Saturday, November 18, 2017

Lynch Park, Terry Porter and the Commute Encumbered by Civic Dispute Long Since Forgotten

Lynch Park, which was an elementary school in South East Portland, on 148th right between SE Division and SE Powell, or, otherwise known as State Highway 26. I am an alum of Lynch Park, (a Jaguar for life) having spent my years of kindergarten through third grade learning how to be the best Jaguar I could be. Our gym did multiple duties; cafeteria, assemblies, whatever. But I remember Terry Porter, #30 of the Portland Trail Blazers, who grew up in Milwaukee Wisconsin, and had an impressive NBA career by way of University of Wisconsin Stevens Point, standing on what was our half court line and draining jump shots as he chatted with our principal, or someone. That memory stuck with me, thinking that he was launching them from half court with ease, draining them. Some years later I happened to be in that building, but it was now a Montessori school but that half gym half cafeteria still had the hoops on either end and the mid court line. The line was closer to the rim than an NBA three point shot on goal. I had not enough experience, as a 3rd grader, to realize that the gym at school was but a fraction of the size of the court this man played on, while I watched him on television. A lesson exists here.

Back to the streets of Division and Powell, both of which originate close to the Willamette River, which is the delineating factor between East and West Portland. The Willamette is the 2nd largest northward flowing river in the entire world. The topmost being the River Nile. These two roads are not even a mile apart and they go eastward, through Gresham. Division eventually fades into another road that heads into the Oxbow area of the Sandy River. Powell continues as Highway 26 and goes through Sandy all the way up Mt Hood to Government Camp and then on into Eastern Oregon. There is a curious thing about these roads, though, in that Powell, all the way until just past SE 92nd, is a 4 or 6 lane major traffic arterial throughway, where it turns into a 2 lane road for many miles. Conversely, Division boasts neighborhoods along inner Southeast Portland, with some of the best Portland has to offer in terms of eating, drinking and shopping. But a major traffic conduit it is not. Two lanes as it passes by Mt Tabor, the extinct volcanic vent, and then all the way until just past SE 82nd avenue until it becomes a 4 to 6 lane major east west channel of traffic. Weird, huh? I think the City and the County had differing ideas of which one would best serve traffic needs. I'd be willing to bet that the reason for our discongrous east west traffic flow patterns in Southeast Portland and East Multnomah County is planners on either side simply could not compromise and just to spite each other, they purposefully left it like this. Maybe it was ODOT as Powell is a State Highway, after all. I don't know.

Back to Terry Porter. I remember a kid on the middle school football team -- now I was a proud Cougar at Centennial Middle School, his name escapes me. A little further east than Lynch Park, now I was pushing up against SE 182nd and we could see this road from the football field -- and we were still between Powell and Division. Regardless, this kid had branded himself with a large "TP" on one of his shoulders. It looked infected -- even middle school me could tell that. We all knew "TP" stood for "Tracy Packard," and yes the name is changed to protect the creeped out, but the initials are the same. He told us it stood for "Terry Porter." I remember all of us laughing until we were sick; he stuck to his story though. Maybe a tattoo covers that homage to Terry Porter, or maybe a shark took the arm. Barring something like that, undoubtedly the "TP" lives on.



This is Terry Porter. Do you see the two scars on his right upper arm? One lateral, wide scar roughly mid-bicep and the other at an angle on his anterior deltoid. I can't tell if the bicep one is actually a tattoo or not. Blazer games radio broadcast was on 1190 KEX, and after the post-game show there was a call in show called "The Fifth Quarter." Often home games were aired from a Tony Roma's rib place a couple of blocks from the Memorial Coliseum. I never called in. I always wanted to call in and ask about the origins of the scars. I never did.

I guess in some way all these things are connected in my mind, with swirling explanations of why and murky questions related to why we hold on to these moments. Of course if we are anything, as humans, we are at the bare minimum, with all dogma, philosophy and religion accounted for, a simple collection of experiences that  shape us and inform us, or, the 'id' -- if you will, meaning that all of us have moments along our journey that imprint on our brains and become a physical form, in our brain, there to stay until wormfood we become.

