Eschewing Myopia

A Eulogy (or at least a Rambling Foray) to Dr. Paul J Bertics

2011-12-23T07:21:00.004-06:00

It's funny, the picture I downloaded from the University of Wisconsin Department of Biomolecular Chemistry website to headline this post was called "Bertics_small." A description that couldn't be further from the truth. With a towering build and hands that could palm a basketball and then some, Paul was far from being a small man. Neither could he be described as a man of small personality, either: always jovial and quick to joke (and never afraid of punning or making geeky pop culture references), he never let his seriousness and passion for science affect the way he went about his business. But I'm getting ahead of myself.

I distinctly remember interviewing with Paul when I was applying for the MSTP position at the University of Wisconsin back in 2001. I was sick as a dog with what was probably something akin to Spanish flu. I was clearly affected, and our program has about 20 interviews spread across our entire gigantic and confusing campus, so I was in bad shape. And I had already done a whole lot of interviews before him. But even in my haze of sickness, I distinctly remember shooting the shit with him about Monty Python and the holy hand grenades. And while most of the interview was kind of a blur (and I still marvel at the fact that I got in at all based on my presentation at that time), I still distinctly remember sitting across from him at his desk (where my eventual office as a grad student in his lab would be located) and just talking with him about everything under the sun. Everything ELSE under the sun than just why I wanted to be a doctor or do scientific research or all that nonsense. He knew my application (he was the chair of med school admissions, after all, and remained that way until, well, now), he saw how badly off I was, and he went straight to setting things at ease. Because that's what he did.

Ending up in his lab was kind of a happy accident. I needed a third lab rotation and I ran into him randomly in the hallway and we struck up a conversation. He amazingly remembered me by the nickname I used to go by (which I had changed to my legal name shortly after my interview 2 years prior) and, on a whim, I asked if it would be OK for me to do a rotation with him. The rest was kind of history from there: the work wasn't the sexiest, but it was good, solid science and, more importantly, it was funded. But I didn't really choose the lab for the work or the funding but, instead, on the strength of the advisor's personality and the effect it had on the people who worked with him. I knew graduate school would be rough on the nerves and the emotional well-being, so I valued above all else an environment where I would feel supported and could get along with people. And I got exactly that.

Paul was, I can pretty safely say, a universally beloved man. A prominent and omnipresent, but also very benevolent, figure in both medical school and graduate school, hundreds of students alone would make his acquaintance every year, and I very rarely heard anything remotely bad said about him. Most people's faces lit up when I told them who my graduate school advisor was, and they invariably follow that up with, "I bet it's awesome working in his lab."

While this was certainly true, Paul was also an enigmatic advisor. A man whose primary fault was that he didn't know how to say no to requests, he was involved in so many things that his grad students had a tough time getting ahold of him: chair of medical school admissions, lecturer for med school biochemistry, serving on well over 100 thesis committees in any given year as well as serving as an editor for a major immunological journal and, as if that wasn't enough, serving on NIH review committees on a regular basis made him a difficult man to pin down. Sometimes this could be frustrating, when science wasn't going well, because he wasn't easy to find to do troubleshooting.

That being said, Paul and I seemed to have an understanding. Not an understanding necessarily unique to me, but an understanding nonetheless. The understanding was really this: I didn't generally come to him for troubleshooting, but once in a blue moon I would at least check in with him for some quality fat-chewing with a little science sprinkled here and there, and I made ample use of libraries and fellow grad students' and postdocs' and staff scientists' knowledge. I only found out much later, when I had graduated from the lab and we could just hang out as friends, that this had always been his plan for all his grad students. He didn't want to hand-hold, he wanted to make scientists, to make people who could go to the literature or find any resource necessary to make it work. It was really for our benefit while he had to do the stuff that kept our salaries paid, our lab open, or prestige elevated. He had to work on the intangibles of science so that we could do nothing but focus on the actual science. Though spinning wheels in scientific research is a frustration surpassed by very few other frustrations, he understood that this was a part of the process and tried his hardest to make sure that was the only thing we as grad students had to worry about. And truthfully, when all was said and done, Paul knew how to recognize the situations where he absolutely needed to come through: editing papers for journal submissions, letters of recommendation, poster/paper presentations, or when our research situation just seemed desperate enough to where quitting the lab seemed like an impending inevitability.

In that way, Paul always kind of reminded me of the misunderstood dad who is most strict with the ones he loves the most. Not that Paul was by any means a strict man, but I do think he loved his grad students the most: we were engaged in the science that he loved, we were the ones helping bring new ideas to fruition, we were the ones who were closest to his passion. So I always kind of saw his approach as a "tough love" kind of stance, taking an "if you love them, set them free" approach to us.

That was sometimes hard to see when I was in the thick of another failed experiment (and believe me, there were many), but I think I (and all of us) always knew that he had our backs at some level. And that never became more clear than at our thesis defense, whereby he would have the opportunity to really tell us what he thought of us. And you could tell from then on how much he cared. His friendliness was never an act, he really just likes everybody and could find the positive in everybody. Though I think I've always personally trended in that direction, I think I'd be hard-pressed to say that his influence probably at the very least strengthened and polished that tendency.

Once I graduated from the lab, I kind of disappeared into the third year of medical school, a time that shuttles you all over the state of Wisconsin for at least 3 months, and otherwise keeps you dutifully engaged during every daylight hour. I was so busy that I wasn't even able to make a joint graduation party thrown partly in my honor (a lab tradition for the graduating students) and had to go to the one for the next crop of graduating students a year later. It was at that time that Paul and I, engaged in a little bit of bullshitting, thought that maybe we should meet for a drink some time to continue the conversation.

This continued a weekly tradition for nearly my entire 4th year of medical school whereby we would go to "Church," more formally known as The Brasserie, and talk about whatever came to mind. This was almost never about science or even lab progress. It first started with talking about movies, sports, culture, music as we were both well-versed in a variety of disciplines (although his command for these far exceeded mine), but we found that we enjoyed the meetings so much that we continued this tradition every week except for the few times he or I were out of town for various endeavors. Eventually, as we kept meeting, discussions drifted into talking about my interviews and job prospects, about good places to live or work and, also, into his own life, past, present, and future. I learned about how he became such a good casino-jockey, about loves lost in high school and college, about experiences as a child and young adult and about the various health issues that had been plaguing his family. So while our initial discussion reinforced his image as a very well-read and interesting renaissance man, I also considered myself a fortunate observer of his own inner mechanics. And, what's more, I could see that he was a caring man who really had a lot more invested in the people he interacted with than we might otherwise think. That his interactions with people were always more genuine and far deeper than we might otherwise think.

When I left Madison, I left with many happy memories and very few regrets. But I can say that leaving Paul and our weekly sessions wore heavily on me (he ended up being one of the last people I saw before moving away). I even remember our last conversation: what I could expect from living in Cincinnati and LA, how brilliant of a band Pink Floyd really was, as well as discussing how beautifully crafted his commencement speech to my med school class was (yes, I told you he was universally loved, such that my med school class who only have him as a lecturer for several weeks out of the entire four years wanted him to be the last person to usher them off into our professional careers). But as a man who is used to moving, I left with a sense of calm, knowing that he frequently came through Cincinnati with his family, as well as LA, both places I was moving to. I was already beginning to make a list of places we could go to in either area for the next time he would come through to make sure we got our beer and bullshit fix. And I knew he would make good on it, because that's the kind of guy he was. And that's how our relationship had become. So while I left with some trepidation, I knew that I would see him again and we'd pick up right where we left off.

Or so I thought.

And so it's with especial devastation that I received the news of his death yesterday, right before I was supposed to start a central line on one of my patients and before the shit-storm of the night gave my mind another reason to reel. I still don't know what happened, nor why a brilliant, kind, and thoughtful mind should have been taken so early from us. I still don't understand why, after all of the hardships and sadness he and his family had to endure, this very difficult year had to end like this for him. I still remember us talking about his future research directions and academic associations he was cultivating, and get angry thinking those will never be. I really don't know what else to say about it all, other than the fact that it fills me with profound sadness. How do you close the book on somebody who was a major part of your career and personal development for 8+ years? How do you reconcile the fact that he had no business dying as early as he did? How do you just go back to work patching up people who willfully mistreat themselves and society at large when such a positive influence is gone from one minute to the next? And then, when I pronounced a patient dead today, all I could think of was whether Paul was looking that way, too. Being pronounced, too. This man, too large in life and personality to be described in his pic as "Bertics_small," staring up lifeless, withered, mouth hanging open.

What a fucking travesty.

I'll compartmentalize for now, and eventually the sadness will turn into gentle pangs of remorse and nostalgia as all grieving goes. Hopefully I'll be able to make the wake, whenever that is. I know I'm going to lose it if/when I go because I'm actually an emotional sap. But you know what? I bet people will be standing in the aisles to attend, and then at least my last parting memory will be of how much everybody could agree that, for all the good and the bad, he was a man who knew how to leave one hell of an impression.

RIP, Paul. May your stardust return to the universe and make it shine that much brighter.

Channeling Sean Connery, or My First Foray Into Scotland

2011-04-23T23:59:00.002-05:00

So now that Dr. T has been in the Old Country for the better part of the week, and now that my tour of duty in the amazingly wonderful neuropathology unit of the Charité Hospital has concluded, it was time that Dr. T and I engaged on our formal vacation (meaning that we would actually do some traveling and not be burdened by even the mere thought of work). Granted, my time in Berlin more or less felt like vacation, even when I was working hard on packing brain material into small plastic capsules and slicing through brains that had bled out or harbored hidden tumors. But it was probably time to actually shut off the ol' brain and worry about nothing more than what tourist attraction I was going to see or whether or not I would make a flight. You know, sweating only the small stuff for a change.

In this vein, I decided that it would be nice if we both saw some stuff that I hadn't seen yet. With my comparatively extensive experience in the Old Country, there were a little less options to choose from where I could truly say that I was venturing into foreign territory. One exception to this, however, was up to the British Isles. Though I have extensive experience in London and Coventry, the rest of the isles are nothing short of a complete mystery to me. And with Dr. T's legacy heralding from these Anglican territories in various combinations and degrees, it seemed only fitting to have us simultaneously explore new territory and maybe encourage Dr. T to gain by geographical osmosis some closeness with her roots. We thus decided on a whirlwind trip through the main countries of the British Isles: Scotland, Northern Ireland, Ireland, and England. Unfortunately, Wales got the short-shrift, but one can only cover so much territory in 6 days (and, besides, I think I was kicked out of the country in a previous lifetime).

In any case, Friday evening the party started by flying into Glasgow, Scotland. Regrettably, I forgot that Germans usually take extra holiday days around major holidays, and so I could have booked an earlier departure time on Friday since I was surprised with an early termination of my duties at the hospital. Nonetheless, we arrived into Glasgow in the early evening with plenty of exploration time from the get-go, so I harbor no complaints in that regard.

Now mind you, from the few people that I asked about Scotland, including both people who had visited and people who named themselves former natives of the country of haggis, nobody had particularly kind words to say about Glasgow. I think the highest form of praise I was able to interpret out of my many queries was that it had a great selection of whiskeys and a raging night club scene which, as it turns out, are not ringing endorsements in either mine or, more surprisingly, Dr. T's book. I did hear that it's very blue-collared and has a propensity for random acts of drunken violence and, basically, that I should make a beeline for Edinburgh as soon as possible. In a mixture of stubborn defiance and old-fashioned laziness, Dr. T and I made the conscious decision to just sit tight and explore Glasgow, despite Edinburgh being the far more popular tourist destination and only a mere 45 km away. It didn't seem right, though, to just abandon Glasgow to the winds of rumors, so we stuck it out and set to explore a scarcely frequented tourist area.

This ended up being a mixed blessing as many of the so-called rumors ended up being substantiated to at least a minor degree. Humorously enough, even the people within Glasgow that we solicited for opinions on what to do or where to go often drew in loud breaths through clenched breath, hemming and hawing, deep pondering that almost had people rolling their eyes into the back of their heads, or just solemn shaking of heads. This was, however, not necessarily a fair reflection on the city itself but more of a commentary on the rather sympathetic and friendly attitudes of the folks we engaged in Glasgow, who were very friendly, helpful, and just plain fun. I didn't make a Scottish friend, per se, but I did cozy up to a couple bartenders who had fun stories and opinions to share. They were probably all ultimately more interested in Dr. T, though, but we did all share beard solidarity.

Unfortunately, despite our short time in Scotland, we were also privy to a blatant display of its less savory reputation of its propensity to drunken brawls, and this was a potential one that was uncomfortable in many ways. However, I would prefer to highlight the many more positive aspects of the trip before running the risk of tainting your views on an otherwise quite pleasant trip to Scotland, so I'll reserve this until the end.

Upon arriving into Glasgow, our immediate goal became obvious: look for food. As a vegetarian, forays into new territory, especially ones with meat-and-potato reputations, usually have me resigned to eating nothing but scant salads or the least offensive meat on the menu. By some strange fortune, however, I remember digging through the on-flight publication of our airline EasyJet and seeing, by recommendation of things to do in Glasgow, that there was a hippie, vegan joint called "Mono" in Glasgow that came highly recommended for its food, drink, and cozy environment. If it weren't for the pressurized cabin, I think my brains would have splattered all over everything, because a vegan restaurant in Glasgow is counter to all of my preconceived notions about Scotland. Needless to say, and not just because of my dietary preferences, this establishment had to be found and seen, and maybe even patronized. So after stumbling around the downtown district and getting lost a couple of times, we finally made it to "Mono," where I gorged myself on a delicious vegan chili and a local, organic wheat beer that absolutely hit the spot. The only true disappointment of the meal was whatever green goo they slapped on my plate that was supposed to pass for guacamole, but otherwise it was a very pleasant first meal on the British Isles.

Dr. T enjoying her first Scottish beer in Scotland. One of many.

With our bellies appropriately satiated, we could continue to explore the nightlife of the city, though we were too tired, and Dr. T did not wear a dress that was short enough to show her ass cheeks, to actually enter any of the music-thumping establishments. It was too dark to take any pictures, so we resigned ourselves to just absorbing the feel of the city and then stopping off for a drink at a nearby bar, "Drum and Monkey." All in all, our first impression was of a working class town on the rise, and rather friendly to not just the student population, but particularly the 30-somethings. So while we didn't necessarily fit into the night clubs, they were still more or less "our people," at least in the age sense.

The next day we got up at a reasonable hour to really explore the city. Unsurprisingly, it started with gray skies and a sprinkling of rain, so we resolved to find an indoor area to explore while we hoped and prayed for better weather in the afternoon (which we got!). We got breakfast at a nearby cafe (which had vegetarian options, again), and then stumbled upon the Kelvingrove Art Gallery and Museum, an imposing, but wonderful (and free!) museum that had a wonderful mixture of exhibits on the sociological and geographical history of Glasgow and the region, interspersed with local and worldly art.

Let's not kid ourselves here: it wasn't the best museum that I have ever been to. But it did feature some very nice exhibits and, shockingly, I actually learned quite a bit about Glasgow that really endeared the city to me. I learned about the city's weird obsession with Western movies and the Buffalo Bill Show, and that there are societies in Glasgow dedicated to dressing up like cowboys and going line-dancing. One Glaswegian artist captured this spirit in a self-portrait displayed in the museum:

Another interesting fact/obsession with Glasgow that we saw at the museum (and later learned from our cabdriver during our horrible airport adventure the next day) was with Elvis Presley. Apparently, The King only came to Scotland once, and he flew into the Glasgow Pitwick airport and performed in Glasgow, so the Glaswegians consider themselves quite lucky to lay claim to his musical tradition. This also then explained the baffling recreation of Elvis outside the gift shop, pointing to Sir Roger, the batshit crazy elephant that used to actually live in the museum before he was shot and stuffed for eternal display. The elephant, not Elvis. And can I also say how awesome it is that the elephant's name suggest that he was knighted!!!

I also thought there were some very progressive exhibits on a wide variety of socially uncomfortable issues, including a display on violence against women in Glasgow and its long history through the women's suffrage movement to the present day and what is being done to address it. There was also a nice brief survey on the history of religious tensions that exist between the native Protestants and the Catholics that came from Northern Ireland, and how this tension still plays out in more or less subtle ways, including a longstanding rivalry between the two Glasgow football squads (soccer, not American football): the Protestant Glasgow Rangers and the Irish Catholic Celtic Glasgow (who, as chance would have it, were set to play in Glasgow for the local derby the day we were departing! And whose match was already stirring emotions when an incendiary bomb was sent to the residence of the Glasgow Rangers' coach). Finally, there was a remarkable exhibit on the immigrant populations that came into Glasgow, on their struggles to integrate into the culture, on their joy at sharing its conveniences, its access to work, hell, even just its regular rain that were all so elusive in the countries they had left behind. Truly an inspiring and enlightening exhibit.

There was also art. Lots and lots of art. There was no rhyme or reason to the art, for the most part, although I did like that they included exhibits (primarily for the kids and the novice museum-goers) on how to look at art: how to appreciate textures, lighting, uses of materials and canvass. Even I, a big appreciator of art (but certainly no scholar thereof), learned some interesting tidbits on how to maximize your viewing experience.

Probably the museum's most famous piece is its singularly displayed Salvador Dalí piece, "Christ of St. John of the Cross." It enjoys its own dimly lit space for display, and boasts the high honor of being the city's favorite piece of art. And I fell in love with a city that cares enough to designate its favorite piece of art. Unfortunately, the lack of good lighting meant a longer shutter time, which meant a blurry shot with my shaky hands, but I think I added a little interpretation to an already amazing piece not easily reproduced.

Of course, it's easy to see why Glaswegians (and many people) like this painting. The pose is unique, both pious and dejected. The emphasis is on the act and not the suffering, the symbol and not the person. It inspires and humbles. Plus, for the sci-fi geek in me, it does kind of look like he's blasting off into space.

