Change we can believe in

Obama was elected President in 2008, the year I started medical school. His re-election has come and gone, but I still haven't graduated. One day (it's approaching?). MD? What the f***.

I am glad I haven't changed much. I still see medicine and all it has to offer in a romantic light. I'm still a fool. I don't say much but someone recently told me my CV and experiences all scream "academic physician." I bet deep inside, I still believe that whittling away constantly at the unknown will eventually produce something of significant value. That's probably not true, but it does increase my chances.

Physicians are fascinated by suffering*. You'd think it was the opposite, but everyone sits and analyzes the failures. What happened? When was he first diagnosed? Then what happened? What happened two weeks before death? If you ever start to encounter a series of questions like this, let me just pare it down for you - the questions they're really asking is - What was that one singular moment that caused that monumental decline?

Take these two cases:
1. 63 y/o male dies 7 months after a diagnosis of glioblastoma multiforme.
2. 28 y/o female dies 4 months after contracting TB.

The first is interesting to me, but the second begs the question above. AIDS? Pneumonia? Car accident? What else happened? Physicians are fascinated by suffering.

Speaking of glioblastomas, look at this thing:

Terrifying isn't it? Sort of like an astronomer looking at the blistering surface of the sun, or a computer scientist watching his code compile, or getting on an expressway using an onramp that's downhill.**

Maybe it's the fact that after 100 years of research, mortality has not even doubled. Or the fact that people throw dozens of agents at it without significant benefit. Or the idea that even with a perfect resection, it always comes back. Like an intracerebral manifestation of evil, sending a chill wave across my torso.

Let me enjoy my pizza and Coke Zero*** please! (Heated up in a hostel oven).

*: In good and bad ways.
**: Try it
***: Nothing more refreshing than a cold Coke, but I can't afford the calories, so Coke Zero it is.

Hostels

First I thought this concept was ridiculous when a friend brought it up. But I've been using them like no tomorrow. I don't need an entire hotel room! Just a bed and a shower. Perfect.

When I was in LA a few days ago I was at a hostel in West LA, which... was okay. My first American hostel experience. The bathrooms were a bit dirty, the bed was "made" and I could feel the springs dig into my side when I slept, and the towels were a bit musty. The internet was fast and it was a convenient location so I rolled with it. People also kept coming in and out of the 8 person dorm room and slamming the door. COME ON.

Last night I stayed in another one in SF, this time, $29 a night, but so much nicer. Much better breakfast, nice beds to sleep in. The downside being, downtown SF is loud at night. I also rediscovered how good toasted bagels are.

In my morning tiredness I also fell off my bunk. This being the result:

Look at those bird-like Frodo Baggins legs. Jesus, I need to moisturize. (and work out) (and nurse my bruises). If I was some old lady, I would have had a vertebral/hip fracture from that fall. But everything turned out okay. I muttered "ow" and moved on to take a shower and get some coffee.

I came back to get my stuff before my bus to LA left and a German guy who was sleeping in the same room accosted me in broken English as I packed my stuff - "UWoau man, was that you who fell off the bed this morning! I saw that man are you okay!"*

Yes, damn it, I'm fine. Feeling a bit worse now that it was witnessed.

Anyway, will let you guys know more about this Santa Monica Hostel I'm heading towards. I'm also fairly certain we (CA shuttle bus) left someone at a Burger King in the middle of no where since he could not be found.

*: Deliberately left out commas for emphasis 

Post, D, Post!

Christ, I need to start writing again. My goal for 2012 was to surpass 2011. Yeah right. 5 posts? Are you kidding me? No wonder I've been going crazy.

I was on a flight back to Houston from LA and I was reflecting on myself over the last year, how things had changed, etc. I feel like I've slowed down a little. The me from years ago would easily look down on the me from today. At the same time, I also feel like I've grown less cocky.

I'm almost done with my interviews, got 2 left (to be done within a week) and then I wait for match day, which is a spectacle. Leave me out of it, please. Can't I just wake up on match day, look at my email, and go back to bed? Sleep. That's what I want. Going to med school is like running a series of marathons.

I'm working in Starbucks right now, on my Thinkpad (for writing) and iPad (for reading). It looks ridiculous but it works well since my Thinkpad is outrageously slow for more than one app open. My battery cycle count is 649. Holy shit! This nuclear powered battery still has a lot of life in it. I think I'll clean out my Thinkpad (read: getting rid of old star trek episodes but don't worry, they're somewhere else too..) and use it until it dies. Which will be never, because I got this before the Chinese screwed with Thinkpad design.

