I don't care what nerve says....

I think this is pretty damn good!

"Hysteric"

It's a pretty good one, and ideal for those end of years. If only the Yeah Yeah Yeahs had made a video of it!

An Admonition: "While there's life, there's hope." (Cicero)

I feel split between two selves.

One: content and proud to feel useful to the world, beers on 2nd floor white-washed balconies, private dance-a-thons with the ipod on at 2 am, blissful in running, flirtation and smiles, balanced and respected.

The other: restless and disappointed, fucked up erotic dreams about people whom I never had much love for in the past, crying the average 2 hrs a week, angry and avoidant, full of poor coping mechanisms.

This is how I have felt since my teens, and age - while having dulled my initial emotions - has not mitigated this. I wonder if I am both of these personas, and if I always will be. Or is one the real me and the other the abberation? And if so, which is which?

the new year comes

... and we are all moving on in this elusive life.

Thoughts on the Inteview Trail

A Prayer: May the good forces that be prevent this post in any way from preventing me from attaining the residency of my dreams.

I've been on the interview trail this month and the last, and it's been something of a jarring experience.

For one, I really hate the process of interviewing. It is so difficult to explain yourself to someone - and to make them love you - in 15 to 30 minutes. What do you focus on? Your personality? Your potential? What if there is a dichotomy between who you are at work and who you are at home? What if you haven't worked out the balance yet (which I haven't)? How can I possibly feel comfortable telling a stranger all of these things when I am too private to tell some of my best friends this?? The solution, of course, is just to present a facade of yourself, something cut and dry, pretty and pressed - and that's why I hate it.

Being on the interview trail, and having little to talk about during the socials besides things related to medicine, also makes me realize - as my friend Ravi says - how NOT FUN we've all become. According to Ravi, the things that used to be fun - the things that other people do - seem trite to him now. To me, it's something even worse - it's not the activities themselves that seem trite, but the excitement of my friends towards these activities. Drinking, flirting, being "artsy" - I find myself getting annoyed with people taking pleasure in these things, and especially if they are proud to be labeled good drinkers, flirts, or artists. I can't relate, and feel, as Andre Gide describes in The Immoralist, "dull, sad, inept, both boring and bored."

When did I become this horrible person? Lacking pleasure in life, convinced that I know more miseries than others, unable to relate? I feel that I need to reconnect with the world, but I simultaneously intuit that this feat cannot be accomplished until I take the proper time to change my own mindset first. I need to feel at peace, I need to get rid of baggage, and I need to be productive and creative again.

Steph might scoff at me for this. Did I learn NOTHING from Loneliness? The alienated and bereft must reach out to others in order to fix themselves. And perhaps she is correct. I still remember the immense gratitude I felt when the random old lady in Long Island recognized my unhappy face and tried to make chitchat with me while I waited for my (late) taxi cab in the bitter cold. I feel bad that I never thanked her. Working other people in, though, is an issue of time, of which I have precious little and obviously I still need work on time management.

There is too much to correct for me to even bother making New Year Resolutions this year.

A Sestina

This lovely piece was found in my bathroom, placed there by my sister. For more about Peter Cole, the author, see here.

"Improvisation on Lines by Isaac the Blind"

Only by sucking, not by knowing,
can the subtle essence by conveyed -
sap of the word and the world's flowing

that raises the scent of the almond blossoming,
and yellows the bulbul in the olive's jade.
Only by sucking, not by knowing.

The grass and the oxalis by the pines growing
are luminous in us - petal and blade -
as sap of the word and the world's flowing;

a flicker rising from embers glowing;
light trapped in the tree's sweet braid
of what it was sucking. Not by knowing

is the amber honey of persimmon drawn in.
An anemone piercing the clover persuades me -
sap of the word and the world is flowing

across separation, through wisdom's bestowing,
and in that persuasion choices are made:
But only by sucking, not by knowing
that sap of the word through the world is flowing.

Today in useful studies

"Falling TV Deaths Remain Concern Amid LCD Fad"

Quick, somebody get the government to take away all old TVs! FOR THE CHILDREN!

New ACOG Cervical Cancer Guidelines and NE Interviews

New cervical cancer screening guidelines have been put forth by ACOG. Some highlights;

• Cervical cancer screening should begin at age 21 regardless of age at onset of sexual activity.
  
• Cervical cytology screening from age 21 to 29 is recommended every 2 years but should be more frequent in women who are HIV-positive, are immunosuppressed, were exposed in utero to diethylstilbestrol, or have been treated for cervical intraepithelial neoplasia (CIN) 2, 3 or cervical cancer.
  