They also had an art exhibit, consistent with its overall theme, that featured Scottish and, when possible, Glaswegian artists. This included paintings celebrating the Highlands and their great military politician, Robert Bruce. They also quite extensive praise for their poet extraordinaire, Robert Burns, and I love how unabashedly they presented his lecherous, philandering personal life in contrast to his beautiful and progressive poetry. A man after my own heart, except not really in any sense.

Obviously a piece celebrating the Scottish Highlands.

This is supposedly a piece memorializing a dead knight that was made during Robert Bruce's lifetime and displays what Scottish knights during the 14th Century may have looked like. I know there's at least one regular reader of my blog out there who is going to immediately recognize this otherwise obscure piece.

There were also some more modern pieces by Scottish artists that I liked, as follows:

I really liked this sculpture, which is supposed to represent how common items look distorted and scary when they are cast as shadows.

And well, you know, given my morbid fascination with disembodied heads/brains, I naturally found myself drawn to these expressive heads floating around the museum en masse:

Finally, the museum also had a wonderful organ filling its main entry hall, and we were able to enjoy a recital midway through our museum visit that featured such pieces as Webber's "Music of the Night" and Cee Lo Green's "F*ck You." JK, JK. But what was really nice is that they had cameras both on the organist's hands and on his feet, so I was fascinated by the multitude of things he had to do simultaneously. And here I bitch about my struggles with the piano. I got nothing on organists. Dr. Torque's parents definitely have a leg up on me.

After that we ventured into the outdoors where, contrary to popular belief, a non-rainy and genuinely brightening day was awaiting us, complete with not infrequent glimpses of the sun! So we walked around the Kelvingrove Park and enjoyed the sights of nature and castles all around us.

View of Kelvingrove Museum from the back, within the park.

A view of University of Glasgow from the park. Given its look, it seemed only appropriate to immortalize it in Glorious Black and White.

And here's a fountain in the park that looked nice and which seemed the centerpiece of a wide variety of activity. I suspect they built that wonderful skate park to keep the skaters from doing ollies and thrashing the fountain to shreds.

It was at this point that we saw the darker reputation of Glasgow and, having appropriately painted a rosy and all-around pleasant picture of Glasgow, I'll share our rather unfortunate almost-encounter with violence: as we were passing through a park, we heard an angry-sounding man calling after...don't know...somebody. I ignored it, knowing that it couldn't have been anything that we had done, and we continued our stroll in silence. Unfortunately, the angry calls continued and, what's worse, drew closer to our present location. Dr. T's grasp on my arm squeezed and tightened a little, but I was still pretty confident of our innocence. As the shouting grew closer and more threatening, a young gentleman of an African origin walked determinedly past us, hands in pockets and back tensed. It became clear that we were getting ourselves mixed into a bit of a racial tension, and that we were likely running interference for this young man who, as far as what we could tell from the other man's taunts, had done nothing more than "looked at him funny." The young Scottish man, white, short hair, yelling obscenities, and clutching something in his right fist presumably to avoid breaking his hand when he landed a blow on some poor unfortunate's skull. The angry gentleman was getting right up in the other man's face, screaming obscenities and racial epithets at him, threatening to beat him to a pulp, and this in broad daylight and RIGHT IN FRONT OF US!!! Fortunately, he seemed to have barely enough sense to know that he was marginally outnumbered, so he paused long enough to try to get his "mates" to hurry up and help him "beat up this [racial epithet deleted]". Fortunately, by the sound of silence from behind us, it seemed like his mates were far enough behind to suggest a complete lack of interest in this crazy and illegal endeavor. And just as I was envisioning how I was about get my ass kicked trying to keep this man from killing the other guy, our black friend seized an opportunity to duck into a nearby hotel lobby and, even more fortunate, the raging white guy had just barely enough sense to know that following somebody into a hotel lobby was a tremendously stupid idea, an idea he did not seem to share with beating somebody up in public RIGHT THE FUCK IN FRONT OF US!!!! Dr. T and I were therefore able to keep moving, the situation having resolved and diffused itself appropriately, and I was thanking my stars that I was not to spend the rest of my vacation recovering in a hospital. And also thinking that maybe it would be a good idea to both finally get in shape and maybe take some boxing lessons, at least, in case something like that comes up. I'm definitely a lover, not a fighter. But no amount of loving was going to keep that guy from getting his skull cracked (or perhaps mine, under different circumstances).

We finished our day bumming around the downtown area around our hotel, snapping some pictures of the town before the sun went down:

Then, as the sun set, Dr. T and I once again went into the "Drum and Monkey" so that I could get some vegetarian(!) bangers, with vegetarian(!) gravy and smashed potatoes, as well as a surprisingly delicious Italian lager (I know! Who woulda thunk it!). I also got some pictures, per request of Master Frogboots, of the establishment:

Power to the labor!!!

Yup, there's a monkey on that drum.

Hmmm...I do not think that means what I think it means. Or it's poorly written. Or, if it does mean what I think it means, I certainly wouldn't pay that much for it. And I'd get that person a doctor.

All in all, our trip to Glasgow was a wonderful experience and I would actually recommend it to other people, although probably not for more than 1-2 days. And I learned some important things from being there, in summary:

1. Sometimes reputations are true. But, of course, they rarely represent the whole truth.

2. The Scots in Glasgow, particularly the women (and Dr. T was in agreement with me on this, so don't go jumping down my throat), are strangely unaware of how to present themselves in any particularly flattering way. What is true of both the men and women of Glasgow, however, is that they all look like they could kick my ass if they really wanted to. They don't look like they take shit from anybody.

3. The accent, while a very raw and powerful sounding one, is still pretty hot.

How's that for soul-searching learning experiences?

Day 14 in Berlin: Talking About Staying

2011-04-08T23:38:00.001-05:00

No, no, I'm not actually staying in Berlin (sadly), but today's theme was about living in Berlin.

Work today was a little bit on the slow side. Now that people are returning from vacation and the work is distributing across multiple people, there has been a little less for me to do. It's certainly good for the residents, who now have time to do their research and all, but it also means that the series of things that we would do in a day is now done simultaneously, leaving me with a little more time during the day to...well...try to find other things to do. Dr. LL was quite stressed out and in a bad mood today, so I thought it best to leave her to her own devices and helped out Dr. Physics. He has quite the amicable personality and likes laughing a lot, so it's certainly quite the pleasure to hang out and chat with him. And I think he likes having the extra hands to help out: not that he can't do it, but it does make things go faster and then we have time to do things in stride and get the occasional cup of tea. One thing we did spend a lot of time talking about was his forensic case. I'm not sure that Germany really has much in the way of HIPAA laws, so I could probably discuss some details, although I probably shouldn't. Suffice it to say that it's a quite fascinating case that involved, from what I can tell, very irresponsible conduct on the part of the hospital that led to a probably needless death, something that an American hospital has about 10,000 safeguards to prevent. I'm not saying that this happens a lot in Germany or anything like this, it's just a remarkably egregious dereliction of duty. The forensic part of neuropathology I find particularly fascinating as it's got some real detective work to it and more closely approximates a true problem-solving incident rather than confirming tumor type and grade, for example. I mean, it's all interesting, just some things are more interesting than others.

In any case, the attending involved in the brain cutting and the forensic cases is a very nice woman with a Portuguese accent who I had assumed came from Portugal. We came into discussion about what I was doing in the upcoming years, and I told her about my plans to go to Cincinnati and then LA, an idea she was particularly fond of in terms of the weather. She asked what I planned on doing afterwards, and I told her that I was still thinking about what direction to take and that, as a result, I would wait to see what my options are before I decided on where to go afterwards (if anywhere at all). She asked, a little bit surprised, "you're not thinking about Europe?" I told her that I would not be opposed to that idea at all, but that I had heard it was difficult for non-Germans or, at least, non-Europeans to get into this system. It was then that she revealed that she is from Brazil, not Portugal, and that she had gone through the process and received her dual citizenship to continue working in the German medical system. She furthermore offered to talk to me about it some time in the next two week in terms of what the process entailed, and seemed quite intent on having me see her about it. I'd love to hear about the process as I would love to come back, so I'm definitely taking her up on that offer.

That being said, talking with Dr. Physics, I found out a little bit more about the hierarchical system here in the German medical system. He told me that, after the 70s and 80s, Germans slowly started shaking off that reputation of being highly regimented, highly hierarchical, and very formal, and that the new generations of Germans are far more relaxed and outgoing than people give them credit for (this has certainly been my experience). But what he did say is that the German medical system apparently didn't get that memo and continues to be extremely hierarchical and formal. He explained to me a little bit about the relationship between Oberarzt (which is kind of like a professor of medicine) versus Facharzt (kind of like an associate professor) versus Assistenzarzt (basically a resident), and that these hierarchies are usually strictly upheld with all the bells, whistles, and formalities. This has been in complete contrast to what I've seen at the neuropathology clinic as the people are generally very collegial and friendly, although I see hints of it with our director: he is a very nice man and jokes around with everybody, but everybody can tell that he wears the pants and he's treated with a little more respect. That being said, our environment in the neuropathology division is pretty similar to the relationships I've been in the American hospitals between the students and residents and faculty. But the stories Dr. Physics told during his time as a student suggest that this is an exception: that the Oberärzte have their particular ways of doing things and force others to comply, that they continue with entourages and extreme pimping, basically that they carry on much like we did in our American hospitals not 10-20 years ago. He even shared a story, during a rotation in radiology, where in a room full of various stages of radiology faculty, the only person who would speak to him casually was the world-famous radiologist who was visiting from the United States. That's a part of the German medical system that is very much less appealing to me, although I'd like to think that by the time I would maybe be working in Germany, that perhaps the old guard will have transitioned out and the newer guard might have inclinations to change this.

Tonight I met with Jay-Dub, as well. And, as expected, we had a lovely evening together. Jay-Dub had some major things occur recently and he was over the moon with happiness about them, so we talked about that quite a bit. The last time I came to Germany was coordinated with a rather negative personal experience in his life, so I'm glad that I've redeemed myself as a harbinger of happier news. In any case, we spent a long time talking about living in Berlin, the culture here, and why he made the transition from Potsdam and Freiburg into Berlin. And though it sounds like his eventual plans may take him out of Berlin, I got the impression that he'll always find a way to at least be close or within access of Berlin. It's something that resonated quite clearly with me.

But the evening was about far more than just Berlin and, strangely enough, Jay-Dub inspired me to at least think about working on my cooking. He recently purchased a pasta press that was so easy to use that I'm starting to think about getting my own. I was also surprised at how much fun and how much connection one could get with making things: I had my hands digging through the noodle dough, could lead it through the press, could grind and combine all the ingredients. It was like working in a delicious-smelling, aromatic chemistry lab. It's not like I've never known this, but tonight really brought it home. But I think what made it especially meaningful was that I was cooking with another person, with somebody I could rap with and enjoy a delicious beer with. Perhaps while I'm in Cincy, I can find a fellow resident or two with whom to cook on occasion. Cooking for one is no fun, and cooking for another person feels weird. But cooking together, I think that's something I could get behind.

As we closed out the night, we went to a little house party that one of his neighbors was throwing as a housewarming: he had just moved in and invited all of the building residents to stop by and say hello. Turns out that Jay-Dub and I were the second apartment to visit (and I don't even live there), but I thought the gesture was nice. I didn't even dream of throwing a party in my neighborhood in Mad-Town and inviting the neighbors. But, perhaps, a good-will gesture could be directed at my next neighborhood or apartment complex, although maybe it would just be weird if I didn't have anybody there that I knew. The people living there seemed nice enough, and we were all able to chat about various things and gave me some more experience with my German (as Jay-Dub and I tend to switch between English and German). I think the only other interesting thing to report was that I met for the first time in a long time a German who knew absolutely no English. Weird.

Day 12 and 13: Getting Things Done

2011-04-07T23:33:00.000-05:00

Not too much to report on these two days. Wednesday I finally got almost all of my grading done, so that was a personal but ultimately un-blog-worthy accomplishment. This weekend I'm going to have to write my final grades and hopefully get them sent off before people start beating down my door.

Thursday, today, was only slightly more interesting in terms of activity. When I met with my landlord, who is an art therapist and an artist herself, she invited me to attend her first-ever art opening in Spandau, outside of Berlin. I live pretty close to the city limit of Spandau, and it's the one direction in my immediate area that I've never walked through, so it seemed like a nice way to both support the person renting me my apartment, get a little exercise, and see a little bit of Berlin that I don't know very well, even if it is a suburb thereof.

I'm guessing by this last statement, you can probably surmise that it was not the most exhilarating of my recent ventures out onto the streets. That being said, I made at least a couple of observations that are worth sharing on here.

The first has to do with the following pictures:

What I am showing here is one of the several gardening communities that I walked by along Spandauer Damm as I was heading out toward Spandau. For about a half hour straight, I walked past huge expanses of these gardening communities. As the first picture shows, a quiet, solitary road, leads down every 50 yards or so into a grid of little plots of lands, each with a quaint shack on its lot and gardens done up in a variety of fashions. These represent little communities within and outside of the city where people (who, presumably, have at least a little bit of money) can cultivate the yard and garden that they want that cannot perhaps otherwise be done in a city dominated by apartment buildings and condos. I think it's absolutely charming that they have these gardening communities (which is not unique to Berlin) and, what's more, that there are huge swaths of land dedicated to them. I mean, a half hour of walking is about 3 km or so. Pretty impressive.

Not too much else to report, other than passing the ever-famous and ever-popular IKEA in Spandau (to which I had been once the last time I was here, so I suppose I have been in Spandau before). For the most part, Spandau felt just like a suburb, just with a German flair. I had always thought of my old town Potsdam as Berlin's suburb, which I suppose it is. But Spandau, even though it is technically incorporated into Berlin, definitely had that suburban feel with cars and big stores and schools and all that. A little hard to explain, but you've gotta trust me that this felt suburbany. And Potsdam is a far more attractive town than Spandau (sorry guys).

Of course, as I was passing into the downtown area, I did catch a nice shot of the downtown area and the looming city hall across the river.

The downtown area, as is true in many German towns (and suburbs) was supremely charming. However, as my legs were already starting to burn with pain from aggravating my cramps from my run earlier in the week, I just beelined it for the Spandau Cultural Center, where the art exhibition was being hosted. My landlord looked quite fetching, donning a gigantic afro and beaming from ear to ear as scores of people came to compliment her on her exhibition. To tell you the truth, I wasn't entirely sure what to expect from the exhibition as the advertisement for it had a bit of a fantastical (like wood faerie) kind of feel to it that is not usually my bag. And while some of the pieces were not something I would normally go for, there were a couple of pieces, particularly in her collages, that I found supremely interesting and engaging. Because I feel weird about snapping pictures of art, particularly in private art showings, I only got off a couple shots of some of my favorites:

This piece was about not wanting to get on the bandwagon of following spiritual leaders of any sort. Something I can at least in some part identify with.

This one appeals to me, both as a cynical doctor and as somebody who is growing increasingly convinced that assholes are raping and pillaging the earth.

One thing that was great about going to the art opening, and something I will clearly have to do more frequently, is that the curator got up and said some words, both about the artist and about the individual works. Her background as an immigrant to Berlin for school and, eventually, work definitely resonated with me. I came to Berlin as a student, as well, shortly after the artist did, and I feel like we went down separate paths in that sense. Even though I really wanted to stay in Berlin, I knew I had to pursue my original commitments to my university, as well as my original career intention as staying here would have drastically changed my stated focus of study. Honestly, I'm a little envious that she had the wherewithal (and the guts) to do it.

I also learned a little bit about her technique, how she only uses primary colors and paints layers until she starts seeing images come into shape. I know that you can make pretty much any color out of primary colors, but I must say she does a magnificent job capturing both bolds and pastels with only those three colors, and you could almost feel the texture of the image jumping off the canvass (sorry, I don't actually have any pictures of her canvass paintings). But it's a technique I can identify with at some level. My writing and my compositions, when I was still doing these, were true to do this philosophy: just seeing where the moment takes you, crafting whatever it is that happens to pop into your head or feels organic, not planning ahead or intending any particular abstraction or conception. Strangely, my artistic philosophy runs counter to pretty much every other way that I live my life. I think that's perhaps why I miss the artistic digressions that I used to engage in, I think they served as a nice balance to my otherwise regimented and non-spontaneous existence, to the hum-drummery and algorithms of medical school, to the formulaic repetition of experiments in graduate school. It gave me that release to explore and let the winds carry me. I miss that, and hearing about her layered technique of painting and letting creation come rather than actively creating warmed my soul a little bit.

After saying hello to her and her friend? girlfriend?, I ducked out under the cover of the throngs and made my way back home to relax. Not the most exciting day but, strangely, it made me miss my artistic side more than I thought it would.

Day 11 Part 2: The New Part of the Hamburger Bahnhof

2011-04-05T23:55:00.000-05:00

So I thought I would finish what I started here, now that I have a little more time, motivation, and energy.

The Hamburger Bahnhof, since I left, opened up an entirely new wing with gigantic warehouse-looking halls full of a variety of sculptures and vieo. I almost made it through the entire thing, but left the basement hallways unexplored before I had to go to my next engagement. Perhaps some time in the next two weeks, I'll get another shot at it.

In any case, here are a couple of the works that I thought I would share (and which may become some of my new friends for future visits down the road):

This was actually in one of the traveling collections, but forgot to post it earlier. I kind of like it. Especially as somebody who plans out almost every step of his life and, really, doesn't want to. This reminds me that all the best-laid plans eventually lead to surprise results. I should put this plaque up in my new upcoming new apartment.

One thing I thought was pretty cool was that they painted and decorated the hallway leading to the warehouse part of the art museum to look like a transfer hallway in a subway station (like, you know, a Bahnhof). They had this little "graffitied" area as above, and also had some large billboard advertisements (including one against atomic power plants. Huzzah!) hanging on the walls for an extra added effect.

One of the first exhibits I came across, but could only visualize truly from the end of the exhibition hallway, was a piece called "No Exit." It was kind of a weird cross between Sartre and a Chinese lantern festival. Yeah, figure that one out. They stretched down the entire corridor of the exhibition warehouse, but were painted only on the side leading back into the main part of the museum.