Sunday, November 12, 2017

Of Quartz It Is Hard Not To Take It For Granite

I've never been mistaken for a nurse. Even when I was in undergrad, working weekends in the emergency department, in a non-clinical capacity (granted, I did wear scrubs and carry a computer or clipboard) I was mistaken for a doctor more times than I can count. Not once did I enter the room and have a patient tell the other end of a telephone conversation that 'the nurse is here, I gotta go." But dozens of times in the span of a year or so, I had them say 'the doctor is here, I gotta go." These days i walk into a room, and they correctly assume I am a doctor. 

When I have patients refer to my colleagues, including medical students, as nurses -- it is always based on their gender. I've seen responses that are highly varied, and I respect them all. But now, I can't help but step in and politely point out the fact that this is actually doctor so and so, or medical student blah blah blah. If nothing else, the patient should be aware of who and in what capacity a caregiver fulfills. At best, they might be reminded that women are actual human beings, capable of operating at the absolute top of any given professional capacity. 

I've never been accused of being a frail, small and incapable man. Tallish at 6'1", big boned with plenty of musculature left over from the days when I would treat myself well enough to actually exercise on a regular basis. I've had very few patients try and physically intimidate me. Furthermore, I've been in a handful of sticky situations in my life, with real bodily harm being a succinct possibility and those were scary places to be. A situation in which a CHF exacerbation patient who can't walk to the bathroom without dyspnea who tries to stand up and intimidate my colleague, who, of course, is female by standing up and raising his voice and trying to tower over her, can be intense, but scary? No way. 

I feel very protective of the people I work with; I think we are all protective of each other. This current climate of men of power being called out for abusing their influence and stature for sexual gratification, exploitation and dominance seems like a healthy cultural purge. If anything, for me, it acts to highlight disparities and conveniences I am prone to take for granted.  I wish to give a shout out to the doctors who regularly do this job on hard mode. Simply for being a woman. 


Sunday, October 15, 2017

I See Crack

For the past few weeks I've been on a laborist service -- meaning I try to catch as many babies as I can. Here and there I see gynecological patients, as well. Saturdays I cross cover for general surgery, too. So far I've been in more cesarean section procedures than vaginal births. I enjoy C-sections; fast and horrific. It is one thing to remove an infected gallbladder or appendix, it is quite another to cut open a belly and pull a live, squirming person out.

Some people choose family medicine as it gives them opportunities with women's health and obstetrics in a way that no other specialty does. This is not me; and these components of medicine will most likely not play a large part in my eventual practice but nevertheless, it is important to consciously expend energy in areas where we feel less naturally motivated or competent.

This idea of focusing on weakness, as unpleasant as it can be, has been on my mind recently. Kind of one of those things where personal experience and the lessons thereof seem pertinent to society at large. This also ties into why I feel so dismayed and deeply disturbed with the current administration and the agenda that is put forth. A barrage of deceit, while composed of individually easily debunked lies, have an effect on a population -- which is first and foremost -- an attempt to normalize dishonesty. Does anyone actually believe the nonsense the 'commander-in-tweets' spews? Well, some people do, I would guess. Some people think the world is flat, too.  But for the rest of us who are rational, thoughtful citizens, it seems we've gone from amusement, to outrage and now have settled into a sense of acceptance that the constant barrage of propaganda and self-aggrandizement is just how our life is now.

And don't get me wrong, it is not as if we've had a government which has been completely forthcoming and honest in its communication before all of this. This is different though.

Furthermore, I am coming to the point where I am starting to believe that this is may be how the modern American Evangelical Christian sells its soul, as a whole, for lip service from the highest man in the land. It mirrors our society's march to come to value aesthetics, or "optics" over substance, or real tangible, proven value.

Grab 'em by the Pussy? We don't care as long as he makes it harder for women to receive health care.

Multiple divorces, affairs and marrying women much younger than he? We don't care as long as the 'gays' cannot get married.

Bankruptcy and a repeated history of financial fraud? We don't care as long as he cuts taxes for the rich and eliminates health services for the poor.

Referring to white supremacists as "fine people" and black NFL players as "sons of bitches?" We don't care as long as  blind patriotism and indiscriminate support for military spending is encouraged.

Private email servers used in this current administration? We don't care! Lock! Her! UP!

Frequent golf trips to his own properties and self-enrichment? We don't care -- as long as he doesn't look like Obama!

