Saturday, January 6, 2018

The Meandering of the Delirium

Hari Seldon is a character in a world which encompasses the known galaxy and beyond and is a mathematician with, in essence, an algorithm that can give insight and predict the future at a grand, macro scale. He sees the fall of the ruling empire at that time followed by a 30,000 year "dark age" where isolation, poverty, death and minority ruling classes subjugate the public at large.



He gathers the thinkers of the age: scientists, authors, artists, philosophers, and mathematicians amongst others to a far flung part of the Universe to create an institution which will preserve the comprehensive wealth of knowledge made vulnerable by dissolution of the failing Government. Shenanigans ensue.



I remember starting this trilogy; I may have never read the third installation. Isaac Asimov's mind a fascinating place.

I minored in creative writing and such an endeavor requires many literature classes, and justifiably so. One of the senior level courses was American literature and was meant to encompass, along with the standard coursework a semester long research project and 20 page paper outlining and arguing the significance of whatever icon of American literature; supposedly at our discretion.


I chose Ray Bradbury. He had undoubtedly influenced me in my writing, especially in the way I approached the crafting of short stories. I saw, and still see him as an understated font of influence in society as a whole, and through his writing he saw and told us stories that gave hope for the future, sometimes with great tragedy. Lessons that remind us of the reality of a Universe and reality much greater than ourselves, a healthy idea for young minds so easily prone to a narcissistic like neurosis.


The case was made to allow me to pursue the works and influence of Ray Bradbury as my research object. Within the past year I spent some time trying to find that project and could not. I fear that it may be gone. My undergraduate institution, bless their hearts, cancelled my email account six months after graduation. At least my school of medical education continues to maintain our email accounts. Oh well.



I understand the pushback against Ray Bradbury from that instructor. I know she was beholden to a certain view of what is literature, and I understand it. A stage with which to use for the world that a piece of writing inhabits that is extraterrestrial is viewed as cheating, in a way, by those who limit themselves to the "known world." That coupled with younger audience demographic has led to a divide in academia. It seems like it is changing, things always do.


Last night I was at a shindig related to work and found myself in a conversation with a gentleman who's career had him dealing with the billing and coding IT aspects of a certain EMR system and we were commiserating about the cruel inefficiencies of the machine and how it torments the physicians who fear computers. It led me down the path to defend those who seek knowledge for the sake of knowledge and the altruistic nature that medicine in its ethereal and idealistic form should exist. This, in essence, encompasses the kind of friendly banter I can engage in these days. I go back and forth between thinking that I've become something that 13 year old me would think is cool and bewilderment why I even would think that is an important marker for success as an adult.


See, the problem is that those who employ an "art" in the practice of coding are usually prosecuted for fraud. Medicine is the application of scientific endeavors that have established principles and understandings that allow us to apply the laws of the universe in the betterment of humanity; we refer to this practice as an art. Perhaps we should sell that idea to the brilliant young minds of the forthcoming generations and restore this profession as the destination of the best and brightest. Let doctors do doctor stuff before a whole generation becomes steeped into the broth that breeds the belief that doctor stuff should encompass 10K clicks of a mouse per day.


And to all those who are pursuing family medicine in this upcoming match, I just wanted to encourage you that these days even we can refuse to see patients just like all the other specialties. Good luck everybody. 

Sunday, December 24, 2017

Creston Park, Holladay Center, The Underground, The Waterfront, Lincoln High and Blue Garage

For the past three or four weeks I've been reading  a treasure trove of 90's skateboarding lore and 'where are they now?' type of things called the 'chrome ball incident.' Over the years I've perused this blog once in awhile over the years but I got caught up in it and have been working my way backwards. I'm reading interviews from 2011 right now. I've become fascinated by these interviews of people who were heavily involved in skateboarding during the same time periods I was. 

Bryce Kanights at the China Banks in 1986. Photo: Grant Brittain


In 1986 I had a passing fancy in skateboarding. Some kids at school were skateboarding, and they wore Vision Street Wear shoes, which I must admit I coveted with the desperation of a fourth grader who wanted to be cool, and liked. 