And here is just a smattering of the offerings, highlighting merely some of my favorites (most without commentary):

This one may look three-dimensional and topographical because, well, it is. Like two maladjusted eyes peering out at you, or a deranged and cracked cruise liner, or perhaps just the topography of a mountain range. The darkness inside, though, was quite unsettling, much like the figure in this following piece:

Next came probably my favorite of all of the exhibition warehouse rooms, one that I lovingly called "The Zombie Room." The following two pieces were in this room:

This piece dominated the majority of this warehouse room, and it was full of other Janus-like head pieces hanging from the ceiling in exactly this same fashion. In the adjoining room, a large and very dark room, emerged the sound of humans buzzing. A quick glimpse inside revealed a gigantic projector, as well as two TVs in the corner stacked on top of each other, showing a constant running image of a man's head spinning around and around making the buzzing sound. A little surreal, but I liked it. Mainly because I like heads, I suppose.

This piece just reminded me of a zombie busting out of a grave or a coffin or something. Of course that's going to appeal to me and my obsession with the undead.

The next room was quite the departure from "The Zombie Room." It had only one gigantic piece which, to me, looked like the skeleton of a weirdly pieced-together pirate ship that was filled with everything you would want in your home, including cooking supplies, a desk area to type and do work, various tools for home projects, and a wide assortment of other essentials. It reminded me very much of a pirate ship equivalent of a tree house, for some reason. It was huge and impossible to capture on one shot, so I fear the photographs I took won't quite do it justice.

There was also this simple, future-style apartment on display in one of the rooms:

Bathroom:

Bedroom:

Kitchen:

Sunroof:

I suppose I should also mention that it's pint-sized and portable. Perhaps I should procure myself one of these when I move to Over The Rhine. That door was passable to me only after ducking and sliding through sideways, if that gives you any sense of perspective.

Perhaps the coup de gras, as well as the most depressing, morbid thing to end a museum visit with, was the following piece by Bruce Nauman entitled "Room with my soul left out, room that does not care." I don't think I need to say anything more about it, pretty much speaks for itself.

It was a cold and windy day in Berlin today, so there was definitely a chill in the air in addition to the prickling despair running down my back when I entered the room and saw this structure before me. It was completely quiet, save for the cold, concrete-resonating steps of my feet. And though the allure of the light initially pulled you into the sculpture, when you saw the brick wall lit by one dim bulb, and stared into the dimly lit abyss underneath your feet through the grates, I could see how one's soul may have been checked at the door. I certainly felt a lot better, and lighter, when I exited back into the sunshine (of course, then I realized that I was upon the "No Exit" exhibit as I mentioned above, so there was still a little bit of despairing left to do).

Fortunately for me and the deep sadness of my soul, I had plans to meet up with all the neuropathology clinicians to get a drink and some fine German food at "Ständiger Vertretung," a play on the representation from Bonn that existed in Berlin when Bonn was the capitol of West Germany and Berlin a divided city. It was good times talking about cats with one of my attendings, speaking about cars and diets with one of the residents, and just generally shooting the shit with some pretty cool and laid-back folk. For a while, it was even a beautiful day to sit outside alongside the Spree, but the rain and wind eventually caught up with us, necessitating a speedy escape. But, all in all, a very good culturally enriching day.

Everything today really made me realize how much I like being a stranger in a strange land. And although Germany, and Berlin in particular, are not particularly strange to me, I'm also acutely aware that I'll never fit in entirely. And, well, I kind of like that, and it's especially a relief to be somewhere (unlike in the States) where they kind of expect me to not fit in. I can embrace the foreignness and not make any gestures of being "one-a y'all." Of course, I also realize the privilege I have, as an American, of doing that, as well as the acute awareness I have to have when the situation could become troublesome, or even dangerous. Fortunately, in Berlin, that is not usually a problem.

Day 11 in Berlin: Settling In

2011-04-05T17:00:00.000-05:00

I went to my rotation today feeling pretty good. I had gotten some sleep the night before during my rather failed attempt at getting some overdue school work done, and so I was ready to rock today. During our microscope session, both in the morning and afternoon, I continued to make strides in having at least the faintest notion of what was going on, although was still not in a position to make suggestions for stains or, really, even make too many diagnostic comments on what we were seeing. But strides, nonetheless.

Today one of the retired physicians was in for some formal consultation, which necessitated a clinic-wide outing to hang out, eat some German cooking, drink some German beer, and engage in random conversation. To my surprise and delight, I was invited along as the lowly student, so of course I couldn't say no. Even despite all the work I had waiting for me at home, it would be rude, after all, not to socialize with the colleagues from work, right? Really had to twist my arm on this one.

However, the late afternoons are dedicated to dictations. And because I don't even possess a license in the United States, let alone in Germany, I'm pretty much useless during that part of the day (I can embed brain tissue like a mofo for microscopic analysis, and I'm getting to have a steady hand at slicing through brains and dissecting out the Circle of Willis, but I'm pretty much useless dictating neuropathological clinical findings). I had a two hour break between when my presence became completely superfluous and when we were meeting for our meet-up, so I decided to go across the street from the hospital to my all-time favorite museum: The Hamburger Bahnhof.

A little back story. My first modern art experience, at least meaningful one, was with my brother. When he went to college in Minnesota, and I was still a pipsqueak in high school, he took me down to Minneapolis one day when I was visiting him. Among the sights that we saw included the Walker Museum of Modern Art. I had seen snippets of modern art in our own museums up in Alaska, but had never seen an entire structure dedicated to modern art. It was beautiful and new and confusing and exhilarating. And though I can't remember most of what was on display there, I can remember the impression and the budding love for modern art that came out of that experience and it remains one of my favorite experiential memories. However, while the Walker Museum may have been my first exposure to modern art, it was actually the Hamburger Bahnhof that solidified my love for it. When I was here 9 years ago, they had some of the most creative and challenging pieces I had ever seen, and even the visiting exhibits were exciting and well-curated. I went pretty much once every other month, and though some of the exhibits obviously stayed the same, they felt to me like familiar (and insanely strange) friends rather than old hat. It was easily the museum I frequented the most back then, s coming back to it after all these years, even for just a couple hours, warmed my heart completely.

The Hamburger Bahnhof, for those of you who don't speak German (i.e., most of you), is a converted train station. It certainly is easier to see from the inside:

The opening exhibit, which could be seen from the above shot, was from Richard Long and focused on "The Berlin Circle." This was an exhibit familiar to me, and given its subject matter, made me feel homesick within my old adopted home.

Because I had a limited time there, and wasn't sure whether I was going to be able to make it back before leaving Germany, I quickly went through the ground floor to visit all of my old, familiar friends. First stop was at Anselm Kiefer's works, a fine collection of chaotic, dark, anti-war works (I'll name the pieces underneath if I happen to know them).

"Wege der Welt-Weisheit," or "Ways to World Wisdom"

"Lilith am Roten Meer," or "Lilith at the Red Sea"

"Maikäfer Flieg," or "Cockchafer Fly" (it's a typical bug around here with a very unfortunate English name, as it would otherwise translate to "May Beetle." The poem above this dreary mixed media print (not visible in this print) reads "Beetle Fly, Father is at War, Mother is in Pommerland, Pommerland has burned down."

Then who can resist a little Andy Warhol? They have a lot of his prints, but these are my personal favorites (but don't read too much into the subject matter, please):

I especially love the Chairman Mao wallpaper that serves as the backdrop to this print!

I also always liked these following works by Keith Haring because of their color and vivacity. Too bad the poor bastard died at the ripe young age of 32. I'd have been curious to see what else he could have put together (all of the following pieces are untitled).

The last of my friends that I had to visit was Josef Beuys. I wouldn't say I'm the hugest fan of his work (or, at least, the works that they have at the Hamburger Bahnhof), but there is at least an old familiarity to seeing them so many times. His works are very mechanical and stark. Probably this is one of my favorites by him. It's entitled, in translation, "The sculpture that never gets cold." You know, because it's made out of foam. Even has a little gauge giving an indication of its consistent ambient temperature.

I also like this one, mainly because I like the idea of a cello being employed in first aid or in emergencies. Break glass in case of emergency Bach String Quartet! Or if you're Yo Yo Ma!

This concluded my "old friends" part of the museum and I went on to see the traveling exhibits. Honestly, the traveling exhibits this time around were not the best that I've seen. But, of course, there were some real gems. I went and saw an exhibit dedicated to Valeska Gert, who apparently revolutionized art with her concept of "Pause," an insertion of footage in movie theatres in-between reel changes. Among them were two pieces called "Baby" and "Death," short films showing her interpretation of these extreme poles of life. Only "Baby" was actually being shown, but that was enough. The scream she gave out imitating a baby sounded absolutely gut-wrenching, like she was being disemboweled or burned alive, like something horrible and horrifying was happening to her. This was followed by contented, even extremely sexually suggestive, suckling of her thumb. It was really quite disturbing to me how intently she suckled on her thumb, and how single-purposed she focused on that activity and with what violent resolve she kept herself from crying. It made me feel more unsettled than I thought it would, but I suppose that's the point.

There was actually a surprising amount of video in the traveling exhibits there. I feel kind of at odds with videos at art museums. I understand that it's an artistic medium and brings images to life that still lives often can't. But I don't go to museums to see moving pictures, I go to absorb the still ones, to let my imagination run wild with the image rather than having it wash over me. So I stayed away from most of the videos, but there were a couple of note. One was a man walking around a room in a suit doing some sort of interpretation of a tribal dance and chant. Perhaps, in the right context, it could be kind of offensive. But there was something sort of mesmerizing about it, like he was about to break into a seizure or start speaking tongues, revealing some truth from the spirits or the heavens above us that would be lost into the untranslatable ether. Another was a video of the artist gyrating nakedly, save for a bag over her head, to a congo drum being played. From the accompanying information, I read that she danced for 6 hours straight and filmed the entire thing to see how her movements would change and what the freedom of the body due to complete exhaustion would look like. Obviously, I did not stick around for all six hours (I think it was edited, anyway).

I did come across a surprisingly mesmerizing video in the Landsart (Land Art) exhibit. A videographer artist filmed a 8 mm called "Pines," where he/she interviewed inhabitants of the Pine area (so-called Pineys) in New Jersey. All of the shots were of the great pine areas of New Jersey, alternately narrated by the people who live there, telling stories about the pine woods, hearing strange and mysterious sounds, choosing to live on the land, and even regaling stories of the Jersey Devil. The un-narrated shots then built on the spirit of those narrations: the talk about living among the beauty of the area was followed by a several minute shot of walking through the pines, looking at the air, and listening for birds. The talk about hearing strange sounds was followed merely by rustling through the woods. The talk about the jersey devil was followed up by a very claustrophobic pushing through of thickly dense woods. 15 minutes went by and I didn't even notice: I was so captivated by the nature, the slow drawl of the narrators and their simple usage of language, the escape into a world so close and so unlike my own. I think it helped that the museum made a special effort to host it in a place that cut you off from all light and sound of the rest of the museum.

In general, though, I thought this little display of art summed up all of the video contributions best:

I think perhaps this post is becoming too long already, but I will leave you with this last piece from the Landsart exhibit that really resonated with me as somebody who loves walking through strange and new places, even old, familiar, and beautiful ones, and who sees walking as not only a meditative practice but, in many ways, an artistic one. The following explication by the artist accompanied this picture, entitled "Seven Winter Midday Shadows; Shadows By Day and Night: A Nonstop Winter Walk"

They opened up a gigantic new hallway adjoining the building that didn't exist the last time I was here that had some tremendously fascinating works. If I can get back there again, I presume they will work themselves into my friend circle. But I think I'll leave that for another day as it's getting late now, and I'll talk a little bit about our night out. More good times ahead!

Day 10 in Berlin: Starting To Come Together

2011-04-04T16:57:00.000-05:00

I didn't really do too much today other than go to the hospital work and then come home to do grading (or, really, just pass out early). This was kind of nice, though, because it sort of gave me a chance to reflect on the first week of being in Berlin.

1. My language is starting to come back nicely. I'm finding that I understand things a lot more quickly, particularly the medical German. While medical German is essentially the same as in English, as we all use the same Latin and Greek terms, it took me a while to process the German pronunciation into English pronunciation into what the terms actually mean. Now it's coming more naturally. Furthermore, I'm getting to be more fluid in my ability to speak with others and the vocabulary is coming to me more fluidly, although I'm still not quite drawing on the fullest extent of my vocabulary yet. I'm guessing that by the end of my time here, by German will be pretty close to my normal fluency. Of course, by that time, I'll be heading back State side.

2. Similar to the language, I'm slowly starting to get what is going on in the pathology clinics. The first week felt like information pounding around in my brain, with little notion of what the dyes meant, what the cell patterns were, where the tissues were coming from, anything. But today, although I'm still pretty lost, I finally started to feel like I was getting things and recognizing the structural variations that were characteristic for certain types of tumors and muscle pathology. I even started to be able to pick out what dyes were being used and what their meanings were. That's not to say that I will be an expert after this month, but I'm feeling a lot less lost than I was last week.

3. I've been completely and utterly drained by the political goings-on in my hometown of Mad-Town. It's been an exciting time to be there, but between all of that culminating and the constant din of the political bobbleheads ever since President Obama took office, I've been getting kind of exhausted by the whole thing. I know I need to keep up with these things, especially as a member of a well-educated class of people. But it has been feeling really nice to just track it peripherally and to be in a state in which I have little personal investment in the politics and that, for the most part, already endorses politically popular ideas that I can get behind (such as an amazing social system, a more sane position toward foreign affairs, not to mention their recent push to withdraw ENTIRELY from nuclear-powered energy).

[Translation: atomic energy? No thank you.]

4. I met another two members of the neuropathology team today. One of the lab techs returned from vacation and has proved herself a most pleasant individual. One of the residents, a former physicist (I'll call him Dr. Physics) who went back to school to get his medical degree (because, you know, you can do that here with little consequence to your social standing or your pocket book), returned from vacation and has proven himself every bit as nice and fun-loving as Dr. LL made him out to be. In her characteristic energy-laden manner and laugh, she grabbed his head and rubbed it playfully and called him her little "Steinbeißer."

I don't entirely see the resemblance. But, then again, maybe. He's certainly quite friendly. On an unrelated note, the Bavaria Filmstadt amusement park in (duh) Bavaria, from which this picture was stolen, has an entire area of the park dedicated to "The Neverending Story." Steinbeißer or not, I think it's going to be good times working with all of the resident physicians there. Very easy to get along with. And, fortunately for me, quite favorably inclined towards Americans (an increasingly rarer phenomenon it seems these days).

Day 9: To The Olympic Stadium

2011-04-03T16:09:00.000-05:00

Not much to report today, I suppose. I slept in and then made my way out to meet up with Dr. Case before she left town to go on a little whirldwind tour of Rome. It was a beautiful day, with temperatures in the 60s to 70s, and therefore a perfect time to make my way to a professional soccer game. One of my favorite teams, Hertha BSC, although woefully relegated to the second professional league in the German Bundesliga last year, is kicking ass and taking names this season. So Dr. Case and I joined thousands of fans at the Olympic Stadium in Berlin (from 1936! I could feel Jesse Owen's spirit running and jumping). Here's a picture of the outside:

It's a pretty stark looking building, but it's very nice inside and has quite the capacity for a crowd. We watched Hertha BSC play against SC Paderborn and score two beautiful-looking goals for a 2-0 victory. The crowd ended up being 70,621 people strong, and I still saw some open seats in the nosebleeds (where we were). That's one helluva capacity, and people were in definitely in a good mood with a hometown team winning (and facing a return to the first professional league in a couple months) and with beautiful spring weather. And with this being Dr. Case's last official day in Berlin, I made sure to round out her German experience by getting her a bratwurst with mustard and a roll straight out of a cart. The only way to eat them.

Afterwards, we battled through the throngs of people and did a little shopping for tourist trinkets that Dr. Case needed to get before departing and then, in contrast to all of our other days hanging out, we got Spanish tapas for dinner instead. Dr. Case was thrilled that, for the first time since coming to Europe, she finally felt like she was in a setting where she had some notion of what was going on. Although I kind of enjoy being lost and clueless in foreign lands, I do certainly understand the energy drain it is to constantly have to figure out what's going on. We then spent about an hour outside of her hotel chatting and enjoying the waning sunlight and warmth of the spring day before saying our goodbyes: she with an early flight to Rome, and me with a long overdue need to finish some school work that I had been putting for way too long.

All in all, a very pleasant day hanging out with an old friend. Hopefully she can make it down to Cincinnati while I'm down there next year, although I know she's facing her busiest year yet. So we'll see. As for me, I would call it a successful first week in Berlin. Slowly the language is coming back, and Berlin continues to feel like home, almost like I never left.

Here are some other pictures that I took yesterday that I forgot to include:

I passed this car on the way to meet Dr. Case at her hotel. I like the idea of driving a car around that advertises my membership in the "Gummy Bear Crew."

In the courtyard of Dr. Case's hotel, I found this sculpture. I'm pretty sure this is a pelvis, but why somebody would construct a sculpture of a pelvis is kind of beyond me.

On our gigantic walk through almost the entire city of Berlin, we happened across the Humboldt University (which is easy to do, since it's right of Unter den Linden). Here's a fuzzy night-time shot of it.

Right outside the Humboldt, in the courtyard, there exists probably my favorite public art display in Berlin. Built right into the underground, in the middle of the courtyard, and only visible by the light coming out of the ground through the glass plate on the ground, is an empty room with empty bookshelves, right on the spot where the massive book burnings occurred during the build-up to the Third Reich. Truly an impressive and moving, yet simple, reminder of the hostility to intellectuals and reasoning that allowed such a horrible thing to occur.

Day 6-8: Late Nights

2011-04-02T19:33:00.003-05:00

Well, I've kind of let blogging go by the wayside for the last couple days, as you may or may not have noticed. I've been reconnecting with old friends for the past three nights, which has been good but has necessarily diminished my capacity to continue documenting my adventures as I have not returned to my apartment before 2 am on any of those occasions. The post isn't really sharing anything deep, just sort of a rundown of hanging out with two of my friends over the last three days. Hopefully as my nights end a little earlier, I'll have some motivation to write something more reflective.

