Moments of Clarity

OB/Gyn

2010-04-26T12:38:00.002-04:00

After TICU, my month on the OB/Gyn rotation was pretty relaxing. And that's saying a lot, considering that I truly hated my OB/Gyn clerkship as a medical student, and that I consider Gyn to be the area of medicine which I least understand.

I'm sure I got a bit of favorable treatment since Karen is an OB/Gyn resident. But I also tried to work hard and combat the unfortunate stereotype that rotating ER residents are always watching the clock.

Most of the attendings were great. During my first week on the delivery floor, I caught 10 newborns and got some excellent teaching from the private attendings. There were also a few occasions when things moved along faster than expected and there was an urgent call for "any doctor" to a delivery room. I arrived moments later, threw a pair of gloves on, and caught the kid before any of the attendings showed up. It made me feel like I was actually doing something useful.

Overall, good schedule, good conceptual learning, good procedural learning.

Trauma ICU

2010-03-05T20:25:00.000-05:00

Trauma ICU, aka TICU.

Ugh. Just thinking back to this month makes me cringe. My time there was just so painful. With the exception of my immediate team of residents, it felt like everyone there was miserable. All the time. I don't mind working hard. But I mind it when attendings mistake ridicule for teaching. Hence me not going into general surgery.

I did a bunch of subclavian lines,which was a good procedure to get comfortable with. I had the opportunity to do two chest tubes...until the visiting MICU resident stole one and the attending insisted the surgery resident do the other one. Grrrr. That was one thing I really wanted to work on while I was there. Since my other residents never screwed up their lines, there weren't any iatrogenic pneumothoraces giving us cause for chest tubes. I suppose that's for the best.

Most of the nurses were smart and reliable. Some were friendly and offered tips on dealing with different attendings. Some were loud, mean, and untrustworthy for reasons passing understanding. At least I made enough friends so that they would usually let me sleep an hour each night.

Anyway, there were no major screwups while I was covering the unit. No preventable deaths. And while I emerged as a more confident doctor, I'm not really sure what I learned. How to be a more efficient lackey, perhaps?

Pediatrics

2010-01-29T23:06:00.001-05:00

Pediatrics floor month.

Since pediatrics was my very first rotation as a third year medical student, and it has now been (thinking...) nearly three years since that time, I'm due for some review. Yes, I already worked a month in the pediatric ER, but it's hard to really get a sense of "sick vs. not sick" if you don't see what sick kids really look like. And since H1N1 already hit (the peak was 3 weeks ago, maybe?), and we're at the near-peak of bronchiolitis season, I have to put on the additional "contact precautions" attire for nearly every patient I see during the day. I've done a few LPs during this month, mostly since I've done more of them recently than most of the other interns. Otherwise, lots of parental counseling regarding home antibiotic regimens, warning signs of more serious illness, etc. One parent was particularly hyper-vigilant. Her daughter had thankfully survived a bout of septic shock precipitated by a community acquired pneumonia, and she was terrified about bringing her home again. We explained the mechanism of septic shock over and over, and said that after 3 weeks in the hospital, she was back to her regular healthy self. I had to review the child's full set of labs, including some of the esoteric results we get from the lab that none of us really use (e.g., mean platelet volume), and explain to the mother that not every single value has to be perfectly normal before discharge (or that, in the average healthy person, not every value will be perfectly normal all the time).

Anyway, the pediatrics residents were generally nice and fun to work with. Overall, a good month.

ER

2010-01-20T11:24:00.000-05:00

I'm working in the adult ER this month. Finally! I'm excited to finally work in my part of the hospital -- although this is my only month here until May-June. I better enjoy it while I can -- TICU is coming up next month.

Orthopedics

2009-12-06T09:50:00.000-05:00

Orthopedics.

A relative easy month...mostly since we're not allowed to do much. It's understandable in a way, since the 2nd year ortho residents only get a few months of orthopedics their first year. I assisted with a bunch of fracture reductions and casting, "revised" a few finger amputations before closing them, and otherwise looked at a lot of films. Learned a lot conceptually, learned only a little in terms of procedures.

MICU

2009-11-14T13:38:00.005-05:00

I survived 4 weeks in the MICU, aka medical ICU. For the non-medical people, the MICU deals with serious "medical" problems -- e.g., bad pneumonia requiring a ventilator, bad cases ond H1N1, sepsis, kidney failure, cancer, other bad infections -- while there are other ICUs for post-surgical issues (surgical ICU aka SICU). There are also similar places for heart disease (cardiac care unit or CCU), traumatic injury (trauma ICU or TICU), etc.

It was a hard month. "Sleeping" in the hospital every 3rd night, aka working through the night every 3rd night, gets old fast. I'm glad to be done with it. But I also had a really interesting time, and I learned a ton. Lots of sick people requiring a lot of care = many opportunities to practice medicine. I placed about a dozen central lines and became much more comfortable starting patients on pressors than I ever expected to be. I also realized how Not Sick many of the so-called Sick patients I see on other rotations really are. If your kidneys are still working and your lungs aren't filled with fluid, walk it off. Or something like that.

We did have a half-dozen patients with H1N1 influenza. A few were really, really sick for weeks. Most were just semi-ill for a few days and then got transferred to the floor. Seeing patients who had been on a ventilator for over a week because of H1N1 certainly made me careful about always wearing a mask!

Next month: orthopedics! And a week of vacation! And Christmas!

Internal medicine wards

2009-10-10T13:01:00.000-04:00

Ahhh, medicine wards, aka the floor. Where things always go....so.....slowly. I learned a lot this month, some of which will be useful in the ER, some of which will not. I did spend many, many hours walking through the hospital. And many, many hours on the phone with social work. I did have a few exciting moments, such as the Code Blue announcements that I ran to and during which I (occasionally) intubated patients in trouble.

I have the utmost respect for social workers -- in part because I'm absolutely terrible at the sort of things they work on. And despite the 75 hours/week I worked in the hospital, it seemed like I spent 15 hours seeing patients, 20 hours rounding, and 39 of the remaining 40 hours working on social work and discharge paperwork.

I had a patient this month who had been in the hospital for 6 months. But by the time I saw her, she wasn't sick. She was actually my favorite patient -- every day we'd spend a few minutes talking about her medical condition (a few aches and pains), her background (Broadway performer during and just after WWII), her daily breakfast (bacon was always overcooked), and the hospital-provided socks (not as warm as she'd like).

She had been admitted for a basic problem that only needed 2-3 days of treatment, but the neuropsychiatry team determined that she wasn't safe to go home by herself due to dementia. Her doctors contacted the social workers and case managers to get in touch with family members about having her placed in a nursing home of some sort. 2 weeks passed.

Oh, except she doesn't have any family members we know of. So we tried to have a guardian appointed for her. Another month passed.

It turned out the patient has a very close friend who knows about her dementia, so we tried to set things up to have her become the legal guardian. 3 weeks go by.

Except her friend is fairly poor, and it turns out you have to pay to process the paperwork to become someone's guardian, and the friend can't afford it. So then the hospital tried to pay the fees for the friend to become the guardian, but for some legal reason you can't do that, so then the hospital contacted the state government to somehow get them to approve it, or pay for it, or something like that, but then the state said they needed a physician to certify that the patient had dementia that would not respond to medical treatment, which I did, and then the social workers said it would be another 30 days for things to get approved.

When I checked the hospital census a month later, she was still there.

The surprising thing? Her 8-month stay looks like nothing compared to the patient who had been there for 3 and a half years.

Pediatric ER

2009-09-11T03:15:00.002-04:00

Finishing my month in the pediatric emergency department.

Highlights? Making some very cute kids feel less scared. And helping some scared parents realize that their kids will be okay. Learning to fix a nursemaid's elbow. Doing a lot of lumbar punctures. Taking medical command calls from ambulances. And learning a ton.

Frustrations? Parents who are angry they've had to wait a full hour (!) to see a doctor. ("My doctor's office is faster than this!") Especially for a child who is "feeling sad" -- nothing else. Or a kid who got in a disagreement with their parents over household chores. Or one who had a headache earlier but now feels fine. Or, parents who want a "full diagnosis" but refuse an IV for their child...or x-rays...or any tests at all. Also frustrating? Attendings who ask me at the end of my shift to "just help with a couple more things"...that then take two or more hours to finish.

Scary things? Seizing kids still freak me out. I know what to do...but still...

Week 1, so to speak

2009-07-18T21:23:00.004-04:00

Okay, I haven't technically started emergency department shifts for real yet, but during orientation I had a couple shifts to get acquainted with my future home. I had forgotten how sick people are -- and, sadly, how much time we spend seeing patients who just want high-potency painkillers...or who want us to babysit their kids...or who insist that they need a CT scan for their stubbed toe that doesn't hurt anymore...or the drug abusers who want plastic surgery to repair the laceration they inflicted upon themselves while high. Hidden among them are the truly sick people. The trying-to-die-in-front-of-us sick people.

And in the first few shifts, I've seen patients with all sorts of problems. The normal -- pneumonia, heart failure, cholecystitis, elderly fall-from-standing patients. The semi-rare conditions like recurrent primary sclerosing cholangitis that I barely remembered from med school. The ticking time bombs like acute aortic dissections. Normal trauma cases, like the non-helmeted motorcyclist who went out for a leisurely ride and was hit at high speed by an SUV. The usual trauma cases -- "I stepped on a garden rake and it went through my foot" to "I slipped and my leg went under the lawnmower." The violent, psychotic patients who try to break everything in sight -- and then start crying -- and then threaten to kill your family. And the demented, frail older patients who are just plain confused and decide to start hitting you while you're performing an ultrasound to diagnose them.

My first month will be split between anesthesia (airway/intubation skills) and ED ultrasound. It's probably the easiest rotation of the year, so I better enjoy things I while I can!

Looking Ahead

2009-03-26T18:41:00.003-04:00

Match Day has come and gone. And in June, I will start work at Rhode Island Island Hospital, as part of the Brown University residency program in Emergency Medicine! Between now and then, I'm also getting married, graduating from med school, and possibly buying a house or condo.

Busy much?

Hi.

2009-03-05T10:36:00.004-05:00

Hi.

It is an interesting time. I'm done with clinical rotations, and now I fill my time by teaching first year med students, finishing my current research project, and going to the gym. I even submitted entries to a few medical student essay contests. Yes, an essay contest just for med students. Because we're known for being such excellent writers.

Anyway, things have been slow. Fortunately, for the last week, Karen and I have been on semi-vacation in Minneapolis, working on some in-person wedding planning. We visited our ceremony and reception sites, tasted some wedding cake samples, and finished most of our gift registry.

I've also been reading for fun -- Paul Starr's "Social Transformation of American Medicine" -- and keeping up my workouts. I've also been playing Wii sports for 1-2 hours a day. Tennis + boxing = very sore shoulders.

Tomorrow we fly back to Cleveland. And Monday we get emails to say whether we matched (yay!) or not. And Thursday is Match Day.

And then we can start planning next year for real!

Where does the time go?

2008-05-27T02:41:00.002-04:00

May. Late May. Time to start blogging again.

I'm finishing my first of two consecutive months of ER rotations. I've been building up some pretty high expectations for these months. Since I've been thinking all through med school that emergency medicine is where I will end up, it's hard not to make conclusions about my future career based on these shifts. I need to recognize that there are ups and downs to it, much as there are in other fields of medicine and, for that matter, in any sort of job. But, perhaps more importantly, I need to look through these ups and downs and see whether the underlying responsibilities and daily activities of an ER doc are something that I could do for a few decades.

So far, so good.

My last few shifts have been particularly rewarding. I feel like I'm finally getting a sense of how the department works, how to most efficiently manage the patients I'm seeing, and how to handle some of the basic procedures performed in the ED. I've done a few I&Ds, a few laceration repairs, and tonight I did my first digital block. Nothing fancy, but it feels good to have at least some basic skills other than interviews and physical exams.

For non-medical folks: you'll notice that I'm using a variety of acronyms, and most of them are interchangable. People have heard of the "ER" and the classic TV show of that name. Some emergency physicians (EPs) now prefer the term ED (emergency department) since the physical space is clearly more than just a couple rooms. And EM (emergency medicine) encompasses the field as a whole.

Okay, 2:54am. Time for bed.

Happy 2008

2008-01-15T22:39:00.000-05:00

Hello!

It's 2008. Things I have celebrated (?) so far in 2008 include:

- the start of my surgery rotation! Seriously. Waking up at 4:30am is one of my favorite pasttimes.
- the arrival of springtime in Cleveland (65 degrees in January?) followed by the return of actual winter
- my new hatred for Bank of America. I really, really loathe them. If every BofA were to spontaneously erupt in a shower of giant fireballs, I would feel much better. Maybe I can just hope that their purchase of Countrywide (one of the leading sub-prime lenders in the country, I think?) will somehow lead to their own little Enron-style corporate implosion. I doubt it, but one can hope. Grrrrrrr. Fireballs.

One more thing

2007-12-18T00:08:00.000-05:00

I hate my upstairs neighbors. While there are many things I like about this place, the neighbors are not one of them. The loud rap music blasting out their windows at 12:04am on a Monday night is just one reason I hate them.

Back in the routine

2007-12-17T23:30:00.000-05:00

Another day, another attempt at a blog post.

I'm tired. And I shouldn't be. I'm on an outpatient block right now, which means I'm working an easy 8-to-5 schedule, more or less. I should be resting up for the inpatient surgery and medicine rotations I have coming up. From what I hear, those are supposed to kill me.

Except that I'm not resting. Part of it comes from the fact that I'm trying to finish up my two research projects. One was supposed to be done ages ago and is still somehow taking up my time. The other one, well, I suppose I knew I'd be working on it at this point. The other challenging thing is the fact that Karen has a particularly brutal schedule that requires her to get up at 4am every morning for work. (That's what I'll be doing in January and February.)

But that means that I also wake up at 4am. I don't stay up long, but it's usually long enough for me to fully wake up and spend a little bit of time getting back to sleep. I just don't feel as rested afterwards. I don't blame her; we all know that we'll have that schedule at some point. In January and February, she probably won't be too thrilled to hear my alarm going off at 4am as I get up and head into the hospital for surgery pre-rounds.

Time to stop whining and get to work. This abstract isn't going to write itself.

A short hello

2007-12-13T22:36:00.000-05:00

Hi there.

It is December. I keep starting to write on here, then I get distracted, save the draft, and forget about it. This post will be short so I can write it, save it, and post it.

It has been a busy few months. I finished my research block at the end of October and have been back on rotations since then. And I'm starting to think pretty seriously about the residency-related application fun that will be coming up in just a few short months.

Between now and 2008, however, I just have outpatient clinics to attend. They're usually not that hard. However, the surgery clinics are always overbooked, which means angry patients, which means frustrated residents, which means no real interest in teaching. Wonderful.

Happy holidays to everyone!

(cough, cough)

2007-08-07T20:24:00.000-04:00

Hello.

It's August. I started writing this post in July. Early July, in fact. The real post I wrote was in April, and I think I made some comment about trying to post more frequently since I would have less free time than ever.

At least I was half right -- on the "less free time than ever" part.

The last four months were pretty intense. A month each of Pediatrics, OB/Gyn, Neurology, and Psychiatry. I thought Peds was fun and worth considering, and Neuro was interesting but probably not my future path. Psych was fascinating, but not in a wow-I-would-like-that-career sort of way. And my month of OB/Gyn, despite my best efforts to like it, made me feel primarily like I were being flogged. I was lucky to deliver a half dozen babies during this time, but it wasn't enough to make up for the rest of the experience.

Anyway.