I wanted these shoes for so long, well, 2 years seems like a really long time in grade school. 

The kid also wore this Def Leppard shirt that I thought was the coolest thing I'd ever seen. 

Def Leppard had graphics and logos that simply enthralled me. The album cover for Hysteria seemed so cool; I remember the smell of the cassette tape inner leaflet, whatever that thing is called. Remember, the drummer from Def Leppard only has one arm and Hysteria was the first album for which this was true

Interestingly enough, this same kid would be one of the most talented dudes on a skateboard I would know. He never seemed to really like skateboarding. He was throwing 360 flips when I was a Freshman and struggling to learn to control my ollies. But I'm getting way ahead of myself here. 

Kobe Bryant had his jerseys retired last week and he, like many others before him, wrote a love letter to basketball. That, plus my recent obsession with Chrome Ball Incident have led me to think about labels, self-identity and appreciating the forces that have shaped me over the years. 

My ideal dream of skateboarding in the 80's


No surprise that I point to skateboarding to providing me with many of the ethos and general philosophies of life and problem solving that I still use today. I've spoken to this point in various manners with different perspectives. Here is yet another way that the love of skateboarding still bubbles up within me. 

I wanted to be a doctor because I thought it would impress the ladies. 

Vision skateboards. Yup. 

That was the first spark that allowed illumination of the path I'm still on. Of course that reason has been retired for many years and I've been able to find many better reasons to keep going. 

Powell Peralta trying to be cool like World Industries here. This is not the Powell Peralta that I grew up with; no skulls or even skateboards or skaters in this ad. 

Similarly I started skateboarding because the cool kids were doing it -- first, in the 80's when Vision and Powell Peralta and the Bones Brigade ruled the day and then later, with a very different style, the early 90 street skaters, with a bizarre look of huge pants and tiny wheels struck a chord with me.

Uniform circa 1991

 My first and main exposure to such styles actually came from friends and family from Edmonton, Alberta. The irony was lost on me at the time, that a kid in Portland Oregon, a place that had and has continued to have an exceptionally strong skateboarding culture and community was turned on to such a fascinating world by kids from the suburbs of Edmonton. Not actually a cousin of mine, but cousins with dozens of other cousins of mine was a kid who was a year or two older who was riding an Andrew Morrison New Deal board. 

Prolly the best skate video of all time, prolly


It was an everslick and the first board that I road that had the double kick -- a staple even now. I had no idea who Andrew Morrison was, nor the history of New Deal, or even what had happened in the industry which had left Powell powerless and Vision Street Wear nowhere to be found. 



I didn't even put together the fact that Blind Skateboards was started by skaters from Vision and that it meant something, but I did know what Video Days the video meant as far as where and how skateboarding would progress; and that is what I cared about. Not many images available of that vaunted New Deal board exist, the best one I can find is from a collectible website. 

My first real skateboard

I had spent the summer in Edmonton and when I came back home to Portland I was determined to become a skaterdude. Initially I bought an old Alva board from a friend and I learned to ollie in my garage and driveway. My birthday is in October and I made my desire to get a New Deal Andrew Morrison Everslick board with Venture 5.0 trucks for my birthday. Cal Skate, perhaps Portland's oldest skateshop was housed on the Eastside at that time in a small warehouse that had a wooden skatepark inside. For about month before my birthday, I would come home from school and call Cal Skate and ask them if they had this board in stock. I mean, they were making fun of me on the phone by the second week and thoroughly disgusted by the 3rd week. By the time my dad took my friends and I down there on a Friday afternoon, it was all they could do not to wring my neck. I was oblivious and was focused, with a singular mind that had this goal that must be achieved. 

Me. Baby blue airwalks. Tiny wheels. New Deal shirt. Alien Workshop hat. And, I'm pretty sure these are thrift store cut-off jeans. 

