Wednesday, September 28, 2011

Guess Mess

The principle that has medicine as an art, in my mind, is what marries the science with the guessing. There have been numerous times in the past few months where we've been told that practicing medicine is really just an investigation that one needs to proceed with to try and arrive at the junction of making a diagnosis with the most information possible. What seems strange to me (or perhaps, felt strange to me) is putting this in the terms of diagnosis being nothing more than a "best guess." Maybe it is the terminology. As I learned the hard way yesterday with a quiz I mis-studied for, the language of medicine is often just renaming principles and structures we already are familiar with, with terms that are often (literally) Greek to me.

Had I tried to articulate this idea prior to entering medical school, I could've probably come up with this, but as I've learned over and over, for me, ideas often take awhile to manifest in realization and/or action. I think there was, and may still be, a part of me that holds the idea of being a doctor on a plain that allows for instant knowledge retrieval from an infinite reservoir. While this is clearly ridiculous, there is something to be said for having the largest possible knowledge accumulation possible, as being able to come up with the initial differential in one's mind is quite an advantage. This of course, is scope of practice dependent and complicated internal medicine cases and the like should always be cross-referenced via resources, including texts but also other physicians.

Here is to being the best guesser I can be.

Sometimes all I can think of when "guessing" is discussed in a lecture is the movie "The Jerk" with Steve Martin which has him working as a "weight guesser" during his time with the Carnival. And that's the only thing I need -- is this book. I don't need this or this. Just this laptop... And this note-card. - The laptop and the book and that's all I need... And this stethoscope. - The book, the laptop, and the stethoscope, and that's all I need... And these scrubs. - The book, and these scrubs, and the stethoscope, and the laptop... And this highlighter. - The book, this stethoscope, and the laptop, and the highlighter, and that's all I need. And that's all I need too. I don't need one other thing, not one... I need this. - The laptop and the book, and the highlighter, and the scrubs for sure. Well what are you looking at? What do you think I'm some kind of a jerk or something! - And this. That's all I need.

Monday, September 26, 2011

I am now at the point where the reality of what others have testified of, in terms of living a life where almost nothing can occur outside of medicine, is my reality. I'm struggling to fit in sleep, much less running and time with my wife.

We have a shortened week at school due to the upcoming Jewish holiday, so I'll be able to catch up on a few things, the least being this blog.

Sunday, September 18, 2011

I've got friends in crawl spaces, with their heads in jars and their arms in vases. And the thunder rolls, and lightning strikes.

I think the main reason that so many people, especially interacting strangers, end up conversing about the weather is that it is one of the few things that everyone has in common. I don't think that it is a stretch to say that at Kaladi Bros Coffee, every day that I worked had to involved at least a passing comment about the weather -- granted, Denver has some incredible weather and it is one of the things I will miss about the Front Range. The house that my wife and I have in Denver and in which we spent nearly the last four years sat on a hill overlooking Central Denver (we could see the Auroria Campus and the Pepsi Center from the front of the house) and massive storm heads building to the East of town were a sight to behold, for sure. The thing is, the way the house was situated inside, there was really no vantage point for sitting and staring out the window. The room in which the office was set up had a nice view across the Platte River Valley (officially, it is called a river, but I think of it as a creek -- at best a stream) into the Downtown area and I spent way too much time staring out the window -- but then again, would I be studying medicine at Harvard had I kept the blinds closed more? Whatever. 

The summer view, from the computer chair in the office of the Denver House.

Today, as I spend a couple of hours relaxing, as there is no material from school that I am immediately responsible for, I stare out the front window from our living room at a view that quite honestly, is amazing. The window in the office at the new house is twice as big, but stares across a walkway directly at a blue wall, which is the other, smaller house that sits on the same property as our home. This home was actually just rented a few days ago, and the new tenants will not take residence for another month. It has been nice to have the property all to ourselves since July, but I recognize the need to rent it out -- especially since we are landlords ourselves. Sometimes I have to escape the office, which is necessary no matter where one studies.

View from our living room couch, looking out over the C&H Sugar Factory (which never returned my skeleton that was erroneously dropped off there) towards the Glen Cover area outside of Vallejo. 