I'm now on a break from rotations. We have 4 months to do research during third year, and I was lucky that I got my research block during the summer months. I don't have to start my next set of clerkships until November.

Let's see what has happened since I last posted...not that much, really. Except for...

going to two weddings on opposite corners of the country (San Diego and Maine)
taking out yet another outrageously large student loan
moving into a new place with Karen
starting a garden
getting screwed by my ex-landlord (re: security deposit) and making plans to take her to small claims court
training for a marathon
buying a kitten!

I think that's about it for now. I'll try to get some photos of the kitten online at some point.

Time flies!

2007-04-03T23:55:00.000-04:00

What a busy month! I took the boards, vacationed in San Diego, and tried to mentally prepare myself for life in the hospital. And after just a week and a half as a 3rd year medical student, I can say with confidence that I had no idea what I was getting myself into. That isn't to say I'm unhappy -- in truth, I've loved my first real exposure to working in the hospital. But it's just such an enormous change from anything I've done before.

"It's like an 18-month job interview," said one of the speakers at our orientation last week. And she was right. Try getting to know your coworkers, while knowing they're responsible for evaluating you, and do it in a completely new environment, with completely new software, with a completely new schedule that is often revealed to you just days beforehand. Also, remember that your responsibilities are not clearly outlined, they change according to who is supervising you each day, and you should always try to anticipate what will be expected of you.

So far, though, I'm having a blast. Now I just need to get to sleep earlier. I have a relatively easy schedule this month -- getting up around 5:45 am, in the hospital by 6:45, done most days by 6:00pm. My friends on Neurosurgery, though, are waking up at 3:45 am to be in the hospital by 5:00 am. Or earlier.

Anyway, sleep time. Now that I have less free time than ever, I'll try to start posting again. :-)

Mood: optimistic
Song: The Killers, "Read My Mind"

Coming Up For Air

2007-02-20T02:01:00.000-05:00

I'm back. For as long as it takes me to write this post. I'm in midst of my preparation time for the USMLE -- the United States Medical Licensing Exam -- and I frankly don't know how I'm going to keep studying. I finished class more than two weeks ago, and in that time I have been studying. All the time. I did take one quick trip to California for a full 48 hours, but other than that weekend I have been studying.

How much studying? I'm aiming for 12-14 hours/day. I usually get in about 9 to 10, maybe 11 if I'm really on top of things. The schedule is pretty simple:

8 am: Wake up
9am - 12pm: Study block 1
12pm - 3pm: Study block 2
3pm-4pm: Magical afternoon free time for errands, recovering my sanity, talking to myself, etc.
4pm-7pm: Study block 3
7pm-9pm: Eat, go to the gym, eat, sit around in a stupor.
9pm-12am: Study block 4
12am: Bed.

Now, let's be honest. Am I really following this schedule? No. But am I trying? Yes. Sort of. Keep in mind that it's 2am now and I'm just finishing for tonight. Eh, so it goes.

And this is what I aim to do between now and March 7th. On March 8th, I will do my best to relax. On March 9th, I take the exam. And the next morning, I'm on a flight to San Diego.

For now, though, it's time to sleep. Tomorrow's Study Block 1 is rapidly approaching, and neuroanatomy is on the schedule. Good times.

Mood: determination, mixed with a little cabin fever
Song: Boston, "More than a Feeling" and David Gray, "The One I Love"

Merry Christmas!

2006-12-25T20:30:00.000-05:00

Hi all --

Here is the obligatory Christmas post. Merry Christmas! I'm thrilled to be home, rested, well fed, rested, with family, and rested.

Time for another snack!

401 and counting

2006-12-05T17:04:00.000-05:00

This is my 401st post. Not bad for a little over 4 years.

When I look back on my 2nd year of medical school, I will probably think of this period. We're hitting on all cylinders -- or at least we're being asked to -- with lectures, class exams, clinical sessions 2-3 days per week, and board preparation....all at the same time. As we get closer to the USMLE, class starts to matter less and less. As it is, I've spent probably half my time in the last two weeks focusing on the boards instead of on class material (endocrinology).

Now I'm off to another Physical Diagnosis session. Another afternoon gone.

Song: Quiet Riot, "Come on Feel the Noise"
Mood: autopilot

24 hours

2006-11-16T16:54:00.000-05:00

Just another 24 hours until I have a break. A full week to sleep, read, relax, study, and set my own schedule. Of course, between now and then there is an exam, and I haven't been 100% confident in my studying recently. I'm putting a lot of time, energy, and effort into it...but I'm not sure how much I'm actually learning.

Fortunately, I don't have a choice about the pulm exam. By lunchtime tomorrow it will be over, and I will be packing for my flight back to Portland on Saturday. Hallelujah.

With the exception of 1 or 2 days of federal holiday, I haven't had a break in months. And the sad thing is that I just want to study for the boards. Sure, I want time to sleep and have some fun, but I don't really resent being busy because it distracts from my social life. I signed up for that. I resent being busy because it means I have less time to study for Step 1. And, now that I have scheduled my exam date, I want to study even more. March 9th is rapidly approaching.

Enough whining. Time for more practice tests.

Mood: dug in, so to speak
Song: A set of Baroque pieces, mostly choral, I just bought off iTunes. I just finished Bach's Concerto No. 1 for One Harpsichord. Now listening to Palestrina's "Stabat Mater," performed by the Schola Cantorum of Oxford. It's the perfect music for translating my caffine high into productive work.

Post-election and pre-Thanksgiving

2006-11-14T02:28:00.000-05:00

I'm finally returning to normal life after the election. The biggest news around here was that our smoking ban passed (by a wide margin!) and that Ohio citizens were smart enough to reject the smoking "ban" backed by RJ Reynolds. Amazing. Oh, and yes, the Democrats took the House and the Senate. That was pretty exciting too. :-)

Otherwise, I now find myself with three days before an exam. And four days before I go home for a week! Can I push myself to the end of this week?

The Onion: can it predict the future?

2006-10-31T02:36:00.000-05:00

GOP Throws All Financial Support Behind One Candidate

SCOTTSDALE, AZ—With just seven days remaining until the mid-term elections, the National Republican Congressional Committee has allocated its remaining $256 million cash-on-hand to Arizona incumbent J. D. Hayworth's campaign, in the hopes of retaining at least one House seat. "Considering Rep. Hayworth's strong stance against terrorism and this infusion of money, we're feeling really good about this race," said White House chief strategist Karl Rove, who is personally managing the remainder of Hayworth's campaign from his Scottsdale office."He's going to be in a very competitive position if he spends just 90 percent of this money attacking [challenger Harry] Mitchell." Hayworth will be joined at campaign events this week by 23 prominent Republicans, including Dick Cheney, John McCain, Bill Frist, Arnold Schwarzenegger, Rudolph Giuliani, Ted Nugent, and Rupert Murdoch. In a poll released today, Mitchell leads Hayworth by six points.

T minus 8 days

2006-10-30T18:47:00.000-05:00

Although I should be preparing for my upcoming cardio exam, I'm spending most of my time looking at election news. I looks like Ohio is safe in terms of the Senate, and tonight we have some exciting news showing Jim Webb up by 5 points in Virginia. With only 8 days to go, any positive momentum in the VA, MO, or TN senate races is really encouraging. And 5 points in VA is huge.

I'm also hearing encouraging rumors about Ford's internal polling numbers in TN. They're internals, so I won't trust them until I see similar results from Rasumssen, SUSA, etc., but they're encouraging nonetheless.

How am I supposed to study renal vascular hypertension when the fate of the Senate hangs in the balance? C'mon, let's get this exam over with...

Two weeks left

2006-10-24T13:38:00.000-04:00

Hi everyone. I'm back...sort of. School is kicking my butt and I'm feeling as busy as ever, but the election is two weeks away. And we all know what I'm most concerned about.

Along those lines, this will be a short post, except for the list below. It's part of a pre-election Google bomb. In short, these are the links that I (and many others) are the best descriptions of the candidates listed below. And, fortunately, we know that Google will pick up on it...

--AZ-Sen: Jon Kyl
--AZ-01: Rick Renzi
--AZ-05: J.D. Hayworth
--CA-04: John Doolittle
--CA-11: Richard Pombo
--CA-50: Brian Bilbray
--CO-04: Marilyn Musgrave
--CO-05: Doug Lamborn
--CO-07: Rick O'Donnell
--CT-04: Christopher Shays
--FL-13: Vernon Buchanan
--FL-16: Joe Negron
--FL-22: Clay Shaw
--ID-01: Bill Sali
--IL-06: Peter Roskam
--IL-10: Mark Kirk
--IL-14: Dennis Hastert
--IN-02: Chris Chocola
--IN-08: John Hostettler
--IA-01: Mike Whalen
--KS-02: Jim Ryun
--KY-03: Anne Northup
--KY-04: Geoff Davis
--MD-Sen: Michael Steele
--MN-01: Gil Gutknecht
--MN-06: Michele Bachmann
--MO-Sen: Jim Talent
--MT-Sen: Conrad Burns
--NV-03: Jon Porter
--NH-02: Charlie Bass
--NJ-07: Mike Ferguson
--NM-01: Heather Wilson
--NY-03: Peter King
--NY-20: John Sweeney
--NY-26: Tom Reynolds
--NY-29: Randy Kuhl
--NC-08: Robin Hayes
--NC-11: Charles Taylor
--OH-01: Steve Chabot
--OH-02: Jean Schmidt
--OH-15: Deborah Pryce
--OH-18: Joy Padgett
--PA-04: Melissa Hart
--PA-07: Curt Weldon
--PA-08: Mike Fitzpatrick
--PA-10: Don Sherwood
--RI-Sen: Lincoln Chafee
--TN-Sen: Bob Corker
--VA-Sen: George Allen
--VA-10: Frank Wolf
--WA-Sen: Mike McGavick
--WA-08: Dave Reichert

What month is it?

2006-09-26T16:15:00.000-04:00

The last time I checked, it was August. Now it's nearly the end of September. And while I now know a substantial amount of information about the nervous system and head/neck anatomy, I seem to have lost a month.

I can't even begin to say what sort of fun things I'm going to do once the exam is over tomorrow. Sleep! Sit! Read anything I don't have to memorize! Leave school before sunset!

Seriously, let's get this over with. 16 hours and counting...

A Reputable Influencer

2006-09-18T22:18:00.000-04:00

I'm swamped with neuroanatomy, but I felt the need to post an email I received a few moments ago. Apparently I'm more popular, or at least more reputable (and more influential) than I expected.

Hi,I was just browsing the 'net and found your Hans Zimmer-related blog entry: http://amateurchef.blogspot.com/2006/09/digging-in.html and I think you may be of some help to me. I'm reaching out to you on behalfof M80 & Image Entertainment regarding the release of 'Yanni Live! The ConcertEvent' on DVD and CD. Since you blogged about Hans Zimmer, I thought that youmight be interested in posting the press release or a review of the DVD or CDon your blog? You seem like a reputable influencer, so I think you'd be a bighelp to us. For your help or review, I would be happy to send you a copy of YanniLive! on DVD or CD.Please let me know if you're interested!
Thanks!
Nico, M80
(email and website removed)

Two comments:
1. Who puts an apostrophe on 'net?
2. Anyone want a Yanni Live DVD?

Sincerely,

Your Reputable Influencer

Deadlines

2006-09-14T18:36:00.000-04:00

When I get stressed, it's usually about deadlines. I have something to do, I have a limited time in which to do it, and I'm concerned that I won't be able to finish it in time. But if I finish the task or if there is a long time left before the deadline, I don't worry too much.

My next real deadline isn't for two weeks, yet I'm already stressed as if it were tomorrow. And I think I know why: I can't truly finish studying neuro. Not even close. I had this feeling last year at times, but it didn't usually last very long because each committee ("class" as most people say) was only a few weeks long. Now, though, I've been studying and studying and studying for a few weeks...and there are still two weeks to go until the exam.

This committee has completely transformed my daily life. Part of me thinks that I'm actually more stressed because of the changes in my daily routine, but I know deep down that I would be even more panicked if I weren't working so hard.

Everyone around me is similarly stressed, or so it seems, and that certainly doens't help things.

Grrrrrr. I've been trying to limit my caffeine intake so I can avoid the jitters and get to sleep at night, but that's not going so well. And I'm getting sick.

I should go running. That would help. But it has been raining and raining, and I haven't been getting home until relatively late recently. Maybe tomorrow.

Time to eat dinner. While I study at a cafe.

Mood: discouraged
Song: Live, "The Beauty of Gray" and Rusted Root, "Ecstasy"

Digging In

2006-09-12T20:37:00.000-04:00

My last post was right -- the next two weeks will be insane. And my entire class knows it. We're not exactly the most cheerful group of people right now.

I'll take a break tonight to catch the primary election results from Rhode Island and Maryland, but otherwise I will be working on neuroanatomy and head/neck anatomy all night. Oh, and yes, my house is still a freaking nightmare.

But otherwise life is wonderful. Woohoo.

Song: Bon Jovi, "Livin' On a Prayer" (acoustic). And Hans Zimmer movie soundtracks. Plus some Mitch Hedberg comedy to lighen it up.
Mood: frustrated/exhausted

Clouds on the Horizon

2006-09-06T23:01:00.000-04:00

Neuro is getting hard - and we still have three weeks left. I'm getting worn down already (!), and it seems like everyone around me is anxious most of the time.

Hmmm. We only have classes for 4 days this week, and the first one of those was pretty short, so this week shouldn't be that hard. Let's see how I feel on Friday afternoon...

Mood: anxious
Song: Metallica, "No Leaf Clover" and something else cathartic

Labor Day

2006-09-04T19:37:00.000-04:00

While med school can certainly give you an altered perception of reality, one thing it certainly makes you more aware of is holidays. Even those for just 24 hours. To say I'm thankful for this day off doesn't truly capture how important this day has been. Last week was pretty brutal, so having an extra day to sleep and sleep is obviously helpful. Perhaps more importantly, though, is the fact that we don't have to add new material to our To Do lists today. One of the hardest things about this committee so far has been the fact that we're covering new material at an astounding rate. If you're not running at full speed on school days, you'll find yourself getting farther and farther behind.

Friday night was a little bit unpleasant as I realized late in the evening that I needed to do some extra work before meeting with my research advisor on Saturday morning. (I thought my analysis had been finished earlier in the week, but I'd missed an important step.) Anyway, I made my way through the analysis (successfull, mostly) and got to bed sometime in the middle of the night...maybe 4am or so. I had intended to get to bed by 11 that night, so I started the weekend with an unfortunate sleep deficit. Fortuntely, the two subsequent nights of 11-12 hours of sleep helped return me to a mostly-human state. And hopefully this week will be a little bit lighter on the extracurriculars than last week was.

On this labor day, I am simultaneously laboring away and recognizing the labor of those around me. Good enough.

Mood: not really sure. a little bored, a little distracted.
Song: Snow Patrol, "Chocolate" and the King's Singers, "Spem in Alium"

PS. No, I don't think anyone else has ever listened to those two songs back-to-back before. I know, I listen to strange combinations of musical genres...

On A Platter

2006-08-31T02:27:00.000-04:00

Two weeks ago, I received an email from the two faculty members who are in charge of my current academic class block (we call them committees, for some reason). They're nice people, but the first few lines of the email set the tone for the course:

Dear Year II Students,

Welcome to the 2006 Nervous System Section of the Nervous System/Mind Committee. This memo may help you navigate the course, and most importantly, focus the use of your valuable time most efficiently.