How about some formatting?

I send a lot of emails. I recently wanted to purchase a pair of UFS-20 stands (off ebay/craigslist) because I'm not paying $100 for two pieces of metal (off the Bose/Best Buy website). The guy responded with "yes, where do you want to meet?"

No capitalization, no time-wise greeting, no greeting at all. Are you kidding me? Lots of people add 'thanks' to the bottom of their email and it essentially means nothing. Sort of like:

Like - "Hi, did you have a chance to read that paper I sent you? Thanks!" Just a reminder/formality so you don't sound like an ass. But time-wise greetings? Awesome. No one says "Good morning" and doesn't mean it (especially by email). The same goes for good afternoon / evening / night. You also have to think about when they'll open the email (is when the greeting should be applicable for).

Also, if I write "Have a good weekend", I mean it. If it's Sunday, and your weekend sucked, give me a call and we'll do something about it.

Enjoy this picture of me from years ago:

A fucking lifeguard, that's what.

Family medicine in the 'burbs

My family medicine rotation is in Baytown, which I'm not terribly enthused about. I show up in the morning, round on the hospital patients in the morning (3 or less), then go to the clinic. Outpatient medicine can be interesting or as boring as you make it out to be.

I've probably had more appreciation in the last week than I have in the last year.

The attending also introduces me as Dr. Dash, which I'm not sure how to take. It always starts off as "Here is my medical student [doing fine..], Dr. Dash [ohgodwhy.jpg], and he'll be asking you a few questions." I don't think I ever want to be called that actually. I'd rather use it in case I need to throw down the hammer.*

What you don't see out there (directly) is death and destruction and that's a nice change of pace. It's nice to not hear that some patient isn't coming to clinic because they threw a large pulmonary embolism and fell face first into a bathtub or developed DIC a week ago and bleed out from every orifice.

I read this piece a few days ago : http://www.nytimes.com/2012/05/27/opinion/sunday/when-doctors-grieve.html

It's true. More importantly, I remember when I was on ICU, where a good 30-40% of my patients died within days of admission, I developed this furrowed browed look whenever I was down about my patients. It could have been interpreted multiple ways.

Are you furrowed because:

1) you realize you could have done more or
2) you're here too late and you don't want to deal with this, or
3) you're actually distressed by this patient dying or
4) some other miscellaneous cause.

Other people on my team had more unambiguous reactions. On top of that, after the "viewing" of the body and before the body would be transported down to the morgue, the family would leave the room, some would shake my hand and say "Thank you, doctor"

First of all, doctor?
Second, thank you? For what, exactly.

Baytown is a nice break.

*: Recall the short coat hammer from a few posts ago. 

Getting things done

I may have figured this out. There are two keys to making life simpler & better.

1. Automation - Automate everything. Bill pay? Automate. How often do you need to look at your bill and dispute charges? (Look at it anyway). Rent? automate. Dividend reinvestment? Automate. Morning routine? Automate. Become that robot so everything goes smoothly. Make a checklist and follow it religiously.

2. Tolerate (and be good) at things you don't want to do but have to do - This is crucial. I'd rather be reading about family medicine or gliomatosis cerebri or something, but I have to do these evaluations. Or clean my place. Or cook for tomorrow. Or think of a schedule for later today. No thanks. Maybe one day I can automate all of that too.

I just finished reading Better by Atul Gawande. It's a good book. Reflects that quote 10,000 hours to mastery? I believe that.

A few years ago, I was roaming around my dad's office, looking at posters, pilfering sodas and coffee creamer and I came across a poster, most of which's details I don't remember, but I remember there was a huge picture of an aircraft carrier and it was advertising "carrier class" reliability (with respect to server uptime).

I looked it up a few days ago, and here we are (wiki):

In telecommunication, a "carrier grade" or "carrier class" refers to a system, or a hardware or software component that is extremely reliable, well tested and proven in its capabilities. Carrier grade systems are tested and engineered to meet or exceed "five nines" high availability standards, and provide very fast fault recovery through redundancy (normally less than 50 milliseconds).

 99.999%. That's a goal worth shooting for.