting an unsolicited lecture on pre-nups soon.
Circumcision:
Well, after being subjected
to watching an ungodly number of circumcisions this week (I don't get why
my doc wants me to hang around and watch every single time, ugg)...
I figured that I might as well revisit my thoughts of the subject (See
Peds
9/12 entry)...
One thought was that maybe
moms should have to personally help, or at least witness their infant's
circumcision to justify the surgery (mutliation?). But that argument
falls through pretty quickly. Personal experience is not a necessary
requisite for the validation of advice or action. For example,
as a physician, I'll perform or order plenty of painful, therapeutic procedures
that I myself will have never experienced