Before I moved to Tampa, Florida a little over ten years ago I really had very little exposure to powerful thunderstorms. In Portland, Oregon, electrical storms, or even powerful storms are relatively rare. This may sound counter-intuitive but it just calmly sprinkles for the majority of periods of precipitation. Days like these in Denver are nearly unheard of, and those that we received were holiday-like for me. Perhaps the first time I really was struck by the intensity of a thunderstorm was in Edmonton, Alberta. I spent a summer there as a young teenager, and among many memorable nights I remember one where it was dark outside, meaning that it was quite a-ways into the night since the sun sets so late in the summertime due to their extreme latitude. I remember it being 15 or so of us, a sitution where everyone except me took it for granted that when the downpour began, we were to head out to the large trampoline in the back yard and get crazy on it -- while pouring liquid laundry detergent all over the nylon surface of the trampoline. In the pouring rain, watching the frequent flashes in the wall of clouds engulfing us, they then turned to identifiable lightning bolts which seemed to feed the fervor of the crazed kids on the trampoline. Someone got drop-kicked right off the trampoline into the fir trees. People landing on other people, others unable to get up from the trampling of the trampoline jumpers. It was awesome.

The next electrical storm that really got my attention occurred in a subdivision in New Tampa (which is a horribly named subdivision north of Temple Terrace, or something like that) on duty for one of the worse jobs that I've ever had -- granted, it didn't have to be as bad as I made it, but let's just say I learned a-lot from my time at the Store of Floors which sits not far from Raymond James stadium, where the Buccaneers play. Not only did I learn the craft of high-end floor installation, but I learned how much of a role I play in my very own well-being - truly a concept for the ages. The couple that owned the business only employed one other person, a long time, disgruntled man who was a Vietnam Veteran from Buffalo, New York. For the most part he treated me well, interspersed with some scathing episodes of verbal abuse.

One afternoon, in a section of subdivision new construction where the section of houses that we were installing floors in did not have power to the individual homes, but instead there was one pole every 2 or 3 lots, and the contractors would have to run heavy-gauge extension cords to run any necessary equipment. I'm sure it had been storming for days, a monsoon end to the summer in the other "Bay Area" I've lived in. It had rained enough to form a solid lake, with the pole that had the electrical drop smack in the middle of. I was told to take the extension cords and get us power -- great. I slodged through 20 meters or so to get to the middle of the small lake, which had me in mid-calf deep muddy water with rain pouring down all around me. I remember thinking that this was not how I wanted to die. I slammed the extension cord into the bank of outlets anyway and ran for it. Obviously, I was not electrocuted, that I remember -- granted I was probably faster ten years ago, but I probably would have a hard time outrunning the electricity even then.

Colorado, no doubt holds many memorable storms for me. One in particular for not the sheer size of it alone, but because I remember it happening on a afternoon spent playing in the creek in the foothills town of Lyons with some friends where I think I may have, for the first time felt at home in Colorado. I think prior to that afternoon, which occurred at least a year in to my 8 years Colorado stint, I imagined myself moving on, and sooner than later. I'll always look back with great fondness for those days.

A lake outside of Leadville, CO in the shadow of Mt. Elbert (14,433').

Even though many, "how's the weather" conversations may seem superfluous and at times, downright unnecessary, I think we as (especially here in America, where stark, unwavering media-driven opinions are the norm from so many people no matter the ideology) need to at least communicate with those around us, even if it seems insincere. I would argue, just reaching out and addressing a stranger, even if it is just to comment on the weather, is definitely is a positive thing.

Tomorrow, when I spend another 8 hours in a darkened lecture hall, I'll be sure to appreciate the requisite sunshine of the late afternoon here in Northern California as I drive home to implement my new and improved study strategies. I've been mulling over the idea that perhaps I would feel like this after every block exam for the next two years, but then again, the first time must provide the overwhelming number of lessons, which makes sense. We don't have our grades for most of the exams from last week, but I do know that in the 2 or so weeks between the first mid-block exam and the full block exam I implemented a few changes that were beneficial, which I am thinking translated to better scores. The last we took last week was an anatomy practical. I think there were 124 items we needed to identify and I was dreading this immensely. Now, remember that we don't have our scores back yet, but I actually feel as if I performed better than I feared I would. Things like that are immensely encouraging. It definitely helps me remember that I can do this, and that now that I feel like I have a sense of the work load and what exactly it'll take to perform well in medical school, I will. It makes pouring over the residency programs enjoyable versus terrifying. So, with blatant disregard for horrible cliche-like engagements, here is my admonition to everyone so that they would stop and reflect and if possible, enjoy the small, little moments in life.