On Thursday night, I had intended to get some very long overdue items taken care of that I brought with me to Germany, and was actually relatively successful until I received an e-mail from my good buddy Jay-Dub, a former ex-roommate of mine from my Potsdam days. Needless to say, when he suggested that we meet up, that definitely shifted itself way up on the priority list. I jumped on the train and met him at the Wedding train station. I was a little nervous, as is commonly the case when reconnecting with old friends you haven't seen in a while, but it all melted away when he recognized him sauntering up to the platform. He was always a very gregarious guy 8 years ago, and that had not changed by any stretch of the imagination. From the moment we hugged hello to the minute we hugged goodbye, we chatted and joked and enjoyed catching up on a lot of lost time. He took me to the Prenzlauer Berg area, which he described as "the hipster scene for rich people," and shuffled our way to a couple of different establishments, including a nice café bar called "An einem Sonntag in August" (On a Sunday in April), then walking around to sight-see a little bit before heading to a hip little establishment called "Kruger," and then finally ending up at place with comfortable couches whose name is failing right me now.

Hanging out with Jay-Dub was fantastic in many ways. He is very easy to talk to and possesses a lot of interests and insights that make conversation both fluid and interesting, and our topics of discussion ranged from heaven knows how many different topics, from German to U.S. politics, from the health care system to the legal system, from law studies to medical studies, to different types of theater and other offerings in Berlin. I'm obviously not going to go into everything, but here are some interesting things I learned from our conversation:

1. Berlin, with its lack of open container laws, offers the hipsters an opportunity to get Fußpils. What normally translates to "athlete's foot," can also translate to "foot pilsener," or the act of drinking a Pilsener as you're hopping from one bar to the next. It was the end of the night when I found out about this, so I kind of let that tradition go.

2. Germany is apparently in a heated discussion right now in several directions. The best publicized is probably their drive to ban all nuclear power plants from Germany, a movement that has gained so much traction that the Green Party, of all parties, has transitioned from a fringe party to a major political force that is in control of the parliament and the lead office in the state of Baden Württemberg (state that encompasses my old home town from childhood). Another issue they have been discussing is the escalating costs of social services, which is actually a pretty popular part of Germany's core political traditions. Some have apparently suggested that the bureaucracy is so expensive, that they could get rid of it entirely (except, I believe, the health care system) and just hand out 1000 Euros EVERY YEAR to every man, woman, and child living in Germany and still break even. 1000 Euros a year, in some smaller towns, could certainly go a long way to paying off debt or rent. Or could buy you a lot of smack.

3. As with every city, there's quite the variety of entertainment and, in particular, live productions. Two theatres, in particular, sounded pretty outstanding to me. One theatre, near which Jay-Dub lives, only puts on a running production in which essentially installments of a running live soap opera is done. Apparently is hugely popular, sold out for weeks ahead of time. Another theater, and I'm really hoping to find out from him what it's called so I can get over there in the next two weeks, is a theatre that does nothing but show puppet shows, marionettes and hand puppets. But it's not a children's theatre, instead addressing grown-up themes. How can that not be good?

4. A cousin of his who works as a resident physician in anesthesia at a hospital nearby where I am staying is currently on maternity leave. Apparently, she just had her baby earlier this year, but has been on maternity leave since last October and is apparently not due to go back until this October. How is that not a freakin' amazing and progressive approach to starting a family?

Some final thoughts on our meeting together, other than it being a rip-roaring good time: I really miss being in an international setting and speaking with a multitude of different people from different backgrounds. For one, every place we went to, while still a majority of German speakers, really had languages from every stripe being spoken at some juncture at or another. I would say English was a large minority, but cultures are definitely well-represented here. And what I really enjoyed in talking with Jay-Dub (and LL and, frankly, many of the young Germans here), is the ability to just jump randomly, as needed, between English and German. Sometimes we would speak in English, sometimes German, and sometimes he would speak in English and I would respond in German. There was just something very organic and beautiful about using the full spectrum of our language capabilities (limited, of course, by my rather paltry knowledge of only two languages). It just feels so civilized, or maybe cosmopolitan. Or maybe it just smacks of that one-world-star-trek kind of thing.

On Friday, work went a little rough. Not only because I was pretty exhausted by the time the afternoon came around, but also because I showed up late for the beginning of the day's duties. This was mostly due to the fact that nobody had informed me that we were meeting earlier on Friday but, in all fairness, I suppose I should have asked before leaving the previous day. But I did successfully dissect two brains and am really getting the hang of it, so that's something, at least. Then, starting at 19:00, I met up with Dr. Case, who had just returned from Prague and spent the entire day at her conference, to go on a little exploration of Berlin. We went down to Ku-Damm, the main shopping district near which her hotel is, and I disappointed her with promises of the Gedächtniskirche, the bombed out church that serves as a reminder to the war, to find that it was all covered up for restoration. I'm not sure what kinds of restorations you do to a bombed-out church whose very purpose is to stand decrepit, but what do I know. We did, however, find a hip little café where she and I could get traditional German eats (she a Wienerschnitzel with roasted potatoes, me a healthy portion of Cheese Spätzle) before we hit the rest of the town. Because I had just been there, I took Dr. Case up to Prenzlauer Berg to show her around, and we stopped at a darling German kitchen to get some drinks and delicious desserts (and where the waitress seemed to be flirting with me a little bit) before making a stop off at Godot for some genuine non-alcoholic hydration. Dr. Case regaled me with stories of her trip to Prague this week, and I was surprised by how much of my own brief visit to Prague came rushing back as she was talking about it. We both pretty much drew the same conclusion that two days was not enough there and that it deserves a more extensive visit in the future.

Today was primarily about walking, it seemed. I slept in until 11:00, ran some errands, and then started watching my soccer team implode after a good start before I had to make my way for another meet-up with Dr. Case. I strolled down to her place and then we strolled downtown and almost ended up back, unplanned, at the place we were the previous evening before our legs and our energy failed us. All told, we probably logged at least 8 miles of walking (an additional 2 miles for me to get to her place), interrupted by a couple of sit-downs for food/drinks. We've now hung out for three evenings this week, and I'm really pleased by how much fun we're having walking around, hanging out, and seeing the city. She's proven quite the enjoyable travel companion. Then today, on the way back from the train station, I decided to make good on my Fußpils. And I have to say, there's something quite enticing about lack of open container, not the least of which is walking into a convenience store at 1 in the morning, purchasing a drink without being asked for identification, and then asking the attendant to pop off the cap for you before you head out. Craziness.

So not too much reflection

Berlin Day 5: What Just Happened?

2011-03-30T16:53:00.002-05:00

Not much to blog today because, truth be told, it wasn't too exploratory of a day. That being said, it was a day characterized mostly by WTF kinds of moments, the kind of day that makes you sink into your chair at the end of it, munch on something unhealthy, unbutton the top couple buttons of your shirt (or your pants, if that's you're thing), and just let out a tremendous sigh as you try to get the whirlwind in your brain to slow down.

I'm overdramatizing the severity of my befuddlement (although I do think it's strangely apt that I'm wearing my t-shirt from the Treinen Farm Corn Maze that defines the word "lost." Gotta be careful about wearing this shirt again, apparently). But it definitely had some odd moments (and ended even more oddly).

Let's start at work which, actually, went very well: I keep making advances in understanding histology under the microscope, I'm getting along great with the people that are there, having a great time joking around with LL, and am seeing some great and fascinating pathology. Which brings me to my first WTF moment, albeit one that will mean very little to anybody not in the medical field. We were examining some muscle tissue from a young girl who had extremely typical findings of a rather common muscular disorder. Problem is, this disorder tends to be X-linked, meaning it's extremely rare for a girl to ever get it. So that was kind of a crazy thing and I'm sure will find some way of screwing up my thinking during my next Step examination when I see these weird exceptions to the rule.

My next WTF moment came from going to journal club. Unfortunately for me, it was kind of a slow day in the lab, so there wasn't much that I could watch or help out with. So when I was told that there was going to be journal club among the entire neuropathology department (clinical and research) going on in an hour, I got pretty stoked about reading the article. The first problem started with just reading the article: I would characterize it as mildly to moderately interesting but, for the most part, it was just kind of a crummy, uninteresting, hugely generalized, poorly justified study. So, looking back on that sentence, I guess it was kind of a dumb study; I'd characterize it as a solid, but ultimately uninteresting, pilot study. What was worse is when I got to journal club: the presenter finished presenting on the paper in 15 minutes and not a single person in the room had any questions about it. In fact, nobody seemed to have even read the paper beforehand (and it only took, like, 15 minutes to get through it. It was a pretty simple clinical study). I thought about asking questions, but the audience looked like it would be pissed off at me for doing it, and then I already knew that it was a pretty crummy paper, so what would have been the point. I was then particularly surprised when one of the graduate students, after the lecture, came up to the presenter and asked what supratentorial is. If you'r studying neuropathology, it seems to me that you would have picked up some basic understanding of neuroanatomy. But what do I know about what graduate students should know?

But by far the biggest WTF moment of today was my outing to the opera. Let me start from the beginning.

I wouldn't call myself a connoiseur of opera. I wouldn't even go so far as to say that I'm a fan. But I do like opera, and I've been to quite a few and almost always enjoy them. I can think of three operas that I've been to in my life that I have not enjoyed for one reason or another.

One of them was the second time I watched Jesus Christ Superstar (you haters out there can argue about whether or not that's an opera, but just because it's rock-and-roll doesn't mean it's not set up like an opera). I'm a huge fan of JC Superstar, mainly because it bends the traditional telling of the New Testament and has some pretty great musical numbers. The second time I watched it, however, the director decided to rely on tradition and stereotype, making Judas a pawn of the devil again (when the original direction was for him to have been manipulated by god to help martyr Jesus) as well as dressing the Jews up in business suits and making them from Wall Street. Classy.

Another one was watching a UW student opera production of Claude Debussy's only opera, "Pelléas et Mélisande." While the music was gorgeous and the singing was outstanding (including a friend of mine who played the lead soprano and has an amazingly gorgeous voice), the actual staging of the production was atrocious: the set was dolled up with weird staircases and railings and stuff, but the actors were given no directions on how to actually use it with any effect, the set relied too much on suspension of disbelief and miming rather than actual props, and everybody was just interacting very strangely on the set. I basically just shut my eyes and let the music wash over me because I was getting embarrassed for the poor singers having to work with such atrocious "direction."

Those used to be the only two "bad"operas I've watched, but unfortunately I have to put my experience tonight with Richard Wagner's "Tristan und Isolde" firmly into that camp, too. This is unfortunate because, after hearing some excerpts and learning about the story many years ago, it's something that I've really been excited about watching (and I don't want to hear any talk of me experiencing self-loathing of my heritage with wanting to watch an opera by Wagner). So it turns out that this was a modernization of the Tristan and Isolde story. Normally I love modernizations, adore them even. I think there is value in updating old stories to keep things fresh and try to attract new audiences. However, this one just didn't make any sense.

But let's start with the positive. The opera is gorgeous and complex! It moves seamlessly between moods and arrangements, and tells a coherent story in and of itself. In particular, the third act in which everybody starts dying is probably the most poignant of the acts and is riveting from start to finish. If you haven't heard the music, I would recommend making it a priority. Wagner may have been an anti-Semite, but that man sure could write a piece of music.

OK, now on to the negative. And maybe not so much negative because, looking back, it was almost fascinating to see what new atrocity they were going to introduce to the stage (although it was disappointing being that it was the freakin' Deutsches Oper). It opened up with the two main characters sitting on opposite sides of the room and making hardly any movements as they sat there singing with their attendants. Each one was singing about ships and sailing, but the leading woman was in a wedding dress and the leading man in a tux. Oh, and they were sitting in a freakin' house. So, really, there was a complete disconnect between the libretto and the scenery, which pretty much defined the entire experience. A coffin was also featured prominently throughout each set, which was a little bit of overbearing foreshadowing, and flowers would randomly drop out of the ceiling without explanation. Characters would show up on the set without explanation and occasionally chime in a sung word or two, and it was not entirely clear how the leading characters could be sitting in the same room and not actually be hearing what each other were saying. Once it got towards the end of the first act, instead of them drinking the love potion, they actually shot up heroin. And then they fell madly in love with each other after having seizures. Awesome.

The second act was no better, being set in a 70's era mobster living room. The actors used about a tenth of the space that was given to them on the set, and weird goings-on were occurring on the back half of the stage that seemed to have little bearing on anything. The music was also a little less exciting in this act since it was essentially an hour of Tristan and Isolde professing their undying love to each other. Although Tristan did get himself inexplicably stabbed by a sword at the end of that act, so that was kind of exciting.

The third act had the much better music, and also attempted to explain the complete weirdness and disconnect from the first two acts. I guess it turns out that Tristan and Isolde are both old senile fogies who had some weird illusion about sailing on ships or something. Tristan I guess was dead all along (which is why the coffin was in each act and why flowers were dropping from the ceiling at odd moments throughout), and I guess Isolde maybe just gave up hope and decided to cry and talk about ships sailing. Tristan's attendant was cast in a cruel light in this scenario, humoring everybody with talk of ships sailing when not a fucking thing was actually going on. The act (and opera) did end on as awesome of a note as it could when the entire choral cast turned into zombies and Isolde went out the door to join them on their lurch (unfortunately, they were not moaning or making any obvious intention of seeking brains).

And how could I forget the best/weirdest/inappropriate part of the entire thing: a naked woman and man walked slowly around the set in both of the first acts, randomly entering and leaving and being weird exhibitionist voyeurs. In fact, the man in the second act, penis flopping around and everything, started digging a grave during the entire scene where Tristan and Isolde are professing their love to each other. When he disappeared into the grave, the naked woman came out, sat on a chair, and watched Tristan get stabbed with the sword. WTF.

So I've gotta give it to this director for being bold with his use of unabashed nudity and the living dead. He also made me feel a lot better about my ability to succeed in show business as a lousy director, as well as keeping me glued to my seat wondering how he was going to surprise me even further with inappropriate and illogical weirdness. But the other part of me is hugely disappointed for dropping 40 bucks on that. Perhaps when/if I go see La Boheme in two weeks, it'll be a different, or at least more faithful, reproduction.

Day 4 in Berlin: Reconnection

2011-03-29T17:20:00.016-05:00

Getting to work today was a lot better: I got loads of sleep to get over my jet lag, plus I actually knew where I was going. That, and I didn't have to be there until 9, so all around a much better going-to-work experience.

I remembered to bring my camera along this time, so I could snap off a couple shots to show the route into work. This first one is of the Hauptbahnhof, which is really quite the marvel of a train station. Perhaps Wisconsin's train station in Milwaukee will look like this once our marvelous train between Chicago-Milwaukee-Madison-Minneapolis is built. Oh, wait. Thanks Governor Walker for killing that dream.

This scary sculpture of a weird mechanical horse also greets me every day that I walk out of the station.

And then this is the building in which I actually work. There's quite a lovely bust of Virchow, who's really one of the leading physicians who got the Charité rolling (and who has many things in medicine named after him), so I do kind of feel like it's upping my medical street cred a little bit just by working there.

The work day was quite productive and I got very much more involved with sample preparation Even did my own brain cutting, although I screwed up the slices of the hindbrain, accidentally making AP slices instead of coronal, but it was otherwise pretty good for a first time. I'm sure the next time I'll do it like a rock star. I also saw some interesting cases, one of which has gotten me curious about a possible case study that could be written up if we can discover what in fact is going on, but it's really quite premature to think in those terms just yet.

After work, which lasted significantly longer due to my complete absorption into the sample examinations, I hightailed it out to Savignyplatz to rendezvous with my old friend from New College, Dr. Case. She's on a research year in medical school and got herself a sweet conference gig in Berlin during the exact time that I'm here. So not only do I get to see an old friend from 9 years ago (!), but also get a travel buddy for a little while. She has a very admirable attitude towards traveling that is quite compatible with mine: let the feet do their walking and directions/plans be damned. I decided to take her to Hackescher Markt and Oranienburg because it's a beautiful and hip part of town with lots of interesting restaurants to choose from. She was particularly proud of getting her first German beer (a hefeweizen, naturally, upon my suggestion) as well as having her first German food (jazzed up versions of Currywurst and Rotwurst). After that we walked and chatted and caught up on the last decade and just had a great time exploring the city. She made it very clear that she wanted to have no part in any decision-making and entrusted me with the duty of showing her cool stuff, telling her about whatever I could remember about the area, and just enjoying the sights and good conversations. She also appreciated that I joined her in the über-touristy photography. Here are some of the shots.

First was a shot of the Jewish Temple in Oranienburg. Unfortunately, there's almost always a continual police presence there. But it remains a beautiful structure and, really, a pillar of the community. There's have been quite the flux of Jews to Berlin, so this has really stood as a testament to that.

After that, we walked through the main drag of East Berlin, skipping the Russian Quarter, but not before getting a nice shot of the Red Rathaus with Neptune looking upon it.

After that, we crossed onto the Museum Island (named because, well, it's a small strip of land that's wedged between two arms of the Spree River that has a bunch of museums on it. Even though it was pitch black, I think I got off a nice shot of the church and the East German TV tower.

We continued our stroll down Unter Den Linden, pointing out the many museums and theaters along the way before getting into the district with the businesses, the banks, the expensive cars, and the American consulate and shops (yeah, I know). Finally, we came across that gem the Brandenburger Tor (where, strangely, there were a group of Russian women dancing and singing in choreographed unison. It was actually a little mesmerizing).

I warned Dr. Case that we would be coming up on the old site of the wall and she'd have to look carefully or else she missed it. She then almost failed to heed my warning about taking pictures of it as it runs exactly down the middle of a trafficked road, but we were able to wait for a break to snap a picture or two.

Of course, shortly thereafter, we actually a couple of real pieces of the wall that were on display near Potsdamer Platz. Not the most interesting or vivid examples, but at least accessible ones.

