Getting There...

Needed to share this song

2011-10-03T09:52:00.001-04:00

I really like this song

2011-05-18T21:50:00.002-04:00

and wish the B.E.P. would make a music video of it

It rained all day in Cleveland today

2011-05-15T00:45:00.001-04:00

and I felt rather out of place wearing my brown dress, with my silk scarf.

I came home and packed, for what feels like the umpteenth time in my life. It was strange to see what I had accumulated and had not during the past four years. My books I can still not let go, though I am giving away some medical books that the internet has since replaced. I threw away some photos and memorabilia from friends in the past - sad to see them go, but new keepsakes and loves need their room in both space and the heart. I anticipate feeling a twinge of sadness when my apartment looks empty again, prepped and sterilized for the next new tenant.

I have been reading Patti Smith's "Just Kids." Her sense of memory resonates with me. I know how vivid it all can be. Some things never quite leave you. I wonder if, in time, I, too, will extrapolate the great quiet messages that accompany our strongest memories, and how my feelings will change.

I think I shall take up writing again. Too much goes by and gets lost in the frenzy of intern year. Just a few snippets a day. Just like I did in high school. That's my therapy to myself.

I would like to...

2010-03-10T01:48:00.002-05:00

... write sestinas
... stop thinking about certain people at inopportune times
... go for long walks along the canal
... enjoy the sun and friends before med school ends

Detox

2010-01-24T15:01:00.003-05:00

My cup is too full.

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

2009-12-28T22:42:00.001-05:00

I think this is pretty damn good!

"Hysteric"

2009-12-25T19:52:00.002-05:00

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!

2009-12-21T00:49:00.002-05:00

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

2009-12-20T22:32:00.002-05:00

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

Thoughts on the Inteview Trail

2009-12-19T01:25:00.004-05:00

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

2009-12-19T01:15:00.004-05:00

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

2009-12-14T23:30:00.004-05:00

"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

2009-12-12T19:37:00.005-05:00

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

2009-11-21T23:45:00.003-05:00

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!!

2009-11-21T20:02:00.000-05:00

I have the sweetest roomie EVER!!

There must always be a reason

2009-11-19T20:16:00.004-05:00

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....

2009-11-18T17:44:00.004-05:00

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

2009-11-16T17:54:00.001-05:00

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!

2009-11-06T19:37:00.002-05:00

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

2009-10-31T22:54:00.002-04:00

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

2009-10-29T22:10:00.001-04:00

Cell Size interactive video

Sand Art by Ukraine's Got Talent winner

Forgetting

2009-10-28T22:43:00.006-04:00

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

2009-09-11T00:16:00.002-04:00

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

2009-08-20T07:46:00.000-04:00

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

A worthwhile read

2009-08-17T22:48:00.001-04:00

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"

2009-08-12T00:48:00.002-04:00

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

2009-08-10T07:35:00.001-04:00

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

2009-06-23T23:29:00.003-04:00

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

2009-06-21T21:27:00.003-04:00

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

2009-06-19T22:50:00.003-04:00

"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

2009-06-16T20:20:00.003-04:00

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

R.I.P, JA.

The Modern Student

2009-06-14T13:10:00.001-04:00

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

2009-04-12T06:28:00.002-04:00

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

2009-03-30T21:02:00.002-04:00

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

what is a heart?

2009-03-17T00:52:00.001-04:00

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

"Burnin' Love"

2009-03-15T21:10:00.006-04:00

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

2009-03-15T20:28:00.004-04:00

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....

2009-03-12T22:10:00.001-04:00

Freak-end

2009-03-08T22:51:00.003-04:00

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

2009-03-02T21:29:00.004-05:00

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

2009-02-21T11:14:00.002-05:00

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

2009-02-17T23:04:00.002-05:00

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

2009-02-15T20:11:00.004-05:00

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

2009-02-10T20:01:00.002-05:00

... is the most tumultuous month for romance.

Use What You've Got?

2009-02-05T20:41:00.000-05:00

courtesy of Ozge Samanci at ordinarycomics.com

"Lover's Spit"

2009-02-03T20:38:00.001-05:00

Tried and tired.

Don't Be a Stranger

2009-02-03T19:20:00.006-05:00

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

2009-01-29T22:51:00.003-05:00

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"

2009-01-26T21:29:00.002-05:00

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

2009-01-26T21:12:00.001-05:00

“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

2009-01-24T19:01:00.002-05:00

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.

Favorite Places

2009-01-19T20:27:00.004-05:00

I've always felt bad that I was never any good at favorites. I could never name a favorite color, a favorite animal, favorite movie, I vacillated between favorite books, and I remain loathe to name a favorite friend. On a philosophical level, I despise favorites. BUT there is one favorite that I always wished I could name, and that is favorite personal spots. Nothing feels more intimate than being privy to someone else's favorite locales, and I've always wished that I could show someone mine. But like I said, I'm bad at favorites, horrible at scouting out nooks and crannies of towns, and generally don't get around much.

I'm trying to change that. I've started giving some thought to my favorites in the current town I'm in (and it isn't that big, which makes my tasks somewhat difficult). Today, I found my favorite daytime place to visit: the canal. It's gorgeous in an understated sort of way, and I can easily imagine myself spending time there to unwind or to talk to a good friend. I'm still working on the favorite night-time place. Maybe someplace with some good finger foods and a view? Somewhere where I won't get shot?

I'll take some pictures later. For now, enjoy this shot courtesy of the world wide web.

Hear No Evil

2009-01-19T19:27:00.004-05:00

I was studying at Borders this weekend, and I got approached by a deaf veteran who was selling US flag pins so he could raise money to learn sign language. I didn't have any cash in my wallet, and I felt tremendously sorry having to turn him away. I'm starting to meet more veterans in my line of work, and for the first time, I'm getting a sense of what hurdles they have to jump through on a daily basis to get their well-deserved benefits. Apparently, in cases of hearing loss, there isn't much that the VA administration can do for you medically or otherwise. Hell, they're not even paying for your sign language classes, so what more could you expect?!

What is the real cost/benefit ratio of joining the military? On weekends, I see all the army recruits walking down the streets, and they seem chipper, fearless, and young. But as for me, I feel fear for them, because my main interaction with them is at the hospital, when all their youthful invincibility is irrevocably stripped away from them. Do they truly know what they are signing up for? Do they have a plan ready for if and when they come home with a war injury?

With the debt from med school building up (I'll prob pay around $150,000 when it's all said and done), I've considered doing a military payback plan. But then I see people like the veteran in Borders, and I realize there's no way in hell I would ever deliberately put myself in a situation where that might happen to me. Luckily, I have that privilege of choosing no, and knowing that my life will probably turn out just dapper anyway. I would imagine that the kids who end up getting recruited have much less rosy options.

I can't change that. I can only change how I treat the veterans I see, how much effort I put in, how much advocacy I chose to take on in my personal career. The more I'm involved in medicine, the more I see that there are SO MANY problems to be fixed, so many injustices, so many situations where I feel overwhelmed. Obama's inauguration is tomorrow, and I think a lot of people are expecting his presidency to usher in a new wave of.... something. I voted for the guy, but I don't think he can do more than inspire us. In the end, it's us who have to do the work, who have to make the commitment, who have to sacrifice some of our precious personal time.
I've given up on finding love while still in medical school - it's a pain in the ass anyway, and after all the effort, I still wind up feeling more bad than good. I'm going to spend the rest of this year just trying to be a good medical student, and crossing things off my list like I promised myself I would. Then maybe I can finally go to sleep at peace at night, without asking myself - as I have for the past few nights - just what the hell it is I'm doing with my life.

"I shall pass this way but once..."

2009-01-18T00:50:00.003-05:00

The quote or the picture? I think it's the quote. Sometimes, I wonder if I've made the right decisions in life, spent time with the right people, done enough good. It's not something I like to think too much about - the images of all the various futures I have already cast off into oblivion are clear enough as it is. And these are hard questions to answer for a girl who's got superglue stuck to her fingers...

This is sort of cute

2009-01-08T22:28:00.001-05:00

Those damn one uppers! Almost as annoying as the Debbie Downers, only that skit is slightly more funny...

most bitchin' use of drawers ever

2008-12-30T23:34:00.001-05:00

and possibly by bitching, I mean pretty. But when that old dresser of mine goes by the wayside, I'm going to totally do THIS to it. Recycle, reuse!

City Lights

2008-12-28T23:03:00.007-05:00

All this time, she had been waiting for someone or something to be that key that would fit the lock of the complicated machine that was her soul, and to click the gears in place. Now she was not sure that there were such a key. Perhaps it was the gears themselves that would change. However, at times, she found this metaphor disturbing.

The vastness of the city was reflected in its ever-burning lights, and she breathed in the sight from the hilltop. How she loved the city lights! Beyond mere loveliness, each light seemed to her a declaration of defiance against the natural darkness. Each light a person struggling to affirm their own brightness amidst the cold callousness of mere existence.

She walked around until she felt her knees go lax, and then she went home, more at peace.

thank you

2008-12-28T03:33:00.002-05:00

All of you. I'm ready for the new year now.