Friday, September 16, 2011

I haven't been to Warm Beach Camp since they eliminated the sulfur tainted water. I'd miss the boilded egg smelling Kool-Aid.

When I was younger, I had two favorite days of the  year, one was Christmas morning, and the other was the first day of Warm Beach Camp. I guess I really don't know young I was. I at least had a firm grasp on how the calendar year works, because, you see I thought it appropriate that since camp usually started the second week or so of July that it provided a nice, balanced bi-annual day of anticipation. Warm Beach Camp is located one of the inner fingers of the Puget Sound, north of Seattle and was a major highlight of the summer.

I've been thinking of a time when I went on a horse-back trail ride. I had wanted to go on one for a number of years, only because I had images of full gallops along the water, urging the stallion ever faster. What it ended up being is a long line of horses, 20 or 30 us, with guides interspersed between 3 or 4 of us. The camp itself, sits on a bluff that ends in an abrupt drop of a few hundred feet down to the water of the Sound. The cliff was not so steep that trees couldn't grow, but if it was much steeper it would have been a sheer granite faced cliff. Criss-crossed through the woods were many trails, and it was one of of these, running along the hillside where our group found itself, plodding away CLOP ---------- CLOP --------- CLOP. Very slowly.

What happened next I remember as if it happened to the horse and rider directly in front of me. The image that is burned into my memory is of the young woman who was a guide in front of me along with her horse falling sideways into the brush and giant David Douglas Fir Trees filled drop off below our trail. If I'm remembering this the right way, the horse fainted (equine syncopy induced trauma is heavily tested on the boards, or so I've heard) or died, basically falling to it's right side and just free-fell. Of course the rider didn't expect this, and I can, even now, visualize them landing, in the same form as they had started, with the rider straddling the horse, and coming to rest a good 20 or so feet down the hill. I think they just landed and stayed put, with no traumatizing tumbling or smashing into timber. And they just laid there. After some of the guides scaled the drop to help her out, some of the other guides got the "civilians" out of there, many of us were crying. I may have been, but I kind of don't think so, I've never really reacted to events like that with crying -- not to say that I didn't cry. I'm sure a couple of them either radioed or engaged in a full gallop by the water to get back to the stables and help. I'm also sure of another thing, I remember being told that the girl only suffered a broken leg, but that the horse didn't make it. I wonder if that's all that really did happen to her? If so, I'm most likely "over-remembering" but, nevertheless, it was the talk of the camp for the rest of the week and I remember being so pleased that I was the one who everyone wanted to hear the story from. How sick is that? But, when the older kids and the cute girls are giving you positive attention, well, let's just say I wasn't one to let that opportunity pass.

Another story youth camp trauma happened when I was older and I'm sure I remember it with much more clarity. This time, I was at a camp near Sun Valley, Idaho that occurred over Labor Day weekend, and while this annual gathering wasn't as long lived as Warm Beach Camp (which still goes on year after year, which is impressive, good job to everyone involved) but was a three day action packed less supervised (which didn't necessarily mean we were up to no good, but provided a good atmosphere for good (and, yes, of course bad too) free wheeling fun). Yes, that was just a parenthetical inside a parenthetical (I've realized over the years that parenthetical mechanisms are a major component in my communication (and my inner dialog), for instance, when I'm conversing with someone, I'll often cite a fact, or occurrence of some kind that is pertinent, and attached to it is a beneficial element that lies in an immediate expression of the fact or incidence as it enhances either the effectiveness or quality of the initial thrust of interest) and I try to limit their occurrence, but I'm in a good mood today, so I yielded to the temptation.