• Women aged 30 or older who have three consecutive negative screens and who do not fit the above criteria for more-frequent screening may be tested every 3 years. Co-testing with cervical cytology and high-risk HPV typing is also appropriate; if both tests are negative, rescreening in 3 years is warranted.
  
• Cervical cancer screening is unnecessary in women who have undergone hysterectomies for benign disease and who have no histories of CIN.
  
• Discontinuation of screening after age 65 or 70 is reasonable in women with 3 or more negative consecutive tests and no cervical abnormalities during the previous decade.
  
• Women with histories of CIN 2, 3 or cancer should undergo annual screening for 20 years after treatment.
  
• HPV vaccination does not change these recommendations.

I'm publishing this post partially so I will remember these new guidelines as well.

Meanwhile, I'm having a lot of fun on the interview trail, even if it is somewhat exhausting. Walked around Rockefeller Center with some friends today, and it was nice that they came out, even if they were sick. About to watch a movie and eat Chinese take-out with old friends - it's nice to relieve college as an adult :-)

Wild Things

What was most powerful about the movie was the accuracy with which it portrayed the angry powerlessness of youth. Where it missed was in thinking that young adults (which was definitely what it was aimed at) would still think "Don't be selfish" is a profound lesson. Yeah, we know already. We're Catherine Keener, not Max Records.

Dorelan is the best!!

I have the sweetest roomie EVER!!

There must always be a reason

Unless there is a direct cost to US taxpayers from elective cosmetic surgery paid for out of pocket, I don't agree with a tax on plastic surgery.

****
WASHINGTON (AFP) – Americans opting to have surgery to suck out fat, grow or shrink breasts, shape their nose or banish wrinkles may pay for a health care overhaul that was unveiled by US Senate Democrats.

The White House-backed plan would impose a five-percent tax on elective cosmetic surgery that is estimated to raise an estimated 5.8 billion dollars over 10 years towards the 849-billion-dollar plan.

The measure exempts plastic surgery done to remedy a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or disfiguring disease.

Individuals who seek purely elective procedures, which are typically paid for directly out of patients' pockets, would have to pay the new tax starting in January 2010.

The global economic recession has not dented US demand for cosmetic surgery procedures, which were up three percent in 2008 to 12.1 million procedures, according to the American Society of Plastic Surgeons.

But breast augmentations were down 12 percent from 2007, to 307,230, while wrinkle-banishing Botox injections were up eight percent to just over five million procedures.

The legislation does not exempt US lawmakers.

Today in the life....

Today, the Obama administration reports that over $98 million dollars of taxpayer dollars was improperly used in 2009. In particular, it notes improper payment rates of 7.8 percent and 15.4 percent in the Medicare fee for service and Advantage programs, respectively. While no one contests that Medicare and Medicaid has poor mechanisms in place for filtering out waste and fraud, I think it's important to point out that a lot of these "improper" payments is defined as such by lack of proper documentation. Anyone who works in healthcare can give testimonial as to how burdensome and confusing government documentation is, and I have to wonder how much of this money was truly improperly spent, or merely appears to be because busy healthcare workers don't have the time to fill out the reams of government paperwork required for simple indicated procedures.

Also, the Augusta Chronicle reports that applications to the Medical College of Georgia are 4 percent higher than last year, outpacing the 0.1-percent national increase. Not surprising considering that, despite astronomical tuition increases from 2006 to present, MCG still remains a competitively priced medical school with decent residency admit numbers. Alumni truly cast a wide net, as evidenced by the Chair of my residency interview today graduating from MCG.

Finally, I am finally back in GA after an exhausting and eventful two months! Here is the song that's been getting me through the past few days...

From the Healthcare Economist

Health Reform Bill Passes in the House: Who wins and who loses?

November 9, 2009

A Health Reform Bill passed in the House despite declining support among the American people. The Kaiser Family Foundation has a nice summary of what is included in the bill. Today, I will review who wins and who loses from different aspects of the bill.

Individual Mandate.

• Winners: High cost individuals. Premiums (may) decline if younger, healthier individuals are forced to buy insurance and the insurance companies. This will only decrease premiums, however, if insurance companies can’t charge lower rates to these healthier individuals.
• Losers: Those who don’t want health insurance or can’t afford it. All individuals will have to pay a penalty if they do not buy “acceptable health coverage.” Low-income families are exempt from this requirement.

Employer funding requirements.

• Winners: Requiring employers to pay for health insurance simply means that individuals will see lower wages in the long run. The big winner here is big business. They already provide health insurance for their employees. Small company competitors however
• Losers: Health insurance is more expensive for small companies. Making them pay for health insurance will drive up their costs and force them to cut wages more than big businesses will. This may make working at a small firm less attractive, especially for younger employees. However, the smallest companies are exempt from this requirement and the government will provide subsidies to cover some health insurance cost initially.