Attacking the 1st amendment? We don't care as long as he lets churches be active in politics and keep their non-taxable status.

Ensure environmental calamity in order to become further dependent on fossil fuels? Sure, as long as my price to 'fill-up' stays the same.

I sense that this ongoing and worsening dichotomy of hypocrisy and blatant power grabbing will push America, in the near-ish future, far from the weird form of American Evangelical Christianity that has taken hold during my lifetime. In many ways I mourn the death of an ideal, while simultaneously celebrating the hard truths that have surfaced. I recently read a long thought out post on Reddit about how Hollywood and the Harvey Weinstein situation is similar to how sexual abuse in the Catholic Church was so pervasive, for so long. I feel a similar analogy can be drawn to mainstream Evangelical Christianity in the United States.

Before I go further, I do feel compelled, even though I think it is obvious, that this is less an indictment on American Christians as a whole -- and more focused on those involved with politics, and those who seek power and money via Christianity. But there is something to be said about those who are complicit and who stay quiet. A few days ago, 45 said that "we are stopping cold the attack on Judeo-Christian values." In a vacuum, with no context, this must sound great to a Christian who lives in America. Unfortunately, I believe that we will be held accountable for knowing the source of such words, and what has been sacrificed in order to hear these words from our dear leader.

For those of you who say 'God can use evil men for good' I ask you how you approached this platitude during the previous administration. I fully believe some of you (us) do not, or at least, try not, to think in absolutes and realize people are dynamic and multifaceted. I try to remind myself of this in the current political climate.

A part of me that thinks we are being trolled on a level never seen before in modern history. Perhaps all of history. Is all of this an effort to dismantle the GOP and their ability to push emotional buttons to ensure that voters consistently vote against their own self-interest? That may be the best outcome from this whole circus show. Unfortunately, I can't say that I much like what is being pushed as a replacement -- fascists, white supremacists, misogynists, conspiracy wackos (and I say that  while at the same time acknowledging that some conspiracies do and have existed) and those who seek to divide on old, tired but powerful tropes. Can this deluge of ridiculous, flimsy propaganda from this administration be carefully crafted to shed light on the swarmy corners of Fox news and Fox news-like propaganda? I mean, it has become harder to believe as time goes, especially when calls to revoke licenses of critical media mouthpieces ratchet up in intensity. But then again, maybe I just don't have the same vision to see exactly how far we need to be pushed in order to be birthed from the womb of complacency.

All of this to give a word of encouragement to all of us, whether you agree with me or not. I implore you to be as self-critical as possible. To not ignore the plank in your own eye, as I am wont to do about the plank that dwells in my own eye. I say to you that unplugging from the television news (fake or not) is a healthy place to start. To venture out of your own comfortable space with aims to build bridges with those unlike you is invigorating and provides perspectives, thoughtfulness and helps in efforts to be slow to anger. I recognize the difficulty that modern culture presents to those who feel their heritage, or family values are being threatened. However, what is built on sand and not solid rock will not stand, and I believe that hypocrisy lives in the spaces between the shifting pieces of sand and acts to pull apart foundations, and can go as far as making ruins out of the most solid looking, stone solid foundations. I see the cracks.


Monday, October 9, 2017

Baby Even The Losers Get Lucky Sometimes

I pay very little attention to celebrity and the going-ons thereof -- I don't really understand the obsession. When a celebrity dies, and people have dramatic emotional reactions, I just don't identify in that they've not played a role in my life, with some exceptions, of course. A week ago Tom Petty died; that day was also the day after the terrorist attack in Las Vegas. I work in LA and many people here have connections to Las Vegas. Numerous people at the hospital had loved ones or friends at the event. Perhaps that is why when I heard the news on Monday afternoon I felt like it was a bigger blow than it might have been otherwise. Today, while driving around completing errands, I had the Tom Petty channel on Spotify playing. It got me thinking, Tom Petty has been a part of many different memories and pivotal points in my life. I'm sure you want to hear about some of them. Here we go.

I kinda think of Tom Petty, Rush and U2 as occupying the same area in my musical catalog, in that when I was a teenager, I loved these bands but it was not cool to be found listening to these bands. NOFX, Pennywise, Minor Threat and Black Flag were the cool bands that I "should" be listening to. I explicitly remember studying in the library in high school with my discman and some of the only other skaters in the school wanted to know what I was listening to and when I reluctantly told them I was listening to Tom Petty's Wildflowers I was looked at with scorn. I got over it, though. Even back then, while much more sensitive to what others thought of me, as is the understandable perils of being a teenager, I had a lot of individuality, for better and worse.