I remember trying to hatch money making schemes and brainstorm for odd-jobs in case I didn't get this skateboard for my birthday in 1992. They did have the board, I got my Venture trucks with the green bushings and was talked into a set of grey Channel One Sidewalk Surfers for my wheels. 

1992 saw TWS advertising articles that discuss how much skateboarders hate snowboarders (I remember when that was a thing) and of course, street style vs freestyle. Oh to be caught up in those things and care so much what I should think is cool, and what is not


Clearly I picked up a skateboard because I thought it looked fun and the people doing it were intriguing. That remains true, but turned into a real joy of riding the board and evolved into a alternative way of viewing the world. 

The holy mecca of skateboarding. RIP concrete formations. Right now there is the annual ice skating rink, not that it matters to skateboarding anymore

The cold and brutalist architecture that comprises many of our urban centers are turned into playlands with ledges to slide across, stairs to jump down and handrails to grind down. Objects serving a purpose completely unbeknownst and inconceivable to the architects and corporate needs that shaped the plazas and courtyards around the world. 



There is something about that, this concept of repurposing objects and procedures for alternative means -- Hip Hop took cuts from the jazz, funk and R&B from the generation prior and gave it now life in a way the composers, musicians and singers did not imagine, parallels exist in street skating. 

Two of my friends and me. I can tell you that I'm riding a New Deal Ron Knigge Everslick board. My friend to the right of me has a well worn Rob Dyrdek Alien Workshop board with Independent trucks and a New Deal shirt. The friend in the back had a Firm board at the time. This stuff meant so much at the time. 

Whether we are rich or poor in America we are surrounded by excess -- the difference being our direct access to those bounties. In this environment it seems like a healthy thing to take an artificial world built of concrete, bricks, marble and glass and use it as a canvas for the art and science of skateboarding.

The magazine scene had Transworld's monthly offerings reduced to thin stapled affairs. Thrasher wasn't much better. I still poured over every page, picking through the ads, feasting on the art and iconic logos that have and continue to function as a rootbed for popular culture at large, to varying cyclical degrees. 

Lean and mean alright. I used to be, too. 

Now I live in a world with much less "EMB" and more "EBM" -- Evidence Based Medicine, that is. we do things for reasons, reasons that are based in research. But this drive to see things in a way that is often perpendicular to the way it was "meant" to be viewed still exists. And yes, I do look at the parking lot's curbs, curb cuts, ledges, ground and gaps -- but that isn't what I'm getting at here. I fully embrace the EBM way of conducting the science of medicine, but the art of medicine is much less science, or evidence based, for that matter. I know I keep writing about this, and well, I think I'm still trying to wrap my own head around how to get best outcomes for patients. And for me. For the most part, my best outcome, so to speak is tied directly to the patient's outcome, allowing that there is just some processes doctors and modern medicine cannot affect, or change -- I get that, it doesn't take long for a physician to see this. But a doctor's best outcome is more than just tied to the patient's clinical course, of course. That is what I'm still fleshing out and perhaps writing about it helps. Maybe I'll figure this out and have something more exciting to write about. Maybe these next three months, which truly will be the doldrums of intern year will allow for a clarity hitherto unknown. 

Here is what I do know: self identity is important and I'm actively fighting against what seems like is the common idea of what doctors like to identify as. In general, I'm thinking of older doctors but not always. I've spent my life being labelled a great many different things by outside entities. I've spent a good portion of my life identifying as a "wannabe doctor" and now that I've been here for awhile I see clearly that in order to be satisfied with the "doctor" label I will have to forge my own idea of what this means. Also a work in progress but through these posts, this is something that I am working on. 

On another note, I'm really enamored with trying to find a destination for a week vacation in early April. Just enough time to go someplace exciting and exotic, but short enough that New Zealand seems too far -- even Europe seems like a stretch. Anyone have any ideas for a week long getaway for early April? Taking a chance on having a ski resort to still have snow seems reckless, albeit something I may be willing to chance. Living in Southern California makes tropical destinations a little less intriguing. My life is not short on palm trees and beaches, it is short on snow and real forests. 