Expand Medicaid to all individuals with incomes below 150% of the Federal Poverty line (FPL).

• Winners: Lower middle class individuals who are now covered by Medicaid who were not in the past.
• Losers: Taxpayers.

Require CHIP enrollees with incomes above 150% FPL to obtain coverage through the Health Insurance Exchange.

• This depends on how well the Health Insurance Exchange works. If it is an efficient system, poor children could get better coverage and the taxpayer bill could decrease. Or poor children could get worse coverage and the taxpayer bill could increase.

Subsidies to individuals with incomes below 400% of the FPL to to obtain coverage through the Health Insurance Exchange.

• Winners: Middle class families not eligible for Medicaid who now will received subsidized insurance.
• Losers: Taxpayers not eligible for the subsidy.

Reinsurance program for individuals aged 55-64.

• Winners: Employees of this age bracket. They will be more attractive to employ since their health care costs will be capped.
• Losers: Taxpayers not aged 55-64.

Tax of 5.4% on individuals with modified adjusted gross income exceeding $500,000 ($1m for families).

• Winners: Individuals getting subsidies, expanded public programs, etc.
• Losers: The Rich.

The Public Option and the Health Insurance Exchange.

• Here, the devil is in the details. If the Public Option provides superior health care at lower cost, everyone wins (except private insurance companies). If the public option provides superior health care but runs a deficit every year, consumers will win while taxpayers and private insurance companies will lose. If the public option loses money and provides low quality care, everyone loses except for government employees now hired to run the public option. Similarly, the health insurance exchange may provide more choice to consumers, a standardized benefit package so the consumers can price shop, or it may reduce insurance choice by limiting the products insurers can offer.

Savings from Medicare and Medicaid

• Winners: If the savings come from reduced waste, Medicare enrollees will benefit (fewer unnecessary procedures will increase their health) as will the taxpayers. However, if the savings come from cuts to necessary services, Medicare enrollees will be harmed.
• Losers: Doctors and hospitals. Cuts to Medicare mean that doctors and hospitals will get less money. If the cuts are from waste, only inefficient doctors will see their earnings hurt. If the cuts come from necessary care, then good and bad doctors will see their incomes fall.

Fascinating!

but also reminds me a bit of the beginning of I Am Legend :-)

New gene therapy halts 2 boys' rare brain disease

By LAURAN NEERGAARD, AP Medical Writer Lauran Neergaard, Ap Medical Writer – Thu Nov 5, 5:12 pm ET

WASHINGTON – French scientists mixed gene therapy and bone marrow transplants in two boys to seemingly halt a brain disease that can kill by adolescence. The surprise ingredient: They disabled the HIV virus so it couldn't cause AIDS, and then used it to carry in the healthy new gene.

The experiment marks the first time researchers have tried that long-contemplated step in people — and the first effective gene therapy against a severe brain disease, said lead researcher Dr. Patrick Aubourg of the University Paris-Descartes.

Although it's a small, first-step study, it has "exciting implications" for other blood and immune disorders that had been feared beyond gene therapy's reach, said Dr. Kenneth Cornetta, president of the American Society of Gene and Cell Therapy.

"This study shows the power of combining gene therapy and cell therapy," added Cornetta, whose own lab at Indiana University has long researched how to safely develop gene delivery using lentiviruses, HIV's family.

The research was published in Friday's edition of the journal Science.

In 20 years of gene therapy research, there have been few home runs and some headline-making setbacks — including a risk of leukemia caused by otherwise successful gene therapy for another rare disorder, "bubble boy disease." That's a risk that specialists hope a lentivirus-based gene therapy will eliminate.

Best known from the movie "Lorenzo's Oil", adrenoleukodystrophy, or ALD, is a rare genetic disease that, in its most devastating form, destroys the coating of nerve fibers in boys' brains. Without that coating, called myelin, the neurological system breaks down. The disease typically strikes between the ages of four and 10, leading to blindness, deafness, dementia and loss of muscle control, and killing them within a few years.

Bone marrow transplants can halt ALD by letting new myelin-forming stem cells take root. But it's difficult to find a matching marrow donor, and the transplant itself is very risky.

So what if stem cells from the boys' own bone marrow could be genetically corrected, eliminating the ALD mutation? To do that, Aubourg's team had to overcome a technical hurdle: Gene therapy works when scientists harness deliver a healthy new gene by attaching to a virus that can harmlessly infect cells. But none of today's so-called gene therapy "vectors" could penetrate enough of the stem cells needed for an ALD treatment to work.

