Wednesday, November 30, 2011

The Reichstag is burning

Today  in school we had one of our "balancing" classes, designed to remind us that we, by necessity must become imbalanced in order not to flunk out of med school. At least, that's what I take away from the classes. Nevertheless, there are usually some nuggets of wisdom to take home, and today provided a couple. The first one, I'll just briefly mention, is about a doctor who was diagnosed with terminal esophogeal cancer and, during this time gave lectures and wrote a book. It was only last spring he was in the lecture hall, kind of as a dead man walking, lecturing about the important things in life. The students who are now second year OMS's got this lecture, and I wish that we would get the same honor, but alas, he passed a few months ago.

The second half of the class we formed small groups and discussed how 9/11 affected us, what happened to us that day, etc. Of course, many of my fellow students were still in high-school back then and in a few short years this will no longer be a day that "everyone" remembers. I can remember growing up and people talking about the day Kennedy was shot, or the moon landing and even Pearl Harbor. Soon, I will be one of those people, talking about the day 9/11 hit. I know everyone has a story about that day, but, since this is my blog, I'll write mine down -- I wouldn't want to forget any of the details in my old age!

In 2001 I found myself in the first real, serious relationship that I had ever been in. We had purchased a house together in SE Portland, I was working with some friends as sub-contractors making decent money in the construction business. Needless to say, I had no intentions of going back to school, much less moving to Florida, where the girl I was seeing at the time was from. That summer she decided to return to grad school, and she wanted to attend a program in Tampa, FL. Long story short, I was to young and naive at the time to figure this out, but I don't think I was really invited to go along. I didn't let that stop me, however, and we packed up the Honda, with our two dogs and drove to Florida. The girl's father had a business acquaintance who owned a retail flooring company, and was kind enough basically to get me hired sight unseen. This was nice, and I appreciated it, but I soon found myself very unhappy working for someone else, as I had gotten used to basically being my own boss. Now, I was expected to show up at 6 AM sharp and take instruction from the Vietnam Vet who was the other installer that worked there. Awesome. Oh, and the fact I was taking a 75% cut in pay made for a very difficult pill to swallow. I was 22 years old at this time, and I'd like to think that I'd handle things much better these days, as I'm sure the Vietnam Vet nor the couple that owned the business were very thrilled with having me around, either.

I'd been working with this outfit for only a few days when 9/11 occurred. Our job that day was to replace glue down carpet in a mortgage brokerage company. Basically, it was one big room full of desks, with a few offices off to the side. We had to slide all the desks to one side of the room (I remember the Vietnam Vet making me unplug all the computers and phones, as he said he didn't want to mess that stuff up) basically making one big desk on one side, while we scraped the carpet off the concrete on the cleared side. Awesome work -- I can feel my lower back tense up just thinking about it. We'd been working for close to 2 hours when the boss burst out of the office, bringing her TV, on a rolling stand with her. Sure enough, a plane had flown into the WTC tower in NYC. We all watched, (well, I snuck peaks while my Vietnam Vet overlord told me to scrape faster) until the next plane hit. That's when people began to pay attention. I remember seeing it live, as the camera panned upwards as the plane screamed low over the buildings. Of course, not long after that there was the Pentagon incident and the Pennsylvania field crash. By 11 in the morning, I was still scraping carpet, but now the 20 or 30 ladies that were still left in the office were all sitting around this one, older lady who was standing on her desk, reading with a booming voice from the Bible. Of course, she was in the book of Revelation, describing bowls of wrath being poured out. Women were crying, weeping, shaking. I was scraping, wondering when I could go home.

A side note, one I had forgotten about until today when we were discussing how that day impacted us, has to do with the US's central command, which is in Tampa. I'm not sure if this is correct, but I remember people saying that all military air traffic was directed out of central command, and that if there were more attacks coming, this base, a dozen or so miles from where I lived was sure to be high on the list. The description of a nuclear weapon brought in on some kind of ship or submarine into Tampa Bay haunted for me for a bit. I, like most people, was just a tad bit more jumpy than usual in those proceeding weeks.

I've always been very skeptical. Of everything. I'm not sure you could call me a "truther" which is a name given to all those who say that 9/11 either was an inside job, or at least coordinated by our Government. However, I'm open to any and all evidence, from both sides. I've always enjoyed history (in fact, I'd love to be a history professor, but, alas . . .) and I wasn't the only one who soon began to think about the Reichstag incident that preceded the Nazi Party's rise to power in pre-war Germany. I really do believe that it is important to know know, or at least beware of the history of this sordid species, capable of great deceit and manipulation. Anyway, enough of that.