Culmination

2008-12-20T18:23:00.004-05:00

Well, peds is done, and that godawful Shelf exam is over with. Whew! Overall, I really really loved my first semester of rotations, and there were even a few moments where I could say to myself, "Good job, me! You can be a good doctor yet!" Next semester promises to be a lot more intense, and I'm hoping I'll hold up alright in it. In the meantime, I'm looking forward to winter break. Main goals? Get in some good sleep, do what I need to do for school and future, and enjoy the precious time I have with my friends and family. Now THOSE are the kinds of ambitions I like :-)

(ps) Lydia just offered me an opportunity to go to Spain with her over Spring Break. Can we say HELL YES???? God, I love that girl!

it doesn't take much

2008-12-16T18:33:00.003-05:00

Feeling nauseated, waiting for my roommate to come home so I can help him take his car to the shop, and then maybe some dinner, which may or may not be crossed off to list due to nausea.

Also realizing that when you're young and feeling inadequate/angsty/confused, one of the constellations of your "world is going to shit" storyline is that your parents are definitely - even if they have said nothing to indicate it - getting divorced. Every argument counts!

Good to Know

2008-12-14T19:14:00.003-05:00

I was just reading about the value of evidence in science today, and lo and behold, out comes this article about one of the most hotly debated topics in women's health: hormone replacement. HRT has been controversial for some time in medical circles because physicians could not reach consensus on how to interpret the results from the WHI (stopped in 2002 because of a surprising and alarming increase in CVD and breast cancer rates in users of HRT compared to placebo). Some, however, argued that the increase reflected long-term use of HRT in older, postmenopausal women, and did not accurately reflect risk in younger women who were using HRT short term.

Even as I started medical school, the conventional wisdom was that it was acceptable to use HRT in women just entering menopause with severe symptoms (eg, hot flashes), but not to use it to prevent osteoporosis or other problems associated with decreased estrogen. But that was the educated guess. Now a new study from the WHI has come out that gives us a better sense of timeframe of the risks of HRT, and thus better guidance for physicians.

In brief, the new WHI study states:

Three years after stopping hormone therapy, women who had taken study pills with active estrogen plus progestin no longer had an increased risk of cardiovascular disease (heart disease, stroke, and blood clots) compared with women on placebo. The lower risk of colorectal cancer seen in women who had taken active E+P disappeared after stopping the intervention. The benefit for fractures (broken bones) in women who had taken active E+P also disappeared after stopping hormone therapy. On the other hand, the risk of all cancers combined in women who had used E+P increased after stopping the intervention compared to those on placebo. This was due to increases in a variety of cancers, including lung cancer. After stopping the intervention, mortality from all causes was somewhat higher in women who had taken active E+P pills compared with the placebo.

Based on the findings mentioned above, the study’s global index that summarized risk and benefits was unchanged, showing that the health risks exceeded the health benefits from the beginning of the study through the end of this three year follow-up. The follow-up after stopping estrogen plus progestin confirms the study’s main conclusion that combination hormone therapy (E+P) should not be used to prevent disease in healthy, postmenopausal women. The most important message to women who have stopped this hormone therapy is to continue seeing their physicians for rigorous prevention and screening activities for all important preventable health conditions.

An article summarizing the findings can be found here.

So what does this mean for physicians? I still think that we should prescribe HRT to women who are suffering intolerable symptoms of menopause. However, given the study's results, I would be more vigilant about screening them for breast cancer while they are on HRT, and be more aggressive about weaning them off of HRT as they reach the 3 year mark in usage. I've seen so many women who have been on HRT for years and years and years (I'm talking like since 1980 when they had their hysterectomy), without close follow-up. Sometimes, we'll get them in clinic and they can't even tell us why they're on HRT. With this new data, there is a lot more incentive to be clear about the proper uses of HRT, and to prevent this sort of "slipping through the medication regime cracks."

The next study to come out is on women who have been only using estrogen, and not estrogen and progestins. That ought to be enlightening too, as hysterectomies are becoming an increasingly common procedure in the field of ob-gyn.

Summer Sandals

2008-12-14T15:14:00.003-05:00

"Flip Flop, Flip Flop," or so Natalie Angier describes them in The Canon. That's also the way I feel about what I'm going to declare in January. For a while I was feeling confident about psych, then I did ob-gyn, loved the rush, and was ob-gyn all the way. Now that I'm distanced from both of them (I'm on my pediatrics rotation at the moment), psych is tugging at me again and the allure of vaginas and surgical tools are starting to fade.

Flip flop, flip flop, and I'm back at square one.

I've made the lists of pros and cons of both fields, but it hasn't been terribly helpful. When it comes down to it, these two fields appeal to two different sides of me, have their own distinct virtues, and I can see myself loving a career in either one. I think I'm taking the rights steps - namely, getting additional exposure to both fields by doing a few days at Wesley Woods at Emory over break, and then doing an elective in REI in March at MCG - but I'm scared that even after those, it'll still be a last-minute, "hope I will never regret this" kind of impulsive decision.

They say you'll just "know" when you hit the right rotation in medical school, but so far, I haven't found that to be the case. There has only been time in my life where I've felt something to be undeniably true, and let's be honest, that incident didn't particularly do me any favors. Some of my classmates pray, but I don't even know who to pray to, or what form my prayer should take. Or if divine intervention is really the solution I'd want to my problem. I know that I've made the right choice by going into medicine, I have no regrets or doubts about that. But what's the next step??

Washington Irving once said that great minds have purposes, while little minds only have wishes. Right now, I don't know what my purpose is, and am treading water because of it. I wish I didn't feel like I was throwing punches in the dark. Ah, wishes of the little mind...

Take a cue from my picture above, God, and shed some light on my life. In the meantime, I'll just do what I keep telling my little sister to do, which is to pick something - or two things - and keep getting engaged in them. Even if we have two loves, we eventually pick one, and it's the matter of which/whom grabs our heartstrings first when the time is right.

Some Funny Sex Acts

2008-12-13T18:53:00.004-05:00

I thought I had heard it all, but these are new to me...

3. The Stranger - Sitting on your hand until it falls asleep and then jerking off, eliciting the feeling of a hand job from someone else.

57. The Flaming Amazon- This one’s for all you pyromaniacs out there. When you’re screwing some chick, right when your about to cum, pull out and quickly grab the nearest lighter and set her pubes on fire, then extinguish the flames with your jizz!

72. The Homolic Maneuver -Using your penis to dislodge an object blocking a choking victim’s windpipe.

80. The Fat Lip - If you get poison ivy and finger a girl, her labia lips will swell. A la, the fat lip.

(found off of "The 99 Most Degrading Sex Acts" on nerve.com)

Site of the day: Jocelyn's Corner

2008-12-13T18:44:00.003-05:00

Whoever writes this satirical blog is just brilliant. Some excerpts:

Christmas shopping made easy!

The way most people do their Christmas shopping just makes me sick. Waiting in stupid long lines for Black Friday specials. Putting tons of new debt on their credit cards. Wasting their hard earned money on gobs of overpriced crap that none of them even need. It's depressing, and it's senseless. This season should be about having fun, and not about spending a lot of money!

You won't find me at those Black Friday sales until just after the stores open. I park my van in a handicapped accessible spot, and watch those first few lucky customers come striding out, smiling over the purchase of a few limited supply items. I follow them from that parking lot to wherever they shop next. Most of them head to the mall. Then, once they've gone inside, I perform a quick smash and grab out of their parked car. Nothing could be easier! Phil is really going to love his new 36" HD television!

Another fun way to stock up on holiday fun is to steal packages from people's doorsteps. I bought the cutest little UPS girl outfit a few Halloweens ago, and it's becoming an indispensable part of my holiday routine. Nobody even notices me when I'm out on my lunch break, hitting up front stoops of houses for a "pick-up". It's nice when the companies put their logos on the shipping boxes so you know what you're getting. I hope my three year old enjoys her new laptop computer!

There's also the option of charitable sources, like Toys for Tots. I apply to those programs with falsified information so my kids can get a few extra gifts out of it. You should see the look on those volunteers faces when they have to deliver that stuff to our well furnished townhouse! But this method doesn't allow you to select what types of toys they bring. So go out earlier in the month and rummage around in their donation bins at the front of stores, and in office buildings. That kid-sized robotic dinosaur I snagged is going to knock little Brandon's socks off!

My final technique is a no-brainer. Folks are always looking for babysitters this time of year. All you need to do is post a few signs up on bulletin boards. Once the baby is asleep you can snag a few items from under their tree and move it out to your trunk before they get home. If you can find extra wrapping paper around you can always empty the boxes and rewrap them. This way you won't arouse any suspicion. My daughter is going to be so excited when she opens up the sassy new Dallas Cowboys jacket I took for her, and all the baby toys I swiped will be perfect for welcoming her unborn baby!

Also, check out her myspace! I'm a fan!

I don't know why this makes me giggle so much but...

2008-12-10T21:06:00.001-05:00

it def has the right combination of irony, smartass, and nerdiness to make it onto my blog

GAAAH

2008-12-10T20:35:00.003-05:00

The power is out in my house, and it won't be fixed until after 10 pm. So I guess I'm stuck at the Tifton Starbucks. I wouldn't complain so much except I'm feeling especially antsy today with all the rain, and I desperately want to dance around with my headphones on (my normal 8-9 pm routine), but obviously, I don't want to look like a retard in public. Boo Hoo.

Thought of the day:
"My wants arrange themselves, I can only prioritize my efforts."

deal with it...