Potsdamer Platz is home to the Sony Center, a modern marvel of flashy lights and cool architecture. Its construction started shortly after reunification and took years to complete, but was really sent as a signal to everybody that Berlin was back and meant business. This is the roof structure, probably one of its defining (and color-changing!) features.

Finally, on our way back to the train station to end the evening, we popped off a couple of shots of the main parliamentary building, the Reichstag. It has a beautiful panoramic copula that affords a spectacular view of the city. Unfortunately, since last November (according to the policeman I talked to at the barricade), the whole area is shut off to the public and you have to apply for a visitation warrant. Considering my propensity to spontaneous visitations, this is a tremendous cramp of my style. But I think it'll be totally worth doing down the line.

After that I escorted Dr. Case back to her hotel and then promptly turned back around to catch my S-Bahn home. All in all, a nice solid day of work, walking, and catching up with an old friend. Tomorrow: to the opera!

Day 3 in Berlin: First Day on the Job

2011-03-28T23:22:00.020-05:00

Today was my first day to work at the Charité Institut, Berlin's and one of Germany's most prestigious academic hospitals. I found myself waking up less intimidated by the reputation and more just concerned about conducting myself in medical German. My vision of myself and my German is that of a 11-year-old kid (as that was the last time I formally learned German), and so I worry that I sound like a 6th-grader when I talk to anybody. And now I have to discuss edematous, inflamed, or cancerous brain tissue? Though my suspicion is that many of the medical terms are essentially the same as those in English, just with a German accent. This is surprisingly true in many instances.

The trip downtown went very smoothly, thanks largely to the well-oiled machine that is the Berlin public transportation system. My longest wait for a subway was 5 minutes, and then the next train was waiting for me at my next stop. Arriving into the Berlin Hauptbahnhof, though, I was strangely perplexed: I didn't recognize anything and was completely disoriented as to where to go. If there's one place that I explored to death the last time I was in Germany, it was the downtown area of Berlin. Here I walked out into this strange bustling area that was completely unfamiliar to me and, what's more, I couldn't figure out what I didn't recognize anything. Once I stepped outside and saw some familiar landmarks, I figured out why: the damn thing was being built the last time I was there, and so my memory is still of a gigantic dirt heap surrounding the entire (and impressive!) structure. I didn't have my camera with me, so I couldn't snap any pictures, but I'll definitely try to include some tomorrow.

The walk to the Charité started pleasantly as I realized that it was only a couple blocks from one of my favorite modern art museums, The Hamburger Bahnhof (a converted a train station). However, the directions I got on Google Maps were a complete disaster, and though I had a half hour to find the department, I found myself with 10 minutes left and no idea how to get there. Fortunately, a very curt security guard sporting a Charité hat was able to point me in the right direction on a serpiginous route to the building.

I introduced myself to one of the secretaries of the department, and the worry instantly set in: she didn't seem to have any idea who I was, and none of the physicians were there. So I sat in the waiting area, wondering if perhaps the whole thing had been a charade, but fortunately my book of Jorge Luis Borges kept my mind on other things as I waited. About 20 minutes later, a nice young woman LL, who would help usher me through the day, came by and led me around to meet the various people and get me on track for the day. The director ended up being a super gracious guy and seemed genuinely pleased to have some new blood in the area. He also had a good understanding of why I was there even though we never formally discussed it: observe and get a flavor for the histological, the autopsy, and the research components of neuropathology, meaning that demands on me personally would be at a minimum and that I could really just go around and see the various components of the institute. Perfect.

The day opened with a nice little presentation about alcohol-related CNS pathology in Germany, followed by some recent pathological samples of alcohol-induced issues, including some textbook examples of Wernicke-Korsakoff changes. This was followed by examination of new tissues to determine presence/absence of tumors or other lesions, and to order further testing on the samples to make a final diagnosis. All through this, I was amazed at how easily I was following along, primarily because, short of the Germans having their own words for organs (which I, fortunately, am aware of), most of the medical terminology is very similar to what I already know (thank heavens for Greek and Latin in medicine, I guess).

LL then had me follow her around to prepare new samples for examination. The work was pretty routine, but it did allow us to chat a lot. Turns out that she has had quite an interesting life already (she's the same age as I), and we talked a lot about practice in Germany, neurology, and neurosurgery (something she is personally very interested in). She was also very curious about research in the States and the process of doing Board examinations and practicing in the US as these are things she might be interested in down the line. She also told me about how she is finishing up her dissertation (although I forgot to ask what it was on! Bad on me!), and I found myself quite impressed that every medical student/resident in Germany has to write a dissertation and, thus, probably has an infinitely better understanding of research than most of us in the States do.

Working with LL on the first day, though, was great. She's got a very European personality (which resonates well with me), but also comes from a camp of Germans (that I fear is dwindling) that still very much enjoys and respects Americans. But she also has a very free-spirited personality (that again resonates well with me) that is not afraid to both dream and pursue those dreams, which is actually a pretty rare quality in any population. We certainly had no shortage of things to talk about as we munched on some sandwiches and baked goods (god, I love all the bakeries all over here!) over a leisurely outdoor lunch (although I felt like a fool in my buttoned up shirt and tie, a mistake I will not repeat tomorrow).

In the afternoon, we re-examined the newly stained samples from the morning to confirm or alter diagnoses, and then all of the physicians, including LL, scattered to dictate their findings or go off to other meetings. Though one of the physicians earlier that morning indicated that the day could last until 6:30 or 7:00 pm (eek!), LL set me straight and said that my days would generally be done by 3:30 or 4:00. True to form, it was 3:30 and I was released to come back at 9:00 tomorrow.

Because I didn't have my camera, I couldn't explore downtown as I would have otherwise done, so I headed back home resolved to walk further down Spandauer Damm, the main drag right by my apartment, and then come back up a "parallel" street of Bismarck Street. It was largely a pretty routine walk, with mainly businesses and residential places, but there were a couple of gems along my loop.

First, a picture of the front edifice of Schloss Charlottenburg. Can't believe I forgot to get this yesterday. Guess I was tired...

I then walked by what I first thought was a church, but then turned out to be the city hall for the district of Charlottenburg.

And, like every good "Rathaus," it had a Ratskeller associated with it. Let this be a lesson to all my Mad-Town friends: this is where and what a true Ratskeller is.

One thing I love about Berlin (and, let's be honest, Germany and Europe as a whole) is how they are committed to preserving the old and somehow fashioning the new around it, such as this example:

Then came something a little unexpected:

Yes, you're seeing that correctly: it's a ginormous landmark to Scientology. The storefront on the ground floor as I passed by was adorned with L. Ron Hubbard books (including, most prominently, Dianetika). A recording of a soothing male German voice was beseeching me, as I walked by, that I could turn my life around and find true inner peace or some such. I almost went in, but figured they probably wouldn't like me taking pictures of all the craziness inside, so I kept going.

I then passed by a charming little theatre that was playing a show that I might be interested in going to next week, but the box office was closed so I let it be. Once I got to Ernst Reuter Platz, I decided to turn down Bismarck and see the opera houses on my way home.

I first came across the Berliner Staatsoper, one of the two opera houses on that block. They had a production that was essentially an operatic rendering of Erik Satie that I really wanted to go see. Unfortunately, they were all sold out, so I had to press on and look further into their schedule to see what else might be of interest.

I then soon came across the Deutsche Oper, one of Germany's (if not THE) premiere opera houses. It's not too impressive from the outside, as you can see, but I assure you it is quite the place. I saw that Richard Wagner's masterpiece "Tristan und Isolde" was playing this week, so I thought I'd chance a run at some tickets. Fortunately, they had some, so I snagged a ticket for this Wednesday. I've wanted to see this production for a very long time, so I was giddy that I was able to procure tickets this late in the game, especially at such a distinguished venue. I was a little shocked at the start time of 6 pm, but was then gently reminded that it's 5-FREAKIN'-HOURS-LONG. So looks like I'll have to get up early on Wednesday if I still want to go on an hour-long walk as I have promised myself to do. Nonetheless, totally stoked.

I was about to head up my street and back to my apartment, but saw a little park from the corner of my eye across the street and decided to check it out. Turns out it's another park, just minutes from my apartment, with a nice path around a lake. Because there was still some daylight left, I decided to go for a stroll:

And as most of you know, I'm not the god-fearing sort, but I do love churches where entire edifices are constructed entirely of windows so that you can gaze across god's beautiful country.

Then I came across this, which I can only presume is a church. The main building and the tower did look it had some pretty rockin' places to be scaled, though.

I also found this building, which to me looked like a museum or a historic landmark or something like this (and the building actually extends several hundred feet to the left and to the back):

Turns out it's just an old mansion and judicial site that is now being used as apartments. How freakin' sweet would it be to live in there?

As I came back around to my starting point in the park, I walked past several pieces of exercise equipment, including these leg-swingy things, stationary bicycles, and ellipticals. You know, in case you wanted to do your work out on the lakefront.

After that, I headed back home. I made a quick stop-off at "Zum Linden" to get my insanely cheap and mind-blowingly delicious Schneider Hefeweizen (which I drank in honor of my old organic lab buddy and unwitting drinking buddy Cindy). It was a little smokey, and two of the patrons had dogs in the bar who chased each other in circles playfully around the table I was sitting at, and then I made my way home to have one of my favorite meals (and one which I took a lot of flak for when I was in college): savory cheeses on delicious fresh bread. Yum!

All in all, a good but tiring day. It's only 10:00 and I think I'm probably going to crash here in the near future. Before I do, though, I also want to send a shout-out and a hearty and loving congratulation to my sister and brother-in-law, who today became parents again to a beautiful baby boy, Coen Beck. I can't wait to meet the newest addition to the family sometime when I return, and I wish them all the best and send them all my love. A delightful way to cap a wonderful day!

Day 1&2 in Berlin: Going "Home"

2011-03-27T16:52:00.017-05:00

Last August, almost on a whim, I decided that I wanted to use the last remaining freedom before residency to do something extravagant and fun. Something I could do for a month at a stretch without any negative consequence to myself. Originally I had thought about going to South Africa or India or a third world nation of some sort to do a medical rotation, learn the hardships of practicing medicine in another country, etc. Then I realized that I'm an academic who will likely never be involved in those kinds of situations and will instead support Doctors-Without-Borders and other similar organizations to do the work I am very unlikely to do myself. Physician, know thyself.

So instead, I decided to find a way to go to my favorite city in the whole wide world (not that I've been to that many, but I've definitely got more than a few under my belt): Berlin. Without any pretenses, I wrote to the secretary of the director of the neuropathology department at the Charité Institute (Germany's prominent academic hospital) and cold-called them about doing a 4-week rotation. To my surprise, they agreed, and things got settled to start on Monday the 28th of March. Which is tomorrow.

Much anticipation was going through my mind over the last month, in addition to the uncertainties of residency and graduation and such. I was finally going back to Germany after I regrettably left it to start my MD/PhD track 8 years ago. I didn't want to leave back then, and I was wondering if it was still going to have the same effect on me this time as it did nearly a decade ago, whether I was going to have that feeling of wanting to leave everything behind and stay there or whether it had moved past me. I also was anxious about my German, whether it was still as good as it was back then, or whether I could quickly get it back to that point. I was nervous about reconnecting with old friends, and am still nervous about looking like an idiot during this neuropathology rotation. Then of course there are the nerves associated with traveling thousands of miles on one's own and finding one's way in a foreign country. Not that Germany is all that foreign to me, but I am essentially starting from scratch in terms of housing, funding, etc.

After a wonderful visit with my brother, sister-in-law, nephew, and niece in Chi-Town, Dr. T and I dealt with predictably bad traffic but got to O'Hare with plenty of time to not only get checked in, but also get the Euros that I was worried about getting in Germany. The flight was pretty uneventful save the fact that I couldn't sleep (an oddity for me), but it did allow for some quality movie-watching, getting caught up on my Oscar-nominated movies. Getting through Heathrow was almost a complete disaster if it hadn't been for the thankfully long layover as they made me check-in with an agent again and go through security again (which took forever!). This all seems kind of stupid to me as we have all clearly gone through security already, but whatevs. Then, after a quick puddle jump, I arrived in Berlin.

The first of my fears, my deteriorating Germany, rapidly melted away when the customs agent took my passport and, after we spoke a couple words, asked me if I live in Germany. I told him I was visiting here for a medical school rotation, and he explained that my German was really good so I must have lived there at some point. This, of course, was a huge relief, and couldn't have been a better start to my newest foray into Germania.

Immediately stepping away from the gate, I felt comfortable. At home, even. I knew where to go, where to pick up my transportation passes, where to even catch the bus and get off to catch my S-Bahn. It all went seamlessly, and everything about the city felt immediately comfortable. Even going to Charlottenburg, where I am staying and which is a region I left completely unexplored the last time I was here, felt comfortable and familiar. The storefronts, the pedestrians, the weather, everything about it resonated with me. I'd almost say it felt like I never left; not to say that nothing has changed or progressed in Berlin, but just that there's an air of familiarity that continues to persist. A smile spread over my lips that, even at this writing, has not subsided.

I got to my new apartment early and the landlord wasn't in, so I decided to drag my luggage around the neighborhood and explore a bit. I clearly went in the direction of further residential living, because there wasn't really much noteworthy. I did stumble across an awesome looking Italian market that sells wines and Italian foods at discounted prices (their a wholesaler, as well), so that was certainly a welcome sight when it's only 75 yards away.

I also came across this piece of awesomeness advertised on the bus stop nearby my apartment.

Because, apparently, The Scorpions count as classics to be performed in an open air concert. "Take me, to the magic of the moment, on a glory night, where the children of tomorrow dream away in the wind of change." For surez.

I also came across a nice little park, but at that time I had to get back to the apartment and vowed to explore what the park was later.

At the apartment, the handover went very smoothly and the landlord seems very nice and personable. She even invited me to go to her art show opening on April 7th and, really, I see no reason not to. The apartment is quite charming, with a cute little kitchen, a large hard-wood-floored living room, a bathroom, a washing machine directly across the way from my apartment, and a bedroom that looks out on a little closed-in patio. What I love most about the place, however, is the living room with its pink walls and curtains, as well as the black-and-white tiled kitchen. Classic.

And then there's this awesome sign randomly hung up on the outside of the bathroom door.

After all that was said and done, I didn't take long to get myself ready to explore the neighborhood. Even though I was feeling pretty exhausted from the trip, the rush of being back in Berlin and Germany, in general, definitely gave me some legs to walk around. Besides, I vowed to walk at least an hour a day while I'm here, so might as well get it done while the weather was beautiful (which it was: partly sunny and around 7-10°C).

The immediate neighborhood was mostly residential, but had some things that pleased me, including three nearby bakeries and a charming-looking pub that I promised to go to later tonight (but which I ended up being waaaay too tired to do). I do like that two of my favorite beers in the whole world (Schlenkerla Rauchbier and Schneider Hefeweizen) are offered here much cheaper than I would find in the States.

Otherwise, not too much to report about my neighborhood. Oh, besides the fact that the freakin' largest castle in Berlin is about 100 yards away from my place! Schloss Charlottenburg (the namesake of the district I live in), is a place I kept meaning to visit when I lived here last but never got around to. It was a beautiful exploratory walk today, though, and I definitely plan on trying to get my morning run in over there whenever I can. Here are some images.

There was also a little island that had a statue of Venus on the one end and Cupid on the other. I think there's perhaps a metaphor waiting to be drawn there...

I absolutely loved walking through that regal park. Not just because it was a beautiful piece of land nestled within the city and so close to my new home, and not just because the weather was pleasant, but because I loved seeing all the other people around. People here don't just walk a lot, but they actually like to walk. When the weekend comes, or even the evenings after work, people actually go out and walk as their pastime, something that is woefully deficient in my own part of the world. It's just part of what people do. Not only that, but the diversity of Berlin is well-reflected on these walks. I heard German, English, Polish, Russian, maybe some Turkish or Arabic. And I don't think most of these people were tourists (like me). They were clearly all people who have made Berlin their home. We take all the credit for being a melting pot of cultures, but we really give places like Berlin the short shrift in this category.

Once I was done with that, I headed towards home and discovered that I had been walking around for an hour and a half! So i went to a nearby Imbiss and picked up some of my favorites: Mezzo Mix (a mixture of Orange Soda and Cola) and a delicious-looking falafel sandwich exploding with veggies.

Once I got home, I think it finally dawned on me that I was finally here and, furthermore, that I was woefully only here for a month. Truth be told, it's been less than 24 hours that I've been here and I really don't want to leave. This happened the last time, too: signed a contract and committed myself to other things that necessitated a departure out of Berlin. Coming back here has absolutely strengthened my resolve to do everything in my power to come back. I've lived in a lot of places, and I've liked all of them, but Berlin is really where my heart belongs.

Taking Stock

2011-01-01T12:54:00.002-06:00

Hello all.

Probably unlikely that anybody is reading this any more, given my particularly long period of inactivity. It's been a busy couple months finishing my med school rotations (for the time being), interviewing, and preparing for the college course I'm teaching for the month of January. But I'm going to make an effort to write more regularly.

So it's officially 2011, just as I was starting to get used to writing 2010 on my personal checks. This means it's time for me to think about what I want the next year to hold and reflect upon what last year brought.

Last year was good in many ways: I learned a lot about medicine, made an important decision about my future medical practice, and was on the road learning about places I want to live and train for my professional development. I made some progress on my long-term goal of learning Spanish (even as it has recently stalled), secured myself a sweet teaching gig and editorship for an ethics journal, and finagled my way into a final med school rotation in Berlin with the promise of visiting castles once I'm done there. There was a lot of routine and hoop-jumping last year, lots of long hours and stressful studying, and also a good deal of uncertainty, but there was also a lot of excitement, anticipation, and mind-expanding opportunities.