Unlike most viruses, HIV can penetrate stem cells, and it sticks permanently. So Aubourg's team removed the genetic parts of HIV that make it dangerous, leaving basically a scaffolding to carry the new therapeutic gene.

Then they culled stem cells from two 7-year-old boys in the early stages of ALD, and mixed in the healthy gene. The boys underwent bone marrow-destroying chemotherapy and then had their genetically corrected stem cells reinserted.

Two years later, the boys have shown no sign of worsening brain damage and are functioning well with 15 percent of their blood cells producing the healthy protein, said Aubourg, who plans to test the experimental procedure in more patients. An advocacy group, the Stop ALD Foundation, is working to raise money for a similar U.S. study.

Fertility, Family Planning, and Female Social Progress

Key excerpts from a fascinating Economist article about the dropping global fertility rate:

"The move to replacement-level fertility is one of the most dramatic social changes in history. It manifested itself in the violent demonstrations by students against their clerical rulers in Iran this year. It almost certainly contributed to the rising numbers of middle-class voters who backed the incumbent governments of Indonesia and India. It shows up in rural Malaysia in richer, emptier villages surrounded by mechanised farms. And everywhere, it is changing traditional family life by enabling women to work and children to be educated."

"Indonesia’s Family Life Survey showed that, on average, each birth reduced by a fifth the likelihood that a woman would have a job—lowering household income and pushing some families into poverty. So smaller families made middle-class status more likely. Between 1974 and 1996, Bangladesh turned a district called Matlab into a giant demographic experiment: some villages and households got family planning, others did not. According to one study of the results, fertility in the areas that received help declined by around 15% more than in those that did not. And over the two decades of the experiment, indicators of the well-being of women and their children—health, earnings, household assets and so on—were all higher in the villages that got the planning."

"A surprising amount is known about how many children parents want, thanks to a series of surveys by the Demographic and Health Surveys programme. The picture it paints is of huge numbers of unplanned pregnancies. In Brazil, for example, the wanted fertility rate in 1996 (the most recent year available) was 1.8; the actual fertility rate then was 2.5. In India the wanted rate in 2006 was 1.9, the actual one, 2.7. In Ghana the figures for 2003 were 3.7 and 4.4... One study in 2002 estimated that as many as a quarter of all pregnancies in developing countries in the 1990s were unintended. Yet another found that more African women say they want to use contraceptives but cannot get them (25m) than actually use them (18m). Unmet demand in turn implies that fertility in some countries could be even lower than it actually is if more family planning were available."

"Another big reason why fertility is falling: the spread of female education. Go back to the countries where fertility has fallen fastest and you will find remarkable literacy programmes. As early as 1962, for example, 80% of young women in Mauritius could read and write. In Iran in 1976, only 10% of rural women aged 20 to 24 were literate. Now that share is 91%, and Iran not only has one of the best-educated populations in the Middle East but the one in which men and women have the most equal educational chances. Iranian girls aged 15-19 have roughly the same number of years of schooling as boys do. Educated women are more likely to go out to work, more likely to demand contraception and less likely to want large families."

Looking at these facts, how can you possibly argue against family planning unless you just don't care as much about the lives of the living as your own personal principles?

cool links of the day

Cell Size interactive video

Sand Art by Ukraine's Got Talent winner

Forgetting

Just watched a fascinating PBS special on "The Botany of Desire," and was particularly struck by the segment on THC and its ability to help one forget. While I'm generally one to stick to the mantra of "If I could do it all over again, I would do it all the same," I can't help but wonder what life would be life if pharmaceutical induction of forgetting were socially accepted.

I feel like this today: Opening strains of Mother Mother's "Ghosting" and the artwork of Midori Yamada.

and the streetlights looked blue tonight as well

slowly my yearning for you fades away
to be tucked away in the mind
like an old favorite word
forever fond, but no longer commanding

so then perhaps nothing has really changed

"The person whose phone calls you always take – that’s the relationship you’re in."
- The Devil Wears Prada

A worthwhile read

Competing Emotions

When I watched an abortion for the first time, my reaction surprised me.

By Sarah Kliff | Newsweek Web Exclusive

Aug 15, 2009

I've covered abortion for NEWSWEEK for two years. The issue has put me in touch with a young activist in rural Colorado, an embattled clinic just outside St. Louis, and chanting crowds in Washington, D.C. Whether I'm covering abortion's staunchest guardians or its most adamant opponents, there's always the same passion: both sides feel abortion is an issue worth waging war over.