2008-12-09T23:37:00.003-05:00

Reading nerve, I can finally confirm what I've suspected all along: Women are narcissistic. Of course, I don't consider that a bad thing, or any case, a quality that makes women worse than men. Because men are narcissistic too :-)

Funny chat status of today (stolen from Viren): "Motion to kick friend whilst down passed."
It's terrible and so wrong, but also kind of hilarious...

Cultural Competence

2008-12-08T23:55:00.002-05:00

Interesting article linked off of the Economist. I think it has a few good observations about intellectualism in this generation....
***

THE AGE OF MASS INTELLIGENCE

By John Parker

Created 04/12/2008 - 00:11

We’ve all heard about dumbing down. But there is plenty of evidence that the opposite is also true. Is this, in fact, the age of mass intelligence? John Parker reports...

From INTELLIGENT LIFE magazine, Winter 2008

Russell Southwood is queuing outside his local cinema in south London, listening to his iPod. Hip-hop and jazz, as usual. What is less usual is what he is queuing up for: not a film but a live transmission of this season’s opening night from the Royal Opera House. “I like hip-hop and opera,” he says. “Not a big deal.”

That’s increasingly true. Every other Saturday, Darren Henley is at the Priestfield football ground cheering on his beloved Gillingham. In the evening, he goes to a concert by the Royal Liverpool Philharmonic or the London Symphony Orchestra, because he is also the boss of Classic FM, a radio station that sponsors those orchestras.

Cultural incongruities are popping up everywhere. When the Guardian, which sponsors the Hay-on-Wye [1] literary festival, picked ten visitors to interview, one turned out to be a check-out clerk at Tesco who saved all his money during the year so he could go to the festival for his holiday. He was far from the most unlikely visitor who might have been found. High-ranking officers from the SAS (Special Air Service), Britain’s crack covert-operations regiment--who have to remain anonymous--have been known to spend their holidays each year travelling from their base at Hereford to Hay for lectures on Wordsworth and Darwin.

The sharpest of all these cultural contrasts, though, was the one taking place at the Royal Opera House itself the night Russell Southwood was queuing. Every seat had been taken not by the furs-and-cufflinks brigade but by readers of the Sun, a newspaper not noted for its opera coverage. Amid huffing and puffing from connoisseurs, 2,200 readers of Britain’s biggest-selling daily, accompanied by a trio of page-three girls (modestly attired), descended on the house of Handel and Callas for Mozart’s “Don Giovanni”. The paper celebrated with an inch-high headline: “Well Don, my Sun” [2].

In most rich countries, the old distinction between high and popular culture is breaking down. Isolated examples of this have been seen for a long time. In the 1960s Karlheinz Stockhausen, a doyen of avant-garde music, appeared on the cover of the Beatles’ “Sgt Pepper” [3]. In the 1990s the Three Tenors found a mass audience for Puccini. But what used to be a characteristic of individuals or particular occasions is now becoming the defining feature of the whole culture.

Millions more people are going to museums, literary festivals and operas; millions more watch demanding television programmes or download serious-minded podcasts. Not all these activities count as mind-stretching, of course. Some are downright fluffy. But, says Donna Renney, the chief executive of the Cheltenham Festivals [4], audiences increasingly want “the buzz you get from working that little bit harder”. This is a dramatic yet often unrecognised development. “When people talk and write about culture,” says Ira Glass, the creator of the riveting public-radio show “This American Life” [5], “it’s apocalyptic. We tell ourselves that everything is in bad shape. But the opposite is true. There’s an abundance of really interesting things going on all around us.”

That may seem Pollyanna-ish. But consider these straws, all blowing in the same direction. In 1999/2000, there were 24m visits to Britain’s biggest museums. In 2007/08, the figure was 40m. Between 1999 and 2001, Britain scrapped entry charges, so the increase is partly attributable to that. Still, it was a lot of people. And another factor is the popularity of blockbuster exhibitions, such as the Terracotta Army show [6] at the British Museum--which are seldom free, so scrapping charges cannot be the sole explanation. In most of the great cities of the West, museums now dominate the lists of most popular tourist attractions. More people go to the Louvre each year than to the Eiffel Tower; in London, three museums--the Tate, the British Museum and the National Gallery--each attract more visitors than the London Eye.

In 2006 the New York Metropolitan Opera started an experiment to reach a new audience. It began transmitting opera performances live to cinemas. In the first year it broadcast six productions to 98 movie houses in America; 325,000 people watched. The second year, it transmitted eight operas to 935,000 people. This year, there will be 11 productions, 850 cinemas in 28 countries and a forecast audience of 1.2m: roughly 100,000 people per show, compared with just 3,700 at the Met itself. A few dress up in finery. Many more stood outside in Times Square, New York, this year staring at the digital displays that usually advertise Panasonic or Disney, watching the Met’s opening-night concert.

* * * * *

One of the commonest complaints by cultural doomsayers is that nobody reads good books any more. Yet in the past two years, the Oprah Book Club [7] in America recommended Tolstoy’s “Anna Karenina” [8] and three novels by William Faulkner [9]--good by any standard, and they all made the bestseller lists. This year, Waterstone’s, which owns over 300 bookshops in Britain, asked two celebrated novelists, Sebastian Faulks and Philip Pullman [10], each to choose 40 titles and write a few words of recommendation. The chain then piled copies of the books on tables next to the entrances of its main shops and waited to see what would happen. Faulks and Pullman hardly dumbed down their choices: they included Fernando Pessoa’s “Book of Disquiet” [11], Rudyard Kipling’s “Kim” [12], and Raymond Queneau’s “Exercises in Style” [13]. The sales increases for these books over the same period the year before were, respectively, 1,350%, 1,420% and 1,800%--clear evidence of latent demand. If you offer it, they will come.

Literary festivals show the same thing. The Arts Council tries to keep track of their number: 43 in Britain in October alone. Some are tiny, like a weekend festival in Mere, a village in Wiltshire. Others are huge. Next year, the Hay Festival expects to sell 165,000 tickets for events over two weeks. When it began, in 1988, there were 2,000 visitors. Its director, Peter Florence, says the audience has grown, about 15% a year for the past 20 years. Now, he is branching out abroad, helping organise festivals in Cartagena (Colombia), Granada, Havana, Nairobi and Beirut. Not far from Hay, in Cheltenham, another literary festival has also grown, from 67,000 visitors in 2005 to over 87,000 this year. It, too, has children: the Cheltenham jazz, science and classical-music festivals have all flourished on the back of the literary one.

Of course, it may be just that there is more of everything, from serious-minded literary gabfests to drunken holidays in Benidorm. “In the past 20 or 30 years”, says Ira Glass, “there have always been little pockets in the culture where people do interesting work. But now there are so many more places, so many more people who are willing to try anything. The result is that there’s a lot of crap, but there’s also more stuff that’s good at every level.” And the internet, with its instant searches and e-mail newsletters, makes it much easier for people to know what is happening and how to get it.

Where you can make direct comparisons, the serious end of a market is holding up as well as or better than the popular one. Take television. There certainly is no shortage of chewing gum for the eyes. But a clever quiz show such as “QI”, which one might have expected to have lasted a season, is now in its sixth year on BBC2. The even more upmarket radio programme “In Our Time” [14] was the BBC’s first podcast, in 2004, and it was an instant hit. Janice Hadlow, the new controller of BBC2, recently told the BBC staff magazine: “I want to see intelligence in popular programming. It’s good to see it cropping up in all sorts of different places--not just those programmes where you might expect it.” A series like “The Wire”, which its creator David Simon admits “requires thought and commitment to watch”, has survived poor ratings to become a critical smash. Barack Obama was one of many to call it the best show on television. The Los Angeles Times used it as an example of what “is generally acknowledged to be something of a golden era for thoughtful and entertaining dramas”.

Television, opera and perhaps museums might be said to be absorbed passively. But that is not true of literary festivals, nor of some of the new businesses taking advantage of changing public taste. In a former grocery shop in Bloomsbury, Sophie Haworth, who used to run the Tate’s education programme, has just opened the School of Life, aiming to bridge the gap between adult education and self-help. Haworth calls it “a one-stop shop for the mind”. It is more rigorous than most self-help groups and more fun than adult education. Its courses are sold out for months ahead. So are public debates for 800 people on propositions like “It’s wrong to pay for sex”, staged by Intelligence Squared. When the company started, says Jeremy O’Grady, one of its organisers, he was virtually offering free tickets to tramps on the streets to fill the hall. Now you can hardly squeeze in. “Marketing people always think the public is seduced by glitz and instant gratification,” says O’Grady. “But we’re less shallow than we think we are.”

Lastly, lest you think the School of Life and Intelligence Squared, which cater for thousands, are typical of the new cultural endeavours, consider Classic FM [15]. Before it came along in 1992, Radio 3 had a monopoly over Britain’s supply of broadcast classical music. But (as is often the way with monopolies) it catered for insiders far better than for anyone else. As Henley says, Radio 3 “super-served the connoisseur”. You almost needed permission from the Royal College of Music to listen to it. During the day, Radio 3 strode about in a corduroy jacket; in the evening, it changed into white tie and tails. “Classical music had a language and a set of values that made it very elitist,” argues Henley. “It said: ‘This is the music. This is what you wear. These are the rules.’ But when we talked to people, they said that while they loved the music, they all thought they were the only ones put off by the way it was presented. It was like a club where the door is always locked. From day one, our aim was to blow open the locks.”