Nonetheless, there are many areas of my life that I think could benefit from some reflection. I feel like I'm still wasting a lot of my time on stupid stuff, such as watching far more television than I should and eschewing good opportunities for reading, writing, and learning. And although I will finally feel like I'm "giving back" by starting an internship, I think I should be able to do more to benefit the people and community around me. I will probably have to accept the fact that this will likely not occur in any meaningful way in the next two years, but I also need to identify even the smallest opportunities to make a difference. Interpersonally, I think I'm doing too little to keep up with my family, especially with two new nieces/nephews in the pipelines. I'm also feeling far less involved with friends than I should be, as well. In other words, as exciting as last year has been, I feel like it's been a largely selfish year, and that hasn't made me feel all that good.

I think circumstances of work may make that difficult to change but, by the same token, I think I need to be more serious about making time and space for non-work endeavors and, more importantly, learn to balance this free time between personal and interpersonal times. Not sure how I'm going to do this, but I think being aware of it is a good first step.

Totally Shilling

2010-10-11T19:36:00.001-05:00

So I saw this new (to me) "Lean Forward" ad campaign on MSNBC and I really found myself drawn to it.

"We were built to evolve, we were not made to sit still." Amen.

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SNL Parody of The Previous Post

2010-10-08T22:51:00.001-05:00

After you watch the ICP post, please strongly consider watching this parody. It'll restore whatever faith in humanity you may have lost while watching the original.

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Late Nite Music Blogging: Insane Clown Posse's Amazingly Regressive Thinking

2010-10-08T22:48:00.001-05:00

So for once when I do this music blogging, I'm actually talking about something that I can't believe exists, let alone is garnering popularity. Their new hit "Miracles" is basically a poorly rhymed piece of tripe about things that they are amazed by. But they dub so many things as miracles, that it becomes sort of meaningless. Not only that, but they mention so many mundane things as miracles, like rainbows and the stars in the sky and childbirth that it just makes them sound completely ignorant of science. They even have a line about how stuffy scientists are a bunch of killjoys who speak above their level of understanding and, by extension, all of their juggalos, I suppose.

I don't really feel one way or another about The Insane Clown Posse, but one thing I know for sure: their song Miracles totally blows, and it makes them seem more ignorant than awestruck by beauty.

After watching this, I highly recommend you look up the SNL parody on youtube. It's pretty brilliant.

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Pay For Service

2010-10-07T23:32:00.001-05:00

By now I'm sure everybody has heard of the situation in Tennessee in which a fire department refused to respond to a fire emergency and essentially witnessed the burning down of a family's house until it threatened to encroach on another property. This was not a personal vendetta but, instead, was because this household had neglected to pay the requisite $75 for the fire services. Even though the family had offered to pay whatever it took, the fire department refused to put out the flames, which resulted not only in the complete destruction of their property, but also the death of several pets.

Now I have always claimed that the only really, truly, moral and good profession is that of a fireperson, and I still stand by it, but it makes me uneasy that firepeople have now been put into this position where they are faced with this decision. That being said, it is really inexcusable for these firepeople, no matter how badly they felt about their inaction, to have refused to respond to this family in need. Their defenders have insisted that this pay-for-service issue is immune from attacks because it's the household's own damn fault for not paying and, quite frankly, they took the same risk that somebody foregoing health or auto insurance takes. However, let me say why this argument rings false, and why I can justify this claim in terms of health care.

Back in the stone ages, when I was a first year medical student, I was fortunate enough to spend my spring break studying homelessness and health care in Chicago. While there, I worked at a soup kitchen and talked to its organizers, stayed and volunteered at a halfway house for homeless people with health care rehab needs, and met with a physician at Cook County Hospital regarding the health care needs of the poor and the homeless. Although it was long enough ago to forget individual points, I do remember one theme loud and clear: health care is intimately linked to shelter. It's no coincidence when we speak of shelter as one of our basic needs as a human being on par with food and water. Homelessness leads to many health problems, not only in terms of emotional health and substance abuse, but also with communicable diseases and, quite frankly, all-cause mortality. That is, homeless people, all things being equal, just die sooner and have more disease. In fact, programs put into place in NYC that provide housing for the homeless not only had the effect of getting "undesirables" off the streets, but also improved their health, meaning less harmful self-inflicted behaviors, less ER visits, and better compliance with medications. Withput shelter, health care deteriorates, and that is no secret any more.

So what does this have to do with the immoral inaction of the firefighters and the pay-for-service firefighting? This burning down will have an effect on this family's health, inevitably. The firefighters were irresponsible to let this happen and not intervene. I mean, can you imagine an ER physician not providing emergency service to somebody who they knew was uninsured or, for that matter, whom they knew couldn't pay? For all the shit doctors get about considering insurance before providing services, they always provide emergency services. To think that firefighters would not do the same in an emergency, especially given how house and property loss tie so deeply into health, is not only immoral but inexcusable. If ever there was a time for civil disobedience from stupid and unjust laws, this would have been the time. I'm very disappointed and, frankly, quite upset.

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Sweet Relief

2010-09-28T17:29:00.001-05:00

Sorry about that not-a-post. I'm figuring out how to use blogger on my "Magic Phone" (TM) and I got all screwed up. I'm in beautiful and charming Eau Claire right now and, unfortunately, there is no internet in the otherwise remarkably nice apartment right by the lake that they're furnishing to me for free. I really can't complain. I could just mosey over to the free wireless at the hospital, which is literally a 2-minute walk from my doorstep, but I'm just too lazy to do it, so I'll make do with my thumbs on my built-in keyboard on my phone.

In any case, if any of you have been tracking my neuroses on facebook, you may have been picking up on a theme there revolving around my extreme lack of confidence in getting any residency interviews in my chosen field. While I have a strong CV, teaching, and research record compared to almost all my competition (and a PhD to boot), I do have what some might call a lackluster medical school record. While my clinical evaluations have been uniformly glowing, I'm a horrible test taker and it has shown. This has made me more than a little nervous about the prospects of getting a residency, especially since I'm applying to nothing but hard-hitting academic centers so I can do research. But fortunately, only a little over a week after submitting my application, and without even all of my letters of recommendation in (which is another story of frustration and lamentation), I have gotten my first magical interview offer. This is very good for me because I feel super confident about my amicability and am pretty convinced that any place I interview at is going to see me as a person that they want to work with, so I'm getting more confident that I might actually have a job next year. Of course, that would ruin my backup plan of cold calling labs in Germany and the UK (including all my old research bosses there) and just doing a postdoc, but I'm sure I'll be fine either way.

All in all, I'm just totally stoked that somebody out there read my application and liked what they saw. My self confidence is starting to claw its way out of the gutter.

Sweet Relief

2010-09-28T17:08:00.000-05:00

Senior Medical Student = Intern Equivalent

2010-08-29T22:26:00.003-05:00

Well, I just arrived in Milwaukee today to get settled into my new digs (and wondering where my roommate is at this late hour given our early start time tomorrow...), getting myself pumped to start my subinternship in internal medicine at a major hospital here for the next four weeks.

For those of you uninitiated in the process of medical education, there are four steps to our education that coincide with the four years of schooling we have to endure. Obviously, each medical school has its own way of doing things, and its own structure, so these distinctions can often be blurred, but they go roughly like this:

First Year: this is the year that you learn the basic language. Anatomy, histology, biochemistry, they introduce you to the names, locations, and concepts that you require to understand disease process. This is generally a long-winded, and largely boring year, as it's mainly about language acquisition and has little to do with actual disease processes and diagnosis other than in the most esoteric of ways.

Second Year: this year is dedicated to understanding pathophysiology, or the processes behind disease processes. Using what you learned in the first year, you finally learn about diseases and, more or less, learn about the mechanics behind the disease process and even get some exposure to how medications and procedures used to treat said diseases really work. This is one of the most interesting, but also one of the most stressful and taxing years.

Third Year: this is the whopper of a year in medical school. It is when you have to get exposure to every core rotation of medicine and attempt to learn the culture of medicine while trying to apply information you learned during your first two years to real-life clinical situations, which inevitably ends in being overwhelmed, frustrated, and stressed as the information has surprisingly little bearing or practical utility to what you now are expected to know and do. This year is best described as "shadowing" with a healthy dosage of "trying to figure out how to get people to like you and make them think you're smart." By far, this is the most tiring of the four years as you have to always be on your game, are in the clinic all the time, and spend a significant amount of energy learning new people, disciplines, and styles and constantly trying to figure out how to fit best into the system and, just as you're starting to figure it out, you have to start all over in a new location with new people and new practices and disciplines. It's certainly interesting getting to do all those varieties of things, and I'm glad that I was able to do some laparoscopy, deliver babies, take out a gallbladder, interview people with acute mania and schizophrenia, and the whole slew of things I got to do and see, but it took the biggest emotional and energy toll by far.

Fourth Year: this is the glorious time when you are deliberately given time to make career decisions and interview for your upcoming new life as a physician, making it simultaneously exciting and relaxing. And while you still have clinical commitments, it's far less (30 credits in 46 weeks or something like this), but there's also a new quality to the clinical work: people actually start to treat you like a contributing member to a treatment team, mainly because they know you're older and at least somewhat wiser and have the requisite minimal experience behind you. I'm a little cynical about this because I think third year still felt like a big hazing process, but, whatever the purpose of third year is, fourth year has felt very nice in comparison. In my first two rotations of fourth year, I have enjoyed unprecedented respect and autonomy on treatment teams, and have felt comfortable to speak my mind and make decisions, although they are all obviously left to the ultimate decision of the senior resident and/or attending. But nonetheless, my opinion is asked and, on occasion, heeded. Which feels pretty good.

This leads to the ultimate culmination, at least at my medical school, of the sub-internship. The internship, or intern year, is the first year after medical school when you've passed the first two of your licensing exams and finished medical schooling and are officially called "MD" or "Doctor," but can't yet fully write prescriptions and be independent as you don't have your third licensing exam under your belt. Essentially, this is the year after med school when you're essentially a full doctor, or at least expected to be one, and take care of the patients in a hospital as a primary caregiver, doing procedures and writing orders and being responsible for their day-to-day issues and, well, their lives. As a medical student, even as a fourth year, we're generally not expected to quite function as an intern, for obvious reasons. However, during this one month, at least my school, we are required to essentially be an intern in order to prepare for our intern year. This is what my subinternship here in Milwaukee is supposed to accomplish.

Frankly, I'm excited to have this unprecedented responsibility and duty to my patients and treatment team. Nurses are going to call me about my patients, and I no longer have to hear about developments second- or third- or fourth-hand. I am going to write orders and make decisions about how to treat. I'm going to write daily progress notes, and dictate admission and discharge information. I'm going to have to call consultations on my patients and follow up on laboratory tests and radiological reads. If the patient has a medical problem, it's me who will hear about it first.

Obviously, as excited as I am about all of that, you can perhaps understand how terrifying a thought all of that is, too. I'm never one to shy away from challenges, but there's still that part of me that wonders what the hell people are thinking putting me in charge of people's lives. Granted, I'll always have a senior resident AND an attending physician presiding over me and counter-signing all of my notes and orders to make sure I'm making the right call and not doing anything stupid, but I'm still on the front lines, too. And there's always that part of me that feels like Dave Foley in the clip I posted above, just cruising through without anybody realizing that I'm hugely underqualified for what I'm about to do.

I'm very excited and very ready to do this, but I'm also nervous about what will be a very challenging and exhausting four weeks. Without a doubt, this will be a make-or-break experience, but will also be the best preparation for next year and, quite frankly, will be the closest thing I have ever felt to being a real physician. So here goes nothing!

Late Nite Music Blogging: The Most Serene Republic

2010-08-24T22:28:00.004-05:00

I had some time, so I guess I'll put another music clip up.

This is a band I've known about a long time, called "The Most Serene Republic." They come from that sort of compositional indie genre, and probably stick out most in my mind for their expertly use of harmonization, fluctuating time signatures, and seamless meanderings of syncopation. They're not a band that I would say you could listen to casually as they're best appreciated when paid attention to, but I think they're very talented and would be perfectly listened to in a pretentious coffee shop while discussing Derrida. I have never done this, by the way.

Good bye, Dr. Tanner (NSFW?)

2010-08-24T22:17:00.003-05:00

I actually had no idea he was still alive, but apparently not any more. Dr. Tanner, of Tanner staging fame, has expired at the ripe old age of 90 after suffering from a stroke. His "obituary" is documented in the NY Times today.

For those of you who don't spend their precious time studying human development and/or pediatrics, Dr. Tanner is known for his contributions to understanding human development, but the so-called "Tanner Staging" in human adolescent development is easily what people in the medical profession remember most about him. Pediatricians use Tanner staging to track appropriate development, endocrinologists can communicate to other physicians to gauge appropriateness of development in terms of delayed versus precocious puberty.

Reading the article, he sounds like he was a pretty decent guy. And there's no doubt in my mind that he's left his mark on the medical profession and any scientific profession studying development. Don't really have too much more to say about it than that, just giving props where props are due.

Late Nite Music Blogging: Plume

2010-08-22T17:02:00.004-05:00

So about once a month I go on a spree to get new music to replace my old standards and try to get a little more exposure to what else is out there. I'm not really hip enough, nor do I have the leisure time, to really keep up on "what's new" or "what's hip," I can really only just skim around and see if there are any new sounds (to me, at least) that are pleasing (to me, at least).

In this vein, I thought I would try my hand at some international music. While the United States and, to a lesser degree, the United Kingdom definitely dominate the popular music scene, and while we do indeed produce some fantastic music for consumption, I do think that other countries get the short shrift. Now, granted, listening to foreign music (other than German), also takes out an important component of lyrical composition, which means that the overall singing quality, never mind the cadence of singing, becomes much more important as there is nothing lyrically to be derived due to lack of understanding. I guess that maybe sets the bar higher, perhaps?

In any case, in my search, I stumbled upon what I think is a gem of a musical group from France called "Plume." I'm not entirely sure if it's a solo female act with rotating musical guests, or if indeed it's a band name, and I don't know French so I can't get much out of this site. But if I had to describe the music, it's sort of a pleasant, meander through the park with folksy DiFranco sensibility. I've listened to her album Même Pas Peur a little bit already and it's proven itself nice study-along kind of music. Hopefully it'll give me that extra inspiration for doing my stupid residency applications.

So I've posted a video above, as you can see. It's not my favorite off the album, but it's nice and I think it's kind of adorable how they're playing the song up in a tree.

The Philosophy of Recovery

2010-08-18T21:56:00.005-05:00

A picture (stolen from here), portraying the statue "Addiction & Recovery" at the Cheekwood Botanical Garden & Museum of Art in Nashville, TN

Today I attended a National Alliance on Mental Illness (NAMI) and the featured speaker was Dr. Mike Miller, who will soon be heading up a clinical division in one of Wisconsin's largest and most prominent rehabilitation centers after dedicating a career to addiction medicine in Mad-Town. Needless to say, he's pretty smart when it comes to addiction medicine. I've heard him speak before on the topic, and he largely covered similar points (although modified in order to address a general audience). What struck me the most, though, and the point he really emphasized for those of us who were health professionals (or soon-to-be) in the audience, was the idea of recovery.

Recovery, as I realized tonight, is a lot more nebulous concept than I initially thought. My little widget dictionary defines it as follows:
1. A return to a normal state of health, mind, or strength
2. The action or process of regaining possession or control of something stolen or lost

I think recovery is generally easy to understand in concrete contexts, such as with sports injuries or broken bones, whereby recovery usually just means that you can play without risking further pain or injury. If it hurts or breaks, you're not recovered. Simple.

But what does recovery from mental illness mean? What about recovery from addiction and substance dependence? In fact, what does recovery from a chronic condition even mean? Is it possible and, if so, what form does it take?

One theme of the discussion today was that recovery is possible in addiction medicine and, although working with addicts seems like it would be both depressing and frustrating wrapped into a gigantic ball of feelings of worthlessness, the reality is that it's a very satisfying discipline because recovery IS possible.

The initial response with most people in regards to recovery from addiction is that recovery is simply abstinence. If this were true, quitting would be a lot easier: stop the offending agent and recovery is over and done. It suggests that recovery by abstinence is simply a matter of will power, that you just have to be fed up enough to say "OK, I'm done with that" and presto! problem solved. The the defining feature with addiction and substance dependence, however, is that you engage in a problem behavior, it causes a detrimental outcome, and then you still do it. It's more than just a frame of mind, more than just a poor behavior that you can spirit away. It's an alteration of your brain chemistry, a pathological way of life that exists at the core of your being. Yes, abstinence is necessary for recovery but, as they say, it is not sufficient for recovery.

Freud once said, when referring to recovery in the context of mental illness through the use of psychotherapy, "Love & Work are the Cornerstones of our Humanness." By love, he meant meaningful relationships. By work, he meant occupation and employment in every sense of the word, that we can successfully function in a society.

Pathology arises when love and/or work are violated, and recovery is about establishing a relationship to love and work in some way. This is as true of addiction medicine as it is of any rehabilitative process. Without this, recovery is neither met nor does it have meaning.

I thought something else Dr. Miller said in his speech today was also very interesting, something that I've known for a long time but have not been able to express as eloquently. Recovery, and the cornerstone of a satisfying existence, has less to do with nirvana than it does with serenity. These may seem like the same thing, but serenity has much more to do with being at peace than reaching an ultimate peace. It's about being satisfied with what you have and not constantly working to reach the impossible that you can never have. There is no ultimate peace, only the minimum amount of peace that we can live with to be happy. Serenity is many things to many people, but reaching serenity is reaching recovery.

I doubt I'll be going into addiction medicine, but I do think that thinking about what it means for people to recover, what it will mean for my particular patient population to recover, will help me order appropriate diagnostic tests, prescribe appropriate medications, and think about appropriate research questions to best help my patients reach serenity. Love, work, and serenity. It's attainable by all.

Reaffirmation That Concussions Are Serious Shit

2010-08-17T23:51:00.003-05:00

Stolen from a site about bicycle safety.

Concussions, for those of you who don't know, are best described as a bruising of the brain.