However, the reason I even bring this up, is that I was mildly and pleasantly surprised by my younger classmates today. Overwhelmingly they felt that 9/11 was used inappropriately. One person mentioned that, if he were old enough when 9/11 occurred that he would have joined the Marines, but now, with the benefit of a decade of failed military action in multiple places around the globe, all intimately initiated because of 9/11, he is thankful that he was 14 instead of 18. I really don't know what the real story is behind 9/11. I'm fairly sure it is not the one told on CNN, but that goes for everything. If anything, I felt like there was hope for the future, and that whoever it was, and whatever they were trying to accomplish by flying those planes into those buildings would not get what they want. Granted, the sample population was young medical students, so I'm not foolish enough to think this is indicative of the general population, but I'm thankful for people who are not so quick to buy whatever the mass media news outlets are selling.

Saturday, November 19, 2011

Is a Monte Cristo sandwich named for the delayed gastronomical revenge it will have?

During one of the first days of my time working in the ER we had a newborn brought in for phototherapy to help with it's hyperbilirubineremia. I really didn't know what this was, it kinda sounded familiar, but I knew next to nothing -- not even how to spell it. When registering patients, we would put in a brief description of what was going on, in this case my more experienced coworker told me to put in "bilirubin." What I wrote was "Billy reuben." Even though it was closer to breakfast, I'm always game for a Reuben sandwich, even if the rye bread is a little more yellow than it should be. 

Monday, November 14, 2011

Sorry bout dat e'rbody

Earlier this year I emailed Billy Hunter & Derek Fisher telling them that David Stern had called them some bad names. I also emailed David Stern to tell him that Billy & Derek had also called him naughty names. I did this so that there would be no NBA season and thereby eliminating the temptation to watch Blazer games instead of doing homework.

I'm glad to get this off my chest, as this is the first I've spoken about it. I would like to apologize, as I know it was a selfish move on my part, but I felt it was what I had to do.

Thursday, November 10, 2011

This post is at least PG-13. R if you live in the midwest.

This week we've had some really good lectures on HIV/AIDS. I'm old enough that I can remember the late 1980's which saw the near panic crescendo from all of this. Perhaps, the climax was Magic Johnson's diagnosis and retirement from the NBA. It is a little hard to believe that that was 20 years ago, as the anniversary was just a few days ago. I can actually remember thinking that this was good for the Portland Trail Blazers, since Magic's retirement left the Lakers in a bind. Of course, this was the thoughts of a young boy insulated from most harsh realities of the real world. All that surrounds the AIDS epidemic is so crazy and dramatic compared to most other areas of medicine. A friend whom I worked with a few years ago was getting a master's degree and in one of the classes she was taking the professor espoused the idea that the CIA had created HIV on purpose and distributed it to people in Africa, and this is where it came from. I really don't know much about that, I haven't read or talked to anyone who holds that position, but even for a person like me with a penchant for obscure conspiracy theories has considerable doubt concerning that one.

I grew up in a very conservative Christian community and I can remember in various youth groups we had some people holding the opinion that HIV/AIDS was a punishment from God, meant for homosexuals. In this same exact logic, one can conclude that diabetes, heart disease and any other random obesity associated disease is punishment for the fat people. Polio is punishment for people who liked to swim in public pools. I won't go off on this for long, but for those who want to prioritize sin (or what they perceive as a sin) had better reread what the good book says about that, as one is just as bad as another. I attended church in Benicia a few weeks ago and the pastor said something that really struck me. He talked about how, in the gospels, Jesus never once mentions homosexuality. However, greed and pride are discussed in a manner that leaves no doubt as to how he views them. How is that the many churches have nothing to say about the greed and pride that are abundant in our economic system but rail against homosexuality as if eradication of it was the prime-directive? Okay, sorry, I'm off the soap box now.

Back to a lighter topic, AIDS.

I remember an afternoon when I was working in the ER when we had a patient come in complaining of priapism, which is an erection that won't go away. He had this erection since the night before when he took a handful of viagra and another handful of various club drugs. This was literally how he was describing his prior night, he was at a dance club and he and his friends just kind of mixed whatever kind of drugs they had together and just ate 'em up. Ecstacy, MDMA, LSD, GHB, Ketamine -- you name it. Oh, and someone had a big bottle of Viagra, so they split those up as well. Let the party begin! This guy did this on a regular basis, but not with the Viagra so now, 15 hours after his weewee came to attention he was in considerable pain and came to see us.

Once the nurse found out it had been 15 hours she rushed him back to one of the rooms. One of the things I liked to do when I worked in the ER was kind of listen in or watch from a distance what the doctor was saying or doing. I think I learned a lot by doing this. If anyone out there is reading this and is thinking about applying to med school I can tell you that working in a clinical setting will provide so much more than an official "shadowing" afternoon will. Anyway, unfortunately the door to this patient's room was shut for the next few hours. But, thankfully some of the nurses were more than willing to give me the play-by-play. At first they tried to get the erection to go down with various drugs. I'm guessing NO was probably one of them (as it relaxes smooth muscle) but I really don't know what else, except that none of them worked. The rooster was still on the roof of the barn cock-a-doodle-a-dooing-away, and he wouldn't come down. Then the nurse told me, as he was gowning up and donning eye protection that the doctor was going to try and take the blood out with a needle, and that the patient was HIV positive, and that he was going to have to be in there as well to assist. I'm not sure what happened next except that when the doctor and nurse came out they were covered in blood. The bed and the floor in the room was soaked as well. I once had a friend that had another friend who worked as a photographer and as such, was in the visiting team's locker room at the Pepsi Center, where the Nuggets play. Supposedly when Shaq walked out of the shower, sans towel, the first thought that came to his mind was no way, a 2 liter bottle!? and, I'll just leave it at that. The reason I even bring this up is I have a feeling that this poor man might have been packing a RedBull can, at best, but you wouldn't know it from the blood that was everywhere. The room had to be thoroughly cleaned and sanitized, as is appropriate, after that.