Writing these stories, I'd become well-versed in abortion policy, the pro-choice and pro-life arguments, the latest legislation. But I'd never actually seen an abortion; I'd never watched the procedure that activists vehemently defend or deplore. And, when I flew to Omaha to spend four days at LeRoy Carhart's abortion clinic for a profile in this week's magazine, I wasn't sure I would. I confess I was hesitant to step into Carhart's operating room. I knew that I'd most likely be watching a first-trimester procedure; while Carhart does offer late-term abortions, the majority of his patients, and the majority of abortion patients nationwide, are early in pregnancy. I learned how long the procedure would take (10 to 15 minutes), what equipment would be used (a long plastic tube connected to a suction device), and what the patients would feel (slight pressure and possibly cramping). Yet I still felt uneasy.

Why was I reluctant to watch? To be fair, I'd never observed a surgery and knew myself to frequently flinch at Grey's Anatomy. But abortion isn't like the complex, bloody operations you see on television: medically speaking, it's a simple and common procedure. About 1.2 million were performed in 2005, the same, numberwise, as outpatient cancer surgeries. I was nervous, I think, to watch something so controversial; no one protests outside cancer clinics. I didn't know how I'd react. Would I find the surgery repulsive? Encounter women whose choices troubled me? Whom I disagreed with? I was uneasy about coming in such close contact with such substantial decisions.

I was still unsure when I entered Carhart's clinic, so I began my day by interviewing patients. I learned their names, why they'd come to Carhart's clinic and how they felt about it. I went with them through the pre-op routine. There was an ultrasound to confirm the pregnancy, blood work and pre-op medications, a patient advocacy session. We sat together in the waiting room, killing time until a nurse called them in to surgery. When their names were called, and I'd spent all morning with these women, it felt unnatural to stop short of the operating room (one woman, who'd come alone, even asked me to accompany her). So I entered a small room that joins Carhart's two operating rooms, where I could see patients on both sides.

A first-trimester abortion, from my vantage point behind the glass window, looked like an extended, more invasive version of a standard ob-gyn exam. A woman with her heels in stirrups, clothes traded in for a hospital gown, a speculum holding the cervix open. Carhart used a suction tube to empty the contents of the uterus; it took no longer than three minutes. The suction machine made a slight rumbling sound, a pinkish fluid flowed through the tube, and, faster than I'd expected, it was over. Women spent less than a half hour in the operating room. I'd anticipated some kind of difficulty watching an abortion; it wasn't there.

At least not physically. But there was a discomfort I hadn't expected, my emotional reaction to watching abortions. It happened when I watched a married couple, in their mid-30s, the husband squeezing his wife's hand, stroking her forehead. Another woman, a single mom with a 10-year-old daughter, started crying when we talked about abortion. "I think it's OK," she told me, "but it's hard to see everyone doing it, there's so many. I'm not mad at them at all. It's just like, wow, there are so many people. There are seven or eight babies out there [in the waiting room]." There was the 23-year-old from Iowa who was 16 weeks along—she'd known about the pregnancy for two months but needed time to scrape together the money. By the time she arrived at Carhart's, she was visibly showing under her striped pink tank top. To be sure, each and every patient had come to the conclusion, on their own, that this was where they needed to be. And I met a few patients who saw nothing complicated about that decision, who never second-guessed their choice. But they were not the majority. In Carhart's clinic, most women were doing their best to balance competing emotions about their abortions, simultaneously sad and relieved, conflicted but confident. No one expected to spend a Sunday morning in Carhart's clinic—but all were absolutely grateful to be there.

When I returned from Omaha, friends and colleagues wanted to know if I had "done it." When I said I had, their reactions surprised me. Friends who supported legal abortion bristled slightly when I told them where I'd been and what I'd watched. Acquaintances at a party looked a bit regretful to have asked about my most recent assignment. The majority of Americans support Roe v. Wade's protection of abortion, about 68 percent as of May. But my experience (among an admittedly small, largely pro-choice sample set) found a general discomfort when confronted with abortion as a physical reality, not a political idea. Americans may support abortion rights, but even 40 years after Roe, we don't talk about it like other medical procedures.

And maybe that's appropriate. Abortion may be a simple procedure medically, but it is not cancer surgery. It's an elective procedure that no one—neither its defenders nor its detractors—expects to elect for themselves. I had (and still have) difficulty understanding my own reaction, both relieved to have watched a minimally invasive surgery and distressed by the emotionality of the process. Abortion involves weighty choices that, depending on how you view it, involve a life, or the potential for life. And my reaction, complicated and conflicted as it was, may have been a reflection of our national ambivalence about a private medical procedure at the center of a very public debate.

500 Days of Summer was "goooooooood"

My life is an Indie flick where the female protagonist is occasionally boring, almost always feckless in her decisions about love, and nowhere as cute as Zooey Deschanel.

little black sandals

Had a blast at Megan's wedding this weekend. It was great to see all the college roommates again, and to see that our persons are essentially still the same.