The human skull has evolved remarkably to accommodate an organ that requires not only extraordinary amounts of protection from the outside environment, but that also requires a low-pressure, low-resistance environment that can accommodate the high flow-through of oxygen and nutrients necessary to keep it running. So The Committee (as my old professor Dr. Al Beulig used to refer to the anthropomorphism of the process of natural selection) got together and gave humans, as well as a whole slew of other mammals, the skull filled with fluid to allow the brain to freely float in a protective, closed environment and allow for absurd amounts of blood to flow through it to nourish it.

Now this was an extremely clever design, and The Committee should certainly pat itself on the back. However, the hard skull can also present as the source of damage in certain circumstances, such as sudden decelerations or extremely hard impacts. It is thus frequently the case that hard blows to the head cause damage to the brain not so much by the impact of a blunt object itself but, instead, the resulting sudden acceleration of the brain and the crashing of said organ into the hard, unyielding surface of the skull. When this happens, the tissue of the brain can become damaged and cause bleeding or an inflammatory reaction. In severe cases, these lead to life-threatening hematomas or strokes. In "milder" cases, it simply leaves you with a bruise, or a concussion.

Now, back when I was a kid, it seemed like concussions were only kind of a big deal, and the main management strategy was to just wake the concussed person up once an hour to make sure he/she was still breathing, or maybe get a CT scan if one was really concerned about altered mental status and bleeding. Even today, most people talk of concussions in terms of "when can you put me back on the field coach?" In other words, I think it's often portrayed more as a nuisance rather than any sort of serious medical condition.

Not that long ago, researchers in the field started noticing correlations between the number and severity of concussions and the development of depression, suicidal, and demented behaviors. Thanks to a study on football players, who are notorious recipients of frequent concussions, evidence started to mount suggesting that players who sustained more concussions manifested a much higher incidence of things like depression and Alzheimer's Disease. This has prompted several football players to donate their brains to science after they die, and has also made everybody take concussions a little more seriously than they used to.

It wasn't really until we looked at concussions and head trauma in the context of soldiers in our ongoing wars that we more closely scrutinized this notion of traumatic brain injury as a prognosticator for future disease, including depression and memory issues [click here for a free download from the New England Journal of Medicine on the topic]. Concussions are no means as benign as we thought they were, and we continue to learn more about their long-term impacts all the time.

Today was no exception.

The NY Times posted a very fascinating article, appealing to all those neuroscientist baseball fans out there, suggesting that Lou Gehrig may not have had actual Lou Gehrig's Disease, or amyotrophic lateral sclerosis (ALS). Instead, the researchers who motivated this article in the Grey Lady suggest that people with severe head trauma manifested a spectrum of symptoms similar to ALS, in which the anterior horn cells, which are where muscle motor neurons "attach" and receive their messages to stay alive sort of inexplicably degenerate. The authors didn't actually explicitly comment about what happened to Lou Gehrig but used his reputation of playing through concussions as an example of how he might have had concussion-related ALS rather than this other, perhaps auto-immune, process of neuronal degeneration.

This revelation, if true, is fascinating for a variety of reasons. In addition to my newfound fear of and respect for concussions and their resulting sequelae, it is also potentially presents a fascinating insight into how ALS develops. Could this suggest a common mechanism among all conditions of presenting like ALS, or does this represent a new, distinct subset that can either be prevented (by wearing better helmets) or treated in a different manner entirely?

The field of neuroscience continues to grow everyday, such that even the mundane things like concussions are seeing a whole new light and are representing a much more sophisticated area of study and disease.

As for me, it's getting to be time to gently lay my head down on that soft, fluffy pillow for the night.

Experiential Theatre: Free-Will in the Anonymous Voyeur

2010-08-16T23:47:00.006-05:00

Picture surreptitiously stolen from Variety.

First of all, let me just state that, with that sonofabitch Step 2 board examination behind me (I find out in 4 more weeks whether or not I passed it, so we'll reserved judgment on the finality of it), and being immersed now in a year all about gaining experience and finding a job rather than taking tests and worrying about impressing the pants off people, I must say that I feel liberated once again to explore my side passion in the arts.

As most of you readers probably know, I have had occasion to write and stage plays during my time here in Mad-Town. Granted, the plays were mostly silly little diversions about the manipulation and meaninglessness involved in formulating romantic entanglements (and even that description is giving them too much credit), but it did whet my appetite for more (and more sophisticated) play writing. One idea I've had for a long time but have not quite brought to fruition is a play of terror, one that would involve the entire audience, which would integrate actors into the audience and ideally leave the audience guessing whether they should participate or not. However, I'm not nearly experienced enough as a director to make amateur actors good at improvisation, and the situation otherwise just smacks of really poorly executed dinner theatre.

But I've continued to be intrigued about plays of terror, interested in the idea of whether you can inspire fear and horror into something as deliberate and staged as a play in a culture that is very experienced with and jaded by entertainment consumption. However, I've never been smart or talented enough to do experiential theatre, especially one that is supposed to scare, in any meaningful way.

I suspect, however, that a recent article I read in the NY Times about a play called "The Duchess of Malfi" may finally have provided the model and the inspiration I've been looking for. It's a free-form "opera" of sorts, in which the audience is given identical-looking masquerade masks and are then allowed to freely assemble across a variety of spaces to watch things unfold as they please. It's a beautiful concept (apparently poorly executed in the case of this particular production, according to the review in Variety). Let me explain why.

First of all, there is the very nature of the audience participation: imagine a story unfolding around you and you, as an audience member, simultaneously in the middle of all the action, free to go wherever you want, but completely anonymous and unacknowledged by everyone around you, especially the actors who do whatever they have to do. The story is unfolding around you, and the story is not truly acted for you in any traditional sense. The actors are going to do whatever they need to do, regardless of whether you are there or not, regardless of where you're standing. And you as an audience member, in your mask, not only are completely meaningless and powerless, but you also have your vision restricted by the mask you are wearing and, hence, cannot necessarily fully interpret what you are seeing even when you are up close and personal.

Which brings me to the next cool point to this concept. Imagine both the exhiliration and the frustration in deciding how to watch the story unfold. There is action taking place in a variety of different settings, all at the same time, and it is up to you and your free will, your biases, your curiosities, your whims, to follow whatever sequence you want to. You may have good instincts and follow a thread that is more or less in sequence, but chances are good you'll make a couple wrong turns and watch something that is less relevant to story development, but more relevant to character development. In any case, you will never know the whole story because you simply can't watch the whole story. You'll have to see it multiple times and pursue different avenues, or band together with friends to exchange notes later on. You might witness one sequence of events and find out only later what the motivation was, which could change your whole perspective on what you saw. A series of actions that seemed confusing may become justifiable with shared information, or vice versa.

I think this is one of the best ideas I've read about in a long time and flies in the face of theatre as a shared, unified experience. Why not make theatre more like real life, letting the audience participate and use their own free will to determine what they take away from the story?

I think writing, let alone staging, a play like this would be pretty darn close to impossible for a greenhorn like myself. But you know what? I think I'm going to try.

How to Revisit an Epidemic

2010-06-30T16:14:00.005-05:00

Well, this NY Times article from today definitely suggests bad news:

"The weak economy is ravaging the government program that provides life-sustaining antiretroviral drugs to people with H.I.V. or AIDS who cannot afford them. Nearly 1,800 have been relegated to rapidly expanding waiting lists that less than three years ago had dwindled to zero.

[...]

"Without reliable access to the medications, which cost individuals in the AIDS Drug Assistance Program an average of $12,000 a year, people with H.I.V. are more likely to develop full-blown AIDS, transmit the virus and require expensive hospitalizations.

"Eleven states have closed enrollment in the federal program, most recently Florida, which has the nation’s third-largest population of people with H.I.V. Three other states have narrowed eligibility, and two of them — Arkansas and Utah — have dropped scores of people from the program.

[...]

"Louisiana capped enrollment on June 1 but decided against keeping a waiting list. “It implies you’re actually waiting on something,” said DeAnn Gruber, the interim director of the state’s H.I.V./AIDS program. “We don’t want to give anyone false hope.”

During the 1980s, we had very little knowledge about HIV/AIDS, and infection rates bloomed exponentially. Even the first drugs introduced in the late 80s and early 90s, what with poor compliance due to horrible side effects, high expense of the medications, and high rates of resistance development did little to curb the ballooning infection rate and the comorbidities, although it did help to slow down the overall prevalence a little bit.

The remarkable advances that have been made in the latter part of the last Century and this new millennium were two-fold: as we understood more about HIV's role in AIDS development, and as society was more willing to accept HIV/AIDS as a non-divine-punishment-against-homosexuals paradigm of disease, we developed better medications and regimens that could target multiple stages of the viral replication cycle and featured more tolerable side effects, which effectively increased compliance and lowered resistance. As it turns out, this served another purpose: by effectively treating HIV, while not curing the individual, at least ushered in a state of dormancy that both lowered the likelihood of transmission to new people (and, ergo, served to stem the rising incidence and prevalence of HIV/AIDS). Furthermore, with appropriate treatment, the medications helped generate people who could still be productive members of society and who were not deteriorating and occupied solely with consuming expensive medical resources. However, due to the high expense of the drugs, government programs and drug industry assistance developed mechanisms of helping finance these medications, not just because it would save on overall societal expense and increase productivity, but because it was deemed the right thing to do for the citizenry and for protecting public health concerns.

The programs have worked. In a relatively recent column in The Times in the United Kingdom speculates that the worldwide AIDS pandemic could be under control in 5 years if we continue to pursue aggressive treatment:

"Dr Williams, a former WHO epidemiologist who still advises the UN body, said: “The question is, can we use anti-retroviral drugs not only to keep people alive but also to stop transmission? I believe that we can. I believe that if we use them effectively we could stop transmission within five years.”

Anti-retroviral drugs are so effective at containing HIV that deaths are becoming increasingly rare in developed countries where patients have good access to them. Only about 12 per cent of HIV-positive people worldwide are currently taking the drugs, however.

As well as preventing the development of Aids, the drugs reduce the concentration of HIV in patients’ blood by up to 10,000 times. This makes them about 25 times less likely to infect others through unprotected sex.

Dr Williams said this could be exploited to halt transmission, provided people are tested annually so they can start treatment soon after infection. It would also be necessary to ensure that most patients take the drugs correctly."

Therefore, news of programs limiting enrollment in our country, halting program enrollment, or even outright dropping people from the drug assistance program, while certainly understandable given the ill health of our economy, is disturbing to me as a soon-to-be physician and as a stakeholder in public health measures. And I fear that if we do not do something soon to curb this problem, people with HIV will go on to develop AIDS and we'll be back to square one. We've come so far in making living with AIDS a chronic disease rather than a killer of epidemic proportions, and I'd hate to see us go back to those days.

Teach The Controversy

2010-05-26T22:12:00.003-05:00

The Onion News Network once again totally nails it. And, of course, this controversy is brought to you by the state of Kansas:

Christian Groups: Biblical Armageddon Must Be Taught Alongside Global Warming

I think my favorite part is when the one expert says that children need to be taught that the seas will turn to acidified waters, whereupon the counterpoint expert interjects, "No, they're going to turn to blood! Ridiculous!"

The thing is, this captures with overwhelming clarity (and satire) the ridiculousness of the "teach the controversy" camp. Nobody is saying that you can't believe whatever you want about how life and the universe (or the ending of said things) came about, but it's ridiculous to think that hypotheses that have absolutely no scientific backing should get equal exposure in a science curriculum. Perhaps we'll "teach the controversy" when we have a little more evidence than a book and a gut feeling.

Color Me Unsurprised

2010-05-25T23:10:00.003-05:00

Or not (via the NY Times):

Nearly all of the herbal dietary supplements tested in a Congressional investigation contained trace amounts of lead and other contaminants, and some supplement sellers made illegal claims that their products can cure cancer and other diseases, investigators found.

The levels of heavy metals — including mercury, cadmium and arsenic — did not exceed thresholds considered dangerous, the investigators found. However, 16 of the 40 supplements tested contained pesticide residues that appeared to exceed legal limits, the investigators found. In some cases, the government has not set allowable levels of these pesticides because of a paucity of scientific research.
Investigators found at least nine products that made apparently illegal health claims, including a product containing ginkgo biloba that was labeled as a treatment for Alzheimer’s disease and a product containing ginseng labeled as a treatment to prevent diabetes and cancer. They also described a salesperson at a supplement specialty store who claimed that a garlic supplement could be taken instead of blood pressure medication.

Seriously, who can say they are honestly surprised that these completely unregulated substances - which skirt the standards set by the FDA and, well, the medical and scientific community - are actually of little positive consequence and, in fact, may have more adverse effects than what they claim? I have long been annoyed about the degree of leniency given to herbal supplement manufacturers and the outrageous claims that they make, but perhaps a study like this might lead to a serious crack-down of the charlatans.

But hey, wait, didn't I see that trace amounts of mercury are in these substances, but not enough to exceed the threshold to be considered dangerous?!? Holy crap! Perhaps the mercury-causes-autism camp needs to jump on this bandwagon. Oh wait. Chances are these advocates were treating their polio infections with herbal supplements. What a conundrum.

Not To Be A Shill

2010-05-22T13:38:00.004-05:00

But this is the best freakin' soccer ad I think I've ever seen. Say what you will about Nike, but they really capture the spirit and the elegance of the beautiful game in this ad. And can I just say for the ten-thousandth time how stoked I am about the World Cup? Opening games on June 11th.

Story of My Life

2010-04-29T19:25:00.000-05:00

The Kids In The Hall summarize it so succinctly:

Mi Estomago Esta Enfermo

2010-04-22T17:32:00.002-05:00

I don't know if that's how you say it in Spanish, but it's close enough.

As usual per my posts, there are a number of people I am going to invite to kiss my ass.

Ever since moving to Wisconsin, much to my chagrin, I have gotten sucked into the game of football. I flirted with an interest in football when I lived in Texas many, many years ago, back in the days when the Dallas Cowboy cheerleaders were all the rage (and when I was too young to care about any of that). My parents nipped that one in the bud by moving to Germany, which turned me on to an entirely different set of athletic prima donnas, but I digress. But when I moved to Wisconsin, almost 20 years later, I became enamored with the fact that a football team could be owned by the people of a state and that everybody had an investment in the team and, for that reason, could keep them playing in a very small and cold town like Green Bay. The idea of an essentially socialist stake in the local professional football team charmed me to the point where I started watching them. And the more I watched, the more I understood, and the more I understood, the more I could...well...enjoy it.

So now I'm kind of a professional football fan, but mainly for the Packers. But, of course, watching the Packers play is a tacit endorsement of the entire national football league as a whole and, well, they continue to make it harder for me to support their franchise.

The most recent example and, to me, most egregious, comes in the form of Shithead McAsshole...err, I mean, Ben Roethlisberger.

Now for those of you who are neither football fans nor residents of the Rust Belt, Big Ben is the star quarterback of the Pittsburgh Stillers, leading that team to two Super Bowl titles in the past 7 years or something like this. So, yeah, he's kind of a big deal in the national football league and particularly in Pittsburgh.

Trouble with Ben, though, is that he tends to be kind of a bad boy. But in that criminal and exceedingly shitty kind of way. His latest digression in morals is summarized succinctly by Timothy Egan in his NY Times opinion column on the matter of Big Ben:

After hours of drinking and carousing, the six-foot-five-inch football player followed an intoxicated 20-year-old student into a club’s bathroom and forced her to have sex, the woman told police. When her friend appealed for help, she was ignored by the bodyguards, the report indicated.

Think that's bad? Well, consider the following to put into context:

This was the second time in less than a year that Roethlisberger has been accused of sexual assault. Last year, a woman claimed in a civil suit that Roethlisberger raped her in a hotel room in Lake Tahoe, an allegation he denies. The Georgia report also mentioned a third woman who said a drunken Roethlisberger accosted her repeatedly on two occasions.

And now for the worst part: he's not going to be charged, because...

Prosecutors said they would not file charges against the quarterback — in part because of sloppy police work by officers who fawned over the athlete — but they castigated his behavior.

Oh, a castigation. I'm sure that makes the woman forced to have sex with him feel a lot better. Yup, that's the wonderful world of Big Ben Roethlisberger, who is a role model to thousands of children in Pennsylvania and who are now learning that it's OK to rape women.

And although Big Ben is apparently not going to be charged with criminal offenses, surely the NFL will see him for the douchebag that he is and kick him out of the league, right? Like they did with Michael Vick, former-quarterback of the Atlanta Falcons, who was kicked out of the league and thrown in jail for about two years after running a dog-fighting gambling operation (and who also would go by the pseudonym Ron Mexico to sleep with women and give them herpes). Or maybe like they did with Plaxico Burress, who got kicked out of the league and sentenced to two years for weapons possession charges and for being a dumb-ass and shooting himself while carrying a loaded Glock in his pants. Surely Big Ben will face similarly stiff charges from the upstanding organization of professional footballers. And perhaps, one day, there will be peace in the Middle East. Here from the NY Times:

Commissioner Roger Goodell met with a group of incoming rookies this week in New York for the annual N.F.L. draft. His message, not surprisingly, was about conduct, comportment, behavior. He told the young men that the National Football League wanted players to understand the importance of responsibility and good judgment. In other years, the commissioner’s words might have gone in one ear and out the other. But not this year, not in the wake of Goodell’s suspension of Pittsburgh Steelers quarterback Ben Roethlisberger on Wednesday for six games without pay for violating the league’s personal-conduct policy.

And, according to the article, this is apparently a harsh sentence and that Commissioner Goodell should be commended for being so tough on bad behavior. I'm sorry, but how should a paltry six-game suspension make me or, what's more, these poor assaulted women (I know, I know, innocent until proven guilty, but I'm inclined to take these charges seriously as I presumed, falsely, the league and the prosecution would), feel any better about sexual assault? This act has essentially gone unpunished and this asshole will likely be drafted into the hall of fame after his career his over and lionized for his performances and athletic prowess, and that's all that we'll remember of him. Well, Big Ben, you can kiss my ass. As can Roger Goodell and his entire league.

The whole thing is so offensive, it makes me absolutely sick to my stomach.