Back to Tom Petty and (sometimes) the Heartbreakers. I am old enough that as a child I was able to witness the MTV when they played music videos. My parents had cable and I remember MTV was channel 25, and in order to not get in trouble for watching MTV, I had to make sure when I turned the television off it was on a different channel, as to not alert them to my watching MTV. Sorry mom and dad -- what can I say, I want(ed) my MTV! 

Real quick side track here: I saw this video having kids listen to Led Zeppelin and reacting to it.  As a child I remember hearing songs that immediately struck me and had some kind of magic to them. Free Falling off of Full Moon Fever was one of them. Baba O'reilly by the Who is another.


This video was in heavy rotation in 1989. I was 10 years old and just getting to the point where skateboarding was becoming I was very fascinated with. The skateboarding in the above video is kind of a last hurrah for that classic 80's fashion, board shape and skateobarding sensibilities. Soon, neon and spandex would be replaced with ultra big pants and unimaginably tiny wheels. Vision Street Wear and Airwalk were out and World Industries, SMA and 101 were in. 

Around this time I remember an afternoon where I was at my friend Adam's house and he had a neighborhood friend a few doors down from him, I believe his name was Billy. Weird and random memory but for some reason this has always stuck with me -- we were at Billy's house, playing, whatever, and he had a CD of Full Moon Fever in his room. I remember looking at it and was just transfixed with the cover. 


In my early teen years, my week revolved around Tuesday night free skate night at SkateChurch, and every year they would have a sleep-over -- basically, from 6 at night to 6 in the morning, or something like that, the kids were locked in the basement where all the ramps, funboxes and such were and we skated until the wee hours of the morning. My mom picked me up going home and I distinctly remember lying on my bed trying to go to sleep but the excitement of the previous night, and all the tricks we learned and saw others pull off ringing in my head and on the radio was Last Dance With MaryJane. It was 1993.


This song was released as a new song on a Greatest Hits album. I listened the shit out of that album, or, is it, I listened to the shit out of that album? Either way, I also remember driving with my friend David and his older brother Josh as we left what was the called the "Youth Rally" and was held in the mountains of Idaho every year at the end of summer. We would start the 10 hour drive home on Labor Day morning and I remember settling into the drive with this album in the CD player -- it may have been a cassette player, I don't know.

This song was released in 1994, on the Wildflowers Album, which, like Full Moon Fever, was a Tom Petty solo album.


And while I probably appreciated this song when it came out, as I definitely had this album on CD (I miss those rainy afternoons dedicated to perusing the local music shops -- Music Millennium, Everyday Music and 2nd Avenue Records -- I mean I still could go to music stores, but I haven't used a CD in over 10 years!) but it was in my early 20's when I found it and felt the sappiness and melodramatic nature appropriate to help me move on from a certain woman. This song, along with Neil Young's After The Gold Rush, and any post-breakup sentimental fool can really start to feel sorry for themselves with earnest.

I have my favorites for long drives, when I feel like I could fall asleep and I need some "sing-along" music and Tom Petty is always a favorite. I also think that some of his videos are truly works of art -- and reviewing some of them while writing this further reinforces that. Some of my favorites are below.
The end of this song is so brilliant. Slog through a few minutes of heavy synthesizer, drum machine and weird vocalizations pay off with the ending which holds my favorite Petty moment, where he goes, "EHHH eeehhh EEEH HEEEH e EHHHE." Unfortunately on the video above the last part of the song fades out and you can hardly hear the 'Ehh Ehhe' thing, but, yeah, I love that last part of that song. 


"Runn'n Down a Dream" has an animated Tom Petty in another weird but impressive video.


"Learning To Fly" is still an interesting video, and one that I don't really remember from my clandestine MTV watching days. The song, however, is one of my favorites -- simple, and cautiously optimistic -- kind of like me, I guess.