Friday, December 22, 2017

I prefer a tikka masala sauce that is creamier and unbroken

ACGME and people in graduate medical education send a lot of mixed signals when it comes to physician wellness for residents. Much of it is program and facility specific. Some places do better than others, but at some point during this year I've had this growing awareness of larger forces at play. Retreats and local, ground level provisions are necessary and appreciated; but our day to day experiences expose us to the worst that humanity has to offer, contrasted, with varying frequency, the best humanity can impart.

A strategy has to be built to deal with the desperation and apathy we are faced with. Frustration levels are high with everyone, most of us, and I mean everyone in the hospital -- from the patients, patient's loved ones to all that participate in the success of a hospital as workers; clinical and nonclinical. Every single one of us has a valid reason for our frustration. We fight for people in an inhumane, rigid yet whirling machine that forces us to feel like compassion is a luxury and five extra minutes with a patient infringes on our paperwork workflow. I'm still strategically strategizing my strategy.

The leaders of this nation have added to the existential dread that seems to have gotten so much worse as of late. I think a lot of good people kind of hoped that the system that capitalizes medicine and healthcare had just been a mistake and not actually an engineered sham. I find it interesting that most doctor lounges, even those in California are more likely to have Fox News on TV than anything else. Admittedly, the channel selection is skewed by the fact that younger doctors, and ones that have good work ethics don't spend time in the doctor's lounge watching TV. Regardless, not many people have much hope for the immediate future and most of us are kinda hunkering down for the onslaught of even more undiagnosed and untreated "run of the mill" pathologies. Unchecked infections delighting in the patient who has neither the time, money or access to a primary care physician will be rushed to the ED in septic shock, with their life in jeopardy. Of course, more resources and money are spent on this patient's acute care than 500 primary care visits would cost -- that doesn't seem like an exaggeration, depending on the hospital course.

It is in this setting that empathy becomes so incredibly valuable. Small talk with jokes or solemn recognition of a patient's suffering, or whatever else helps keep the lifeline of human relationship patent and flowing with good will. Some patients are manipulative, some nurses and doctors are too. Deal with people with respect and maintain proper boundaries and this stuff becomes secondary, and much less of an emotional suck.

Nights are tough -- call nights with no chance for rest take their toll. In some ways though, I really like the fact that it feels more like a normal work shift. I mean, day time is filled with rounding, discussing, teaching -- us being taught, and us teaching students. At night, you get the work done and if that means 10 Uptodate articles, so be it. I like it. I've missed feeling like I have a "normal" job more than I previously realized. Doesn't mean I'm not going to take advantage of having tonight off and not leaving the house the rest of the day and ordering delivery Indian food, though.

Tuesday, November 28, 2017

And I Love That Basketball. I Took That Basketball Everywhere I Went. You Know What? That Basketball Was Like A Basketball To Me

Went home for Thanksgiving. First time travelling away from the LA since residency started this summer. It was nice seeing family and friends. My mother had a birthday recently, so the idea was to take her to Powell's  bookstore with a mandate to find books we would then buy for her. Of course, it had been a long time since I had wandered around the store, too. I found a handful of books related to the book I'm writing, and also this one:


Golden: The Miraculous Rise of Steph Curry by Marcus Thomson II had been a book I've been meaning to read. I was in the Bay Area for six years. When I arrived the Warriors were not good, at all. And other than the 'We-Believe' team with the Baron Davis dunk and dismantling of the number one seed Mavericks, had last had real success around when last the Trail Blazers won a title -- the late 70's. Keith Smart was the coach, with Mark Jackson soon to come. Andris Biedrens was still on the roster. Sniffing the playoffs would have been considered successful with this team. The number seven pick of the 2009 draft had glass-like ankles, seemingly. I went to a handful of games at Oracle Arena where the Trail Blazers were the visiting team, until the last year, when we were priced out of the arena. While it is fun to sit even in the nose-bleeds, I confess I much prefer to sit closer (duh) and would rather not spend way too much money to sit at the top of the gym. Regardless, between live games and streaming games, watching the Warriors become the most unlikely juggernaut, two championships in three years with a 73/82 win season. They won 89% of their games that season, and besting Jordan's Bull's team that had previously won 72 games out of 82. History would tell us that an NBA team that wins 50 games in a season is successful, most likely makes the playoffs, and may even be good enough to get hot at the right time and see major victories in the playoffs. And even now, they harbor superior talent and are the favorites to win the chip.