Classic FM’s launch was nothing short of sensational. Within four months, it had 4.2m listeners--twice Radio 3’s audience at that point and a vivid example of latent demand. “The audience was always there,” Henley says. “We just identified a need that wasn’t being fulfilled.”

Now, with 6m listeners a week, Classic FM is easily the largest commercial radio station in Britain (BBC Radios 1, 2 and 4 are bigger but are not commercial). One in nine of Britain’s adult population are regular listeners. They are not just the cardigan-wearing classes, either. At least 1m Classic FM listeners also tune in to Radio 1. So do about 400,000 children under 15 and, during the spring, half of all those who call the station’s musical-requests programme are students who, it seems, switch from pop, rock or dance music at exam time to something that helps them concentrate or relax. The station’s presenters embody its crossover appeal. One, Alex James, was the bass player for Blur, one of the leading Britpop bands of the 1990s; another, John Brunning, was lead guitarist for the 1970s band Mungo Jerry.

Like any good marketing operation, Classic FM divides its audience into segments. It labels them nervous discoverers, background listeners, classics as pop, popular enthusiasts and connoisseurs, and it provides programmes tailored to each. In the morning, when there are more background listeners and nervous discoverers (the youngest of the groups, also the Radio 1 listeners), the music is bright, breezy and interspersed with news and talk. In the afternoon, programmes turn more soothing for the popular enthusiasts (older, affluent, more women than men). In the evening when listeners have time, and connoisseurs tune in, you get traditional concerts.

The station goes out of its way to be user-friendly. For new or occasional listeners, it sells guidebooks (“The Friendly Guide to Classical Music” [16]). For the enthusiasts, there is a monthly magazine. Last Christmas, it even held a “Barbie at the Symphony” concert in Liverpool’s Philharmonic hall--“The Nutcracker”, “Swan Lake”--for another target audience: doll-loving girls (and their parents).

This leaves it open to accusations of dumbing down. It is certainly true that a good deal of Classic FM’s output is undemanding; the most ferocious and rebarbative contemporary music is banned. But it plays the world’s greatest music in proper recordings. It takes the classical canon beyond the traditional audience of connoisseurs and, with its magazines and books, tries to engage new audiences more deeply with the music it plays. Darren Henley’s quest is unfinished. “I've no doubt”, he says, “that one day, everyone will listen to classical music, maybe not all the time, but at different stages of their lives. It offers people a spirituality, an otherworldliness that they want. We hear that from our listeners all the time.”

* * * * *

Philippe de Montebello, soon to step down after 31 years as director of the Metropolitan Museum in New York, is fond of saying “the public is a lot smarter than anyone gives it credit for.” He seems to be right. But why? It’s unlikely people are more intelligent than they used to be. Perhaps the elites that enjoy high culture are now bigger for some reason? Perhaps popular tastes have changed in such a way as to benefit high culture? Or perhaps it has nothing to do with changes in the audience, and more to do with the artists and institutions, who have become more skilled at attracting people? Answer: all of the above.

Hard though it may be for professional pessimists to credit, educational standards have risen appreciably over the past 40 years. A good way to measure this is to look at how many people have degrees in each generation. The Organisation for Economic Co-operation and Development [17] (OECD) in Paris has worked this out and found that 29% of Britons between the ages of 25 and 34 have what it calls “type-A tertiary education” (basically, universities). But the share is little more than half that in an older generation (16% of those between 55 and 64). This reflects the expansion of universities in Britain since the 1960s. And in case you suspect the effect is merely a result of relabelling polytechnics as universities, the OECD has allowed for that, too. It calls the polytechnics “type-B tertiary education” (ie, vocational and higher training). Type B education in Britain has been flat. The growth has come from universities alone. In a literal sense, there has been an expansion of mass intelligence: more people have been trained at universities to want, or expect, more intellectual stimulation.

People with degrees are much more likely to go to museums than anyone else. Two researchers from Oxford University, Tak Wing Chan and John Goldthorpe, studied the influence of income, occupation, social class and education on whether people go to theatre, dance, cinema, music and the visual arts. They concluded that education is by far the most important factor. “The higher individuals’ education level,” they write, “the higher, one might say, is their capacity for cultural consumption.” They also looked at whether people tended to concentrate on one thing (going to the movies, say) or to engage with lots of art forms. They found that university graduates were far more likely to be “cultural omnivores” than “cultural univores”. Others have found the same thing. In 2007 the American research group MRI looked at the viewing and reading habits of the elite market, which it defined as those who went to, or subscribed to, at least two of the following: the New Yorker, Atlantic Monthly, The Economist, HBO, theatre, art galleries or classical concerts. They found that of this group, a third also read People magazine, watched “American Idol” and subscribed to the cable sports channel ESPN. One of the features of the market for mass intelligence is its heterogeneity.

There is a second, indirect link between education and culture, albeit one that is hard to pin down. Over the past two decades, education has been increasingly rewarded; in the “knowledge economy”, university graduates have done much better than others and the value of a degree has soared. People with degrees also go to cultural events more often so, though there is no necessary connection, there is a correlation: education, culture and income or status tend to go together. A study by the Pew Research Centre in America last year measured this correlation by proxy. It found that 60% of people with incomes of less than $20,000 a year said they had a low knowledge of current affairs; 15% had a high knowledge. For those on incomes of $100,000 and over, the shares were almost exactly reversed: nearly 60% high, less than 20% low. Keeping abreast of current affairs is obviously different from going to the opera or science festivals. Indeed, going to an arts event is often an escape from work. But it is also a way to gain status, to network and to use and burnish the thing that helps you at the office: knowledge.

An alternative explanation for the growth of mass intelligence comes from Peter Florence of the Hay Festival. Forty or 50 years ago, he argues, the public appetite for debate and intellectual curiosity was partly met by politics. The 1960s was a period of political ferment. Later, the current of public interest ran through television and radio; the BBC and ITV played a huge role in bringing theatre, opera and the rest of it to a wider audience. The tradition of public service, he thinks, “nourished an appetite for culture that has survived the splintering of monolithic public-service broadcasters and been encouraged by the rise of the internet”.

No doubt these long-run trends have played a role. But if they were the sole explanation, you would expect the market for mass intelligence to have developed slowly, imperceptibly. And one of its striking features is how rapidly it can appear--as Classic FM, Waterstone’s and the Met have all shown. The behaviour of arts providers makes a big difference too. Most successful arts organisations are busy blowing away a certain dustiness and injecting a sense of fun and style. Adult education and debating societies used to mean draughty halls and comfortless benches. The School of Life, in contrast, looks like a designer shop and the Intelligence Squared debates take place, says O’Grady, “in the most comfortable leather seats northern Italy has to offer”. This year’s Christmas programme at London’s Southbank Centre includes a Quentin Crisp lookalike contest and a concert by an orchestra using instruments scavenged from rubbish--drainpipes, traffic cones, discarded soy-sauce bottles.

When arts organisations do this, they can not only expand their audience but sometimes create new ones in the most unexpected ways. This is what Naxos Audio Books [18] has done with recordings of classic books on CD and tape. Its bestsellers include abridged versions of Milton’s “Paradise Lost” (three CDs) and a four-CD account of James Joyce’s “Ulysses”. Amazingly, Naxos sells thousands of copies of an unabridged version of “Ulysses” (22 CDs). “When I first proposed it, my colleagues thought I was mad,” says the company’s founder, Nicolas Soames. “At the start, it was just a hunch. I thought that if we read writers like Dante or Milton aloud, it would make them live again for a new audience.”

What was most remarkable was the origin of that audience. “I was a judo journalist,” Soames says, “and when I visited judo groups I found that everyone wanted to learn. The -do in judo means ‘the way’ and the concept inculcates in those doing the sport a strong desire to learn. These people would never sit down and read Dante or Joyce. But they would listen to them if they were read well enough. Now we know there is a group of people I call self-improvers who want a wide range of intelligent stuff, including the classics.”

From opera in cinemas to audio books for judo-players: the expanding market for intelligence is certainly unexpected. But what does it really amount to? Is it a profound cultural change or a mild shift upmarket? Here are three tentative conclusions. First, the growth of a market for intelligence may not imply anything about the quality of art being produced. Artists and patrons do separate, if related, things. Accusations of dumbing down are legion. On the other hand, the LA Times’s view that this is a golden age for serious television might be applied more widely. It is hard to believe that those who accuse arts institutions of dumbing down would want audiences to be smaller.

Second, the growth of intelligent interest may help resolve an argument that exists in universities between those who say culture is really all about class or income, much as it always was, and those who say that, no, sweeping statements about class are no longer relevant, and that these days personal taste, not class or money, is what matters. The new audience suggests both schools are partly right (or wrong). Taste has become fantastically heterogeneous: people do indeed watch and read whatever they want; intellectual snobbery is breaking down. But as Drs Wing and Goldthorpe have shown, one group--those with university degrees--read more, watch more and mix and match more than anyone else.