If you don’t read any of this memo, please understand the following:
• Neuroanatomy is time consuming. Very time consuming. Respect that.
• There is only one exam. If you don’t keep up, your butt will be handed to you on a platter. Did we mention that you are expected to know neuroanatomy on the exam?
• (etc., etc., etc.)

The email continued for a couple pages, but those first few lines really captured the essence of what I'm feeling now: this stuff is hard. Really hard.

Today, after three hours of class and two hours of anatomy dissection lab, I studied straight for 12 hours (exluding some minimal driving time). I read several chapters of a textbook, a few dozen pages of class syllabus, and a few pages of a condensed review book, plus used a "virtual glossary" to understand the 3-dimensional nature of certain brain structures. And a few dozen horizontal, corontal, and sagittal "sections" of brain, mostly on CT or MRI. And I am still having a freakishly hard time understanding the acoustic and vestibular systems.

And, believe it or not, after thinking hard for 95% of my waking hours today, it's hard to concentrate on anything at 2:25am.

Tomorrow is Thursday. Then Friday. Then a three-day weekend.

And the unfortunate part? A three-day weekend just means an extra day to hopefully understand this stuff.

Enough is enough. I'm going to bed.

Mood: semiconscious
Song: "I Want You to Want Me" by Cheap Trick (live version)

Olbermann hits it out of the park

2006-08-31T01:10:00.000-04:00

Inspiration. I've been studying for nearly 12 hours straight, and I can barely keep my eyes open. But moments ago I found inspiration.

Keith Olbermann's commentary on Countdown tonight was spectacular. Olbermann spoke about Donald Rumsfeld's comments yesterday to an American Legion convention in Salt Lake City. In short, Rumsfeld stated that anyone who disagreed with the administration on Iraq (more than half of US citizens, mind you) suffered from "moral and intellectual confusion" and was willing to appease "a new type of fascism," clearly referring to the appeasement policies of the Chamberlain government toward Hitler and Nazi Germany in the 1930s.

Olbermann's comments tonight highlight so many things I despise about this administration...maybe I'm just thankful to hear them finally expressed by someone in the media. It's refreshing to hear someone comment clearly on a issue that you feel strongly about, especially when you're well past the point of being able to think.

I'll post the commentary below. You can also find the transcript at MSNBC, but the best idea is to watch the video at Crooks and Liars.

Without much further ado...

The man who sees absolutes, where all other men see nuances and shades of meaning, is either a prophet, or a quack.

Donald H. Rumsfeld is not a prophet.

Mr. Rumsfeld’s remarkable speech to the American Legion yesterday demands the deep analysis—and the sober contemplation—of every American.

For it did not merely serve to impugn the morality or intelligence -- indeed, the loyalty -- of the majority of Americans who oppose the transient occupants of the highest offices in the land. Worse, still, it credits those same transient occupants -- our employees -- with a total omniscience; a total omniscience which neither common sense, nor this administration’s track record at home or abroad, suggests they deserve.

Dissent and disagreement with government is the life’s blood of human freedom; and not merely because it is the first roadblock against the kind of tyranny the men Mr. Rumsfeld likes to think of as “his” troops still fight, this very evening, in Iraq.

It is also essential. Because just every once in awhile it is right and the power to which it speaks, is wrong.

In a small irony, however, Mr. Rumsfeld’s speechwriter was adroit in invoking the memory of the appeasement of the Nazis. For in their time, there was another government faced with true peril—with a growing evil—powerful and remorseless.

That government, like Mr. Rumsfeld’s, had a monopoly on all the facts. It, too, had the “secret information.” It alone had the true picture of the threat. It too dismissed and insulted its critics in terms like Mr. Rumsfeld’s -- questioning their intellect and their morality.

That government was England’s, in the 1930’s.

It knew Hitler posed no true threat to Europe, let alone England.

It knew Germany was not re-arming, in violation of all treaties and accords.

It knew that the hard evidence it received, which contradicted its own policies, its own conclusions — its own omniscience -- needed to be dismissed.

The English government of Neville Chamberlain already knew the truth.

Most relevant of all — it “knew” that its staunchest critics needed to be marginalized and isolated. In fact, it portrayed the foremost of them as a blood-thirsty war-monger who was, if not truly senile, at best morally or intellectually confused.

That critic’s name was Winston Churchill.

Sadly, we have no Winston Churchills evident among us this evening. We have only Donald Rumsfelds, demonizing disagreement, the way Neville Chamberlain demonized Winston Churchill.

History — and 163 million pounds of Luftwaffe bombs over England — have taught us that all Mr. Chamberlain had was his certainty — and his own confusion. A confusion that suggested that the office can not only make the man, but that the office can also make the facts.

Thus, did Mr. Rumsfeld make an apt historical analogy.

Excepting the fact, that he has the battery plugged in backwards.

His government, absolute -- and exclusive -- in its knowledge, is not the modern version of the one which stood up to the Nazis.

It is the modern version of the government of Neville Chamberlain.

But back to today’s Omniscient ones.

That, about which Mr. Rumsfeld is confused is simply this: This is a Democracy. Still. Sometimes just barely.

And, as such, all voices count -- not just his.

Had he or his president perhaps proven any of their prior claims of omniscience — about Osama Bin Laden’s plans five years ago, about Saddam Hussein’s weapons four years ago, about Hurricane Katrina’s impact one year ago — we all might be able to swallow hard, and accept their “omniscience” as a bearable, even useful recipe, of fact, plus ego.

But, to date, this government has proved little besides its own arrogance, and its own hubris.

Mr. Rumsfeld is also personally confused, morally or intellectually, about his own standing in this matter. From Iraq to Katrina, to the entire “Fog of Fear” which continues to envelop this nation, he, Mr. Bush, Mr. Cheney, and their cronies have — inadvertently or intentionally — profited and benefited, both personally, and politically.

And yet he can stand up, in public, and question the morality and the intellect of those of us who dare ask just for the receipt for the Emporer’s New Clothes?

In what country was Mr. Rumsfeld raised? As a child, of whose heroism did he read? On what side of the battle for freedom did he dream one day to fight? With what country has he confused the United States of America?

The confusion we -- as its citizens— must now address, is stark and forbidding.

But variations of it have faced our forefathers, when men like Nixon and McCarthy and Curtis LeMay have darkened our skies and obscured our flag. Note -- with hope in your heart — that those earlier Americans always found their way to the light, and we can, too.

The confusion is about whether this Secretary of Defense, and this administration, are in fact now accomplishing what they claim the terrorists seek: The destruction of our freedoms, the very ones for which the same veterans Mr. Rumsfeld addressed yesterday in Salt Lake City, so valiantly fought.

And about Mr. Rumsfeld’s other main assertion, that this country faces a “new type of fascism.”

As he was correct to remind us how a government that knew everything could get everything wrong, so too was he right when he said that -- though probably not in the way he thought he meant it.

This country faces a new type of fascism - indeed.

Although I presumptuously use his sign-off each night, in feeble tribute, I have utterly no claim to the words of the exemplary journalist Edward R. Murrow.

But never in the trial of a thousand years of writing could I come close to matching how he phrased a warning to an earlier generation of us, at a time when other politicians thought they (and they alone) knew everything, and branded those who disagreed: “confused” or “immoral.”

Thus, forgive me, for reading Murrow, in full:

“We must not confuse dissent with disloyalty,” he said, in 1954. “We must remember always that accusation is not proof, and that conviction depends upon evidence and due process of law.

“We will not walk in fear, one of another. We will not be driven by fear into an age of unreason, if we dig deep in our history and our doctrine, and remember that we are not descended from fearful men, not from men who feared to write, to speak, to associate, and to defend causes that were for the moment unpopular.”

And so good night, and good luck.

News from the Rothenberg Political Report

2006-08-26T15:05:00.000-04:00

I like what I'm reading:

The national mood remains bleak for Republicans. President George W. Bush’s job performance ratings are terrible, and the public still gives Congress low marks. A majority of Americans continue to tell pollsters that the country is headed in the wrong direction.

That’s a recipe for a GOP disaster, and there is no reason to believe that things will change dramatically between now and Election Day to improve Republican prospects.

At the district level, voters are more critical of Republican incumbents – and supportive of even unknown Democratic candidates – than they usually are at this point in the election cycle. GOP candidates are running behind where they would be in anything approaching a “neutral” year. While some firming of the Republican base is likely over the next ten weeks, that alone may not be enough for the party to retain the House.

Strong fund raising by the DCCC should mean that some Democratic candidates won’t face the huge financial discrepancy that they have in the past, though RNC money should boost the Republican ground game nationally.

To hold the House, Republicans must retain at least a handful of districts that now appear likely to go Democratic, probably by discrediting Democratic challengers and open seat hopefuls. Unlike previous cycles, when the burden was on Democrats to create upsets, the onus is now on the GOP to save at least a handful of seats before Election Day.

Therefore, we are raising our estimate of likely Democratic gains from 8-12 seats to 15-20 seats, which would translate to between 218 and 223 seats – and a majority – in the next House.

With this in mind, I can resume studying neuroanatomy in peace.

For Ze

2006-08-25T16:50:00.000-04:00

Scrubbing Bubbles.

They work hard so you don't have to.

(This post is for The Show with Ze Frank. If you don't know what I'm talking about, get with the program!)

I am Neuroanatomy.

2006-08-22T23:18:00.000-04:00

Or at least for the next 4 to 6 weeks I am.

I'm cutting out many activities that aren't essential. I'll keep the gym workouts and the Stone Oven trips -- the former for sanity and the latter for studying -- but many other things will have to disappear for a while.

And here we go...

Read Between the Lines

2006-08-21T23:15:00.000-04:00

Ralph Horwitz, the dean of my med school, announced yesterday he would resign on September 15th. In December, he will begin a new role as the chair of the department of medicine at Stanford.

Students were decidedly unhappy, especially the first year students who began only weeks ago. I don't blame them -- Dean Horwitz started some pretty major changes here at Case, especially in the curriculum, and many of them started only recently. It's natural for people to feel uncomfortable when a leader makes big promises...and then departs when they're only partially complete. Change is uncomfortable, and change without a leader is even more uncomfortable.

Case has been hit full of drama in the last few months, including the resignation of university president Edward Hundert following increasing deficits (up to $40 million) in the university budget and a vote of no-confidence by the faculty. Horwitz' departure certainly will not help stabilize things around here, at least in the short term.

But I disagree many of the views expressed by other students regarding Horwitz's departure. In the last 24 hours, I've heard students explain that Horwitz left because:

He was upset with the condition of the university and/or the resources allocated to the School of Medicine.
He didn't think the new curriculum would work.
He was sick of hearing people complain about the new curriculum.
He was sick of being dean, or he wanted to be chair of a department again.
He wanted a higher salary.
etc.

Of these ideas, the only one that I think is even somewhat reasonable is the first one. However, there are two reasons why I don't agree with any of these idea. First, when examined individually, the reasons listed above don't make a lot of sense. Second, in the context of Hundert's departure, the recent resignation of several other deans, and comments from Horwitz yesterday afternoon, I think there is a likely alternative reason why Horwitz would leave.

First, let's look at the reasons offered as for Horwitz's departure.

He was upset with the condition of the university and/or the resources allocated to the School of Medicine. I would say this is probably true, yet I find it doubtful that this would be enough to make Horwitz leave Case. After all, the major budget issues have been resolved, there is a new university president coming in the next few months, etc. And why would he leave right now, just into the start of the academic year, instead of departing in the summer when he wouldn't have to deal with students?
He didn't think the new curriculum would work. Since the new curriculum was a core piece of Horwitz's plans for the school, it was in his best interest to ensure that it succeeded. If Hortwitz thought the new curriculum wasn't working, it would make sense for him to stay at Case and work on improving it. University administrators, like executives in other industries, gain prestige by and are rewarded for managing complex organizations, making and meeting institutional goals, and successfully developing new projects. Thus, the idea that Horwitz would leave to protect his professional credentials doesn't make any sense. In contrast, departing before the new curriculum is fully in place only dimishes Horwitz's professional standing.
He was sick of hearing people complain about the new curriculum. Are you serious? Deans of schools work with dozens of different constituencies, and I suspect that most of them are complaining about something at any given time. The idea that a dean would leave his position because of complaints about the curriculum is just ridiculous.
He was sick of being dean, or he wanted to be chair of a department again. This, too, is a poor reason. It's not like Horwitz took the position of dean without being aware of what the position would entail, and even if this were his reason, I seriously doubt that he would choose to leave at the very start of an academic year. It's possible that Horwitz wants to be a chair again...but why would he take a "demotion" of that sort? After working in that position at Yale for nearly a decade, it's not as if he doesn't have other, more prestigous academic opportunities.
He's all in it for the money. He wanted a higher salary. You bet. Horwitz leaves his dean position to take a chairmanship position....for the money? I see.

It's clear that I don't believe most of the other reasons for Horwitz's departure. However, his departure marks the fourth resignation of a dean at Case since Hundert's resignation in March.

On June 21, just two weeks after Hundert resigned, Arts & Sciences dean Mark Turner announced he would resign on July 1. Time as dean: 29 months.
On July 12, Dean Robert F. Savinell of the Case School of Engineering announced he would resign at the end of the year.
On July 21, Myron Roomkin announced he would leave the Weatherhead School of Management on August 1. He spent only 21 months as dean.
Horwitz's announcement came one month later.

It's not unusual for deans to depart when a university president leaves, and this set of resignations seemed to fit that pattern.

Perhaps the thing which most caught my attention, however, was Horwitz's response to my question during his brief Q&A session with students on Monday. When asked to comment on the fact that three deans had resigned since Hundert's departure, he replied "This set of departures will allow the new president of Case to build his or her own leadership team from the ground up." He then added something along the lines of " Sometimes, it's important for a new leader of a university to be allowed to pick individuals who share common goals."

Now, I didn't expect Horwitz to come out and say that the Board of Trustees asked him to resign, but his answer certainly gives the impression that the trustees are trying to clear out top management of the university in preparation for a new president. (Besides, stating publicly that he was asked to resign would merely undercut confidence in the university even more. I was just surprised that Horwitz didn't use the "I want to spend more time with my family" excuse.)

It makes sense from the Board's perspective for two reasons. First, Case has a better chance of getting a recognized, highly qualified president if that individual will have an opportunity to bring in individuals who they prefer to work with. Similarly, after going through two presidents in five years, the Board wants to make sure that the president they select will remain. Any deans who were seen as combative, ineffective, or difficult to work with would therefore make the Board's task of retaining a president even more diffcult (Turner, Roomkin, and Horwitz had all been described as such). And perhaps most importantly, at least from the Board's perspective, they had all been appointed by Hundert. Out with the old, in with the new.

So, on that note, I will add that this blog has once again achieved its intended purpose. I can whine about whatever issue is bothering me, and the only thing that has to listen is the giant anonymous Internet void. No irritated friends, no lengthy arguments, etc.

On a completely unrelated note, I got new contacts today and had my pupils dilated as part of my eye exam. So now I can't focus on anything closer to my face than at least 2 feet. Reading a book is certainly out of the question. So....now what do I do? Maybe a nap is in order.

In the zone

2006-08-20T17:40:00.000-04:00

When I started the second year of med school three weeks ago, I was slightly anxious about the return to classes. While first year wasn't exactly easy, I had heard from several people that second year would prove to be a much greater challenge -- specifically, integrating "all" the material I've learned so far.

While I'm not counting my chickens yet, I feel optimistic about this year. I'm being more productive than I was last year, I'm remembering more material, and I'm starting to make connections between concepts in different topic areas. (Yes, there are confounders to this, namely the facts that I'm well rested, our current class block is relatively easy, and we're not required to do dozens of other activities such as CPCP or PD yet.) And even though the boards are only six months away, I feel like I can make it through the academic sprint of the next 180 days.