So, that's what we're studying yesterday and today. And then on into other viral and bacterial infections.

Tuesday, November 8, 2011

Alexander the Grape, Johnny Apple treats and Cherry Clans don't tast as good as Apple/Cherry/Grape-heads.

This evening I made a run to the small market  a mile or two from our house. Seeing as how today was the last day of our block exam fiasco, and my knee is progressing to the point where I can nearly bend it without blinding pain, I figured it was important to pick up some laffy taffy and lemonheads. While in the market the lady who owns the place, whom I've gotten to know, asked me about my still prominent limp. I started to tell her about the whole experience of being diagnosed with gout and how bad it was and that the timing was about as unfortunate as it can get and all. In the line behind me was a younger guy, could have easily been me from 7 or 10 years ago who chimes in and tells me that doctors are just drug pushers who are no better than a crack dealer. He says this with a sly grin, obviously having no idea that I was actually working my ass off to try and join the ranks of the "crack dealer." I just kind of half smiled, nodded and finished up my conversation with the nice shop owner, took my candy and started to limp away. The guy behind me set both of his 40oz Ole' English Charcoal filtered malt liquor bottles on the counter and also asked for some Swisher Sweets.

When I arrived back at my car, my 90lb dog (who I had brought along with me just to be nice) had dropped a couple turds in the back seat. I had to drive home with the literal and metaphorical smell of excrement all around me. This is not to say that I completely disagree with the Malt Liquor aficionado's accusations, however, the idea of hopeful crack dealers traveling the country and interviewing for a chance to actually disperse crack rock (after spending 4 years learning all the abstract, peripheral knowledge surrounding crack rock and then acing the CRCAT)) on the corner sums up my opinion of his opinion.

Sunday, November 6, 2011

If I was living like a King, perhaps I could understand why this is happening to me.

Since we moved to California from Colorado, I've had a couple of weird things happen with my joints. In fact, throughout my life there has been many issues. Dozens of dislocations, mostly of the shoulder, but also an elbow, patella and a couple fingers. The only surgery (besides wisdom teeth removal) was a shoulder reconstruction deemed necessary from all the dislocations. In July, before school started I came down with an attack of gout in my large toe of my right foot. I was drinking a few glasses of wine most nights, but other than that I really wasn't engaging in overt gout promoting behavior. It put me down for 3 or 4 days though. There have been a few other times where my knee would swell up, and since it correlated to a coldish, stormish front moving through I chalked it up to one more thing that confirms my old-fartness. Well, if I needed one more confirmatory episode I was handed a whopper over the last few days. I had another gout attack, except this time it was in my knee. And, again, I really had not engaged in overly suspect activities this past week. As I have been preparing for my exams I wasn't drinking alcohol at all and, if anything I had more cheese than I might normally, but it's not as if I ate a few pounds of the stuff. Today, the pain got to the point where I actually visited the emergency room.

I wasn't completely sure it was gout, but since there was not trauma to point to and no obvious paths of infection to cause what appeared to be a swollen, cellulitic knee I figured I should be seen. If nothing else I was going to need a doctor's note if I could not even move or walk for my practicals that are scheduled on Monday and Tuesday. The doctor in the ER did not identify gout right away, and said he really wasn't considering it until I told him about the attack I had in July. I guess I feel a little better about that, as that means he didn't see me as a prime gout patient, but on the other hand, why am I being struck with this horrible, utterly tortuous affliction? I even told my wife that if I could ward off another attack I would gladly give up all meats, fish and yes, even beer and wine. That is how bad a gout attack is.To think I thought the toe was painful, well, I learned my lesson and now know that the knee trumps the toe, multiple times over.

Thankfully, I was provided a large dose or prednisone at the hospital, which allowed for significant pain reduction within the hour, I was given a script for the rest of the week. I was also given a mild antibiotic (a 1st generation cephalosporin, for those that care meaning that he suspected a gram (+) bug if any at all) in case there was any infective process at work. All I know is that that was a continuous pain, that disallowed me to sleep or think straight for nearly 2 days straight.

As I was preparing to leave and the nurse was chatting with us, she learned that I was a first semester medical student. She said something to the affect that I should've just diagnosed myself. Well, I did, but since I have a few years until I'm writing scripts I figured I should still be seen. Nothing like a Bout of Gout to Sprout Doubt and make one Shout.

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