The camp here was much more isolated and in one of the most beautiful places I've ever been. The camp was on the shore of a small lake, perhaps a mile, at most across. However, it was fed by a creek that was at the terminal end of a much, much bigger lake at the foot of a stunning peak in the Grant Teton range. The small lake was so clear at points that one could easily see 30 or 40 feet down, through the water. Large schools of fish were abundant and boulders and logs on the  bottom were easily identifiable when in a canoe on a sunny day. The camp had two docks for our use, on was in a swimming area and the other is where the canoes were kept. People were not supposed to swim here, but it was much better for it, as it was much deeper and the swimming dock sat over hip deep water. Also, imagine 2 floating docks, about 15 feet away from each other as they extend into the water, this is how the boat dock was situated. However, they are connected by a bunch of 2X4's at the terminal end, providing stability. It also provided a place for gladiator like contests with two people duking it out with life-jackets fights (like a pillow fight), or perhaps oars, trying to knock the other into the water. This happened all the time and there was never really an issue -- maybe, once in awhile someone would say something about not swimming there, if they did it was halfheartedly and non-commital.

A very popular thing to do when I was growing up involved the dire need a young boy feels when near a body of water. The unexpected push-in of a friend or a cute girl was so irresistible that I can't help wondering what happens now, in the world of constantly carried cell-phones and personal electronic devices. Do kids still do the push-in, in the same manner that we did? If my child had a few hundred dollars worth of electronics ruined due to the push-in, I think I'd split my frustration not only at the fact someone pushed him or her in, but also that this is the state that we live in now, constantly armed with electromagnetic devices. Secondarily, I'd be concerned that I didn't teach my child well enough so that they'd anticipate the push-in  and shed the devices in preparation for the push-in. Anyway, I guess this is a good time to apologize to anyone who received the push-in from me, I'm sure I'm guilty of more than a few unrepented wettings. So, if you ever see me again and you're worried that I haven't outgrown the push-in, rest easy my old friend, I've moved on. Now I'll just want to palpate your ischial tubercles and try and diagnose your latest and grossest. An improvement? Who's to say?

This push-in from my past, I'm glad to say was not one that I am guilty of, thank goodness. A foursome, two girls and two boys are on the dock, hanging out, two of them are my cousins. I don't believe we were planning on a canoe trip, but only just hanging around. Of course, my compadre, a good lifelong friend of mine initiates the push-in. I remember it like this. My friend pushed the first girl in with the surprise push in the back, and while trying to get the second young lady in (me thinks she doth protested much) she managed to drag him in with her. Tumbling into the water together, they untangled beneath the surface leaving both of them disoriented. They both got their bearings and swam for the surface, the girl, seeing she was under the dock, engaged in evasive maneuvers, and in doing so kicked powerfully to get her to the surface. As she was nearing the surface she was oriented so that she was face-up, in that that when she kicked, the dorsal area of her foot faced the surface. Or, in this case, it slammed into the underside of the edge of the dock. Right where there happened to be a huge, rusty, algae covered nail. Actually, "spike" provides a better image, as it was several times larger than a 16-penny nail. This pierced her foot, from the top and then exited her foot on the inferior side. She was pinned there, forced to tread water, on her back, with one of her feet secured to the underside of the dock, which, of course was near the surface. It all made for a very uncomfortable place to have to stay afloat. I remember her saying during this that her foot was caught, that is, she thought that it was just lodged between some boards or something and that she tried mightily to pull it out. Can you imagine what this might do to the site of injury? Thankfully, the water was not far away from its origin, which was either the snow pack or the glaciers that lived high on the mountains surrounding us -- it was cold. Eventually, some of the adults were brought down to help and I remember a man (again, I vividly remember who did this and looking back it was one of the many things that have spurred my desire to work in emergency medicine -- to be capable in these kind of situations is something I find intriguing and desirable) who spent a good amount of time getting her foot off the spike. The water was so cold she wasn't losing copious amounts of blood. Other people took turns helping the spike-stuck-girl stay above water with the aid of a few life-jackets. They got her out of the water and drove her into Sun-Valley, which must have been nearly an hour away. She was fine, and was back later that evening.

I'm not sure, but I think that might have been the end of my push-in tendencies. If they weren't, they should have been. I guess I have taken lessons from others' experiences -- Who would of thought?

