25 October 2010

Lady Research smiles again.

Now that she has lifted her 1 week long nazar off my work and I found my swim goggles again and I'm sitting in a Starbucks sipping a iced green tea while listening to Led Zeppelin, I feel like a million bucks. So I'll tell you a story.

Quite some time ago, I thought I'd compose a few bits about my family. Namely, extended family, because that's where all the crazy resides.

I have this uncle on my dad's side - dad's sister's husband. Let's call him the fat one.* This is really a story for another day, but on my dad's side, me being the only grandson (heir to coconut plantations?), I was the favorite. This was most evident through my grandmother, who kept a 8"x11" picture of me on her dresser (and, unabashedly, of no other grandchildren). So everyone who came to visit her instantly knew who she liked. And of course they had to like me in the process**. The fat uncle liked me, and wanted me to visit. I'm not saying he had to like me or anything, just that, if there was a grandchild to be liked, it was me.

So one day I visited. Plus, he had HBO and a nice theatre system so I was like, fuck this, I'm going over there to chill. The problem was, as I should have seen it coming, he loved food. Loved. I make fun of people constantly for liking food a lot but this guy LOVED FOOD. Every time he came back from work - pakoras (of different varieties). There was a pre-dinner dinner. A dinner dinner. A late dinner dinner while sitting around and talking. You'd wake up on Saturday and there'd be aromas in the house in the morning. From 7am! Multiple kinds of drinks/teas, pastries, veg/nonveg items - and that was just brunch.

Lunch was another spectacle all together. You wanted mushrooms? You got 2-3 mushroom dishes within 15 minutes. You wanted lamb? (I love lamb) You got lamb in 15 minutes. He had a nearby restaurant that he ordered so much from that they'd essentially be on standby and he'd fetch the servants to get the food. Now that, was part of the fucking problem. Not doing anything yourself.

Maybe some of you are salivating right now. I will tell you that after a day I was sickened. It was so hard to say no. The constant pestering of trying new things (it all tastes the same after a while). Every day. Even if you were full - you can take another bite, no? Just one more. Just finish this portion of this dish and right when you think your stomach is going to explode it filled up.

Part of it was my problem too - I try so so so hard never ever to waste food. The greatest luxury is not in vehicles or rapid transportation or concierge service, but never having to worry about food, having it always available, and having a selection to cater to your palate. I go to Costco and I see food piled from floor to ceiling and I think - I could have anything my heart desires in that warehouse.

I sometimes think that if you were to bring a caveman to modern times, and you were instructed not to teach him anything that would alter the course of history, but only to show him something amazing, I'd take him to Costco. Space shuttle launch? Eh, it's like magic to him. For all he knows, the thing is controlled by the gods. Medical miracles? Give me a break, he'd get bored in the OR. But to show him food stacked in an airconditioned warehouse 3 storeys tall? He'd understand how far man has come. Walk in, take what you want and swipe some shiny piece of plastic? Mind-fucking-blown.

It came to be psychological torture after a while. My mom called me (as she did almost every day, I mean, still does) and quickly picked up on my deteriorating mood. She visited later to dole out some truly Imperial-command level reprieve. I hid behind her, so to speak. She just said "no", and food, there was none. And she saw the tables cleared and the burden lifted, and it was good.

*: Undisputed.
**: Remind me to tell you the one story about how my grandmother once rained hell with regards to what happened to me.

10 October 2010

Chimeric med students.

I was out partying this weekend, and people always want to hear patient stories. And I've got some good ones, as does almost everyone in my class. Even better - attending stories.

See, when you first start out, the simplest things seem fucking cool. When Bala first described a case where a woman started losing her peripheral vision before her central vision, leading Bala to instantly diagnose a pituitary tumor, we all felt like part of an episode of House. And that was fucking cool.

But now, decreased peripheral vision would easily elicit a differential of a pituitary adenoma or a craniopharyngioma. Instantly. Not only that, most of us could give a differential of what kind of a pituitary adenoma to look for, what symptoms to ask for, etc. etc. All this has become standard. But do any of actually believe we have achieved some miniscule level of Bala-greatness? Not in the slightest. Often, we'll ascribe that to someone else. That wasn't D, that was V.

A few weeks ago, when a elderly gentleman collapsed on my American Airlines flight, I had to assess his slight chest pain and syncope. If you asked me to describe that episode in excruciating detail, I'd probably stammer and 5 minutes later, come up with a half-hearted differential. But I knew then. I knew to look for the deadly chest pains and keeping in mind that common things are common, that he was probably dehydrated and fatigued. But that was someone else. All I do is mostly eat and sleep and occasionally crack open a book. Who was that delivering babies and performing CPR or explaining the side effects of FOLFOX to the patient constantly in denial? When the need arises, he better be back. The fear is, that he might not.