"Learning To Fly"

Well I started out down a dirty road
Started out all alone
And the sun went down as I crossed the hill
And the town lit up, and the world got still

I'm learning to fly, but I ain't got wings
Coming down is the hardest thing

Well the good ol' days may not return
And the rocks might melt and the sea may burn

Well some say life will beat your down
Break your heart, and steal your crown
So I've started out for God knows where
I guess I'll know when I get there


RIP in Tom Petty -- you're death actually touched me and this time around, it is an appropriate emotional response, in that your music played a such a longstanding role in my life. Earlier this week I pronounced a patient dead and within that hour was pulling a baby into the world, screaming and squirming, as if it knew what life was about and wanted to go back to the safety of the womb. The cycle of life continues and getting old is not for the young, but once in awhile we have to pause and recognize the innate frailty of being human and that none of us get out of this life alive.




Sunday, September 24, 2017

This is the Water, and this is the Well. Drink full, and Descend. The Horse is the White of the Eyes and Dark Within

I didn't watch Twin Peaks when it was initially on broadcast television. But for the last, oh, maybe 20 years I've been waiting to see Laura Palmer again. And true to her, and by extension, David Lynch's word, she came back. As did Agent Cooper with many of the old characters and plenty of enjoyable new ones. Plenty has been written about Twin Peaks and never so much as now, with (what seems like) the conclusion to the series finished and available for consumption. 



And I stand not as a Twin Peaks authority; I am relatively a neophyte compared to many of those who count themselves as David Lynch aficionados. Similarly to how I feel about music, in that I've never tried to make it, is cinematography and filmmaking. Skateboarding inherently has video cameras involved, but a Sony DCR-VX1000 and some skater friends do not a cinematographer make. So, there is one small aspect I wish to focus on. The scene which takes us into the heart of the first nuclear detonation at White Sands, Nevada in 1945. This is a well thought out blog by someone who describes the "most Lynchian scenes" in the newer episodes -- scroll down to read about the nuclear explosion scene. 



This transfixing yet strangely disturbing journey towards and into the heart of the explosion is really something. Truly, the idea of pulling asunder the very building blocks of matter, of the Universe as we know it, is an act which even in the minds of modern rational humans engenders and promotes the wonder of the unknown. A feeling that, just maybe, what we are doing is wrong. This scene implies that the BOB, one of the evil characters in the movie is born, or perhaps he gains access through this window created by the tearing apart of the atom. After a few minutes of the string section of some strong fingered musicians, we enter what we presume is the middle, or heart of the explosion, or perhaps what is serves as a glimpse to another place, dimension, time, existence, whatever. 



This episode is the only one that goes back in time, as a flashback. Most of the episode is in 1945. It feels important in the grand scheme of the Twin Peaks Universe, and while much of David Lynch is being weird for weird's sake, his art persists and has relevance because of a grand vision, or message that comes through. Of course we've seen nuclear accidents, or radiation exposure play prominent roles in much of pop culture. Spiderman, Radioactive Man, and of course, Gozilla are good examples. He serves to add to this by incorporating it into this world of Laura Palmer's. 

J Robert Oppenheimer, the scientific lead of the Manhattan Project had this to say about how he, and the crowd reacted to seeing the Trinity test come to a successful explosion in White Sands, New Mexico in 1945:



The men who knew most about what scale of destructive potential exists in this technology were vocal against using it against other human beings. Men of war who witnessed the explosion thought very much the same words as Oppenheimer uttered, yet I imagine they had an evil gleam in their eye and a sinister grin on their face. 

I grew up in a relatively isolated culture that, at times, verged into celebratory apocalyptic teachings. I remember the first Gulf War, I was in 8th grade. I remember a preacher, a fiery and entertaining (again, this is all relative and "fiery and entertaining" for our church meant he might wave his arms or tell an interesting anecdote from the pulpit) guy who proclaimed that Jesus was coming back within the year, and that we were witnessing, via Cable Television, the unfolding of Armageddon as Evangelical Christians of the Hal Lindsey (The Late Great Planet Earth book was everywhere when I was growing up and made me really sad) and "Left Behind" theology understand it. I remember that Sunday morning -- I was in the balcony of the church on Mitchell Street, in Southeast Portland. My Dad ran the sound system -- a Sun sound board that had a ton of cool knobs, switches and lights I wasn't  allowed to touch. The preacher told me that life was going to end before my teenage years had really started. Before I kissed a girl, drove a car or dunked a basketball (still waiting for that one -- I dunked a volleyball on a 10' rim oh so many years ago) it was going to be all over. I took that to heart. Maybe some other people in the congregation took it with a grain of salt, maybe some were ready for the pain and rigors of their well lived lives to be over. Maybe some others took it like I did -- there was little time to have fun, to experience what life had to offer and living for the now and preparing for a healthy, well balanced long-lived life was no longer an option. I still fight this. 