I'm going to try to start that "City Lights, City Heights" art project. I think the trick is going to be nail polish.

blueberry picking

Today's newly discovered pleasure: the serene solitude of fruit picking in the late evening. Tomorrow, I can look forward to yummy blueberries that pop in the mouth, yay! :-)

summer vacations

Just 1 week away and I can't decide what to do! I love the majesty of the mountains, but cannot deny the sensuality of the sea :-)

and this is true

"porque todo el tiempo
que pase junto a ti
dejo tejido su hilo dentro de mi

y fue por ti que descubri
lo que es amar
lo que es amar"

A First

I wept, not because Death was there, but because I was so helpless against it.

R.I.P, JA.

The Modern Student

As per my MKSAPP program:

"A 19-year-old man is evaluated for depression of 6 weeks' duration. He enrolled in college as a freshman 5 months ago and began participating in extramural basketball, football, and soccer in addition to carrying a full academic load and having a part-time job."

"Diagnosis: Hypomania"

If this is hypomania, then you apparently can't be successful in this world without having a mental disorder.

And then in sharp contrast: The Underworked American.

Liftoffs and Landings

Flying is its own kind of holiness. The city miniscule below you, to be in the vastness of sky like an ocean - how can one not think thoughts apart of the ordinary bustling world, not think of God and meaning instead of work and the next to-do? I love flying into cities and seeing their geography laid out below me, each with their own unique signature. This is especially prominent at night, when the lights of the major cities shine like jewels. And they are each so different! Chicago shines in grids like a microchip with the downtown rising from the squares to lead your gaze towards the Great Lakes. Atlanta more organic like gold sea kelp lazily spreading out from city center to the suburbs; Atlanta at night is a sprawl of tendrils, which I love. Cities like Barcelona and San Francisco arise out from the mountains, creating contours of human defiance that is simply magnificent.

One day I will create a series of canvases depicting this topography of city lights with the meticulous smattering of lights and jewels that befit the labor of human construction.

House of Cards

"This week is time for a major identity change."
- Nerve Horoscopes

what is a heart?

marble and lime
cracked and shine
persimmon in taste
earth and vine

"Burnin' Love"

Dido's new song suits a rainy weekend.



"I tend to live in the past because most of my life is there."
- Herb Caen

Happy Friends

I am saddened that my favorite people never seem to get what they deserve, and disgusted that people I despise seem to get the world.

And now, for a quote from Judy Garland:
"Be a first rate version of yourself, not a second rate version of anyone else."

Jesse McCartney can redeem some points for this....

Freak-end

Too much time off makes me neurotic.

Case in point: Since I've started REI (when I actually get to go home at 5 pm), I've started getting paranoid that I'm going to end up one of these barren middle-aged career women who are suddenly and unpleasantly slapped with the realization that their professional aspirations have cost them their biological ones. The magic number, apparently, is 37, or earlier if you're one of those unfortunate premature ovarian failure types. Asking me to get pregnant with a stable home situation by age 37 sounds like a lot to ask of me right now. Silently, I freak out in the clinic as I watch these women pay thousands of dollars to get Clomiphened, sperm injected, ultrasounded and phlebomotomized. It makes me cringe to see the hope and fear on their faces during each follow-up, as they tell me that they pray nightly for that miraculous joining of sperm and egg. It's not because I think they're pathetic. It's because I can see myself becoming one of them. It's because fertility means a whole lot to me, yes, little feminist, pro-choice me. Egads.

Then I get home, away from the clinic, and realize that I've got over a decade to go before that magic age hits, and I scoff at myself at how crazy I'm being. Yet that feeling of nervousness that my biological clock is ticking towards destruction - that feeling never really goes away. Holy Christ, I am entering the land of my mother and her incessant attempts to set me up with every single boy she knows.

Frown and consternation. Read books and try to forget about it all. Recommend to all my friends that they read Watchmen and then watch the movie. It wasn't half bad. Stop freaking out.

From Other People's Eyes

I like seeing commentary on physicians from non-medical people. It reminds me that we often get caught up in our own little medical world, and without meaning to be, end up being curt and insensitive to our patients.

And now, for 3 resolutions, all beginning with "I will be..."
... a piscetarian until Spring Break
... not bitter and jaded
... reading again :-)

The ethical dilemma of writing an ethical dilemma paper

Since these papers - for whatever reason - are not submitted anonymously, I suppose that pretty much rules out writing about the fucked up hierarchy within medicine....

and again, the Russians prove they are WAY cooler than us

Now, I'm a big fan of LOLcats. But THIS is even better!