On that note, I'll end this post and get back to the review books. Another day or two of solid studying and I'll be done with GI.

Mood: calm
Song: Red Hot Chili Peppers, "Snow (Hey Oh)" and Fleetwood Mac, "Never Going Back Again"

An Awkward Conversation

2006-08-18T17:28:00.000-04:00

While studying this afternoon at a local cafe, I stood up from my table and walked to the service counter to get a beverage. While the server/employee was getting my drink, I glanced down at the copy of the Plain Dealer. When the person returned, she looked down at the paper and asked I'd heard about that crazy movie "with Samuel L. Jackson on the airplane."

Me: Snakes on a plane?

Cafe Server: Yeah, that one. Did you see this review?

Me: No, I didn't see the review, but I did see it at the theater last night.

**pause**

CS: Really?

Me: Yeah.

CS: How was it?

Me: Entertaining, but in that campy, B-movie style way. I mean, even the movie doens't take itself seriously.

CS: What is it about? I mean, is it like, terrorists on a plane? Is the title just a metaphor for terrorism?

**pause**

Me: Um, no, not at all. The plot, if you can call it that, is based on having hundreds of snakes -- you know, reptiles -- released on a passenger flight over the Pacific.

**pause**

CS: Why?

Me: Supposedly to kill a government witness who is going to testify against some mobster guy.

CS: And why exactly are they using the snake approach?

At this point, two other employees had walked out and were listening to the conversation. While I could have explained the entire plot in another 15 seconds, I offered just a few references to the newspaper review, picked up my drink, and tried to extract myself from the situation. Realizing that they couldn't exactly force the customer to keep talking, they continued the discussion amongst themselves. As I was walking back to my table, though, I heard one of them pick up the paper:

CS: "This review says, quote, 'It is a rare example of a film not just living up to the hype, but surpassing it. And it is the best time you will have at the movies all summer, if not all year.' I still don't know what it's about, but maybe that's part of the fun.

CS #2: "So you're going to see it?"

CS: "Yeah, probably. I just hope it's not too serious...this has been a long week, and I need something fun. Maybe this will do the trick."

Not too serious? I think she's in luck.

SoaP

2006-08-18T00:50:00.000-04:00

I just got back from the 10:00pm night-before-the-actual-release showing of Snakes on a Plane.

The verdict? Pure cinematic genius.

I'm not saying the movie is good. But it was the most entertaining event I've been to in many months. And at least 10-15% of my med school class was also in attendance. :-) At least we have fun when we can.

Snakes on a Blog

2006-08-17T14:52:00.000-04:00

Snakes on a Plane doesn't technically open until Friday, but apparently there is a 10pm showing at my local theater tonight (Thursday). Since I bought the shirt and sent calls from Samuel L. Jackson to nearly a quarter of my med school classmates, it's not surprising that I'll be going.

Several of my classmates weren't interested in going to the show because they don't think the movie will be very good. To those people I say: yes, you're entirely correct. Others say that the movie didn't make the Top 10 Reviews for the coming weekend. And I say, yes, the movie wasn't even screened for critics. It's not as if there is any pretense about the film's quality. And still others just think it's strange that I'm interested ("in a cult-like way") in this film. And I have to agree with them. I don't really know why I think SoaP is so funny (although my old roommates and their relentless emails might have something to do with it). But starting another year of med school was a little bit depressing and it was nice to have something ridiculous to laugh about.

Mood: focused. On academics, not the movie. Mostly.
Song: David Gray, "Disappearing World"

Updates

2006-08-14T15:40:00.000-04:00

I figured it was time for a change, so I switched to a new template, expanded the sidebar, succumbed to Google's AdSense program (see the toolbar), and added a few new links. Nothing fancy, especially compared to Semisimple, but it's nice to try something different.

Lieberman's Lesson

2006-08-09T18:31:00.000-04:00

Josh Marshall's article this afternoon was right on target. Lieberman learned his lesson -- and I'm not talking about election results. I'm referring to Lieberman's explanation for his independent run and how it comes straight out of Bush playbook for the Global War On Terror.

The lesson has three steps. First, say that your values reflect those of the "mainstream voters." Second, insist that anyone who disagrees with you is "out of touch" and dangerous to the country. Third, repeat as necessary.

It's like a mini-version of the Iraq War or the War on Terror. You're either with Joe or you're with the extremists. Apparently half of Connecticut Democrats are outside the mainstream.
This is really the attitude that got poor Joe into this bind.
The mainstream is Joe Lieberman, along with possibly Sean Hannity and Bill Kristol. If you disagree with Joe Lieberman, a disagreement about policy is the least of it. It's a major existential crisis for the Democratic party which risks conquest by unreconstructed leftists, extremists and miscellaneous other freaks.
The idea that Ned Lamont is 'outside the mainstream' on any issue I'm aware of is laughable.

Marshall makes another good point. It's not as if Lieberman is merely saying that he's a competent senator who might be favored by 51% of Connecticut voters in a general election. He's attacking his own (former) party for not agreeing with him, and claims that he needs to run as an Independent to save the party from itself. After all, if Joe didn't believe he was the moral barometer of the Democratic party, I'm not sure what else he would have to do.

As a matter of civics, if Joe Lieberman wants to run as an independent, good for him. If 51% of Connecticut voters want to vote for him, that's democracy. As a Democrat, he should get out of the race now. And every Democrat should tell him to.
If he wants to run as an independent he should and could go to Connecticut voters and say, "A lot of people in my own party disagree with me on this or that issue. But I've served all of Connecticut's citizens for 18 years. And I still think I can be the best senator. So vote for me."
I wouldn't agree with that. But I could respect it.
But he's not. It's all about him and stabbing his own party in the back while he disingenuously pleads that he's trying to save it.

I had forgotten how much I enjoyed Josh Marshall's writing. Apparently he has an article in Time this week about the CT primary results. Good stuff.

Back to studying GI pathology...

No Turning Back!

2006-08-07T02:28:00.000-04:00

I just bought my tickets for reunion. A roundtrip trip with nonstop flights, between Cleveland and San Francisco, for barely more than $300? I nearly fell out of my chair when I saw this deal. Admittedly, I will miss one more day of school than I had planned for, but I'll save nearly $100 over what I had been expecting and I'll have nearly another full day (arriving at 11am vs. 9pm) of California vacation goodness.

And now it's 2:30 am. And I have class in five and a half hours. It's bedtime. Now.

But at least my plans for reunion are in motion!

Mood: cheerful
Song: David Gray, "Life in Slow Motion"

It's not that much money, really.

2006-08-04T12:02:00.000-04:00

April 2003

"Well, in terms of the American taxpayers contribution, this is it. The rest of the rebuilding of Iraq will be done by other countries who have already made pledges, Britain, Germany, Norway, Japan, Canada, and Iraqi oil revenues, eventually, when it's up and running and there's a new government that's been democratically elected, will finish the job with their own revenues. They're going to get in $20 billion a year in oil revenues. But the American part of this will be $1.7 billion. We have no plans for any further-on funding for this."

-- Andrew Natsios, USAID Administrator

vs.

August 2006

The US has spent $437 billion on Iraq, Afghanistan, and other parts of the war on terror since 2001. The Congressional Research Service estimates conservatively that we might spend another $371 billion on these operations through 2016.

It's too bad this whole thing will cost us 475 times more than expected. So much for fiscal responsibility.

Hello Again

2006-08-01T15:37:00.000-04:00

A month since my last post? I suppose that's what summer relaxation/inactivity can do. Have no fear, though...I started classes for my second year of med school today, and one of my new year's resolutions (new academic year, ahem) is to take a few moments each week to convey some of my crazy med school stories here. In part to entertain, mostly to maintain my own sanity.

For now, though, it's back to doing what I do best: video games. Eh, strike that. Studying. Yeah, that's what I do. Something about becoming a licensed professional....

Mood: excited, jittery, optimistic, anxious, adjusting to my first caffeine jitters in over 2 months.
Song: Live, "The Beauty of Gray"

Anybody looking for a room in Cleveland?

2006-06-15T00:07:00.000-04:00

Because I might have one available. Or, more specifically, my house might have one.

Living here is driving me crazy....and yet I'm bound to another 375 days here.

Anybody? Please?

The Same Script As Before

2006-06-10T11:14:00.000-04:00

Are they really going to use the same playbook all over again? Anybody want to be when we'll hear that American troops will be greeted as liberators?

Reuters - yesterday

CAMP DAVID, Maryland (Reuters) - President George W. Bush said on Friday that Iran has "weeks not months" to respond to a U.S.-backed offer aimed at containing Iran's nuclear ambitions and said Tehran needs to suspend uranium enrichment. At a joint news conference with Danish Prime Minister Anders Fogh Rasmussen, Bush said that if Iran does not suspend enrichment, "there must be a consequence."

The London Guardian - January 30, 2003

The US president, George Bush, has said he would give diplomacy over Iraq "weeks, not months" - but that he would welcome the exile of Iraqi leader Saddam Hussein. "For the ake of peace, this issue has to be resolved," Mr Bush said, in an effort to increase pressure on a divided international community. Mr Bush was speaking after meeting Italian president Silvio Berlusconi - one of eight European leaders to back the US position in articles in the Times and
the Wall Street Journal today.

I won't even make a joke about Congress being able to keep the president in check. Some things just aren't funny anymore.

30 hours

2006-05-25T02:00:00.000-04:00

Just over 1 day until the end of my first year of med school. And, wow, I need a break...but what an amazing year. I never thought I could learn so much in so little time.

Time for sleep. Tomorrow will be a really busy day...doctor's appointment, exam review, studying until late...wish me luck!

"Tax relief for all Americans"

2006-05-17T16:19:00.000-04:00

I'm thrilled the president extended the tax cuts today. The sign at his signing ceremony was so inspirational -- "tax relief for all Americans." All Americans!

(ahem)

Let's say I was still in the working world and made, say, $50,000 per year. Bush's tax cuts would save me about $112 per year, or about 0.2% of my income.

Let's say I'm well-paid businessman who makes just over $1 million per year. Bush's tax cuts would save me $42,776, or about 4.2% of my income.

It's a good thing we decreased the top-bracket tax rate. I mean, I want to make more money, but I realize that working hard to earn more money is pointless because the government will increase my taxes! And if I make more money, my taxes will increase! Life is so unfair, especially when you're making over million dollars a year. Rather than trying to advance my career and earn more money, I'm going to just stay in this job, just so the government won't increase my taxes.

Well, if everyone is getting tax cuts, it's a good thing that we have a federal budget surplus. Oh, wait, there isn't a budget surplus! We're spending $350 billion more each year than we bring in. Don't worry, though, we're working hard to make sure that government funds aren't wasted on silly programs such as student loans and health insurance for poor mothers. Congress cut $12.6 billion from these silly programs and raised the cap on student loan rates by about 1.5%. But that doesn't affect real people does it? Not really. I'll only have to pay an extra $25,000-$40,000 in loan interest. Too bad I'm not a millionaire...that $42,776 in tax relief would really help with these student loan payments. And poor mothers? Don't worry, it's not like they can't get health care if the government slashes Medicaid funding. Oh, wait, they can't. Well, it's not like they will actually die if they don't have health insurance. Oh, wait, research shows that's not true either. If we have to sacrifice students and poor mothers just to give tax cuts to the wealthy, then that's what we have to do.

Well, even though there is a budget deficit, it's a good thing we're not that much in debt. Ahhhh, that's right - the president has asked Congress to increase the debt limit four times! Now we only owe $8.3 trillion, and we can borrow up to $9 trillion. I'm glad the president took the approach of starting a war, cutting taxes repeatedly, and just borrowing money to cover the different. I mean, it's not like the current generation of American leaders can really afford to pay down this debt...you know, we're in a war! And multi-millionaires keep having to pay taxes to the government! Every time millionairs have to pay taxes, the terrorist win! Only those people who hate America will be unwilling to make a personal sacrifice during the War On Terror. (Millionaires automatically exempted from this requirement.)

It's a good thing that my generation will be able to afford to pay off the billions of dollars in interest on the national debt. Just keep passing responsibility to the next generation...

Thinking on your feet is an important job skill...

2006-05-16T11:10:00.000-04:00

Let's say you're interviewing for a job. A technical job, something relating to database management, at a TV station. You arrive at the office of your prospective employer and are directed to a room -- one of the studio sets -- for your interview. An employee, presumably your interviewer, walks in and introduces herself, then asks if you're ready. You say yes. You become slightly alarmed when another employee appears, clips a microphone on your shirt, and disappears. Before you have time to ask what's going on, bright lights turn on and your "interviewer" begins speaking to the cameras on the other side of the room. And now you're live on TV.

Welcome to the BBC.

As I read about the incident on CNN:

LONDON, England (AP) -- An applicant for a job at the British Broadcasting Corp. who accidentally found himself on live television recalled his moment of fame, returning -- on purpose -- to the program on which he inadvertently appeared.

Guy Goma appeared on the News 24 program after a mix-up led his being mistaken for an expert on Internet music downloads. The network put Goma back on the air after he became a news story unto himself.

"I was very shocked," Goma said after watching a replay of his interview Tuesday on the BBC's all-news channel. "But I think now it is all right."

The confusion occurred on May 8, when Britain's High Court awarded a victory to Apple Computer in a lawsuit against Apple Corps, The Beatles' commercial arm.

The BBC had intended to interview computer expert Guy Kewney, but after a mistake at a reception desk, employees brought Goma to the studio. Goma was waiting in a reception area for his interview.

After BBC News 24 consumer affairs correspondent Karen Bowerman ostensibly welcomed the apparent expert, there was a Kafkaesque moment in which Goma winced and tried to open his mouth as if to explain.

When Bowerman asked if he was surprised by the verdict, a befuddled Goma managed to offer that he was "very surprised."

But his performance later swept the Internet in part because he simply pressed on, offering the best answers he could and growing more confident in his punditry as the interview progressed.

Meanwhile, the real Kewney watched the exchange in shock from outside the studio. During Tuesday's program, the BBC also interviewed him by telephone.

When offered a chance to speak directly to Kewney, Goma shook his head.

"I just want to say to him, sorry," Goma said.

Goma told the BBC that he didn't know yet if he got the tech job he sought.

But Britain's industrious tabloids have already put him to work. The Sun newspaper offered Goma a punditry platform beneath a story headlined the "Big Bluffer."

Goma, who has offered to speak on a variety of subjects, offered snap assessments on Saddam Hussein's trial ("He deserves to face justice"); Prince Harry ("It is difficult for him as everything he does is watched") and Britain's Human Rights Act ("We should treat each other as we wish to be treated.")

Of course, video clips of the incident are also available. And while there were probably a ton of signs that should have alerted this guy as to what was going on, it's hard not to feel bad for him. Watch the video and notice his momentary deer-in-the-headlights look when the host introduces him -- with the wrong name. At least he "recovered" and faked his way through the interview...mostly. Apparently now he is enjoying his 15 minutes of fame in the UK. Of course, the real question is whether he got the job or not.

On an unrelated note, I just finished my Heme/Onc exam. Eight days and one exam left until the end of my first year of medical school.

Time for a nap...

The end of "The West Wing" and talk about tax cuts

2006-05-15T11:43:00.000-04:00

Sadly, last night was the final episode of "The West Wing." While I'm getting over my personal loss, I figured it would be appropriate to post something on here to spark some political conversation and debate. Most people who know me wouldn't be too surprised to learn that I think the administration's recent tax cut extensions (along with most of their tax cuts in the last 6 years) have done nothing but transfer the tax burden from the rich to the poor and from their generation to mine. With that in mind, here is Sebastian Mallaby's op-ed from this morning's Washington Post:

"The Return of Voodoo Economics"
By Sebastian Mallaby

Nobody serious believes that tax cuts pay for themselves, as I noted last week. But most senior Republicans flunk this test of seriousness.