This, mixed with the constant background baseline anxiety secondary to being "left behind" provided for some unhealthy formative years.  Sure, I was saved, and I was told that I would now be a part of the lucky few to be zapped out of this existence right into heaven, and into my new body. But what if I forgot to ask forgiveness that night prior? What if my Mom and Dad and all my cousins were zapped without me? I would be left to navigate a world bent on not only torturing me in this life, but ensuring my eternal damnation to boot! This was a problem for me in 1990. I was 12 years old. 

And what if the Ruskies dropped a nuclear bomb on my head while I was sleeping and I had forgotten to ask forgiveness for a particular transgression the day prior? That is like getting zapped right to hell. The instantaneous nature of the rapture and nuclear annihilation, in my young mind, lent credibility to both. In 4th grade I remember a play we watched as a class about Hiroshima, and I remember envisioning what that must have been like, to be reduced to ash blown in the wind in the briefest of imaginable moments-- the only tangible reminder being the shadow you left on the side of the building when the bomb went off. 

Now, we have a world stage that looks like a sinister blackface Vaudevillian act has merged with an avant garde puppet show rendition of Othello and it seems like nuclear destruction as a real problem for people on this planet is back on the menu! Last night there was a rocket with a confidential payload that took off from Vandenburg military base and went roughly due west out over the ocean. Well, I didn't see it but browsing reddit before I fell asleep there were many posts asking what that was. Before I read the answer (with a very small but nevertheless real sense of relief) you can't help but wonder if we shot down a missile, or if we're sending a Cruise Missile at a ship, or submarine, or who knows what. Maybe a return ICBM for an attack somewhere else in the nation. I'm not sure if that would have been my first thought 3 or 4 years ago. This speaks for itself. 

As kind of an aside, I thought it would be fun to see this clip from the 44th President's first year. Just, just -- I can only say that I get a twinge of PTSD listening to this. For those who don't watch embedded videos (me included but it seems so fun and dynamic while writing a post) you can learn how we will all be microchipped by 2017, how Obama is clearly fitting all the requirements of being the antichrist, and how a move to dictatorial rule was underway. All backed up by multiple scripture citations every other sentence.  




Anyway, somebody smarter than I said something along the lines of: art is more important than ever, as it evokes emotion and strikes at what it means to be human in an increasingly inhumane and mechanistic, practical world being carved for consumption by the bleeding edge of the razor sharp bottom line. We hear the countdown at the beginning of the clip from 1946 in New Mexico. The camera accelerates towards the burgeoning explosion that came from the 30 foot tall steel platform not far from the McDonald Farm in New Mexico, and from which was suspended "The Gadget." We enter the hot gas cloud still accompanied by the high pitched shrill of the music. It feels intense. It is designed for anxiousness. It succeeds. I felt like I was back in the pew that Sunday morning, a Sunday morning that is roughly 1458 weeks ago, yet still stands as a pivotal moment in my life. And for that I thank you David Lynch. 

Wednesday, September 20, 2017

A Resident Should Get Student Discounts, Right?

A lot of emphasis is put on the team aspects of modern medicine and in some circles, this is viewed as a negative aspect, or more precisely, an encroachment on the (often) paternal and blanket authoritarian rule of law. Different environments have varying degrees of teamwork and each individual physician, in any given clinical scenario has a sizeable impact on the "temperature" of the room. Over time, with relationships built, and with a trust between people, people who work well with people will enjoy a healthy workplace community, in general.

As a medical student, there is not enough time to let time naturally build relationships and trust, and the astute and emotionally competent ones set out to get to know the people they will rely on to do their 'job' which is being a physician-in-training. Of course, by the time the support staff knows your name, it is time to go to the next rotation.