I am kinda tempted to turn this into a Steph Curry kiss-ass prop-piece. I don't know a lot of people that I would even consider doing that for. It's tempting to extol his virtues, of which there are many. Some of you may not know much about basketball, nor care about it. I get it. I don't really like the NFL, or the other major sports, in terms of rabid fandom. And while, yeah, I consider myself a "fan" of the Trail Blazer team based in Portland, Oregon, I do enjoy watching basketball. In general, if one spends time a bunch of time engaged in a certain activity, watching the best do it is fun -- the memories of what it was like to be able to run and jump with abandon force us to live vicariously through the professional athlete. I've played a lot of round-ball in my life. But what Steph Curry brought to the world of the NBA transcends the game of basketball and shines in sharp contrast too many in our culture who boast loud bullhorns and shy not away from abusing their position. In short, Steph Curry has positioned himself to widely considered the best shooter in the history of the NBA, and for those who argue he has not had the longevity to warrant such a title, I can't really argue with you, but, there is no sign of slowing down and we shall see in the next ten years what happens. This cat has won two MVP awards, and the second one was unanimous -- the first time that had happened. He is 6'3" on a hot day and does not have the chiseled, imposing and intimidating physique that many NBA players have. Much has been made of his light skin tone. He doesn't overpower people by smashing into them, but he does bend men to his will.


I think one of the reasons I've become fascinated with The Chef, is, like so many of us, imagine that his public persona and modus operandi is representative of what we would do, best case scenario, if we were in his position. Obviously he isn't some infallible deity, and of course I'm speaking in generalities, but the consistency is there, from childhood, through prep school and into and through college into the professional ranks. He was raised by a family with means; his father, Dell Curry was a bonafide sniper from 3 point range, for his time, at least. And while NBA players in the 90's were not making the kind of coin they do in this era, in no way was the family struggling to make ends meet. Furthermore, Steph grew up around basketball and NBA players, nevertheless, this has seemingly worked against him in that he wasn't ranked as a prep player, in his state of North Carolina or in the nation. He was not recruited by any major collegiate basketball programs; Duke and North Carolina had no interest in him; he ended up at Davidson, in part due to their academic prowess. While there he led the nation in scoring and led this small, otherwise unknown (at least in the world of NCAA basketball) school to the elite 8 of the Final Four tournament. And while he was picked 7th in the NBA draft, he was the third point guard taken. Through all of this he has taken every slight, underestimation and write-off and internalized it, and from a distant, outsider's perspective, has used that for fueling a healthy response. He does not speak ill of other players or past associates. The only negative thing I can recall him espousing is a contradiction of Under Armor's CEO praising our Tweeter in Chief, which I count as a positive thing overall. Other players, past and present have piled on in subtle and heavy handed ways over the past few years. Members of successful teams from the past stating that Golden State would not stand a chance against them in a hypothetical head-to-head match up. Players from the 80's and 90's have long since criticized teams and players for being soft in this modern day hand check free game. While I risk losing every reader if I go down the tangential rabbit hole that is "get off my lawn" attitudes of older people who love to denounce younger people practicing in the same field as they used to. One would be forgiven to think that Larry Bird never missed a shot, that Magic had a triple double every game and that players worked harder, smarter and were more efficient back in the day -- oh, and this was all done while being mugged by the defense. This assumes that the great players of today wouldn't adapt. That they are not tough enough to deal with hand checking. That they don't have superior technology and an improved, deeper pool of resources. Could a 30 year old Michael Jordan dominate in today's league? Yeah, I think so. Could Stephen Curry go into 1989 right now and battle the Piston Bad Boys and be victorious? Hell yeah.