Third, what does all this say about the widespread view that societies are dumbing down, educational standards are crumbling and people’s ability to concentrate is collapsing? The reply must be that it cannot be true across the board and that for a significant number, the opposite is the case: people want more intellectually demanding things to see and hear, not fewer. Surely both things are happening at once: part of the population is dumbing down, part is wising up. But something has changed. H.L. Mencken, the so-called sage of Baltimore, said: “No one in this world...has ever lost money by underestimating the intelligence of the great masses of the plain people.” A growing number of people are proving him wrong.

slippery bastards

2008-12-08T20:19:00.002-05:00

This is so true, for med school, love school, and life school....

who the hell is writing Nerve's horoscopes now??

2008-12-08T18:38:00.001-05:00

First they're a week late, then the entries blow. Look, bitches, I don't want to have to read someone else's horoscope to understand my own, ok?? It's not supposed to be a series of personal jokes for YOU!

Seriously, look at this crap:

Aries (Mar. 21-Apr. 19)
You are a squirrel. As such, you do not understand why your forest seems to be exploding. You are very concerned.

How the hell am I supposed to plan my life from this????

grandparents

2008-12-03T17:14:00.003-05:00

Randomly thought of my grandparents today. Well, maybe not so randomly. I had to write a short paragraph for peds on why I wanted to become a physician, and I realized their attitudes towards life and society had a lot to do with it. But it's not like they ever sat me down and talked to me about that. It was just in all the little everyday things they did that showed me what they believed. That made a far deeper impression upon me than any grandstanding they could have done.

(Those, by the way, are my paternal grandparents. My maternal grandparents have also made a deep impression upon me, but less upon my choice of career. More on them another time.)

I hope they are well. I realize they are getting on in the years, and it's hard for me sometimes to reconcile that fact with the spry, playful grandparents I remember from my youth. I'd really like to go back to China after graduation; originally, they were planning to come here to see me get my MD, but I don't think their health will allow for that now. So it's my turn to go to them.

Finally, I hope I grow up to be someone's hero like they are mine.

the most touching dating confession i've seen

2008-12-03T00:42:00.002-05:00

"I always miss you...you used to tell me you missed me too...I miss that most of all."

see more at nerve.com

Playlist

2008-12-02T19:29:00.004-05:00

I saw a first outbreak of herpes for the first time today. It was terrible. Poor girl.

On a brighter note, the 3 songs on rotation on my ipod right now:

Race and Class

2008-11-29T23:58:00.003-05:00

I like this short blurb from TIME magazine because it draws attention to the fact that racial tensions in America are increasingly gaining meaning as class tensions, and not merely as issues of color. Race still matters, but in this modern age of interracial offspring and the black middle-class, the conflict lies more in cultural and lifestyle differences than in differences of complexion. In the future, it would be prudent for the NAACP to pay attention to the growing rift between the haves and have-nots in the black community. At the same time, they would be wise to use this moment in history to integrate black disadvantages into the more generalized picture of American poverty. I don't deny that poor blacks face somewhat unique circumstances, but to continue to stand apart from Americans in general - that is, to insist that their economic history is fundamentally and permanently different - invites only division, and not useful discourse.

***
National Association for the Alleviation of Credit Pandemonium

Nov 19th 2008

At 100, the NAACP still has a mission

Corbis

The struggle of the century

Barack Obama’s campaign for the White House raised many questions, for all Americans, about what it means to be black in America today—just in time for the centenary of the nation’s oldest civil-rights organisation, the National Association for the Advancement of Coloured People

The NAACP was formed on February 12th 1909 (itself a centenary, of Lincoln’s birth) by a bi-racial group of reformers. It promised to fight for equal rights and opportunities for black Americans. Primarily using litigation and legislation, it has been fighting the good fight, with varying degrees of success, ever since.

Does the election of the first African-American as president mean the battle has at last been won? NAACP members gathering in New York in July 2009 for its 100th annual convention could be forgiven for wondering how much their organisation still matters. Mr Obama and other young black leaders, such as the Massachusetts governor, Deval Patrick, embody the successful black middle class; and for many 20-something African-Americans the NAACP’s mission apparently means little when they feel overt discrimination is no longer an issue.

Hoping to make the NAACP relevant to that new generation is Benjamin Todd Jealous, a 36-year-old Californian who is the youngest chief executive in the NAACP’s history. Mr Jealous has plenty to do.

When he took over the helm in September 2008, the NAACP had been in turmoil for several years. Never a mass organisation, its membership now languishes at around 300,000, from a high of around 600,000, the association claims, just after the second world war.

Mr Jealous launched his tenure with an ambitious online voter-registration programme aimed at young blacks. As priorities for the coming year the NAACP is also targeting discrimination in the criminal-justice system, improving public schools, increasing black political and economic empowerment and boosting African-American representation, for example as surgeons, in the upper reaches of the health sector.

However, the credit crunch could prompt a shift in that strategy. African-Americans account for a disproportionate share of subprime loans, and tougher lending rules and tighter credit threaten to erode many of the gains made in recent years by black households.

The NAACP is suing 14 mortgage companies for discriminatory practices but it will need to do more, from expanding financial-literacy programmes to helping its constituents recover from financial crisis. In doing so, the NAACP might just find it matters once more.

How Georgia Stacks Up

2008-11-29T21:07:00.003-05:00

(facts courtesy of the Guttmacher Institute for Sexual and Reproductive Health. Information is current as of Nov 1, 2008.)

Sexual Education and Family Planning

Issue: Sexual Education

Nation: Most states require that public schools teach some form of sex or STI/HIV education. Guidance on sexual activity is heavily weighted toward stressing abstinence; contraception, if it is covered, is not required to be stressed. Most states also have opt-out clauses so parents can remove their children from sex ed classes.
Georgia: Sexual education is mandatory in the state of GA, and abstinence must be covered whereas contraception does not. Information about STI/HIV must also be covered, with the emphasis on abstinence again. Parents can opt their children out of the curriculum.

Issue: Family Planning Funding

Nation: Beginning in the 1990s, a small number of states imposed abortion-related restrictions on state family planning funds. Some ban the use of state family planning funds to provide abortion counseling and referrals to women who have unintended pregnancies. Additionally, these restrictions often require strict separation between organizations providing state-funded family planning services and organizations providing abortion-related services. Currently, 4 states explicitly prohibit the use of state family planning funds for abortion counseling and referral.
Georgia: Guttmacher offers no information on Georgia legal restrictions on family planning funding, but as of Nov 11^th, Georgia’s state budget for family planning clinics was cut by a whopping 34%. Governor Sonny Perdue had only specified that state programs be cut by 6%.

Issue: Physician and Pharmacist Refusal

Nation: Most states allow private physicians and individual institutions to refuse to perform abortions. The real issue here is the topic of referral. ACOG has more or less stated that it is a medical obligation to refer to a professional that will provide the services you refuse.
Georgia: Allows both individual physicians and institutions to refuse to provide abortions. 1 of 4 states that allows pharmacists to refuse to dispense contraception, although pharmacies themselves are not given explicit permission to refuse. As for the topic of referral, community sentiment decides whether Georgia healthcare providers will give meaningful referrals.

Issue: Emergency Contraception

Nation: On August 24, 2006, the FDA approved Plan B as an over-the-counter medication for those aged 18 and older; it remains a prescription-only drug for minors. 16 states require hospital emergency rooms to provide emergency contraception–related services to sexual assault victims. 15 states require emergency rooms to provide information about emergency contraception. 4 states explicitly allow pharmacists to refuse to dispense contraceptives, including emergency contraception.
Georgia: No laws mandating that ERs provide information on EC or dispense it upon request. No rules to allow pharmacists to dispense EC without physician prescription, even though the FDA has recommended it as OTC for individuals over 18 YO. No requirements that pharmacies stock or fill valid prescriptions for EC. Explicitly allows individual pharmacists to refuse to dispense EC (one of 4 states).

Issue: Insurance Coverage of Contraception

Nation: 27 states require insurers that cover prescription drugs in general to provide coverage of the full range of FDA-approved contraceptive drugs and devices; 18 of these states specifically require coverage of related outpatient services.
Georgia: Requires that insurance covers prescription drugs and devices, but not outpatient services. No provisions allowing for refusal to provide for employers, insurers, etc.

Abortion

Issue: Who can legally provide abortions?

Nation: Most states require that only licensed physicians (and hence not Physician Assistants or licensed nurses) perform abortions, and that a 2^nd physician be involved after a certain point in fetal development (often after viability or 3^rd trimester).
Georgia: Pretty much in line with the rest of the nation. Georgia prohibits abortions except in cases of mother’s health after the 3^rd trimester (28 weeks GA).

Issue: Reporting Abortions

Nation: For the last three decades, the CDC has collected aggregate statistics on abortion in the US; states are not required to submit abortion data but the overwhelming majority of them do. Information gathered generally includes information about the facility, the patient’s demographic characteristics and medical history, and the abortion procedure itself, including the method used and gestational age.
Georgia: Required reporting with information on the procedure performed.

Issue: Funding

Nation: First implemented in 1977, the Hyde Amendment, which forbids the use of federal funds for abortions except in cases of life endangerment, rape or incest, has guided public funding for abortions under the joint federal-state Medicaid programs for low-income women. 32 states and the District of Columbia prohibit the use of state funds except in those cases where the woman’s life is in danger or the pregnancy is the result of rape or incest. In defiance of federal requirements, South Dakota limits funding to cases of life endangerment only. 4 states restrict coverage of abortion in private insurance plans to cases of life endangerment.
Georgia: Public funding of abortion limited to cases of rape/incest/endangerment. However, anecdotal stories support the idea that women rarely use state or federal monies for their abortions due to the burdensome requirements placed upon the women to acquire that money. Georgia has no limitations to coverage by private insurance.