In politics, and popular culture at large one often hears about 'the movement of the goal posts,' which in this slickly packaged reference to our now non-intentional post-modern society of fluid truth and it  stands as the short-sighted idol to the evil of a progressive and self-critical society. In reference to the life of a medical student in their clinical years, it is much simpler with, usually, a more myopic gestalt, at least in day to day operation. Each physician I've worked with over the years has certain things they uniquely incorporate into their daily practice -- which stems from the interpretation and utilization of the collective experience, this is how training works. Sometimes it may be just a different way of questioning, or perhaps idiosyncrasies in bedside manner and communication, and of course all this when incorporated with the art of clinical practice it can be summarized as the exclusive approach to the art of medicine. Each hospital has their own culture, and within that setting the residents, attendings and of course, each Graduate Medical Education office has their own requirements and needs, too.

Medical students are often seeing things that we've seen many times over, for the first time. Knowledge is compartmentalized and a big-picture perspective is yet to grow. However, the third year students, who are all fresh off of taking the first round of board exams, have the largest working knowledge of esoteric and abstract facts and mechanisms. Stuff that I used to obsess over while studying for step/level I now seems like a fuzzy memory. It is good to remember the foundations of pathophysiology and I appreciate the students for this.

If life has taught me anything, and as a dedicated life-long learner, I enjoy trying to soak up lessons and experiences that are, at times, uncomfortable -- I can boil it down to two maxims, which are generally true some of the time, it is this:
  1.  NO GOOD DEED GOES UNPUNISHED When doing the right thing, or when doing something nice or considerate for others, expect to pay a price. You can make a clear choice when acknowledging this as general law of the Universe
  1. BETTER TO REMAIN SILENT AND THOUGHT A FOOL, THAN TO SPEAK UP AND REMOVE ALL DOUBT This is definitely true in medicine. In front of patients, support staff and colleagues, it is imperative that one chooses their words carefully and thoughtfully. In some ways it could be described as 'defensive speaking,' akin to 'defensive driving.'
Obviously I did not come up with these well-used cliches, but I do recognize their utility. And, as far as being a med student is concerned, the second one should rule one's conduct throughout the clinical training years. Knowing when to ask questions and perhaps, more importantly, the difference between asking a question versus having a question and making a note to look something up, or asking later is a skill that can make or break a rotation. 

I've not been in the military and nor do I have a lot of first, or even second hand knowledge of what being in the armed forces is like. However, medicine has a defined hierarchy and properly navigating the power structure demands adaptive behavior. Of course, when you are moving from one distinct environment to another on a regular basis just as med students do, it can take a toll on those who cannot adapt and who are not adept at "reading the room." Like all professional relationships, success doesn't necessarily come with all parties understanding the expectations of their role but I assure you that if even one party has an issue with understanding or failing to live up to the expectations set forth, failure is forthcoming. And that is the key -- expectations set forth. Often the most important expectations of a role are the ones that go unsaid. How unfair! Not only are the goal posts in motion, but you can't even see the goal posts! Once again, when humans are involved, communication is key.

So, as the interview season heats up for residency and the match process, I tip my hat to those catching the red-eye that they booked on their other credit card, the one that's not maxed out, just to get back to their rotation and catch hell for taking a couple of days off. Just know that you won't be wearing the Ice Cream Man coat forever.









Saturday, September 9, 2017

The Laws of Nature Abides No California Stops

A patient the other day asked me at the end of her visit what I liked best about being a doctor. The question caught me off guard, mostly because we were talking about mother-in-law dynamics and how she was glad to have a good relationship with her daughter's husband. I said something about a mandate for life-long learning and building relationships, whatever. Yeah, that is all true. But I've been slowly grinding on that question for a few days and on a day off may have identified, specifically what I like best.

Last week I went to a drug rep dinner (maybe the best one I've been to, with a charismatic speaker and valuable information no less) but, no, while as a resident these dinners are appreciated, they are not my favorite aspect of being a doctor.

The trust that people have in me, is something that I never take lightly and while I couldn't be a physician without this dynamic I couldn't do that as well without the doing this -- Active Self-Criticism.

I'm not criticising myself to make myself feel bad (sometimes it feels bad) but to change my behavior and grow my "toolbox" in order to be a better physician -- with increasing ability to develop my judgement and efficiency in managing interventions, medications, evaluations, and communication with patients -- with an emphasis on effective two way communication.