In January, George W. Bush declared that, "by cutting the taxes on the American people, this economy is strong, and the overall tax revenues have hit at record levels." Regrettably, this endorsement of what his dad called voodoo economics was not a one-time oversight. The next month, Bush told a New Hampshire audience, "You cut taxes and the tax revenues increase."

Bush is not alone in this. Dick Cheney, allegedly a serious person, asserted in February that the "tax cuts have translated into higher federal revenues."

Bill Frist is sometimes taken seriously, not least by himself. And yet the Republican Senate leader is capable of saying: "Many people in Washington have long known a dirty little secret about tax-cut measures: When done right, they actually result in more money for the government."

Chuck Grassley chairs the Senate Finance Committee and ought to know about this stuff. But he mouths the following nonsense: "There is a mindset in both branches of government that if you reduce taxes you have a net loss, if you increase taxes you have a net gain, and history does not show that relationship."

And just last week Sen. Rick Santorum (R-Pa.) celebrated the extension of the Bush tax cuts by saying, "We've put these tax provisions in place and they've raised money."

Okay, so let's review this issue with the help of some experts. I'd like to cite Richard Kogan of the Center on Budget and Policy Priorities, because his work inspired this column. But to win over reasonable conservatives, I'm going to choose N. Gregory Mankiw of Harvard, a proponent of tax cuts who chaired the Council of Economic Advisers in the Bush White House. Mankiw is a top-notch economist hired by Bush and Cheney to advise them. And last year he published a paper on how far tax cuts pay for themselves, reporting enthusiastically that this self-financing effect is "surprisingly large."

How large, exactly? Mankiw reckons that over the long run (the long run being generous to his argument), cuts on capital taxes generate enough extra growth to pay for half of the lost revenue. Hello, Mr. President, that means that the other half of the lost revenue translates into bigger deficits. Mankiw also calculates that the comparable figure for cuts in taxes on wages is 17 percent. Yes, Mr. President, that means every $1 trillion in tax cuts is going to add $830 billion to the national debt.

Let's engage in what Bush might call the soft bigotry of low expectations and cut Republicans some slack. Hey, maybe they just overlooked that Mankiw paper? Or maybe, despite hiring Mankiw to head the Council of Economic Advisers, they later acquired reasons to doubt his judgment? In that case they should at least have listened to Douglas Holtz-Eakin, another conservative economist who worked in the Bush White House and who went on to run the Congressional Budget Office.

In a study published under Holtz-Eakin's direction last December, the CBO estimated the extent to which a 10 percent reduction in personal taxes might pay for itself. The conclusions confirm that the free-lunch mantra is just plain wrong. On the most optimistic assumptions it could muster, the CBO found that tax cuts would stimulate enough economic growth to replace 22 percent of lost revenue in the first five years and 32 percent in the second five. On pessimistic assumptions, the growth effects of tax cuts did nothing to offset revenue loss.

So Mankiw isn't with them. Holtz-Eakin isn't with them. Which raises a question: When top Republicans go around claiming that tax cuts pay for themselves, which economic authorities are they relying on? None, is the answer. These people's approach to government is to make economics up.

The Republicans' only argument is that tax receipts have boomed in the years since the 2003 tax cut. But the question is whether tax receipts increased because the tax cuts worked some kind of magic or because the economy was headed up anyway after the recession, thanks maybe to low interest rates resulting from the Asian savings glut. Friends, the reason we have economists is so that they can solve these puzzles for us. Ignoring their solutions is like ignoring the judgment of medical science in favor of faith healers and quacks.

Politicians are always speechifying about how the United States must lead the world in research to maintain its edge. But having the world's best economics research isn't particularly helpful if those same politicians are silly enough to tune it out. The truth is that American business excels at turning university research into world-beating products; the paranoia on this score is overdone. But American government is often lousy at turning research into policies. That's what we should fret about.

And now, back to the books. 22 hours until my second-to-last exam of the year.

Mood: cautious
Song: Red Hot Chili Peppers, "By the Way"

I don't like people...

2006-05-06T00:56:00.000-04:00

...who don't pay their full portion when settling the bill after group meals.

A breakthrough?

2006-03-16T00:51:00.000-05:00

Anatomy and histology have not been my strong point in medical school this year. They're both longitudinal committees (or "classes" as most people say), which seems like a good idea in theory (learn bit by bit instead of having to "master" the subject in just a few weeks), but in reality the longitudinal structure seems to just make it easier to never actually learn the fundmental principles. And, perhaps more importantly, both subjects rely heavily on visual interpretation, a skill which I've never really had to practice in an academic context.

And yet, for some reason, I've made huge strides in both subjects in the last few days. Conceptually, things finally seem to be falling into place. In part it's because we've had a lot of this material before. But that doesn't explain it all. At any rate, it feels good to no longer be paralyzed with frustration on both topics.

Our endo/repro exam is coming up on Friday, so the next 31 hours will consist of either studying or sleeping. And so far I'm loving endocrinology.

I also figured out my summer research plans -- more on that after the exam. Back to the books for now...

Mood: upbeat
Song: Eric Prydz, "Call on Me" (Ministry of Sound)

P.S. Three years from tomorrow I'll be matching for residency. Crazy.

Going home? Returning home?

2006-03-04T14:26:00.000-05:00

Last weekend I went to DC for a few days to attend an AMSA Political Leadership Institute. It was basically a weekend seminar on politial skills -- speechwriting and delivery, grassroots organizing, interacting with the media, preparing issue briefs, lobbying, delivering presentations, etc. It was particularly fun to meet other med students from around the country (most of whom were 1st-years) and hear about their experiences. I'm looking forward to seeing most of them at AMSA's national convention at the end of the month.

It was both exciting and unnerving to be back in DC. Living there was a really good experience for me -- good job, fun social scene, lots to do. And the fact that I got into med school while I was there certainly doesn't hurt. And I got to see a lot of my friends while I was there. The strangest part about being there, however, was the feeling that it was home. Or that it had been home. And that I hadn't really recognized it while I was there.

It's an understandable feeling -- I only lived there for a year, but it felt a lot more like home than had Baltimore (which, admittedly, was only my home for 10 months). DC was the place where I established my first real community after leaving California...among coworkers, old college friends, and new friends. It was the first time I'd really forced myself to become more independent by living alone. And unlike Baltimore, I didn't really want to leave.

Anyway, the trip helped me recognize how much life has changed in the last 7 months, in terms of friends, lifestyle/schedule, personal goals, and self image. The fact that is has only been 7 months is pretty scary...but at least I'm able to visit my old home, enjoy it, and come back to a place where I am happy to be.

streams of consciousness

2006-02-11T01:16:00.000-05:00

Med school can really screw with your emotions. While Case certainly isn't a cutthroat academic environment, there is always a fair amount of underlying competition that merely reflects the ridiculously large quantity of material to be learned. Even if you're not competing with your classmates, you're nearly always competing with yourself. It's impossible to learn everything that we're supposed to know, let alone learning it all in just a matter of weeks (each academic block is just a few weeks, so you can't put off learning the material for more than a couple days). No matter how hard you work, you will never learn it all. Never. The idea of "catching up" is just a poor excuse for a coping mechanism. "I'm almost caught up" is a common phrase around here...but what does it mean? You've reviewed the absolute bare minimum content for each lecture? Please. I'm just thankful that most of my friends and I have absolutely no clue as to how many times we'll actually need to cover this material until it gains the most meager foothold on our long term memories.

And most of all, I've never been this busy before. Not even close. Maybe during junior year when I was going 60+ hours of extracurricular junk each week and sleeping 4ish hours each weeknight. But that still doesn't compare with this. I've been trying to finish this entry for nearly two weeks, but free time really is a thing of the past. 10 or 15 minutes free here or there? Not really. If you think of walking home from school as free time, then maybe you're right. Tonight I brought a textbook to the gym for the first time, theoretically to read while I was on a stationary bike. But I couldn't bring myself to do it. It reminds me of a book I read a few years ago about students going through medical school. At one point, the author's roommate makes the fantastic discovery that if she puts each of her notecards in a plastic bag, she can study them while she's in the shower. That passage didn't sit well with me at the time, and it still doesn't now...but now I'm starting to understand it. And it seems like a very slippery slope.

State of the Union: 24 hours later

2006-02-02T01:45:00.000-05:00

I've been too busy to blog recently, but this article was too good to pass up:

Administration backs off Bush's vow to reduce Mideast oil imports

By Kevin G. Hall
Knight Ridder Newspapers

WASHINGTON - One day after President Bush vowed to reduce America's dependence on Middle East oil by cutting imports from there 75 percent by 2025, his energy secretary and national economic adviser said Wednesday that the president didn't mean it literally.

What the president meant, they said in a conference call with reporters, was that alternative fuels could displace an amount of oil imports equivalent to most of what America is expected to import from the Middle East in 2025.

But America still would import oil from the Middle East, because that's where the greatest oil supplies are.

The president's State of the Union reference to Mideast oil made headlines nationwide Wednesday because of his assertion that "America is addicted to oil" and his call to "break this addiction."

Bush vowed to fund research into better batteries for hybrid vehicles and more production of the alternative fuel ethanol, setting a lofty goal of replacing "more than 75 percent of our oil imports from the Middle East by 2025."

He pledged to "move beyond a petroleum-based economy and make our dependence on Middle Eastern oil a thing of the past."

Not exactly, though, it turns out.

"This was purely an example," Energy Secretary Samuel Bodman said.

He said the broad goal was to displace foreign oil imports, from anywhere, with domestic alternatives. He acknowledged that oil is a freely traded commodity bought and sold globally by private firms. Consequently, it would be very difficult to reduce imports from any single region, especially the most oil-rich region on Earth.

Asked why the president used the words "the Middle East" when he didn't really mean them, one administration official said Bush wanted to dramatize the issue in a way that "every American sitting out there listening to the speech understands." The official spoke only on condition of anonymity because he feared that his remarks might get him in trouble.

Happy 2006

2006-01-01T18:21:00.000-05:00

Happy 2006 to everyone! 2005 was a pretty fantastic year for me -- a great time living and working in DC, getting into med school (finally!), and forming a new group of friends in Cleveland. So here's to a great 2006!

I'm still working on resolutions. As usual, one of them is to get back in touch with people I haven't heard from in ages -- usually at least a year or more. Otherwise, I'd like to resolve to stop biting my fingernails, but that has been one of my resolutions since the early 90s and I still haven't succeeded. Perhaps the 14th resolution will finally be the one? :-)

Merry Christmas!

2005-12-27T03:26:00.000-05:00

I'm back in Oregon for a few days after spending some quality time with my relatives in southern California. I don't have a ton of time to relax, but hopefully this will give me time to rest and relax before I head back to Cleveland at the end of the week. And, hopefully, the new year will bring me back to the blogging world. The med school schedule hasn't been particularly conducive to keeping up with the blog, to say the least.

In the words of Rep John Dingell (D-MI), "Merry Christmas to all, and to Bill O'Reilly, Happy Holidays."

Happy Thanksgiving

2005-11-24T23:00:00.000-05:00

Happy Thanksgiving! This is my first Thanksgiving away from home, but I've had a pretty good day. Baked a few tarte tatins this afternoon, went to a Thanksgiving dinner hosted by one of my med school classmates, and played a little bit in the snow. I'm pretty sure this is the first time I've had snow at Thanksgiving in a long, long time.

It will hopefully be a nice, slow, relaxing, restful weekend. Wish me luck!

When you least expect it

2005-11-06T12:41:00.000-05:00

This weekend has been surprisingly fun. We have a enormous cell physiology-neuromuscular-histology-anatomy exam on Thursday, so this weekend (and all of next week) is supposed to be filled with studying, anxiety, and books. And while that has been true to some extent, the last few days have also been incredibly reaffirming. On Friday night I went to a theater to see Shopgirl, which I liked for the most part. Last night I went out for dinner at the Great Lakes Brewing Company to celebrate a friend's completion of the Series 7 exam. And I've spent a lot of time building some bonds with some very important people.

This week is going to be pretty rough for the next 96 hours, but I know I can do it.

First goal? Finish my note summaries on our neuromuscular lectures. Here goes...

Mood: surprisingly relaxed and content
Song: Some of the music from Shopgirl...don't know the names of the songs yet...

Mental wanderings

2005-11-02T01:04:00.000-05:00

In just a few short months, I've learned that med school can get pretty intense. Every so often, you need a day that can focus on more than academics -- on errands, on financial demands, on personal issues. Today was one of those days. I know that the next eight days will have some serious academic demands, but for now I feel content. Right now I'm happy. I can handle the next week.

And, by the way, our Halloween party was insane. Turnout was two or three times higher than expected, and everyone seemed to have a pretty good time. Certainly a night to remember.

Mood: cheerful and optimistic (despite near-constant fatigue)
Song: Toad the Wet Sprocket, "All Right" and Van Halen, "Not Enough"

The Lights Come On

2005-10-28T01:32:00.000-04:00

Somehow, in the last 24 hours, anatomy has started making a lot of sense to me. I don't know what happened, and I'm not sure if it will last, but for now I have the first hint of academic confidence since the start of med school. And I like it.

And tomorrow is Friday. Hooray. (The fact that I plan to study nearly the entire day doesn't make a dent in my excitment.)

And Saturday is our Halloween party. Super hooray.

Mood: optimistic
Song: Live, "The Beauty of Gray" and REM, "Man on the Moon"

Studying as default?

2005-10-22T16:46:00.000-04:00

I've noticed recently that studying is now my default behavior. Unless I have something else to do -- eating, sleeping, going to lecuture, etc. -- I will virtually always be studying. And somehow it seems normal. In the past, I had a difficult time imagining how medical students could really study so much...didn't it get old? Didn't they want to do anything else? Didn't they lose their minds?

As I've learned, the answer is "yes." But that doesn't mean I won't keep going. When virtually everyone you see is studying most fo the time, it somehow becomes a normal baseline activity. If someone asks what I'm doing this weekend, I will probably say, "Not much." If it's a med student who asks, they'll assume that means I'm studying all weekend. If someone else asks, they'll just think that I'm not very active.

As a side benefit, I seem to be able to repress most of my emotional issues when I'm studying. It doesn't do anything to resolve them, but at least I can ignore them for a while. Amen.

Back to anatomy. Only another few billion names to learn.

Mood: Calm
Song: Evanescence, "Listen to the Rain" and Garbage, "Only Happy When It Rains"

End of the week

2005-10-22T03:01:00.000-04:00

It's late and I should go to bed, but I have an odd feeling in my mind that I can't describe. I feel great for the most part, but I've been feeling strangely conflicted about my emotions recently.

For example, I had a pretty hectic week and I'm happy it's Friday...but I've said that nearly every week since starting med school.
I'm building some great friendships here at Case, but it seems strange to say that since I've only been in school for 60 days. Yet there are a few people here who I know far better than some of the people I interacted with in DC for an entire year.
I studied for nearly 12 hours today. I feel like I made a lot of progress. And yet I still can't help but think that I'm still re-discovering how to study...often I get done studying and I can't remember a single thing I've learned.
We started anatomy this week...had dissection labs on Monday and Thursday. Did I pass out or get nauseus? No. Am I comfortable with the idea of cutting through the tissue of a donated body? Not entirely. And did I want to know what it smelled like when you're making cuts with bone saw? Not at all.
I saw the Navy recruiter at a residency fair today on campus. I still need to sit down look through all the program material. I'm still months away from making a decision....right now I think I'm in denial/avoidance mode. I like so many parts of the program, but there are so many unknowns. What if I want to enter a really competitive residency that would be impossible to get in the military? What if this decision ruins my ability to pursue a career in academic medicine? What if I meet someone in medical school who is perfect for me...except that she doens't want to deal with my mandatory years of service after med school? I could go on and on. I've been thinking about these issues for two or three years now, yet I keep coming back to this program. At least I have a few months to think about it before the deadlines start getting close.