Not the Attendings. They don't have multiple personalities or the fear. They've got this. The white whales flee at sighting an attending.

Wikipedia says:

an attending physician (also known as an attending, or staff physician) is a physician who has completed residency and practices medicine in a clinic or hospital.

I guess? That definition is for the layman. 'Attending' means something else altogether.

And you always wonder if you'll actually ever get there. Even in middle age, you see yourself pilfering coffee and muffins and using silly mnemonics and stammering after every inquiry and running to UpToDate to look up everything.

But really, the point is, to never actually feel like you're there. One of Bala's favorite stories is the one about Type 1 diabetes, where upon administering exogenous insulin, a severely malnourished young boy regained his appetite and was back on the curve to good health. And you think, I could read, and listen to my patients, and not treat medicine like a game, I could be there.

Well, yes and no.

08 October 2010

The uprising

It might be a good idea to include more of my thoughts, slowly delving deeper into the crazy. 


So this morning - I'll talk about my morning. I awoke from a zombie dream - really common these days. Zombies are the one true evil I actually have a shot against.* 

So naturally, I woke up semidelirious in a hypnopompic state thinking there were zombies outside my apartment, but they had not realized my presence yet. Also, I didn't hear anything outside (no A/C machines, no pets, etc), so this only reinforced things. 

I slowly reached over to my phone, put it on silent, and checked its connectivity. Boom. 3G. 4 bars. Of course cell towers would still be operational; power plants were miles away. By this time, the music was already playing in my head. 

Hit play, and read the rest of the blog while it's playing.

So I'm slowly waking up out of this delirious state and I'm starting to realize that this is all probably false. So false in fact, that if there were zombies roaming outside my apartment (and in all of Houston), I might as well conjure up something else - an M92F on my desk with a few clips of ammo in the kitchen. You see, I was awake enough to logically conclude that as I was semi-dreaming, I might as well dream up a Beretta, but not awake enough to take me the entire way and snap me out of this delusion.


I also conjured up some serious handgun and melee weapon** skills. I was ready to take on the zombies. Level 1 was supposed to be - wake up, arm yourself, survey your surroundings, realize everything had gone to hell, kick the door open and make my way to my vehicle and run over some zombies on my way to TMC.

Level 2 was to open with a cut scene of my disabled vehicle in the middle of TMC (in utter shambles), and the ground gives way to the anatomy lab underground (which is a formidable opener for a zombie level). Level 2 was to end with me escaping Houston in a MEDEVAC chopper.


Ok! Let's do this! checks Twitter feed for 77030*** - no reports of bitings or the dead coming back to life. Damn it. I must be fully awake.

I then woke up and made some veggie patties from the batter I had made last night. No M92Fs, epic melee battles or hospital levels to fight through on my way to the roof.


*: I think.
**: Working on this IRL.
***: I seriously did this.

04 October 2010


I've been searching for the right word for literally weeks now, and I haven't been able to find it, so we'll just have to roll with it. This about 'nice' and how I think almost everyone misuses it. Or at least, makes it so broad of a definition* that it becomes meaningless. So let me try to describe three categories of positive people:

Congenial - This is what most people think "nice" is. What do you think of that person? Oh, he's a nice guy. Well, what about the girl that brings cupcakes and brownies? Also nice? Fuck that. He is congenial, as in, won't pick fights, say mean things, is polite but generally remains within his comfort zone and would not dare to leave it / go out of his way for anything. Congenial. Most people are congenial or polite. They may not have your interests at heart, especially if it means deviating out of their comfort zone.**

Nice - This word, I think, has been ascribed such a large variety of meanings that I consider it to be grossly misused. A Nice person goes out of his/her way to do something. Often this has to do with food, but it can also mean foreseeing problems and correcting them from the beginning. Nice people also take risks with intervention, advancing their (non-selfish) opinion on how things should be for your own good. Sometimes they're wrong, but more often than not, right. But the risk is worth it.

Fiduciary - Now this is the word I have been looking for a replacement for, but haven't been able to find. Fiduciary is another level in itself. I thought about other words for a replacement - parental (already widely used and comes with a restricted connotation), watchful (too big brother-ish), patriarchial/matriarchial (also widely used and overbearing), so I've settled on fiduciary. It's a difficult word to describe. A few teachers would fall under this. The good primary care physician would fall under this. Fiduciary is going above and beyond the call of duty.

Wow, that explained nothing, huh.

Whatever, enjoy this fucking awesome song:

There really aren't that many words to this song, and Santana's solo very adequately complements them. Excellent.

*: We shall be talking about broad definitions soon, wrt Nobel prizes.
**: Not particularly a problem.