This is a difficult thing to do, it is tiring. In medicine we are taught, in class and ultimately by taking care of patients, that "anchoring" is dangerou and needs to be actively guarded against. Very simply, anchoring is latching onto an initial diagnosis or impression despite new or changing data that indicates otherwise. On a complete side-note, I go back and forth on my feelings of using italics, or (God forbid) all caps to emphasize any point I try to make. I rarely send text messages with more than one exclamation point or question mark in a row -- if more equates to stronger sentiments, where does it end?


Just as Bobby Digital, amongst many other luminaries are fond of saying, I try to adhere to the "word is bond, yo" philosophy, and as such, why should an italicized word mean more than the letters of increased verticality? But, then I must contemplate and meditate on the fact that my speech is not of all the same quality and that by the mere way I say words can add to, if not completely supplant the words and the meanings they traditionally hold. A life of conscious duality isn't too bad.

Back to anchoring -- this isn't unique to medicine, this is obvious. The essence of anchoring is choosing the path of least resistance even if the path is a dead end. It is lazy and mandates instant gratification or satisfaction over truth and ultimately, experiencing the best outcome of any given setting, situation or problem. We do this in our lives in so many ways; perhaps our self-image hasn't kept up with the actual shape our bodies are in. Maybe a relationship that has been neglected is still viewed through the lens of years ago. See, we hold on to old data because it helps us build a reality that is emotionally pampering versus the truth, that reality will not allow for what would have been the best outcome.

I saw the clip of Rush Limbaugh saying that Irma, and hurricanes in general were welcomed and capitalized upon by the liberal democrats who desired to advance an agenda based on climate change and the repercussions thereof. But, no -- wait, he did not say the 'repercussions thereof' -- he just left it at "agenda of climate change." This of course is so completely disingenuous -- and I hope all of you can see this. BUT, why not extend this fallacy to see how it holds up. What if climate change is a hoax? An evil agenda to -- to, uh, reduce the power of the oil industry which is nearly indistinguishable from the industrial-military complex? An evil agenda to decrease risk to a fundamental vulnerability to live, produce or defend ourselves in the setting of even a minor production wane? An evil agenda to transfer jobs from coal mines, which destroy lives and mountains to jobs manufacturing windmills and solar power products? An evil agenda to clean up the air and reduce particulate pollution in the city so my wife can breath without an inhaler? An evil agenda to have roofs made of solar panels that can store energy in batteries in the garage and sell power to the grid when the need is high. The people who want these things, these hippy, libtard, overeducated, safespace-needing, common-sense lacking cucks are taking us to a dark world indeed. Anyway, Rush ended up evacuating after all.

While Mr Limbaugh may not necessarily actually believe the things he says, especially knowing that drama and controversy brings listeners. But on some level he is being dishonest with himself. If he does believe the things he says, he definitely is lacking in active self-criticism. If he does not, he is using deception to advance a political agenda and this is profitable for him. It is one or the other. He has the luxury of sitting back and not being held accountable for lies, or misinformation that may harm individuals or the country as a whole. He is immune in that capacity, legally speaking,  however if you believe in a God or higher power, or whatever, this kind of individual is asking for trouble when it comes to accounting for their actions and life's work. But most of us, to some degree or another, do not have this luxury. That is, we are held accountable for what we say and do at work and in our lives, in general. A shitty carpet installer won't have a job for long. A careless doctor may find themselves in deep doodoo. A doctor that intentionally deceives people may go to prison.

This dynamic of professional development can, if one desires, spill over into other aspects of life. Especially as doctors advance in their profession and the fundamental foundation of competently managing their patient population, we can obsess over other professional endeavors and, of course, hobbies can become all consuming, as well. I write all this at the risk of sounding like a self-righteous self-help peddler of propaganda. But this lesson is something that can be applied in every one of our lives. Whatever you are doing during the day, endeavor to do it well. Maybe all you are going to do is lay in bed and watch Rick and Morty, old Simpsons seasons and maybe a Ken Burns documentary with the most active aspect of the day being doing laundry. Do the laundry well. Get. Those. Stains. Out. Make sure the dryer vent isn't clogged. Remember to check the lint filter.

And it is this component -- that I must always evaluate my performance and prepare to improve forever and ever amen, that I most like about being a doctor.

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