Issue: Mandatory Counseling

Nation: 17 states mandate that women be given counseling before an abortion that includes information on at least one of the following: the purported link between abortion and breast cancer (6 states), the ability of a fetus to feel pain (8 states), long-term mental health consequences for the woman (7 states) or information on the availability of ultrasound (6 states).
Georgia: All women receive verbal counseling about the specific procedure they are getting, while receiving written information on all common abortion procedures. They are verbally told the gestational age of their fetus, while given written material on fetal development throughout pregnancy. Patients are given both verbal and written information on the ability of the fetus to perceive pain. According to Guttmacher, the written materials detailing the risks of abortion and the emotional responses thereafter are accurate, although some abortion clinics may still be using outdated (and inaccurate) state pamphlets on abortion.

Issue: Ultrasound

Nation: Some laws and policies require that a woman seeking an abortion receive information on accessing ultrasound services, while others require that a woman undergo an ultrasound before an abortion. Since routine ultrasound is not considered medically necessary as a component of first-trimester abortion, the requirements appear to be a veiled attempt to personify the fetus and dissuade a woman from obtaining an abortion. Moreover, an ultrasound can add significantly to the cost of the procedure. Only a few states (6) require verbal counseling or written materials to include information on accessing ultrasound services.

Georgia: Providers must give verbal information on how to access ultrasound services. If an ultrasound is performed as part of the procedural workup, the patient must be offered an opportunity to view it.

Issue: Waiting Periods

Nation: 24 states require a woman seeking an abortion to wait a specified period of time, usually 24 hours, between when she receives counseling and the procedure is performed. 6 of these states have laws that effectively require the woman make two separate trips to the clinic to obtain the procedure.
Georgia: Mandatory 24 hour waiting period, but no mandatory trips to the clinic for counseling (can be done over phone prior to procedure).

Issue: If Roe v. Wade were Overturned

Nation: 20 states have laws that could be used to restrict the legal status of abortion.

4 states have laws that automatically ban abortion if Roe were to be overturned
13 states retain their un-enforced, pre-Roe abortion bans.
7 states have laws that express their intent to restrict the right to legal abortion to the maximum extent permitted by the U.S. Supreme Court in the absence of Roe.

Georgia: Has not passed any explicit resolutions in this matter recently, but there is good reason to believe that Georgia legislators would attempt to impose restrictions on abortions should Roe v. Wade be overturned (see recent legislation proposed in Georgia: NARAL ProChoice BillTracker and Planned Parenthood Legislative Update )

Issue: Choose Life License Plates

Nation: 17 states allow production of “Choose Life” license plates. 7 states donate the monies to anti-choice organizations, 13 states donate the money to agencies or organizations that provide adoption assistance, and 8 states specifically prohibit using the funds raised from aiding organizations that provide abortion services, counseling, referrals or advertising.
Georgia: Choose Life plates are allowed, although Choose Choice plates are not allowed. Funds go explicitly to maternity/adoption services agencies. Unclear which these agencies are (for example, Crisis Pregnancy Centers, which are notoriously anti-choice in their operations).

Parenthood and Minors Access

Issue: Minor’s Access to Prenatal Care

Nation: 35 states allow minors to access confidential prenatal care. Of those, 12 allow physicians to inform parents that their minor daughter is seeking or receiving services when they deem it in the best interests of the minor.
Georgia: Explicitly allows minors to consent for prenatal care, without any rules allowing the physician to notify parents.

Issue: Minor’s Access to Contraception

Nation: Most states have adopted laws supporting Supreme Court rulings that extend the constitutional right to privacy to a minor’s decision to obtain contraceptives.
Georgia: Explicitly allows all minors to consent to contraceptive services

Issue: Parental Involvement in Minors’ Abortions

Nation: 22 states require one or both parents to consent to the procedure, while 11 require that one or both parents be notified and 2 states require both parental consent and notification. All of these states also provide for an alternate way of obtaining the procedure in the absence of parental consent, usually via judicial bypass. Some states even allow grandparents or other adult relatives to be involved instead of the minor’s parents, and some states waive the consent altogether in cases of rape or incest
Georgia: Georgia has a parental notification law, as opposed to a parental consent. There is an option for a judicial bypass if parental notification is not done. There is an exception to this rule in cases of a medical emergency, but not in cases of abuse/assault/incest/neglect.

Issue: Minor’s Rights as Parents

Nation: Though most states require parental involvement in a minor’s decision to terminate a pregnancy, they overwhelmingly consider minors who are parents to be capable of making critical decisions affecting the health and welfare of their children without their own parents’ knowledge or consent. Nearly every state permits minor parents to place a child for adoption. Moreover, most states authorize minor parents to make health decisions for their children, and some allow minor parents to authorize surgery.
Georgia: Minors can consent to placing their children up for adoption without 3^rd party involvement, and minors can consent for medical procedures/services for their child.

Issue: Drug Use During Pregnancy

Nation: No state specifically criminalizes drug use during pregnancy. However, several states had expanded their child-welfare requirements so that prenatal drug exposure can provide grounds for terminating parental rights on an individual basis (DFACS involvement, usually). Further, some states authorize civil commitment (such as forced admission to an inpatient treatment program) of pregnant women who use drugs. A number of states also place a priority on making drug treatment more readily available to pregnant women.
Georgia: Legally, in GA, substance abuse during pregnancy is neither considered grounds for child abuse or for civil commitment. There is no state required reporting or testing. There are no targeted programs for pregnant women, but they are given priority in general treatment programs.

Issue: Safe Haven Laws

Nation: Every state, beginning with Texas in 1999, has enacted a provision intended to provide a safe and confidential means of relinquishing an unwanted infant. These infant abandonment measures—also referred to as “safe haven” or “safe surrender” provisions—typically allow a parent or other specified party to relinquish an infant under certain circumstances without threat of prosecution for child abandonment.
Georgia: Parents may abandon their children up to age 7 days to any health care provider. There is no specific law protecting anonymity. The acceptor does not need to provide ID bracelets, ask for health information, or investigate “missing child” status.

I wonder...

2008-11-27T19:34:00.002-05:00

- Why the kids on the Tifton peds wards just stay in their rooms all day? They should really get out more, and play in the open spaces. It sucks just being in your own stinky room all day, and unfortunately, there is no coordinated system for getting the kids outside (reading hour, crafts time, etc).

- "If a wound heals and you don't notice when or how, is that good or bad"? (courtesy of Ozge Samanci at ordinarycomics.com)

- Why emotions are always so much stronger at night?

Thanksgiving

2008-11-27T18:32:00.002-05:00

Rachel Maddow of MSNBC says that 1 in 10 Americans will be on food stamps this holiday season. And AP News reports that soup kitchens and food banks are expecting an all-time high in needy this year. Here are two links to organizations in Augusta and Atlanta that can help feed the needy this season. Please get involved - I know I will.

Madonna v. Lady GaGa

2008-11-25T20:18:00.002-05:00

You decide.

Some Great Fails

2008-11-23T21:17:00.006-05:00

because I don't feel like thinking too much tonight, and because these amuse me...
(courtesy of FailBlog.org)

The 1st step may not be the noblest...

2008-11-20T20:45:00.003-05:00

... but it should prompt you to take more.

Today, walking out of pediatrics to head home for the day, I saw a Hispanic lady in the waiting area outside the ward weeping into a towel. I had seen her earlier on the floor; she was presumbly the parent of one of the kids on the ward (not one of my patients). She had expressed to the nurses in her broken English that she was stepping out to get some air, and her demeanor then had been cheerful and pleasant. Imagine my dumbfounded surprise when I saw her crying.

I wish I had done more than just ask "Are you OK?" and accepted her hasty nod yes. Not that I believed her, but because at the moment, I was scared and felt inadequate and didn't know if I could help her. But that last bit is a sympathetic lie to myself - of course I could have done something to help her, and I should have. Even walking out, I knew that at any moment I could turn back, call the translator, and try to assuage what worries she probably had about her child. I would not have been overstepping my boundaries, or if I truly felt that I was, I could have called her physician to talk to her. But the fear of doing something unfamiliar stopped me, so there I was, sitting in my car, justifying my inaction on the grounds that she would feel better soon, maybe she just needed to cry, the translator might be out... name an excuse, and I thought of it. And then I drove home.

Not long ago, Lydia and I discussed how the 21st century, despite all its progress, is an era that has cultivated fear. I'm not referring so much to 9/11 and the subsequent actions of the Bush administration (although that certainly changed my experience of America more than I would like), but to the caution that was drilled into us even as young children. We are the generation of throwing away unwrapped Halloween candy, of never picking up hitchhikers, of not looking the homeless in the eye. So is it any surprise that as adults, our mindset is insular, hesitant even when our sense tells us we won't die if we help a random stranger who does not dress like us or talk like us? The world is our oyster, but we crack it open with only a select few.

I had thought about all this before, yet I still hesitated today. I am certainly not proud of that.