Since I've rambled on this long already, I want to expand on my thoughts about the parenthetical manner of thought that I find myself constantly in. I think that it has been, and will continue to be valuable while in school. Learning about the human body in the context of medicine really is like one big parenthetical. Every thing that I learn about, is connected to another thing, and so on in perpetuity. This is obvious, but I had just not put into the context  of my previous existing self parenthetical theory until now. Lectures given have parentheticals that are concerned about the pathology of a certain function, which leads to another that speaks to the appropriate and inappropriate treatments and so on. Looks like I chose the right field.

Thursday, September 15, 2011

Uhh, Hmmm. What? Okay. Wait a minute, what?

"Of course it happened to me, because that's just how things go." Do you ever find yourself saying that to yourself whenever something unfortunate happens? I found myself, this afternoon thinking that exact thing, as if my life had been one long string of unfortunate incidents, as if there were a grand scheme to screw everything up for me. This is a dangerous trap; one that is easy to fall into but getting out of posthaste is imperative.

So, the last day of block exams we had to deal with three separate exams. The middle one was a doctoring practical that basically was identifying surface anatomy landmarks and palpitation. You know, find the thyroid cartilage, identify the left middle lung (okay, trick question, you got me, there is no left middle lung!) and the auscultation points of the four heart valves, and much more. In fact, we (the students) were provided a page of landmarks that constituted a predetermined set of things we were supposed to know going into the exam. Great, sounds good.

The exam starts with having me find 4 different pulses. Excellent. Then I am asked to identify the lobes of the anterior upper lungs -- again, no problem. To finish off the exam, I am asked to identify the exact auscultation points for the upper posterior lungs. Oooooookay. From simple deduction, I can figure out (on the fly, no less) that it is not a good idea to listen to the lungs through the scapula. So, I try and pass it off by saying that just medial to the scapula, superior to T3 but inferior to T1, in hopes that's good enough. You see, this wasn't on the rubric provided to the students. If it was, I would've known to point out rib 4 was what the proctor was looking for. I didn't, because I didn't know it was going to be asked.

Of course, this was the moment I began to think that of course, this happened to me, because that is just precisely what happens to me. In the grand scheme of things, this isn't a big deal, and even during the exam I knew this and I was never in danger of losing perspective. In these doctoring exams they partner you with another student. In this instance, I was the student who was the "doctor" first. When my fellow student had her turn, she was asked to provide landmarks and palpitations that were listed on the rubric. She did just fine, but as the afternoon progressed, I couldn't help think (and in the process, get caught up in the trap) that these things are just the type of things that happen to me.

Like I said before, these things are amplified in our minds, especially when we're so focused on these exams, determined to not sacrifice any points to lack of preparation. And, now that the week of exams if over, and I had some nice Indian food with the wife and now am watching a movie on the couch (Cedar Rapids, if anyone is curious, which is the kind of movie I like, especially with Dr. Steve Brule in it -- for your health! Maybe the happy ending is a little too much) with the same wife, and life is good.

For someone in my position, who admittedly, has gotten away with more than I deserve, it is important to remember that the world isn't conspiring to foil my plans. After all, my car did start this morning.

I'm sorry for the lack of entertainment value in this post. I'll have some good stuff this weekend after a good night's sleep. Hang tight.

Wednesday, September 14, 2011

1st Block Exam week.

This is what this week has felt like. Three more tests tomorrow. Unfortunately one of them is the anatomy practical, for which I am not prepared as I should be. One way or another tomorrow night will get here though.

Wednesday, September 7, 2011

If Sabonis had come to the Blazers when he was drafted, many more people would consider Kobe to be a better player than MJ. A strange dichotomy for Blazer fans.

The following excerpt is not only from the book mentioned, but directly from TrueHoop which is a long standing favorite blog of mine, not only because Henry Abbot is a Portland native but because in my opinion, intelligent discussion involving the NBA is severely lacking (why this is is up for debate, but the vacuum seems to extend from the playgrounds to the mass media) and TrueHoop brings the best commentary together in one place. Anyway, this idea espoused by Michael Jordan is one I've heard before, but recently I've been thinking about the principles in a different manner. Discussion will follow the excerpt.