As usual, I'm sure sleep will help. Tomorrow is another day of studying.

Mood: Jumbled. Relieved? Anxious? Lonely?
Song: Jason Mraz, "I'm Yours"

A little more intensity, please?

2005-10-19T01:22:00.000-04:00

School is starting to become my life. We started anatomy on Monday and I'm still not sure how I feel about it. It's an amazing educational opportunity, but that doesn't mean I'm sure what my emtional reactions are. Free time is becoming quite rare, and by Monday evening I was already hoping for Friday.

I have tons to talk about -- the dissection, my still-in-progress Navy decision, the identify crisis/transformation that med school triggers, etc. For now, though, it will have to wait. Sleep is the top priority now.

Going to the Jason Mraz concert tomorrow. Ought to be a good time.

Mood: tired but adapting
Song: Michael Nyman, "The Piano"

Another left-wing conspiracy?

2005-10-16T01:57:00.000-04:00

Bill Kristol has an interesting article in the October 24th edition of the Weekly Standard:

THE MOST EFFECTIVE CONSERVATIVE LEGISLATOR of--oh--the last century or so, Congressman Tom DeLay, was indicted last month for allegedly violating Texas campaign finance laws, and has vacated his position as House majority leader. The Senate majority leader, Bill Frist, is under investigation by the Justice Department and the Securities and Exchange Commission for his sale of stock in the medical company his family started.

White House deputy chief of staff Karl Rove and vice presidential chief of staff Scooter Libby have been under investigation by a special federal prosecutor, Patrick Fitzgerald, for more than two years. When appointed in 2003 by the Bush Justice Department, Fitzgerald's mandate was to find out if the leaking to reporters of the identity of a CIA employee, Valerie Plame, was a violation of a 1982 statute known as the Philip Agee law, and if so, who violated it. It now seems clear that Rove and Libby are the main targets of the prosecutor, and that both are in imminent danger of indictment.

What do these four men have in common, other than their status as prosecutorial targets? Since 2001, they have been among the most prominent promoters of the conservative agenda of the Bush administration.

I don't expect Kristol to actually blame these people for their current situations, but his approach certainly did surprise me. Why are these four people under investigation? If you ask him, it's because the left wing has decided to pursue a strategy of criminalization to defeat conservatives. What Kristol leaves out is that fact that it's only because the left wing is so organized and holds so many powerful positions in Washington that this strategy is possible.

Why are conservative Republicans, who control the executive and legislative branches of government for the first time in living memory, so vulnerable to the phenomenon of criminalization? Is it simple payback for the impeachment of Bill Clinton? Or is it a reflection of some deep malady at the heart of American politics? If criminalization is seen to loom ahead for every conservative who begins successfully to act out his or her beliefs in government or politics, is the project of conservative reform sustainable?

We don't pretend to have all the answers, or a solid answer even to one of these questions. But it's a reasonable bet that the fall of 2005 will be remembered as a time when it became clear that a comprehensive strategy of criminalization had been implemented to inflict defeat on conservatives who seek to govern as conservatives. And it is clear that thinking through a response to this challenge is a task conservatives can no longer postpone.

Pardon me while I laugh.

Much Better

2005-10-11T23:04:00.000-04:00

After a six-hour nap this afternoon and a two-hour high intensity jujitsu workout tonight, I'm feeling like an entirely new person compared to this morning. Now I'll head to bed and get nearly 8 hours of sleep. Life is good.

Mood: Peaceful
Song: Moby, "Hymn" and "First Cool Hive"

Recovery

2005-10-11T11:45:00.000-04:00

I passed the exam. Woohoo. Now I'm feeling the effects of my marathon study session last weekend and the re-emergence of my coffee habit. After an hour of lecture this morning, I realized that I was having a tough time doing much of anything. And while I didn't feel specifically tired, I felt empty. Every internal alarm kept telling me that I needed to sleep, and soon. So I came home and in a few minutes I'll take a nap...for 4-6 hours.

The last few days have been really odd. I haven't been myself. I've been making rush decisions without thinking them through, I've been having a tough time paying attention to even the most basic conversations, and I've been talking a lot more (babbling, really) than I usually do. It's as if I've been walking around in a semi-drunken state since the middle of last week. Plus I'm feeling emotionally unsettled but I'm not really sure why. All in all, I need to recover from the last five or six days. That's my self-prescription for today...sleep, food, cleaning, laundry, and more sleep. Tomorrow I hope to be my usual self again.

Mood: fuzzy
Song: Coldplay, "Fix You"

Must...Keep...Studying

2005-10-10T00:14:00.000-04:00

32 hours of studying in the last 3 days, and I still don't feel like I have covered all the material for the exam tomorrow. Who ever thought that molecular biology, genetics, and human development could be so...complicated??? (Don't answer that.)

On an unrelated note, I saw pictures today of an ex-girlfriend's recent wedding. Talk about a shock to the system. Fortunately, studying for this exam has pummeled my mind into a state of emotional numbness so I don't really have to think about it. But....wow. Congratulations, MG.

One more hour, then I sleep. Tomorrow will be a busy day.

Mood: Don't really have one right now.
Song: Ottmar Liebert, "Spanish Steps (Rome in May)" and Coldplay, "Talk"

Watching the crowd

2005-10-08T15:08:00.000-04:00

Quick note -- there's this guy at Starbucks today who I've seen around the Coventry area a few times. As usual, he is sitting with a drink, staring at a wall, and not saying anything. For hours. We're talking zero movement. He's not sleeping, either, unless he can sleep with his eyes open. Suddenly, an attractive woman approaches (who he apparently knows?) and the frozen mime act suddenly evaporates. He greets her, tries to engage her in conversation, and she replies a little bit. He says he's been working on a practice test of some sort, at which I silently laugh. He hasn't moved in two hours!

As soon as she sits down and their short conversation ends, he picks up a set of papers (the practice test?) and begins to look over them. After a minute or two, though, he puts down the papers (too much work?) and resumes the previous frozen position. We're back to square one.

Update: After another 40-45 minutes, he stands up, walks around the store for a minute, and sits back down. Picks up a newspaper, reads for about 30 seconds, and puts the paper down. Goes back to looking at the wall.

Now I feel a lot better about my level of productivity today. :-)

Mood: In the zone. Studying all day and somehow feeling okay about that.
Songs: Blink 182, "Some Girls Try Too Hard" and Uncle Kracker, "In A Little While"

TGIF...sort of

2005-10-07T21:38:00.000-04:00

It's finally Friday...and I'm studying all night. We have a big exam (molecular biology, genetics, and development) on Monday morning, so this entire weekend will be dedicated to that cause. It has been an incredibly long time since I've studied on a Friday night (4 years? 5 years?), but it was an easy decision to make since (a) all my friends are doing the same thing, and (b) fear is a very strong motivator.

I talked with the Navy recruiter on Wednesday. It was a productive conversation, and I discovered that I don't have to finish the application until early next year, so I feel a lot better now that I don't have to panic and rush to finish the application. I still have a lot of issues to figure out in that regard, but fortunately I can wait until next week to think about them.

We formed our groups for Anatomy today. I think we'll "receive" (?) our cadavers next week...ought to be a pretty amazing/stunning/uncomfortable experience.

For the first time in recent memory, life is starting to get complicated again. The time requirements of school continue to grow and grow, and I'm starting to look ahead to extracurricular plans (AMSA, most likely in their policy group) and my HPSP/Navy decision. And that's just the start of it...

Back to the books.

Mood: Cautious, a little anxious, a little optimistic. Trying to focus.
Song: Gypsy Kings, "Galaxia" and Ozzy, "I Just Want You"

All I wanted...

2005-10-06T23:41:00.000-04:00

...was to sleep. For nearly every waking moment today, I just wanted to stop listening/studying/working, curl up in a ball, and fall asleep on the floor. That's it. And, of course, now that I'm home and relaxed and trying to go to sleep, a million thoughts flood my head and sleep evades me...

Mood: Really, really confused
Song: Evanescence, "Anywhere"

The "To Do" List Keeps Growing...

2005-10-04T00:58:00.000-04:00

Med school life is starting to get pretty busy. A month ago, I only had to handle 5 hours of lecture and an occasional meeting or review session. Now, though, it seems like each day is filled from morning to night with seemingly essential activities.

Today I had my first RAMP rotation (adolescent pediatrics @ Univ. Hospitals). It was a good educational experience. I'm still getting used to the idea of wearing a white coat...and having patients believe that I'm actually qualified to wear it. I had a good time in the clinic today, but I get the feeling that pediatrics might not be the best match to my interests. (I like kids, but I don't know if I want to spend my career doing well-child exams and ordering vaccinations.) Joking aside, the pediatricians I worked with today were exceptionally talented and I was thankful that they were so helpful/encouraging/supportive/instructive.

I'm not really looking forward to this week...it bodes of late nights, early mornings, endless reading, and more coffee. (sigh) I have a ton of "errands" (i.e., any non-academic task) to do: student loan determents, getting paperwork approved by the registrar, calling the Navy people, starting the HPSP application, sleeping (is an errand?!? nevermind, forget I wrote it), and more. And that's on top of the 1293812 hours of studying I have to do in the next six days. At least my weekly jujitsu class tomorrow evening will help with the stress, although last week I screwed up my ankle during class and that didn't help. Maybe tomorrow night I'll just take it a little easier than usual...

I've found that I get nervous about most of our non-classroom activities: patient communication workshops, physical diagnosis, etc. The strange thing is that I think I do pretty well in these sessions, especially the communication workshops, yet I still get nervous about them. I think most of it has to do with the fact that we're interacting with standardized patients. And, yes, I recognize that the purpose of standardized patients is to allow us to learn skills in a controlled, low-pressure environment...yet I feel that any environment in which I'm being tested on my interaction with patients will make for an inherently stressful interaction. Or something like that. Of course, I feel good about myself and the stress goes away each week when I complete each session and recognize that interacting with patients is something I do naturally. I just seem to forget that lesson each week.

Still working on the HPSP post. I'm hoping to call the Navy recruiter tomorrow afternoon to get some information, so perhaps I'll have more to write about by tomorrow night. Talking about stress...this decision certainly provokes it, yet I keep coming back to it, time and time again.

A friend commented tonight that the process of getting to know our new classmates is both fun and frustrating. How true that is. I think we've made it through a few different phases of getting to know each other...the working-hard-to-impress stage during the first week, the see-how-we-all-react-to-stress stage, the collective anxiety or discomfort with certain shared conversations/experiences, etc. Just a week or two ago, the pervasive question during our 10-minutes break between lectures was about which of our classmates would hook up/start dating/make a scene first. By this week, though, it seems like everyone agrees that those quesions are cliche/obsolete/no longer relevant. Perhaps it's because an exam is approaching and we won't risk the distraction; I'll wait a see if the same questions resume next week after the test.

At the same time, I realize that I've only been in Cleveland for six or seven weeks. To think that I actually know anybody yet seems quite premature...yet I feel like I already know who my friends are going to be. If that sounds confusing, then I probably explained it correctly.

Bedtime.

Mood: Anxious. And sleepy.
Song: Staind, "Right Here Waiting" / Patrick Park, "Something Pretty" / Speechwriters LLC, "Annie Dan"

Three years!

2005-10-01T18:58:00.000-04:00

Wow -- it has been three years since I started this blog! It's pretty strange for me to think about. Three years ago I was disappointed with my job, getting rejected from med schools left and right (I really should have a retrospective post about my three years of med school applications), and was generally worried about where things were heading. Several dozen applications, three states, and one master's degree later, I'm finally where I want to be. And three years from now? I think I'll be applying to residencies. (shudder) For now I'm just thankful to have made it this far. :-)

I'm working on a post about my upcoming decision on whether I should apply for the Armed Forces Health Professions Scholarship Program...hopefully I'll finish that tomorrow sometime. In the meantime, I'm going to relax and enjoy my Saturday evening. Tomorrow is a big studying day.

Mood: Optimistic
Song: Queen, "Somebody to Love" and The Wallflowers, "Closer to You"

Finally

2005-09-28T18:05:00.000-04:00

CNN:

Rep. Tom DeLay says he will step aside as House majority leader after a grand jury indicted him on a conspiracy charge, accusing him and two others of improperly funneling corporate donations to a Republican political action committee.

Hallelujah. It's about freaking time.

Everything Comes Together

2005-09-26T20:28:00.000-04:00

I study at Starbucks all the time. Usually it's a great place to study, but there can be good days and bad days in the world of studying (as with anything else in life).

Tonight, I have the right level of noise, the right level of caffeine (which is certainly lower than you would expect), the right music, and my study materials in front of me. And everything is coming together...I've probably accomplished more in the last two hours of studying than in most of the last week. Let's just hope I can remember what I've learned tomorrow...

Mood: My classic intensity (just without the usual caffeine high)
Song: Dvorak's Symphony No.9 "From The New World" - IV. Allegro con fuoco

Good weekend

2005-09-26T00:42:00.000-04:00

What a great weekend -- had a party on Friday, caught up on sleep, reorganized my room, finally set up our cable and internet, and started my serious studying for cell bio/genetics. For the first time since arriving in Cleveland, I finally feel like I'm moved in and settled. I'm not excited that tomorrow is Monday, but at least I feel prepared to start the week...

Mood: Calm, optimistic
Song: Ottmar Liebert, "Little Wing"

Wikipedia: Xenu

2005-09-25T17:33:00.000-04:00

As I said previously, Wikipedia offers an incredible variety of online articles. And while I don't want to trash anyone's religion, an article I found on Wikipedia convinced me that Scientology is...overwhelmingly different from my view of the world. I'll just leave it at that.

Consider the Wikipedia entry on Xenu. It's among the most entertaining things I've ever read online. For starters...

In Scientology doctrine, Xenu is a galactic ruler who, 75 million years ago, brought billions of people to Earth, stacked them around volcanoes and blew them up with hydrogen bombs. Their souls then clustered together and stuck to the bodies of the living, and continue to cause people problems today. These events are known to Scientologists as "Incident II", and the traumatic memories associated with them as The Wall of Fire or the R6 implant. The story of Xenu is part of a much wider range of Scientology beliefs in extraterrestrial civilizations and alien interventions in Earthly events, collectively described as space opera by L. Ron Hubbard, the founder of Scientology.

Got it? Xenu stacked the people around volcanoes (instead of merely dumping them into giant piles), then detonated hydrogen bombs to vaporize their bodies. And now their souls cling to us and cause problems? Seems easy enough.

But wait - there's more. (Italics are from the Wikipedia article.)

75 million years ago, Xenu was the ruler of a Galactic Confederacy which consisted of 26 stars and 76 planets including Earth, which was then known as Teegeeack. The planets were overpopulated, each having on average 178 billion people. The Galactic Confederacy's civilization was comparable to our own, with people "walking around in clothes which looked very remarkably like the clothes they wear this very minute" and using cars, trains and boats looking exactly the same as those "circa 1950, 1960" on Earth.