All of that is besides the point. The demeanor in which Steph Curry, a leader within his field, treats those around him is a strategy that has, is and should be employed in every professional field. Boasting, in general, does the exact opposite of the boaster's intentions. Tearing down others in efforts to shine brighter serves to illuminate deficiencies in character of the 'tearer,' not the other way around. In general I feel like helping others succeed, whether it be teaching, encouragement or simply (trying) to set an example, is how I can be the best me that I can be (I write this knowing how cheesy this probably sounds) and often this means that glamour, glory and accolades are showered on others. Perhaps being an introvert plays into this dynamic -- anecdotally it seems to favor this type of disposition; I don't wholly buy into this but certainly it easier for those who shun the spotlight to allow others to bask. In my opinion (as if someone else's opinion would show up here) the largest element that allows one to willingly, or even, enthusiastically, desire those around them to succeed is simply contingent on a solid perception of high self-worth.


The summer before last saw the Warriors lose in the final series of the NBA playoffs to Lebron James' Cavaliers. That was the season Golden State earned the highest win total, ever, in the history of the NBA. The contrast in being the best regular season team ever, with then losing the 'ship was, I presume, painful to the team and their fans. A few weeks after the playoffs ended, free-agency started and Kevin Durant, a previous league MVP decided to leave Oklahoma City (can't blame him -- I spent 3 weeks there last year) and join the Golden State Warriors. Much has been said and Durant has been much maligned for this decision, but that is not the issue at hand. What is impressive is that Curry welcomed another MVP to his team, a team that had won a championship two years prior and followed that up with a record breaking regular season. Undoubtedly Curry's light would be partially hidden under a bush even in the best of circumstances. Durant is a basketball machine, at nearly seven feet tall and slim with quickness usually reserved for men much less his stature, might even have a more complete game relative to Steph Curry. Last year the Warriors made it to the championship series for the third straight year (as did the Cav's) but this time around the Warriors rolled with relative ease. Durant was named the finals MVP -- and he deserved it. Curry showed no signs of jealousy, remorse for having Durant join and at times, take up most of the spotlights shine.


For you or I, this might not seem like much. But in the world of professional athletes, especially NBA players, this is unique. Not all of these things are unique to Curry alone, but the way he consistently responds to judgements and evaluations deeming him less than worthy of not only his potential, but also his past works, is unique, I think, in his world. He has continued to assert his dominance, to put on display his superiority in ability to put a ball through a metal ring from a long ways away and this gives him rights that he doesn't exercise. Maybe because he grew up with the bright lights of the arenas and cameras that he doesn't seem fazed by them, maybe it is why he seemingly feels so comfortable under the lights. Maybe he knows that life requires human beings to be multifaceted, to be dynamic in their behavior and that one size will never fit everyone. Perhaps his upbringing taught him that despite what the columnists say and what the talking head television pundits spout off on, it is never all about him. The joy that the Warriors bench celebrates on court awesomeness is indicative of Curry's overall attitude.


I'm old enough to remember Michael Jordan when he played, and not just for the Wizards. WGN would broadcast all the locally televised games out of Chicago, and whatever cable service we had at the time carried WGN. It was exciting to watch him play -- what crazy thing would he pull off in this game? There have been plenty of stars in the NBA who approached this level of intrigue. But since Curry has come into his own the past few years, it is the first time I've felt that excitement about a player. Kobe, Shaq, T-Mac and Vince Carter were all exciting, but they all played within a certain framework allowing for sensational acts, to a certain degree. Kobe scored 81 against Jalen Rose's Raptors -- pretty damn incredible. But nothing has compared to Curry and his ability to invert the basketball court and allow his outside shot to open up his inside game, it has always been the opposite. Inside game allows for the outside game to develop.


Anyway, here's to a Kerr/Popovich ticket for the 2020 Presidential Election!

Saturday, November 18, 2017

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

Lynch Park was an elementary school in South East Portland, on 148th right between SE Division and SE Powell, 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.


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