In the book "Driven from Within," Michael Jordan talks about his crunch time mentality:
If I miss a shot, so what? Maybe even a shot that could have won a game. I can deal with that. If I don't miss the shot, then I don't miss it -- we win. I can rationalize the fact that there are only two outcomes: You either make it, or you miss it. I could think that way because I knew I had earned the opportunity to take that shot.

I had put in all the work, not only in that particular game, but in practice every day. If I missed then it wasn't meant to be. That simple. It wasn't because the effort wasn't there. It wasn't because I couldn't make the shot, because I had taken the same shot many times in every situation. As soon as the ball went up, there weren't any nerves because I had trained myself for that situation.

I was as prepared as I could possibly be for that moment. I couldn't go back and practice a little harder. I knew I had done the right things to prepare myself for that situation. One way or another, I knew I was prepared to be successful. Now, if you know you haven't prepared correctly, or you know you haven't worked hard enough, that's when other thoughts and emotions creep into your mind. That's stress. That's fear.

It's the same process for doing anything, anywhere in life no matter how big or small the stage. ... If you are confident you have done everything possible to prepare yourself, then there is nothing to fear.
 On the Truehoop blog, there are some good points as to why not every player in the NBA (if any, really) should think this way. Basically, the idea is that basketball is a team sport and going into an end-of-game scenario, the person who takes the last shot shouldn't necessarily be predetermined, and that the unfolding play should dictate who takes the winning shot. I couldn't agree more.

I hope to follow a path into emergency medicine (I think) and compared to many other areas of medicine, decisions need to be made quickly and often, without adequate information. This means, at times, life saving and ending decisions are made by making the best guess. In order to make the best guess, the most complete scenario needs to be compiled, which means that more preparation can lead to better outcomes. Nailing that jumper over Byron Russel (yes, I do think he pushed off -- would you have made that call as a ref?) is impressive. MJ's preparation undoubtedly led him to that point. I hope my preparation will lead me to a point where lives are saved, that might not otherwise be.

As is evident by this blog, I've been relating many things back to medical school in my life. Hopefully readers of this blog will understand this, as this is an outlet specifically for just that: thoughts on med school. I don't care how many Team Based Learning exercises the school wants to put us through, I don't think they will ever allow Team Based Exams, and that really is the crux of it, isn't it? Just as life is, so is this whole process, we are born and die by ourselves (I would argue that even twins experience the birthing process in a solitary manner) and we take exams by ourselves. In medical practice, there is a move towards team based care, which I am not disparaging here, as the goal is to provide better care for the patient. However, the buck stops with the physician, who is, after all, the lawful leader of the team. The EMT won't be named in the mal-practice lawsuit (even if there was wrongdoing on their part, depending on the setting of the care, there is much less money to be had for going after the EMT). When it comes time to prove my skills and capability, whether it be an exam or a clinical situation, I really do want to know that I did all that I could to prepare. Striking the balance between having a semblance of a life and continuously studying is important. There will always be another concept that I don't fully understand -- just like there were more windsprints and freethrows for Michael Jordan to do. However, I think the body when it's physically exercising provides better feedback as to when it needs a rest compared to the mind/brain, which can talk itself into a downward spiral of no rest and only studying. I'm trying to strike that balance, writing this is part of that. I was becoming frustrated trying to calculate membrane potentials and after a period of mounting anguish, I decided to take a break.

Okay, break over. Let's see here, the Nernst value for sodium is +67  . . .

Saturday, September 3, 2011

Skate or Die, Dude.