I guess if one good thing came out of that experience, it's that I will absolutely loathe myself if I allow it to happen again. The next time I see a scared patient or family member, I will get involved, even if it means I feel stupid doing so. Even if the fear is not gone. After all, what is the worst that can happen?

In Psychiatry, Can a Punchline be a Lifeline?

2008-11-18T22:19:00.001-05:00

A friend posted this on facebook, and I thought it was a charming little article. I remember feeling the same way during my psych rotation: Can I crack a joke? Are the paranoid schizophrenics going to go crazy if I smile at them? Will the demented people take what I say the wrong way and tell my attending I harassed them? In the end, it's a matter of discretion, but it's nice to know that there ARE times to loosen up, and be able to address your patients - even the ones who are supposedly "not all there" - with some semblance of humanity. After all, whoever said that WE were the ones who should control the show?
****

In Psychiatry, Can a Punch Line Be a Lifeline?

By BENJAMIN BRODY, M.D

“Has anything changed since the treatments began?” I ask the patient, as he lies down on a stretcher in the ECT suite. The anesthesiologist places an IV line in his arm and checks his vital signs. My attending psychiatrist adjusts the machine that delivers the electric stimulus. I’m a psychiatry intern, and this is my electroconvulsive therapy rotation. I’m here to watch and learn.

“My cellphone always has a great charge,” the patient deadpans.

If this were a friend or colleague, I would laugh easily. But this is a patient I barely know. He has bipolar disorder, a previous suicide attempt and a history of bizarre, impulsive behavior. In that context, his joke just feels inappropriate and overly familiar.

I’m taken aback. Is it O.K. to laugh, I wonder? An intern, with years of experience being inexperienced, I quickly glance around to take stock of the room.

The nursing assistant laughs and the anesthesiologist grins broadly. The attending psychiatrist remains stone-faced, and says, “Clearly he’s improving.” As the anesthesiologist injects a sedative, a telephone rings. Everyone’s hands are occupied; the ringing continues. Just as the patient starts to drift off, he looks over at me and says: “Can you get that? It might be the governor calling to stay my execution.”

A moment later, he’s out. The attending hands me the leads, and I feel slightly uncomfortable as I bring them to the patient’s head. The nurses are still laughing as he begins to convulse.

When I was an intern on the medical service, I often joked with my patients. It’s how I naturally relate, and carefully joking with a frightened patient is a powerful way to establish rapport.

But when I left the internal medicine floors for psychiatry, the humor stopped. On the advice of the attending doctors, I tried to be more concrete and matter of fact with psychotic patients, more empathetic with depressed patients and more authoritarian while working in a volatile emergency room. Not since adolescence had I spent so much time worrying about how I come across.

I had a vague sense that prompting a patient to laugh could sometimes be therapeutic. But when is it safe — let alone useful — to joke with a psychiatric patient? At least in the hospital, the patients seemed to have enough trouble relating to me without having to decode the nuance of humor. It seemed too risky, too ripe for misunderstanding.

Still, there were patients who insisted on joking with me.

Leading a community meeting on the inpatient unit, I asked the patients and staff members to introduce themselves and say something about who they are. “I’m a social work intern!” a staff member said brightly, followed by a patient, who declared, “I’m a chronic bipolar patient.”

This wasn’t what I had in mind; I’d imagined some type of biographical detail, not a recitation of titles and diagnostic labels. I grew uneasy as the patients started describing their personal pathology to the group.

Just as I was getting uncomfortable, one of the patients acknowledged the tension. “I’m a nursing student,” he said, with mock authority. The next patient, someone who had trouble relating to others and often missed social cues, said, “I’m the nursing manager.”

The entire group, myself included, erupted with laughter. The moment was a striking contrast to the unit’s usual sober atmosphere. Not for the first time, I wondered whether it might ever be appropriate for me to lighten up and initiate a joke.

At the end of my internship, I got my answer. I was on call at 1 a.m. on a Thursday, admitting my last patient of the evening. She was a woman in her 60s, brought in by the police for disruptive behavior in her apartment building. After being involuntarily admitted, she hid in her room and refused to talk to the nurses.

When I tried to interview her, she buried her head under a pillow, exclaiming, “I refuse all psychiatric care!” But beneath her refusal, I noticed something playful in her tone.

“That’s O.K.,” I said. “We’re good at treating people who refuse psychiatric care.”

That got a little laugh.

“Can you tell me how you got here?” No response.

Maybe I should try something more concrete? Given her age and the story I got from the senior resident in the E.R., it dawned on me that she might be cognitively impaired. “Who’s running for president right now?” I asked.

That got a response. Three people, she replied, using an epithet I can’t repeat here.

What are their names? I shot back, using the same epithet.

“Clinton, Obama and McCain,” she said. She was looking at me now.

“O.K., so what’s a nice lady like you doing in a place like this?” I asked.

Suddenly, I was in. She started telling me about her paranoid delusions about her landlord and neighbors. I sat down and started writing.

“Tell me more,” I said.

I'm just curious...

2008-11-14T20:19:00.002-05:00

Why isn't Condeleeza Rice being re-considered for the position of Secretary of State? I thought she was doing a pretty good job, and the world leaders are used to working with her already. Is that not allowed to serve 2 terms in a row under different administrations as SOS? Has she stated that she is not interested??

"the slow fade of love"

2008-11-12T20:19:00.001-05:00

Hmmm.... is Rilo Kiley ever going to play near me? At a time I can actually go to? Because if so, I'm THERE.

"If livin' is the problem, well that's just baffling."

strange sad song

2008-11-11T21:30:00.002-05:00

Tell me one more time
Why you went away
It makes a little sense
In the light of day
When evening comes around
All my senses fly away

Pediatrics

2008-11-11T19:34:00.002-05:00

I really like the way my current peds rotation assigns responsibilities to the med student. As I've mentioned earlier, I really think med students could do a lot more, and their personalities are generally those that like to rise to the occasion. Thus, there is no better way to teach and cultivate a med student than to have them perform tasks that are just a little bit above their comfort level (with supervision, of course).

Anyways, I'm on call tonight (in fact, I'm on call all week), but I'm FIRST call. So if a patient needs something, or if they're getting admitted, the nurses call ME first. Totally sweet! I really feel like I'm learning a lot better this way. I wish all rotations were like this. I like peds just fine so far, but I don't think there's anything intrinsic about the field that calls to me. But the way this rotation is being run, peds is going to be much higher up on my list of possibles than if it were being run the way, say, L&D was run.

I'm very excited about these next 6 weeks :-)

life is good

2008-11-09T13:00:00.003-05:00

I'm sitting outside at my parent's house, enjoying the fall colors and breeze, and getting in some of my Vitamin D. Yes, I am doing some USMLE World questions, but Pandora is on playing some kick-ass songs, and the neighborhood is content and calm. Life is good.

Now for some music videos from one of my favorite bands from the 90s.

random thought

2008-11-08T21:21:00.003-05:00

I think it would be very ironic to make paper cranes to M.I.A's "Paper Planes."

On a related note, I finally learned how to make a paper crane today. I'll be trying the origami on this website next.

I just want to...

2008-11-07T15:17:00.003-05:00

I finished up ob-gyn today. I really liked the rotation, and I can see myself doing it for a career. But I haven't discovered an area of it that I really really love yet, and that worries me. Perhaps I just need more exposure to the field. I find that I tend to like things better if I'm more involved with them. So let's hope my REI elective next semester goes well, and if not, I'll try something else in gyn-onc.

There's a lot I need to figure out right now, and I gotta admit, I feel a bit confused and flustered in just about every aspect of my life. Maybe I will recharge this weekend with the fam.

Right now, I just want to listen to music with my headphones on, lying on rooftops.

30 random songs off my iPod

2008-11-06T20:52:00.003-05:00

I'm bored. This takes up time. Guess the song - I've given the 1st line. And yeah, some of these songs might be embarrassing, but it sure is a good foray into nostalgia! Email me with the most correct songs without having to look them up, and get a prize :-)

1. In the day, in the night, say it right, say it all
2. If you ain't got no money, take yo broke ass home
3. If you had my love and I gave you all my trust, would you comfort me?
4. All I wanted was to feel the way you feel, all I wanted was a chance to make it real
5. Love love is a verb, love is a doing word
6. It's not worth anything more than this at all, I'll live as I choose or I'll not live at all
7. I've been had and I've been held with the ghosts at bay
8. Driven through the canyons, I was dazzled by the mountains, and we didn't go very far
9. What to say, what to say...
10. Come to me, stay the night, you say the words, but boy, it don't feel right
11. Today is gonna be the day they're gonna give it back to you
12. And we're not going back into rags or in the hole
13. I gotta be honest, I think you know, I'm covered in lies and it's ok
14. There was a game we used to play: we would hit the town on Friday night, stay in bed until Sunday
15. You gotta a fast car, I wanna a ticket to anywhere
16. Blackbird singing in the dead of night
17. Anyway now, it don't seem right, he's in there and you're on the outside
18. Ecstasy is all you need living in the big machine
19. When there's nowhere else to run, is there room for one more song?
20. I look at you all, see the love there that's sleeping
21. I'm tryin' to tell you something 'bout my life
22. On the way to your brother's house in the valley, dear
23. How many special people change?
24. What I want from you is empty your head...
25. Sometimes I find myself sittin' back and reminiscing, especially when I have to watch other people kissin'
26. What's wrong with the world, mama? People living like they ain't got no mamas.
27. I am a little bit of loneliness, a little bit of disregard
28. Life, it's ever so strange, it's so full of change
29. Squint your eyes and look closer...
30. You say, I only hear what I want to