Xenu was about to be deposed from power, so he devised a plot to eliminate the excess population from his dominions. With the assistance of "renegades", he defeated the populace and the "Loyal Officers", a force for good that was opposed to Xenu. Then, with the assistance of psychiatrists, he summoned billions of people to paralyse them with injections of alcohol and glycol, under the pretense that they were being called for "income tax inspections". The kidnapped populace was loaded into space planes for transport to the site of extermination, the planet of Teegeeack (Earth). The space planes were exact copies of Douglas DC-8s, "except the DC-8 had fans, propellers on it and the space plane didn't." DC-8s have jet engines, not propellers, although Hubbard may have meant the turbine fans.

When the space planes had reached Teegeeack/Earth, the paralysed people were unloaded and stacked around the bases of volcanoes across the planet. Hydrogen bombs were lowered into the volcanoes, and all were detonated simultaneously. Only a few people's physical bodies survived.

The now-disembodied victims' souls, which Hubbard called thetans, were blown into the air by the blast. They were captured by Xenu's forces using an "electronic ribbon" ("which also was a type of standing wave") and sucked into "vacuum zones" around the world. The hundreds of billions of captured thetans were taken to a type of cinema, where they were forced to watch a "three-D, super colossal motion picture" for 36 days. This implanted what Hubbard termed "various misleading data" (collectively termed the R6 implant) into the memories of the hapless thetans, "which has to do with God, the Devil, space opera, etcetera". This included all world religions, with Hubbard specifically attributing Roman Catholicism and the image of the Crucifixion to the influence of Xenu. The interior decoration of "all modern theaters" is also said by Hubbard to be due to an unconscious recollection of Xenu's implants. The two "implant stations" cited by Hubbard were said to have been located on Hawaii and Las Palmas in the Canary Islands.

In addition to implanting new beliefs in the thetans, the images deprived them of their sense of identity. When the thetans left the projection areas, they started to cluster together in groups of a few thousand, having lost the ability to differentiate between each other. Each cluster of thetans gathered into one of the few remaining bodies that survived the explosion. These became what are known as body thetans, which are said to be still clinging to and adversely affecting everyone except those Scientologists who have performed the necessary steps to remove them.

Right. Space planes, hydrogen bombs, disembodied souls, electronic ribbons, and 3-D super colossal motion picture cinemas. The Wikipedia article also discusses the origins of the story (including, not surprisingly, Hubbard's diet of stimulants and depressants) and the influence of Xenu on Scientology. My favorite section, "Critiques of the Xenu Story," includes some wonderful comments:

Critics of Scientology have pointed out that there are many factual and scientific problems with the story of Xenu. There is no scientific evidence that the events Hubbard described ever took place, though in fairness Hubbard never did try to put a scientific gloss on the story.

Hubbard did not elaborate on the number of space planes required to transport a population of some 13.5 trillion people. The Douglas DC-8, said to be an exact copy of Xenu's spaceships, seats a maximum of 250 people and has a payload of only around 40–50,000 kg, depending on the specific model. This means that, assuming the Galactic citizens had bodies about the same mass as humans, only about 600 to 700 human-sized frozen bodies could have been transported with each trip. It would therefore have required around 54.1 billion trips with everyone seated or 19.3 billion trips with frozen bodies packed more efficiently.

Assuming the people were about the same size as humans, 76×178 billion×2 ft³ per alien is 184 cubic miles (766 km³). This is about ten percent of the volume of the Chicxulub Crater, the site of the asteroid impact that is credited with killing the dinosaurs in the Cretaceous-Tertiary extinction event 65 mya (million years ago). The frozen bodies would have had to have been stacked a mile (1.6 km) deep, covering an area more than six miles (10 km) across around 6 volcanos. Even assuming that they were all killed, their fossilised remains would certainly be visible in geological strata today. There is no sign of any such remains.

The energy required to blow up Xenu's victims would also have been colossal. Thousands of hydrogen bombs with a cumulative explosive force equivalent to gigatonnes of TNT would have been needed. This would certainly have left physical traces; Forde lists plausible craters as the Manson crater (35 km, dated at 73.8 MYA), Eagle Butte (10 km) and Dumas (2 km, both 78–74 MYA).

Such a huge release of energy, more than during a full-scale nuclear war, would have wrecked the Earth's climate, causing a nuclear winter and prompting a mass extinction of terrestrial life. The hydrogen bombs would have left a residue of radioactive isotopes which would have been easily detectable today. It has been suggested that Hubbard meant to explain the Cretaceous-Tertiary extinction event through the Xenu story, but got the dates wrong — 75 MYA as opposed to 65 MYA — though this is unproven. There is no evidence of mass extinctions around the earlier time.

The volcanoes that Hubbard mentions in the story (notably Las Palmas and Hawaii) did not exist at the time that the events of Incident II are said to have taken place.

Finally, the earlier Incident I is set four quadrillion years ago, which is nearly 300,000 times the currently accepted age of the Universe of 13.7 billion years.

There's more, but I'll leave you with that. When you need a mental break from whatever you're doing (studying, anyone?), you can rely on Wikipedia for a distraction.

Wikipedia

2005-09-23T01:33:00.000-04:00

You've all heard of Wikipedia, right? I hope so. If not, check it out. In short, it's an online encyclopedia. As it describes itself, "Wikipedia is a multilingual, Web-based, free-content encyclopedia written collaboratively by volunteers and operated by the non-profit Wikimedia Foundation based in St. Petersburg, Florida." But it's so much more than that. It's a source of nearly infinite entertainment and mental wandering.

Each article in the Wikipedia has links to other relevant articles. Let's say I'm interested in Halloween, for example. I search for "Halloween" and am rewarded with a large article on the holiday:

Halloween is a holiday celebrated on the night of October 31, usually by children dressing in costumes and going door-to-door collecting candy. It is celebrated in much of the Western world, though most commonly in the United States, the United Kingdom, the Republic of Ireland, Canada and sometimes in Australia and New Zealand. Irish, Scots and other immigrants brought older versions of the tradition to North America in the 19th century. Most other Western countries have embraced Halloween as a part of American pop culture in the late 20th century.

The form "Halloween" derives from Hallowe'en, an old contraction, still retained in Scotland, of "All Hallow's Eve," so called as it is the day before the Catholic All Saints holy day, which used to be called "All Hallows," derived from All Hallowed Souls.

The article goes on to discuss Halloween traditions, religious perspectives on Halloween, and characters that are commonly associated with the holiday. Let's say that I'm interested in Dracula, one of the characters listed in the article, so I click on the link to the Wikipedia entry on Dracula. The article begins with a basic description:

Dracula is a fictional character, inarguably the most famous vampire in literature. He was created by the Irish writer Bram Stoker in his 1897 horror novel of the same name.

Since I don't know much about Stoker, I click on his name and read the article about him. It turns out that he was born in a suburb of Dublin; I don't know much about Dublin so I jump to the Wikipedia article about it. I learn that that St. James's Gate Brewery (which produces Guinness) is in Dublin, so I click on the article on Guinness. One passage mentions a common misconception about Guinness:

Despite the "meal in a glass" reputation the beverage has among some non-Guinness drinkers, Guinness only contains 198 calories (838 kilojoules) per imperial pint (1460 kJ/l), less than an equal-sized serving of skimmed milk or orange juice.

From here I could go on to dozens of other articles. So, to recap, Wikipedia allowed me to learn in a stream-of-consciousness fashion:

Halloween -> Dracula -> Bram Stoker -> Dublin -> Guinness -> ???

And that's one reason why I love Wikipedia. The other reason is that I can find articles on the most ridiculous of topics. I'll post my thoughts on that tomorrow.

Enjoy the weekend!

Faith and Charity

2005-09-21T01:35:00.000-04:00

I've been reflecting on this Newsweek article by Melinda Henneberger about faith, Hurricane Katrina, and taking care of those most in need.

Overturning the Gospels
Katrina has reminded us that Christian morality should be about responding to the wretched and loving the unlovable - not about other people's sex lives.

September 14, 2005

There was a great piece in Harper's last month, "The Christian Paradox: How a Faithful Nation Gets Jesus Wrong" by Bill McKibben, about how three out of four Americans believe the Bible teaches this: "God helps those who help themselves." The Gospel according to Mark? Luke? Actually, it was Ben Franklin who came up with these words to live by.

"The thing is," McKibben writes, "not only is Franklin's wisdom not biblical; it's counterbiblical. Few ideas could be further from the gospel message, with its radical summons to love of neighbor. On this essential matter, most Americans—most American Christians—are simply wrong, as if 75 percent of American scientists believed that Newton proved gravity causes apples to fly up."

Now, in the aftermath of Hurricane Katrina, we have seen—and been unable to look away from— the direct result of this self-deception.

And if such tell-me-I'm-dreaming scenes as rats feeding on corpses in the streets—American streets—isn't enough to make us rethink the public-policy implications of turning the Gospel on its head in this way, then truly, God help us.

We as a nation—a proudly, increasingly loudly Christian nation—have somehow convinced ourselves that the selfish choice is usually the moral one, too. (What a deal!) You know how this works: It's wrong to help poor people because "handouts'' reward dependency and thus hurt more than they help. So, do the right thing—that is, walk right on by—and by all means hang on to your hard-earned cash.

Thus do we deny the working poor a living wage, resent welfare recipients expected to live on a few hundred dollars a month, object to the whopping .16 percent of our GNP that goes to foreign aid—and still manage to feel virtuous about all of the above.

Which is how "Christian" morality got to be all about other people's sex lives—and incredibly easy lifting compared to what Jesus actually asks of us. Defending traditional marriage? A breeze. Living in one? Less so. Telling gay people what they can't do? Piece o' cake. But responding to the wretched? Loving the unlovable? Forgiving the ever-so-occasionally annoying people you actually know? Hard work, as our president would say, and rather more of a stretch.

A lot of us are angry at our public officials just now, and rightly so. But we are complicit, too; top to bottom, we picked this government, which has certainly met our low expectations.

The Bush administration made deep and then still deeper cuts in antipoverty programs, and we liked that. (The genius of the whole Republican program, in fact, is that it not only offers tax cuts and morality, but tax cuts as morality. Americans do, I think, want to feel they are doing the right thing, and when I hear an opponent of abortion rights say, "I'm voting for the most vulnerable, the unborn," I have to respect that. Of course, we also like tax breaks and cheap gas and cranking the thermostat up and down—so when Republicans play to both our better angels and our less altruistic ones, it's not that tough a sell.)

But have Democrats loudly decried the inhumanity—or even the hidden, deferred costs of the Bush cuts in services to the most vulnerable among the already born? Heavens, no, with a handful of exceptions, such as former vice-presidential nominee John Edwards, who spoke every single day of his campaign—and ever since—about our responsibilities toward those struggling just to get by in the "other America."

Most party leaders are still busy emulating Bill Clinton, who felt their pain and cut their benefits—and made his fellow Dems ashamed to show any hint of a "bleeding heart." Clinton's imitators haven't his skills, though, so his bloodless, Republican Lite legacy has been a political as well as moral disaster.

That's not, of course, because voters give a hoot about poverty, but because along with the defining moral strength of its commitment to the underclass went most of the party's self-confidence, and all of its fervor.

Incredibly, they even ceded the discussion of compassion to President Bush, a man who has always struck me as empathy-free—to an odd extent, really, as we saw again last week when he cracked jokes about his carousing days on his first trip to the Gulf Coast.

Immediately after the disaster, Bush quickly intervened—to make it possible for refiners to produce dirtier gasoline. He has since zapped working people on the Gulf Coast all over again by suspending the 1931 law that requires employers to pay the prevailing wage to workers on all federally financed projects.

Others in his party have expressed concern about all the freebies evacuees will be enjoying: "How do you separate the needy from those who just want a $2,000 handout?" Alaska Gov. Frank Murkowski asked—by way of explaining why debit cards for Katrina victims were a bad idea.

So far, though, I'd love to be wrong, I see no reason to think the president's sinking poll numbers will persuade him that there's more to (pro-)life than opposing abortion.

I still dare to hope Democrats may yet remember why they are Democrats, though. And that would be a real come-to-Jesus moment.

The Big Day

2005-09-16T07:19:00.000-04:00

The biochem exam is here! Wish me luck.

By the Numbers

2005-09-13T16:00:00.000-04:00

My life, by the numbers:

Class days since I started med school: 21
Class days since I started biochemistry: 13
Class days until my biochem exam: 3
Hours until my biochem exam: 64
Hours of lecture, review, or other structured academic time before the exam: 16
Hours of study time before the exam (projected): 24-28
Times I have worried that typing this blog entry will take too long (within last 5 minutes): 3
Number of chemicals, enzymes, or reactions I need to know for this exam (approx): 250-300
Percent of which I understand little or nothing: 20%
Percent of which I understand at a bare minimum: 50%
Percent of which I understand comfortably: 30%
Faculy members who equated med school to "drinking from a fire hydrant" sometime this week: 2
Consecutive hours studying at Starbucks on Sunday: 7.5
Beverages purchased during that time: 3
Cost of said beverages: $7.10
Cost of studying at Starbucks, per hour: $0.95
Percent of roommates who agree this is a reasonable cost: 100%
Free meals at school since classes started (avg/week): 1.5
Percent of free meals consisting of pizza, salad, and soda: 80%
Score I need to pass this exam: 65%
Score I received in a dream last night: 53%
Percent of classmates who have reported having dreams about the exam: 70%
Percent of students who pass the exam in their dreams: 0%

Busy

2005-09-10T13:18:00.000-04:00

I had forgotten what it was like to be a student. And, not surprisingly, med school is taking the student experience to a whole new level.

For example, I never thought I would see so many of my classmates studying at Starbucks...on Friday...at 10pm. Or at the library the next morning at 9am. Yet, at the same time, most of my classmates are friendly and willing to help each other. I'm happy that the dreaded competitiveness of med school has yet to materialize. (Knocking on wood...)

"Busy" was good title for this post when I started writing it, but "overwhelmed" might be a little more accurate now that I think about it. There's just so much to learn...and each day we're asked to learn more and more and more.

Music has been so important over the last week of intense studying. I'm spending 4 to 8 hours in each location when I study, so music helps keep me sane. And right now, I am reminded that Ottmar Liebert is truly a god among men. I can't imagine better studying music.

Back to the books. Four days until the exam. Then the party. :-)

Mood: Tired, confused, overwhelmed, but generally optimistic. (And contradictory, I suppose...)
Song: Ottmar Liebert, "Rome in May/Spanish Steps"

NYT: "Waiting for a Leader"

2005-09-01T15:01:00.000-04:00

The NYT lead editorial today finally acknowledged the truth: Bush's response to Hurricane Katrina and the disaster in New Orleans has been horrendous:

September 1, 2005

Waiting for a Leader

George W. Bush gave one of the worst speeches of his life yesterday, especially given the level of national distress and the need for words of consolation and wisdom. In what seems to be a ritual in this administration, the president appeared a day later than he was needed. He then read an address of a quality more appropriate for an Arbor Day celebration: a long laundry list of pounds of ice, generators and blankets delivered to the stricken Gulf Coast. He advised the public that anybody who wanted to help should send cash, grinned, and promised that everything would work out in the end.

We will, of course, endure, and the city of New Orleans must come back. But looking at the pictures on television yesterday of a place abandoned to the forces of flood, fire and looting, it was hard not to wonder exactly how that is going to come to pass. Right now, hundreds of thousands of American refugees need our national concern and care. Thousands of people still need to be rescued from imminent peril. Public health threats must be controlled in New Orleans and throughout southern Mississippi. Drivers must be given confidence that gasoline will be available, and profiteering must be brought under control at a moment when television has been showing long lines at some pumps and spot prices approaching $4 a gallon have been reported.