I've been thinking for awhile that I really wish I could look inside my body. I not talking about any scope or imaging technique, I'm thinking about actually peeling back the layers and looking at stuff. I look back through my life and for the most part, I've been engaged with some sort of damage inducing activity -- that is, more than just the everyday life toll. When I was a wee lad, I really loved playing soccer and I played on a team for a number of years (4, maybe 6 or 7 years perhaps) and I can remember a few booboos incurred during those Sunday afternoon games. Then I started to fall in love with basketball and I played that all the time. I remember being on a middle school team that took a trip down to Coos Bay, which is on the southern Oregon Coast. In one of the first games I crumpled to the ground after a large pop from what most likely was a dislocation of my patella tendon. Ouch. But up until then, my exploits were nothing more than the expected bumps and bruises that are to be expected. Then, I found skateboarding, which was an all consuming passion for the next 10 years or so. In fact, even now I'll still think about things in terms of being a skateboarder. I notice the quality of concrete and asphalt wherever I go, I look at stairs, rails, ledges and embankments as if I still had a skateboard in my trunk, ready to go. I even dream about skateboarding, albeit much less than I used to. To be clear, especially these days, with so many people pushing around on those long-boards, I would have never been caught dead on one of those, and still won't If I can't ollie up a curb or kickflip on it, I don't want to be on it. Whatever though, I begrudge them less than I do rollerbladers, but all of this is tangential to my point. As soon as I started riding a skateboard, I began to destroy parts of my body. Even to this day, my wrists, ankles, palms of my hands, left hip and elbows are weakened and noticeably hampered either by asymptomatic scar tissue or hindered range of motion. I can remember joking in my teenage years, saying that I will "regret this stuff when I get old." Due to the loss of range of motion and specific angles of strength, I'm convinced that I am not able to spin 360 kickflips (regular stance, not that I ever had them down switchstance, but at least I could spin the board . . .) because of damage to my right ankle. Oh well.

Of course, snowboarding took it's toll on my body as well. Off the top of my head, I can think of 5 left shoulder dislocations and one right shoulder separation. I can think of 3 other left shoulder dislocations off the slopes before I finally had stabilization surgery. After the procedure, I remember being chastised by the nurse during a followup visit because I wasn't keeping my arm in a sling. I told her that it really wasn't hurting any more and that the sling seemed unnecessary. She then printed out the surgeon's notes and had me read them. She pointed to a section where the doctor made notes about massive damage not seen on the X-ray (they didn't have any soft tissue imaging done prior to the surgery) and that he was now concerned that the level of trauma and deterioration to my shoulder may cause massive complications down the road. This was in the actual surgical documentation.  Hmm. She then reminded me that all trauma I had incurred over the years had probably severed some nerves, lessening the pain, which was good in a way but obviously very dangerous. So I continued to read how the surgeon had to anchor some muscles in atypical areas and was basically hoping for the best.Thankfully, my left shoulder is in remarkably good shape. Thanks, doc.

I would really like to be able to peel off the layers of muscle and see exactly where he put stuff and then analyze the placements to see how the changed angles affects my range of motion. I'd also like to see my left Greater Trochanter and relive all the times I smashed into the ground off of my skateboard, sometimes from frightening heights. While I'm at it, I'd like to pull apart my knee and look at all the little floating pieces of torn cartilage and the degeneration of the meniscus, reflecting back on all those times I played pickup basketball games on asphalt, wearing skateboarding shoes.

My point here is not that I'm falling apart or anything, because in many ways, I feel like I'm doing great. That being said, I try not to play basketball without stretching and a pair of appropriate shoes. I also don't foresee many 10 stair handrail attacks in my future either. What my point is, is that learning about the human body is one of the best things I've ever had the privilege of doing, and that (just about) every day I am in awe of how this bag of bones actually works. Simple things, such as learning how to do a physical exam and finding where all the different lobes of the lungs are to be found and where to listen for the different heart valve sounds is amazing to me. It puts things like metabolic pathways into perspective, and enables me to stay motivated.


Thursday, September 1, 2011

One time in an undergrad writing class, the instructor actually had to tell the class to omit any baby punching jokes from their stories.

So I ordered a skeleton. I used to own a skeleton, but loaned it out not to be seen again. I figured a 3 ft. skeleton on my desk might aid in finding some points of reference during studying. It was sent via FedEx, and according to online tracking was delivered yesterday. I find no package anywhere on the premises, so I call up FedEx and long story short, the driver delivered it to the C&H Sugar Factory (the only C&H factory outside of Hawaii) which is right down the hill. I find it slightly humorous to imagine the employee who opened the package, finding a skeleton lurking inside. The good news is that FedEx says they'll send a driver to retrieve the package and bring it up the hill to my home. Hopefully, unlike my own flesh encased skeleton, all the joints will be well articulated and have a full range of motion.