I present to you: ROLcats, English Translations of Eastern Bloc LOLcats.

Have strength, my little cabbage. By the mercy of NKVD Order No. 00447, we have been chosen for Resettlement.

We will show the tin mines of Kolyma the true power of the proletariat.

The bar has been raised, ladies and gentlemen.

Whisked Away

Saw Twilight tonight and enjoyed it despite the bad montages and cheesy one-liners. Afterward, though, I was reminded of Marjorie William's 1997 article on the death of Princess Diana (I've been reading her collection of essays, The Woman at the Washington Zoo, which has been pleasantly entertaining and provoking). Writes Williams:

"Diana brought to life, on the grandest scale, the archetype of the princess inscribed on every girl's heart. It is written there by fairy tale, by girls' games and jump-rope rhymes, by Uncle Walt and his insidious successors at Disney.... Every girl has, at some age, some totem - a swirling dress, a tattered wand, a spangled tutu - that is her own claim to the throne.

Note, though, that it is the rare little girl who wants to grow up to be queen. To wish to be a princess is not simply to aspire upward, to royalty; it is also to aspire to a perpetual daughterhood, to permanent shelter. To dependency.

Once the hysterics surrounding the paparazzi's deplorable behavior subside, there will be only one clear conclusion to draw from Diana's sad end in a car owned by the Fayeds and driven to its violent end by an intoxicated Fayed functionary: that for all her fame and her thirty-six years and her accomplished motherhood and her millions, the life of a princess prepared her very poorly to look after herself.

And this is why the manner of her death, even more than her life, has such a terrible power for women... As long as Diana was out there, plying her glamorous, uncertain path to a full self, we could at least retain our ambivalence about the myth. We've known for a while that trying to be a princess can stifle you, but it's horrible to think that it could kill you.

This is where men begin to adopt puzzled frowns. Can this old drama really be so powerful in the lives of modern women? In fact, this drama IS girlhood and young womanhood in America: a succession of choices between the possibilities of independence and the seductions of dependence.

It is the rare woman who hasn't a story about silencing her own fears while riding shotgun, as a teenager or a young woman, in a car driven recklessly by a guy she wants to please. I have my own humiliating memory of riding through France... It was one of the few times I've feared for my life in a car. But in the course of four or five hours, I only managed to peep a few times, in my most apologetic, placatory, good-girl tones, that I wished he would slow down. My cowardice is unthinkable to me today. Yet I still have pangs of nostalgia about being swept off to France; and there are times, I regret to say, when I miss that good girl's easy manner and pleasing ways.

This, finally, is the difference in men's and women's feelings about the life and death of Diana, Princess of Wales. The moral of the story is that whether she's riding in a gilt carriage that bears her to St. Paul's Cathedral for the wedding of the century, or in a black Mercedes that bears her to her death, a passenger - which is the most a princess can hope to be - is never in charge. It's a hard lesson for women to learn, and it's one that men knew all along."

My 26 year old friend described it accurately when she stated that Twilight put butterflies in her stomach again. But those are the twitterings of the princess in us - that old fantasy that dies hard, and perhaps not at all. It is easy, as Williams points out, to miss that girl who wishes to be a Princess and the warm affections she seems to garner. But as she points out, there are better things to aspire to, and I have a feeling that all women who wish to become Real People must one day transition from Princess to Queen.

February

... is the most tumultuous month for romance.

Use What You've Got?

courtesy of Ozge Samanci at ordinarycomics.com

"Lover's Spit"

Tried and tired.

Don't Be a Stranger

W.B. didn't smell good, spoke like he had thick gauze stuck in his mouth, pestered the nurses for narcotics every half hour, and was introduced to me by all the staff as "not the nicest guy." Today, we took off W.B's last remaining leg.

Having never seen an amputation before, my initial reaction to seeing a heavy human leg wrapped up in sterile blue plastic and tossed in a biohazard bin was an immediate image of slaughterhouse meat. It was uncanny how much like a prime cut of beef it looked. But of course, it was not the same. It was a piece of a person, and as I watched him struggle out of his anesthesia-induced sleep, I wondered how it must feel to have reached your old age literally only half of the man you used to be.

I no longer wish to go into geriatric medicine, but the thought that attracted me to that field remains: That our characters and lives should be more reflective of who we are as we age, that old age should be a culmination of self and not a destruction of self. For a good number of individuals, that is what happens. Yes, the body ails, but for some people, the physical defects in no way diminish who they are.