A Historical Moment

2008-11-04T23:13:00.002-05:00

I am so glad we can finally strike one line from this amazing song. America has shown its desire to move forward in the 21st century. I'm ready and hopeful :-)

10 Favorite Quotes

2008-11-03T23:13:00.002-05:00

"Fairy tales do not tell children that dragons exist. Children already know that dragons exist. Fairy tales tell children that dragons can be killed."
- G.K. Chesterton

"Make no judgments where you have no compassion."
- Anne McCaffrey

"There are no events but thoughts and the heart’s hard turning, the heart’s slow learning where to love and whom. The rest is merely gossip, and tales for other times."
- Annie Dillard, Holy the Firm

“I think the way we are as we get older is a result of what we knew when we were children.”
- PJ Harvey

"All God’s children are not beautiful. Most of God’s children are, in fact, barely presentable."
- Fran Lebowitz

"Kindness is in our power, even when fondness is not."
- Samuel Johnson

"Everyone is entitled to his own opinion, but not his own facts."
- Daniel Patrick Moynihan

"They always say that time changes things, but you actually have to change them yourself."
- Andy Warhol

"Earth's the right place for love; I don't know where it's likely to go better"
- Robert Frost, “Birches”

"To grow up would be an awfully big adventure."
- Peter Pan, movie version

Taste

2008-11-03T23:09:00.001-05:00

She places the leaf on her tongue. She relishes the gritty feel of dirt. It tastes like a boy she once knew. A boy she once knew reminded her of the earth that she loves. All is solid, all is good. She smiles: a sweet memory perfectly contained in the cave of her mouth.

Random Thoughts I Had Today

2008-11-03T22:40:00.004-05:00

After seeing a cancer patient in a pain crisis: Why don't we use pain-perception altering drugs like pregabalin instead of typical narcotics for cancer pain?

After seeing a really bad cervical tumor: Oh god, I can't handle smells.

After Dr. Barnum's lecture on PMS: Maybe it would be good to micro-track my life for a while. What I'm eating, what I'm thinking, who I miss, when I wake and sleep, etc...

After getting home: Why didn't I make small talk with my roommate?? And why am I still not?

After getting onto my internet homepage: Could Obama really be assassinated? How bittersweet it would feel to win the presidency after your most cherished role model passes.

After logging onto Tastespotting.com: Ugh, I can't handle food today. I might have the VRE.

After sitting in bed for a while: God, I really want to leave the country for a while. I still don't feel like I've really lived yet.

After listening to "Transatlanticism": How odd and touching it is that we miss even those things/people that we chose to let go of.

normal aging

2008-11-01T19:04:00.002-04:00

My emotions change. Feelings seem stronger in the past, but I feel smarter and more confident in what I feel today. Is this normal aging? It seems good, but then why do I sometimes feel so bad?

confession

2008-10-29T22:46:00.002-04:00

Ok, I totally fucked up Josh's beef stew recipe from the other day. I'm sorry, Megan! Somehow, I burned it so badly that when I heated it up for lunch the other day in the ob-gyn office, the chief resident walked in and immediately asked, "Is there a fire??!" So yeah... that got trashed. Next time, smaller batch, more frequent stirring.

BUT I did manage successfully the paprika chicken from this recipe, which turned out just delicious! Caloric intake is probably disastrous, but right now, after working long hours on gyn-onc, I really don't care. Besides, I can always work out "tomorrow" :-P

a punch in the face

2008-10-29T20:08:00.002-04:00

... sometimes is just what you think someone deserves.

What can I say? I can't be sweet 24-7.

Happy Pumpkin!

2008-10-28T20:57:00.002-04:00

I'm probably not going to dress up for Halloween, unless it involves some hairbrained scheme to allow me to wear the new dress I just bought. But actually, I don't feel like freezing or being a pretty pretty princess this weekend, so I guess I'll just console myself with my happy-as-hell pumpkin that I carved the other day with Lydia. I mean, seriously, look at this guy! It makes me smile every time I pull my car up to my door :-)

If you've got a creative costume idea to bring me out of my nay-to-Halloween stupor, please let me know. I already loaned out my genius idea of the year to the brother of a friend. Oh, he BETTER do it...

article from Tim

2008-10-27T20:57:00.002-04:00

Tim posted this article on his Gchat, and I really liked how it started and progressed, but was not such a big fan of how it ends.

* spoiler warning *

The author gave a great discussion - with some truly convincing examples - of the idea of competing selves and how it influences our actions without contradicting an idea of "self." He then goes on to discuss paternalistic libertarianism and how it utilizes this notion of "good self" versus "bad selves." At this point, I had a vision of where the article was going to lead, and it had to do with caveats. And indeed, the author's next paragraph starts out with "It’s more controversial, of course, when someone else does the binding. " Sweetness, I thought! He's going to talk about the potential problems of paternalistic libertarianism.

Only... NOT. Read the article, and I think you'll understand what I'm talking about.

I mean, seriously? "We benefit, intellectually and personally, from the interplay between different selves, from the balance between long-term contemplation and short-term impulse." does not cut it. It's not news. It gives no guidance for policy. It's crap.

Is it not obvious that the main danger of paternalistic libertarianism is that it could be wrong about what is best for ourselves? As a pro-choice advocate, I immediately thought of the mandatory consent laws and 24 hour waiting periods that stand in the way of young women getting legitimate abortions. Those are paternalistic measures too, but I'm hard-pressed to see how they encourage our "best" selves. Moreover, while some people who push for these types of measures are just assholes, the majority of them truly believe they are doing good.

The question, then, comes down to who should make the laws in a paternalistic libertarian society or how. This is where the idea of a republic of selves within ourselves mirrors itself in the political process of America itself, and convolutes the metaphor too. After all, we can all believe that there are good and bad versions of ourselves, but in the make-up of American society, which of us are good and which of us are bad? And if we're the neurons making up the moral and intellectual network of America, who, then, is the total self??

I know I know I know

2008-10-26T22:26:00.000-04:00

mixed feelings :-/

Josh's beef stew recipe

2008-10-26T01:29:00.002-04:00

It looks delicious, and if I can get a hold of a bottle of wine tomorrow, I'm definitely making it! Thanks for passing it along, Megan!

Here is my recipe. It makes a lot of stew (about 8 large bowls).

Ingredients:

2.5 Lbs. Cubed Beef (I usually use Chuck); larger chunks are better than smaller
1 Bottles (750 mL) Red Wine (cheap wine is best for cooking!); an extra bottle is a good idea so you can add extra wine instead of water (and have something to drink with your stew, if you're not a teetotaller)
2 Small Onions (or 1 really big onion)
1 Package (2 Lbs.) of Carrots
3 Lbs. Russet Potatoes (about 7 Potatoes)
1 Package Frozen Peas
Vegetable Oil
3 Bay Leaves
Thyme
Flour
Salt
Fresh Ground Black Pepper
Water

Recipe:

1. Brown the Beef

In a plastic bag, combine flour, salt, pepper, and beef. Shake and work the beef until all chunks are thinly coated in flour. In a large stew pot (or in a frying pan), heat vegetable oil on medium-high. Once hot, brown the flour-coated meat on each side. You do not need to cook the beef through, just brown the outside. You may need to brown the beef in multiple batches, depending on how much meat you have and the size of the pot. Once all the beef is brown, set it aside.

2. Saute the Onions

Coarsely chop the onions. In the stew pot, head some vegetable oil over medium-high heat. Once hot, add the chopped onions and saute until soft and slightly brown.

3. Start Simmerin'

Once the onions are ready, add the beef back into the pot. Pour in a bottle of wine, and add 4 cups of water. Add bay leaves, salt, pepper, and thyme to the pot. Cover the pot and bring it up to a simmer, then cook for about 70 minutes.

4. Add the Carrots

Peel and chop the carrots (Big chunks! This is a stew for MEN, not little babies). Add them to the pot, cover, and return to a simmer. Let cook for about 20 minutes.

5. Add the Taters

Peel and dice the potatoes. Make sure to set them in water as they are diced so they do not turn brown. Again, big chunks are best! Add the potatoes to the pot, cover, and let it cook for 70 minutes. You may want to add a little more water (or wine, if you have another bottle); you want the top layer of chunks to be just above water level.

6. Add the Peas

Add the frozen peas into the pot. Return to a simmer and let it cook for about 5 minutes. Season to taste with additional thyme, salt, pepper, or anything else you want to put in there.

7. Keep Cookin' (if necessary)

The stew is ready at this point, but if it's still soupy you want to cook it uncovered for up to another hour in order to boil off some water; your goal is a stew which is very thick!

8. Resist Temptation

Smell your stew. Mmm . . . delicious. NOW DON'T EAT IT. This stew will taste much better in a day or two. Put it in the fridge and let it "stew" for a while. It can also be frozen and stored for quite a while.

9. Enjoy!

If you made it right, this will be a stew you can eat with a fork. I recommend a nice loaf of bread to mop up the sauce, and I'm told a nice bottle of red table wine (perhaps the one you didn't finish off while cooking) goes very nicely with it.