I wanted to bring up a news story I saw this morning, having to do with the US infant mortality rates dropping even further, putting us below nations such as Cuba and Lithuania. In my opinion, there is a two pronged reason for this. The first one being the obvious one: lack of access to healthcare, plain and simple. My wife, who is currently working in a contract position has had the misfortune of trying to find and pay for insurance independently. For those of you who haven't had to do this because of a steady job or pension plan, or whatever, take a few minutes and just look around and see what is available out there. We're looking at paying nearly $200/month for a plan that has a $5000 deductible, and maybe, just maybe some of the preventative visits might not be included under the auspices of the deductible. Oh, there is always a $75 copay no matter what. Thanks to recent legislation, she is actually able to get insurance, whereas before she was only able to get catastrophic medical due to "preexisting conditions." Anyway, without getting all "political," in my opinion, those who say there is no need for change are quite delusional. What kind of change needs to happen is up for solid debate, but again, in my opinion (coming from someone who has worked in and ER as a Patient Access "specialist," AKA the guy who gets your information, verifies insurance and then comes back for your credit card) the for profit model of health insurance is not the way out of this mess, especially considering (again, in my opinion) they are a big part of the reason we are in this deathly expensive hole.

The other part of the problem has to do with my perception of the American public as a whole, especially the younger generations, which I still consider myself to be a part of. You know, those in the age group who are having children. I think that the lack of overall ability (including know-how and to a certain degree, willingness) to take care of one's self is to blame. There really are people who think that fast food is just fine for everyday consumption -- mother's who think that feeding their children via a drive-thru provides all sustenance a growing body needs. Despite growing up in a household that ate more than it's fair share of fast food, I don't think there was ever the idea that is was the healthy thing to do. However, above and beyond this delusional subsection of society, there is also the overwhelming majority of people who know quite well what it is to be healthy, but just don't care enough to do anything about it. If this is the state of mind you exist in, and then you find yourself pregnant, well, why would there be any difference during those nine months? Some might say that there is more reason during those nine months than at any other time of their lives, and, I would agree. Say the mother decides to quit smoking (or decrease her habit) during her pregnancy but prior to conception didn't really take care of herself. Obviously, the child is still at a disadvantage from the get-go.

I was inspired to write this when I read the article about the infant mortality rate (which, it should be clarified that the infant mortality rate actually decreased in the US, but just not as much as the 40 or so countries that have a lesser rate) the main onus of blame was placed on the health care system, specifically OB-GYN and the surrounding services. Undoubtedly there are issues here, but I'm not really in a position to discuss them as I don't yet know what they are, at least, from the inside. I also want to make a note that when I was working in the ER, I was almost always on the weekend shifts (as I was still a full-time undergrad student) and that in the hospital that I worked in had expecting mothers come through the ER registration in order to get to the OB floor anytime other than weekday office hours. No one outside of those with the purse-strings of the hospital thought this was a good idea. Can you imagine making pregnant women sit in a waiting room in the ER which is often populated with sick people just because the hospital didn't want to pay another registrar (who at most makes $13.00/hour) to do the registration outside the confines of the ER? Anyway, I'm getting off track here, but my point is that I registered hundreds if not thousands of mothers in my time there. The scary part is this, since I worked in a privately owned hospital, I saw the "better" portion of all expecting mothers, in that I wasn't at the community hospital. There is something to be said about the adage that those who should be having kids are not, and those who are having children should not be. This doesn't have anything to do with race, creed or color. It might have a little something to do with socioeconomic status, but even this isn't the whole of it. It has more to do with the fact that, from what I saw in my time registering all those mothers, way too many of them didn't want to be pregnant. On the other hand, it could be that they were just upset from being made to wait for 30 minutes, sitting between the guy with FLS (flu like symptoms) with vomiting and the 3 little kids who have runny noses and are screaming like crazy while the mom watches movies on her iPhone. What do I know? I don't even have kids much less the ability to become pregnant.

Seeing as how I am a student-doctor, I should be thankful for all the job security that the unhealthy will provide. But, it sure is hard to find bony-landmarks on the obese.


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