But then there are the others - the ones whose health problems have precipitated a landslide of events that swallow up the self. You can tell who these people are because they are the quiet ones, the drug-seeking assholes, the one-track minds, the incessant babblers, the ones who have nothing left to focus on except the small and mundane. They usually have no supportive family, and because of the way they are, will be unlikely to get any support in the future. They come at random times to the hospital and inevitably leave in a wake of aggravated relief. They are the ones who get lost to medical care, the ones who come in sicker each time, until they finally, ignobly die.

Medicine, at times, is breaking my heart.

They say no effort is too little, but I'm not convinced that a lot of little efforts add up to enough. This is the talk of the medical pessimists, of course, the stuff that no one says in the hospital, and certainly not in front of your *gasp* attendings. Doctors are an optimistic bunch, you see, and I agree that we can do amazing good. But we don't heal as many lives as I wish we could. There is always so much left to do, and perhaps too much that we can never do.

If I were to be honest, I would say that the best I can do for W.B. is to send him home tomorrow with a genuine smile and some pain pills, and maybe he will remember me for a day or two. After all, in his life, I'm just passing through.

No food blogs today

I ate too much at a drug rep dinner tonight. Now, browsing through my normal food blogs makes me sick. Ugh.

I'm almost done with Plastics Surgery. It was surprisingly enjoyable and diverse in practice. When I asked my attending why he went into the field of plastics, he said "because they do good work and they're a fun bunch of people." Not the most clever response, but true to the core. It would be hard to work in a field of medicine where you thought your co-workers were all self-promoting assholes. I think the first part of his statement is definitely true; the jury is still out on the second.

On a similar note, I've decided that I don't actually like people with high ambitions. It's too easy for them to adopt the "drop 'em if they can't help you" mentality - which should be a big no-no in healthcare anyway. However, I must say that my inherent dislike of the notion that our relationships should only advance us is probably why I am making one of the most stupid, potentially hurtful decisions of my young life. Oh well. What can you do? If you claim to have principles, then you have to adhere to them, and no one ever promised you that it would be easy or fun.

I like the thought in the collage above.

"Ordinary Tragedy"

Maybe it is precisely because there is no one to point the finger to that this news story made me so sad...
***********
93-year-old froze to death, owed big utility bill

Mon Jan 26, 3:32 pm ET

BAY CITY, Mich. – A 93-year-old man froze to death inside his home just days after the municipal power company restricted his use of electricity because of unpaid bills, officials said.

Marvin E. Schur died "a slow, painful death," said Kanu Virani, Oakland County's deputy chief medical examiner, who performed the autopsy.

Neighbors discovered Schur's body on Jan. 17. They said the indoor temperature was below 32 degrees at the time, The Bay City Times reported Monday.

"Hypothermia shuts the whole system down, slowly," Virani said. "It's not easy to die from hypothermia without first realizing your fingers and toes feel like they're burning."

Schur owed Bay City Electric Light & Power more than $1,000 in unpaid electric bills, Bay City Manager Robert Belleman told The Associated Press on Monday.

A city utility worker had installed a "limiter" device to restrict the use of electricity at Schur's home on Jan. 13, Belleman said. The device limits power reaching a home and blows out like a fuse if consumption rises past a set level. Power is not restored until the device is reset.

The limiter was tripped sometime between the time of installation and the discovery of Schur's body, Belleman said. He didn't know if anyone had made personal contact with Schur to explain how the device works.

Schur's body was discovered by neighbor George Pauwels Jr.

"His furnace was not running, the insides of his windows were full of ice the morning we found him," Pauwels told the newspaper.

Belleman said city workers keep the limiter on houses for 10 days, then shut off power entirely if the homeowner hasn't paid utility bills or arranged to do so.

He said Bay City Electric Light & Power's policies will be reviewed, but he didn't believe the city did anything wrong.

"I've said this before and some of my colleagues have said this: Neighbors need to keep an eye on neighbors," Belleman said. "When they think there's something wrong, they should contact the appropriate agency or city department."

Schur had no children and his wife had died several years ago.

Bay City is on Saginaw Bay, just north of the city of Saginaw in central Michigan.

Very true

“To most physicians, my illness is a routine incident in their rounds, while for me it’s the crisis of my life. I would feel better if I had a doctor who at least perceived this incongruity.”

- Anatole Broyard

Urgency

Met with my former psychiatry department adviser to get a letter of recommendation, and broke the news to her that I declared ob-gyn instead. I think it's the right choice, but I still felt kind of bad about it. Especially when she mused, "So many promising psych students end up going into urology, surgery..."

Somewhere in medical school, the allure of investigating the unknown gets swept up by the urgency of impending death. It's hard to juggle both at once, because one requires lots of time spent sitting and thinking, and the other requires action. In the end, we all end up picking one of the two. I guess at heart, I'm a bit of an adrenaline junky. Who would've thought.