Sacrifices may be necessary to make sure that all these things happen in an orderly, efficient way. But this administration has never been one to counsel sacrifice. And nothing about the president's demeanor yesterday - which seemed casual to the point of carelessness - suggested that he understood the depth of the current crisis.

While our attention must now be on the Gulf Coast's most immediate needs, the nation will soon ask why New Orleans's levees remained so inadequate. Publications from the local newspaper to National Geographic have fulminated about the bad state of flood protection in this beloved city, which is below sea level. Why were developers permitted to destroy wetlands and barrier islands that could have held back the hurricane's surge? Why was Congress, before it wandered off to vacation, engaged in slashing the budget for correcting some of the gaping holes in the area's flood protection?

It would be some comfort to think that, as Mr. Bush cheerily announced, America "will be a stronger place" for enduring this crisis. Complacency will no longer suffice, especially if experts are right in warning that global warming may increase the intensity of future hurricanes. But since this administration won't acknowledge that global warming exists, the chances of leadership seem minimal.

Inspiration...or not.

2005-08-31T00:25:00.000-04:00

Tonight was my first night at the new jujitsu gym. Pretty cool place. I will blog about it later.

After jujitsu, I went to Starbucks to study. I had a ton of great blogging ideas, but then I came home, got tired, and decided that it would have to wait.

I bet I'll look at this post tomorrow and have absolutely no recollection as to what I was going to write...

ahhhhhhhhhhh............

2005-08-28T11:54:00.000-04:00

Sleep such a wonderful thing. I know I'll have to go without it for much of the next four (eight? ten?) years, but for now I can enjoy sleeping in both days of this weekend. I hadn't had a full night's sleep since orientation, and I was getting pretty sick. After two nights of 10-12 hours' sleep, I feel much better.

Today we have the annual Case Fall Picnic, where each of the med school "societies" compete for some sort of prize. (The societies are arbitrary groups that students are assigned to during their first year for advising purposes.) It sounds like it's going to be a pretty good time. In the afternoon, I'll probably leave the picnic a little early to go to the Cleveland-area Stanford Send-Off Party...it's an event for the students who are preparing to begin their freshman year at Stanford, and local alumni are encouraged to attend to talk with the students, give advice, and generally get them excited to begin school.

As far as med school is concerned, I'm pondering whether to do the joint degree program in bioethics. I'm a huge fan of joint degree programs (an additional degree for no additional cost?), but I'm really not sure which one I like most. My friend David is doing the MD/MBA program, but he started taking classes last summer and I would probably have to dedicate this upcoming summer to MBA classes if I wanted to complete both degrees in four years.

I was also interested in the master's degree in applied anatomy, especially the fact that students in the program score a full standard deviation above the Case average (which is already reasonably high). But I don't want to be a surgeon (the group that is usually most dedicated to anatomy) and my impression is that the program is pretty intense.

There's also the joint degree program in bioethics, which originally was not of much interest to me. After our bioethics lectures during the first two weeks, though, I had a lot to think about. The program isn't supposed to be that hard, and it would give me a lot more training to face some of the difficult decisions I'll have to make as a doctor. The program is supposed to be fairly easy, at least when compared to the other two programs. I don't really want to be an ethicist exactly, but I think I would like to know more about the topic. Fortunately, I have some time to make the decision about the program...

Off to the picnic!

Mood: Relaxed
Song: Jason Mraz, "The Remedy" (acoustic) / BT, "Somnambulist (Simply Being Loved)"

Progress

2005-08-25T22:27:00.000-04:00

We started biochem today, and so far I love it. I'm sure I will soon learn to hate it, but for now I'm excited to be studying real science again....it has been a pretty long time for me. Don't tell anyone, but I actually enjoyed our five hours of lecture this morning. :-)

I'm also making progress on finally catching up on sleep. I took a 4-hour nap this afternoon, and tonight it looks like I'll be in bed before 11:00. I'm also sick, which sucks, but it's a good reason to finally get my sleep schedule arranged to where it needs to be.

Mood: Other than being sick, I'm in a pretty good mood. Friday is almost here.
Song: Uncle Kracker, "In A Little While"

Confidentiality

2005-08-23T11:12:00.001-04:00

This morning's lecture on patient confidentiality just began. It's one of several lectures we will have on bioethical issues. It has been particularly interesting when the lecturers (all of whom are bioethicists) make the point that doctors do not always obey certain expectations of laypeople. Truthtelling in medicine, for example, is a relatively new idea. We've had several quotes from famous physicians -- from Hippocrates to individuals just a few decades ago -- who insisted that there was no need (nor any benefit) to telling a patient about a serious diagnosis. It was believed that telling the patient this bad news would merely worsen his or her condition. Instead, it was commonly accepted to warn the patient's family and let them take care of the issue. We were asked, "Would you rather (a) be honest with your patient or (b) provide the best health outcome for your patient?" There was some pretty strong debate on that question.

Patient autonomy is another bioethical issue. We usually hold autonomy to a pretty high standard, but the lecturers brought up numerous situations in which most of us agreed that patient autonomy could potentially be superceded. And now we're talking about confidentiality; as usual, we're finding some situations in which confidentiality is paramount and others in which we defer to the principles of justice, beneficence, or "doing no harm." And we're barely scraping the surface of the issues we'll face in the clinics and hospitals. It's an intimidating feeling.

Who Needs Sleep?

2005-08-22T23:40:00.000-04:00

Let's see how many nights in a row I can get to bed before midnight. I haven't had a full night's sleep in nearly two weeks, and I'm starting to get sick, so I think sleep is pretty important.

In other news, my small group made a ton of progress on our project. I'm excited that we're finally almost done with it -- it has been a great way to meet people, but I'd rather start on the real med school classes. Biochem starts Thursday...

And so it begins...

2005-08-22T14:49:00.000-04:00

So far, so good. We just started the second week of class...and we have our first exam on Wednesday! Our first class (or "committee" according to the Case nomenclature) is pretty easy -- we're covering the fundamentals of biostatistics, epidemiology, study design, etc., as well as bioethics and health economics. It's not too hard, especially since I already covered most of the material in my master's degree program.

Case provides all first and second year medical students with a desk in a study room. It sounds really basic -- it's just a desk with electrical and ethernet connections for a laptop -- but so far it has had a huge impact on my schedule and ability to study. The study rooms are right next to our lecture room, so we're never far from a place to work (instead of having to walk to a library), and there are usually people in the study room who you can talk to if you have questions about a lecture topic. I'm pretty sure this room will be a major part of my life this year.

Alright, enough blogging. Back to the problem set, then to the gym, then to a group project meeting, then home by 10:00 or so.

Mood: Focused
Song: Jason Mraz, "Wordplay"

PS - Jason Mraz is coming to the House of Blues in Cleveland in October. Anyone interested?

Update from Cleveland

2005-08-13T03:22:00.000-04:00

Wow. The last few weeks have absolutely flown by. I moved to Cleveland, took a short vacation to Portland, and returned to Cleveland to begin orientation at Case. I'm so busy with the basics -- i.e., moving into my house -- that I don't even feel like I have time to think about school. That better change soon!

Don't Use U-Haul

2005-08-03T22:25:00.000-04:00

U-Haul is among the most frustrating and least competent companies I've ever seen. I was originally going to write a lengthy story about how they screwed me over multiple times during my move, but I decided that I preferred not to lose another hour of my life thanks to them. In short, I will recommend that everyone look at Don't Use U-Haul and rent from another company. Penske seems to get good reviews from my soon-to-be classmates.

Moving complete!

2005-08-03T15:34:00.000-04:00

After two months of thinking about moving, a week of packing, a few days of getting screwed by U-Haul (which I will soon write about), a long drive, and a lot of carrying, I am finally moved into my house in Cleveland. I'm back in Portland, Oregon to visit my family for the week.

Time to relax......

Packing day!

2005-07-30T10:26:00.000-04:00

The big day is here! Time to pack everying up. We won't drive to Cleveland until tomorrow, but there is a lot to do between now than then.

I'll be unplugging the internet connection in a few minutes so I can return the equipment to my ISP.

As my running teammates used to say before a particularly brutal workout, I'll see you on the other side...

Mood: Anxious, excited.
Song: Acoustic Alchemy, "The Alchemist"; Patrick Park, "Something Pretty"; Aerosmith, "Dream On"

Sleep

2005-07-28T12:20:00.000-04:00

Wow, I feel better. I was planning to get up this morning to see the Washington Monument, but that meant I would have needed to get up at 7:30 to go wait in line for tickets. No thank you. Instead I slept in and dedicated today to packing.

Sleep really does help with the pre-moving anxiety. And I'm sure I'll feel even better once I make a lot of progress on packing today.

Boxes and tape, here I come.......

Everything You Leave Behind

2005-07-28T01:09:00.000-04:00

Hmmmm. The emotionally difficult part of moving is starting to set in. I've been trying to get away from it for a long time, trying to fill my schedule with as many activities as possible so I don't have to think about moving. But now it's very, very close. And I have to deal with it.

I'm not really sure why this move is so difficult. (pause) I suppose that's not entirely true. I have a pretty good idea of why it's different. When I left California, I was desperate for a change of location. I love northern CA, but it was time for me to leave. Overall, it wasn't that hard. (I think?) I was in Baltimore for 10 months -- long enough to meet people in my Hopkins program, but not really long enough to feel established. I was really excited to move to DC, and Baltimore was close enough that I could go back and visit if I wanted to. I think that moving down to DC wasn't too hard emotionally. But now? Now I'm happy in DC. I feel settled, I have a nice group of friends, I enjoy(ed) my job, etc. I have no reason to leave...except for the fact that I have a great opportunity to start a completely new career. I'm wishing that I had deferred school another year, but I'm pretty sure that I would have regretted that decision once I got sick of work...probably by October or November.

Timing is everything in life, a friend wrote to me the other day. True. I've wanted to go to medical school for years and years now, so I should be excited that I finally have that opportunity. Now that I have the chance to go, however, I'm tortured by the fact that I have to leave after getting settled for the first time in two years. Realistically speaking, I feel professionally settled for the first time...ever? My job at Stanford after graduation was a good experience for me, but "rewarding" certainly isn't the first word I would associate with it. At Lewin, I felt like I was producing high-quality work, learning consistently, and establishing a solid base of professional experience. I also feel socially and emotionally settled; I'm more comfortable with my current friends in DC than with many of the people I knew at Hopkins last year. There are also people in DC who I've known just a few months -- or even less, in a few cases -- who I would get to know better if I just had more time.

I think that loneliness is the major feeling I have right now. I'm not really sure why -- I haven't left DC yet, so it seems like I shouldn't be missing people yet. But I've already said a lot of goodbyes, and many of them feel incomplete. The good news is that I checked flights from Cleveland to DC and found that they're only ~$120 or so. Not too bad for a long weekend visit.

As usual, sleep will probably help me feel better about things. Let's hope.

Mood: Lonely, anxious, frustrated. Cheerful, eh?
Song: Coldplay, "White Shadows" and "Fix You"

One small step...

2005-07-25T00:58:00.000-04:00

Friday was my last day of work. Saturday was my first day on the beach in many, many months, and today marked the start of my final week in DC...for now, at least.

Now what do I do? I have a week until I move. I'd like to avoid thinking about my departure for as long as possible. It doesn't mean that I won't start packing or prepare to leave, but I'll feel better if I can avoid thinking about the people in DC who I won't see for a long time. With that in mind, I'm going to visit the Air & Space Museum tomorrow (the Dulles annex, for those of you who are familiar with it) and then tour the Capitol on Wednesday.

I actually feel better about leaving DC now that I'm done with work. I feel like it's the first small step towards trading this reality for another one.

Sine Qua Non

2005-07-21T00:12:00.000-04:00

I'm going to miss a lot of people in DC, many of whom I don't know nearly as well as I would like. Here's a toast to missing your friends and longing to see people again....it's okay to feel bad if it's for all the right reasons. This speech reminds me of that truth.

"Love is life's longing for itself, says the Prophet, in a book by Kahlil Gibran. For me, that comes the closest to explaining why we love you -- which is why we are working in this school district, why is why we are in this world. Because most of us -- teachers, principals, secretaries, coaches, administrators, patents, volunteers -- are not here for the money or the intellectual challenge or because we have no other choice; we are here for love.

"I myself did not sign on to this job for love. I signed on to the school board to pursue and social and political ideal. Three years later I have met with little success in that regard, but I gained something else instead. I have learned at gut level what I had known only in theory: that tangible results and official accomplishments are not the only measure of success in work and in life.

"The first years I was on the board I met with a group of Lakeridge kids to talk about school issues. These students came to my house once a month to share stories, ask questions, offer ideas; there were savvy and insightful and often drop-dead funny, open an generous, honest and thoughtful, and -- most amazingly -- they trusted me and each other. They taught me, by example, what I was really here for, and it wasn't the academic task. I was here for them, and for me, and for the connection between us. I was here for love.

"Caring, helping, supporting one another; feeling sympathy, affection, excitement; sharing a personal connection, being on the same wavelength: love is the sine qua non, the essential element, without which nothing we do has meaning or purpose or lasting value.

"But of course, love is not just warm and fuzzy, like a Hallmark card or a Meg Ryan movie -- as you probably know, it can be 10 parts pain to 1 part pleasure. No, it is both reward and punishment for being alive, for getting involved, for leading with your heart. I said to my friend, 16-year old Alexis, "I've decided to talk about love at graduation. Tell me something about love, Alexis." "Love," she says, "it sucks." So I had to give Alexis a copy of The Velveteen Rabbit -- we education people are always giving people books -- wherein the Skin Horse places the pain of love in its proper context, the context of being real.

When a child loves you for a long long time," the Skin Horse says, "not just to play with, but REALLY loves you, then you become Real."
"Does it hurt?" asked the Rabbit.
"Sometimes," said the Skin Horse, for he was always truthful.
"Does it happen all at once, like being wound up, or bit by bit?"
"It doesn't happen all at once," said the Skin Horse. "You become. It takes a long time. That's why it doesn't happen to toys who break easily, or who have to be carefully kept. Generally, by the time you are Real, most of your hair has been loved off, and your eyes drop out and you get loose in the joints and very shabby. But those things don't matter at all, because once you are Real you can'y be ugly, except to people who don't understand."

"Which is to say, we are here because we need you as much as you need us -- you make us glad and proud, exhausted and used up -- you make us Real.

"Love is life's longing for itself. And we see our lives reflected in yours; in your incessant guitar-playing, your interminable phone conversations, your obsessions and idiosyncrasies...we see ourselves reflected in you, in your excuses and apathy and infuriating procrastination, in your heartbreaking misery and despair, in your painfully familiar self-consciousness and shyness, in your stubbornness, your impatience, your hopefulness when the odds are terrible, in your disappointment with the world, in your screw-ups and failures, in your energy and determination and fundamental goodness -- you remind us of nobody like ourselves. And thus you keep us connected -- hopeful, vulnerable, and still believing in love.

"So. I recommend that you stay open to taking the emotional venture, the personal risk, that you stay open to life and to love. Imperfect as it is, painful as it can be, it still comes back more than anything else ever will. When your heart lurches, trust it -- it knows the work you should be doing, the risk you should be taking, the person you should be getting to know.

"And if you remember nothing else from high school, not the Pythagorean Theorem or the taxonomic classifications, remember this: you are loved. That's why we are here. And everyone single one of you will be sorely missed -- as the Skin Horse said, it hurts sometimes."

Susan Blackman
Lakeridge High School graduation
June 5, 1997