My Foreseeable Future

2010-04-17T00:42:00.002-05:00

As I am starting to come to conclusions about what my future medical career will look like, I take this funny little YouTube clip as a warning message:

Wearing Thin

2010-04-16T09:01:00.002-05:00

I've been back in medical school now for 9.5 months and, in general, I've been very happy with my return to the clinics and hospitals. Working with people and doing your best to make them comfortable and treat their disease, or to simply hear them out and let them know that somebody cares, has been an immensely satisfying experience and stands in stark contrast to the doldrums of delayed (if any) gratification that defines a graduate student's experience. In this time, I've seen bladders converted into bowel, pulled teeth out of a cancerous jaw to reconstruct the jaw, excised moles for biopsy, witnessed extractions of thyroids and parathyroid glands, helped remove a gallbladder and ablate a liver cancer, treated kidney failures and heart attacks, evaluated and treated strokes, watched the transformation of severely mentally ill people into normal human beings after being ordered to take medications, and any number of cool and interesting things. Even my most recent delivery of a baby and its placenta (all on my own, I might add) counts to one of my most satisfying and career defining moments.

However, the OB/Gyn rotation, while it has its moments, is making me realize just how sick of being a medical student I'm starting to get. OB/Gyn, more than any other rotation I've been on, and especially as a male student, requires so much walking on eggshells and is a topic so radically different from what my institution encourages in its educational mission, that I feel almost completely useless on this rotation and have no leverage or ground to stand on to get the patient interactions that is the only thing in medical school that offsets the feeling of complete ineptitude. It's hard to explain, but there's a delicacy that must be adhered to because of how emotionally charged issues of pregnancy and gynecology are. What's even more draining is that, as a medical student, your role is to really jump in and get to know people and try to behave as much like a physician as possible (of course, pelvic exams are discouraged, understandably). However, in the same breath, we are told to be very mindful of patient privacy as well as "ownership" of patients by the nursing and physician staff. In principle, I agree that we should not impose care onto patients that is unwanted or makes them feel uncomfortable. On the other hand, it seems unreasonable to expect me to get a full experience out of this rotation without having some sort of backing to get the appropriate training and exposure that would immerse me in the clerkship. And while there's still the element of awe in seeing new things and meeting new people, I'm getting pretty sick of alternating between being a wallflower and chasing around after physicians and residents trying to figure out how to be useful. Although it'll carry a lot more responsibility, I'm looking forward to the time when I can feel like I'm managing my own patients, making my own decisions, and getting the best exposure and information without feeling like I'm getting in the way of other physicians or imposing upon patients. But for now, I'll continue to tiptoe through this rotation as I have been. Only two more weeks...

Space, The Continuing Frontier

2010-04-15T16:38:00.003-05:00

Say what you want about space exploration, but I personally think it's one of the coolest and effective mechanisms by which to advance science and technology. Although it sounds trite to advocate for an eventual orbit and landing on Mars, the progress and innovation that will have to go into this endeavor will span much more utility than merely sending a person in a capsule to a planetary surface. NASA, for all its criticisms, has consistently brought excitement and inspiration to us will simultaneously delivering rapid advancements in technology. Far from an outdated, cowboy-esque venture into the realm of science fiction, NASA spurs innovation and dazzles our minds with promises of future curiosities and new philosophical perspectives.

It is for these reasons, and many more, that I was delighted to see that President Obama threw the full weight of his support behind the mission of NASA. I think developing new projects and contracting private industry to help make these into realities will serve both our intellectual curiosity and our wounded economy well. Here is his press conference to NASA in which he gets the Kennedy Space Center, and this humble writer, totally jazzed about space exploration.

Visit msnbc.com for breaking news, world news, and news about the economy

New Look!

2010-03-23T20:01:00.002-05:00

I've updated ye old blog a little bit to make it a little more hip for the kids. It's gotten significantly busier, but I guarantee that it will be the same crap content that I usually write about. Or, at least, that I will write about when I'm not busy studying ophthalmology and neurological sciences. But for now, enjoy the new look and enjoy the multitude of links that I'll be adding over time. If you like what I've got, and lord only knows why you might, then perhaps you'll like some of these other stooges I read on a regular basis.

Mitternacht Musik: Duhks

2010-03-22T23:46:00.001-05:00

Taking a slight departure tonight with a Canadian folk act, featuring probably one of the most heavily tattooed folk singer I've ever seen. The quality of the recording isn't that great but, compared to many other YouTube live presentations, it's actually quite clear. But I digress.

I first heard The Duhks about a year ago and was pretty impressed by the diversity of their sound and their singer's mournful/raspy voice. On their album Migrations, from which the song I have posted stems, they transition easily between traditional folk to old spirituals to Celtic-flair to mournful dirges with gentle ease. It's a nice selection to drive down the road to as it calms the nerves, and it's something you could perhaps see yourself even dancing to if you're into that arms-outstretched-spinning-in-circles hippie kind of dancing. All in all, this is a nice song from a pretty solid album.

Confronting The Squishy Eye

2010-03-22T23:31:00.002-05:00

Today was my first day on ophthalmology. Now, for those of you lucky enough to be entirely divorced from the medical discipline, the examination of the eye is probably one of the more intimidating exams for medical students. Much of the eye exam is fairly straight-forward, such as testing visual acuity or visual fields, or even just testing eye movement. These techniques require by far less training compared to recognizing additional heart sounds or murmurs, or performing proper musculoskeletal examinations. That being said, missing something on the eye exam is very, very bad and can have devastating consequences if missed, resulting either in blindness, coma, or even death. In particular, one of the most important eye examinations is using the direct ophthalmoscope to visualize the retina, the fundus, and the optic nerve because the optic nerve, in particular, serves as a direct method of observing what is happening in the brain and can be the first clue to changes suggestive of cerebral hemorrhages, pressure or mass lesions, or a variety of other neurological disorders. And unlike other organ system examinations, such as the heart, where you can often inform yourself with ancillary testing such as EKG or even CT or MR imaging, the eye exams is often all you've got to work with to establish an appropriate working diagnosis.

What's worse is that the funduscopic examination is really freakin' hard. Trying to look into a very small pupil by shining light on it is kind of the gross-level embodiment of the Heisenberg Uncertainty Principle: you affect the system merely by observing it. Medical students won't ever admit it to you, but more often than not when we look into your eyes with an ophthalmoscope we have no idea what we're seeing. And I suppose that is why we have this week-long exposure in the first place. And, sure enough, after a thorough orientation, I have already successfully identified features of four separate optic nerves without too much difficulty. Granted, these were all on dilated pupils, but you have to start somewhere.

Well, that perhaps wasn't too interesting, but I'm saving my more thoughtful writing for when I have more time. Like after my three final examinations culminating at the end of this week...

Mitternacht Musik: Cougar

2010-03-21T22:48:00.003-05:00

Taking my cues from other blogs that I read, I think I'm going to start posting songs from bands that I like in the off-chance that anybody cares.

This is a selection from a band called "Cougar," a band that Dr. Bizzarro turned me on to with a Xmas gesture. They're an all-instrumental band but, being signed to Ninja Tunes, have a distinctive jazzstep/drum-and-bass kind of feel to them. Though this particular song has a bit of a harder edge to it, in general it's music that you can groove to, featuring some interesting time signatures and floating melodies while remaining completely and utterly acceptable. I could almost - almost - see it in a dance club.

This particular song off their new album "Patriot," called "Stay Famous," is a nice example of their work. The corresponding video is incredibly stupid, not to mention completely missing the mark on how to correlate the mood of the song with events ongoing in the "film." But if you ignore the crappy video, or just turn your screen off, and listen to the music, I think you'll find it quite enjoyable, too.

Of Mice and Straw Men

2010-03-21T21:58:00.004-05:00

Well, it's official. I just saw the House of Representatives pass the senate health care bill by a margin of 219-212. The Democrats also shut down procedural roadblocks of the reconciliation bill, which they subsequently passed with a margin of 220-211. While I'm certainly happy that we are moving in the right direction here, I'm certainly far from satisfied regarding the scope of health care reform, but I guess we take it one step at a time. One thing is for sure: the whole process of health care reform has really made me appreciate just how despicable some people can be.

First of all, it is absolutely incomprehensible to me how you can ever make a moral argument against extending health care coverage to your fellow citizens. Fiscal responsibility is all well and good, but moral philosophy dictates that we do as much as we can to maximize overall "happiness." And part of being a civilized, moral, evolved (and rich!) society is that we take care of our own by whatever means possible. Besides, it is absolutely disingenuous for people to scream bloody murder about spending on health care reform when untold trillions were spent on two needless wars and tax cuts for the wealthy, not to mention there is ample evidence from the government accountability office that investment in preventative and evidence-based medicine will actually be more affordable in the long run.

Secondly, what the hell is up with protesters of the bill yelling racial and sexual orientation epithets at Congresspeople entering into the legislative chamber? I don't really see what ad hominem attacks have anything to do with health care reform, but I guess I do understand how desperately angry people might resort to such vitriol when they know they're losing.

Finally, I'm pretty sick of the misrepresentation of health care reform that there has been with regards to "Death Panels" and federal funding of abortions and exponentially increasing deficits and assaults on democracy and such. These are absolutely ridiculous arguments with no basis in reality and meant only to distract people from the facts.

It's not quite what I would want out of health care reform, but I'm happy that we're trending in the right direction. And with any luck, perhaps if people start seeing the value in extending health care coverage, we'll reach that promised land of health care for all. Perhaps.

Random Musings

2010-03-12T07:05:00.002-06:00

Believe it or not, just as I was hoping, I'm starting to come to some conclusions about my further professional development in few uncertain terms. However, I'm going to ride the rest of my rotation out here on neurology, and hopefully talk to some staff and residents, before making a final decision and, ergo, writing about it on this here blog. But rest assured, I've gone through some pretty serious mental acrobatics over the last several months and I'm beginning to come to terms with my decision now that I have a good deal more information to operate with. But, again, I think I'll table that for now.

Part of it could be that my mood is significantly improving now that winter seems to be dispelled with a rainier, but altogether more temperate, season. Perhaps this will be the first year that I can enjoy an actual spring before my allergies inevitably kick in around May/June.

And finally, a quick opinion about health care. There is some definite, palpable uncertainty and excitement around this here hospital now that a bill is inching ever-closer to reality. I think there's a great deal of apprehension, for sure, but being in a liberal town does bias most opinion toward at least a cautious optimism.

OK, I actually just wrote this because I've gotten complaints about having not updated for the past month. ;-) More soon when I have a little more time.

Thoughts on Psychiatry

2010-02-08T15:37:00.002-06:00

Well, I suppose some words are appropriate to describe my psychiatry experience:

My assignment for my third-year psychiatry clerkship was at one of the state hospitals here in America's Dairyland. As I am considering a potential career in psychiatry (one of four disciplines in the running), I thought it only appropriate to see the sickest of the sick to determine whether this was the field for me or not. I must say, this was extremely rewarding work and though I felt mostly out of my element the entire time I was there, I did learn a lot about things I hadn't anticipated to learn about:

1. Working with a patient population that mostly has no insight into their conditions was very challenging. First I had to overcome that internal alarm telling me I was being paternalistic, like somehow I knew the answer to what was wrong with them. When working with the severely psychiatrically ill, you have to realize that patient-physician partnerships are entirely different beasts than in other settings. No patient of ours thought that there was anything wrong with them, even when they were telling us they thought they were Jesus. But even the less severely ill don't have insight into their conditions, so you have to develop a bond of trust, playing into their frames of mind while simultaneously not reinforcing it. And you have to do all of this and suppress that feeling that you're swooping in and telling them what's wrong with them, which is what medical schools are teaching is us the wrong approach, however appropriate and necessary it might be in this setting. It's a very tricky thing to do, and it's certainly not something that just anybody can do.

2. My first week there, I was constantly getting completely different take-home messages out of my admission interviews than my attendings were. Whereas I heard a very sad story and saw a victim of circumstances sitting in front of me, my attendings were always more skeptical and more prone to detecting overt manipulation than I. Inevitably, it turned out they were right and upon getting more information from people that we had releases to talk to, we would get a completely different story. My main attending would always tell me, when I would walk away from an interview feeling discombobulated and perplexed, that I would never have enough information to know the whole story so I would always have to keep digging. Another psychiatrist that I asked about this put it more succinctly: "you should believe everything the patient says while also believing nothing the patient says." In other words, the story is the truth when the patient recounts it, and you should respect this perspective, but you should also realize that the story is coming from a person who not only frequently lacks insight into their condition, but is also a human being and, like the rest of us, tells stories that favor a personal slant. Psychiatrists aren't soothsayers or lie detectors, you just have to evaluate the whole person the best you can, collect information the best you can, and synthesize conclusions that have a healthy degree of uncertainty. It's really hard work and takes a long time to develop that sense, and perhaps that's why residency in psychiatry is 4 years long (whereas fields like internal medicine, family practice, and emergency medicine are only 3 years).

3. Psychiatrists have to do so much management of patients that it's kind of ridiculous. It's not just the intake assessment and the drug management, it's coordinating all of the other care, discussing social issues with the social workers to determine feasibility of medical and personal management, working with occupational therapy to determine whether they can take care of themselves in the first place, coordinating care with other physicians to determine previous medical and psychiatric management and complications, advocating for patient safety and population security in court cases determining orders to treat and involuntary commitments, working with nurses to provide the best possible care while simultaneously ensuring that they are safe around your patients, and coordinating psychological testing that is appropriate for every particular patient. Mind you, the psychiatrists I worked with had an amazing team of social workers, occupational therapists, nurses, lawyers, and other officials with whom to work, but in the end the psychiatrists had a lot of say in the coordination of these activities even if they didn't do the work themselves.

4. What I think I loved most about psychiatry, besides the interesting patient populations, the multifaceted work, the reasonably good working hours, and the rewarding outcomes is that it's a thinking discipline of the most philosophical order. Psychiatry is one of the youngest medical disciplines and is so unbelievably unexplored that it allows, and actually invites, its practitioners to constantly and actively consider theories to explain behavior. The scientific research in this discipline is certainly ripe as it slowly begins its reunion with the discipline of neurology, but until then it allows one to wax philosophically about disease etiology and the human condition. It's a lot of fun to do and keeps the mind constantly engaged. I can definitely see why every psychiatrist I've ever talked to, and there have been quite a few, are so happy and wouldn't trade their job for anything else in the world. Seeing happy practitioners, and academically and intellectually engaged practitioners, is a pretty huge draw to the field. So we'll have to see.

Quite Interesting, or How the BBC Destroys American Television

2010-02-01T11:21:00.005-06:00

I don't know if anybody has seen or heard of the show QI hosted by Stephen Fry, but the point of the show is to have comedians come on and take guesses at a variety of questions that they are unlikely to know the answer to. The thing that's nice about it is that they have a great time coming up with answers and make everything very light and humorous, but you learn a lot about trivia, popular culture, political culture, science, and what have you as well from the answers to the questions as well as the discourse that their tangents can generate. Here's an episode for your viewing pleasure, the topic being "The Future" (and just click on the play icon and don't worry about the low vs high quality buttons):

I always thought "Politically Incorrect" with Bill Maher was quite good about that when that show was on, and Real Time gets sort of approximates that kind of format, but the guests are frequently journalists, politicians, and such and I think it becomes a bit of a diatribe and polemic. QI is nice in that it explores a variety of topics without any particular agenda. Just good clean fun, and you might learn something, too.

Every Single News Report Boiled Down

2010-01-30T09:31:00.003-06:00

Well, I just finished my psychiatry rotation yesterday and, other than absolutely bomb-ing my final exam, I had an absolutely fantastic four weeks. I think psychiatrists don't get the credit they deserve as they are only seen as med management point people. They do so much more, as I found out over the last four weeks. But I'll write about my impressions later (if I remember to).

For now, I found this funny clip about the construction of newscasts that I thought was pretty hilarious as I was surfing through onegoodmove. It's funny because it's true. Gotta love the BBC.

I Wonder if Halliburton Can Come Camping With Me...

2010-01-24T18:57:00.004-06:00

...Because apparently the Supreme Court thinks corporations have achieved personhood status. I wrote about this pending decision a little while ago, but now it has become a truism in the eyes of the law. This decision by the Roberts Court has released a lot of checks on corporate spending for political gains. And though I think Olbermann's Special Comment is a little on the hyperbolic end of things, I do think that it will have some potentially serious, and devastating, consequences. Guess we'll find out in a couple months when the election madness begins anew, won't we?

Visit msnbc.com for breaking news, world news, and news about the economy

Simultaneously Hilarious and Sad

2010-01-19T20:22:00.004-06:00

A Democrat losing a major senate seat in Massachusetts is probably one of the funniest, and most tragic, things I've heard in a long time.

How stupid/inept/incompetent/supercilious/foolish/egotistical do you have to be to lose a senate race for Ted Kennedy's seat in Massachusetts as a Democrat? Apparently, your name has to be Martha Coakley and you have to perpetrate any number of foolish missteps including disappearing from the race until the very last weeks, running on a negative advertisement campaign when you are in the race, and just proactively pissing off Massachusettsians at every bend.

And now Democrats are bitching and moaning about how health care reform will never happen, blah blah blah. Color me delusional, but part of me thinks that the Democrats are relieved about having less than 60 votes in the senate because it gives them an excuse to be completely ineffectual and operate as victims and martyrs, just like they did for the last decade. I think this is a similar principle as retaining the incompetent and ineffectual Harry Reid as senate majority leader just so they wouldn't have anybody to actually bully the party into adopting some sort of hard and fast party line.

You gotta give the Republicans one thing, at least, and that's that they know how to stick together as a party. Kudos to another deserved victory, Republicans. You win this round.

The Future Is Here, And It's Freaking My Shit Out

2010-01-11T23:38:00.003-06:00

So I stumbled across an article in the NY Times again today, as I'm apparently wont to do, talking about the most recent technological expo featuring products that are controlled by your body and hand movements. We are moving to a controller-free society, people; we're getting to the point where we will not actually have to touch anything and can still consider ourselves as interacting. Take, for example, this advertisement for the so-called "Natal," that Microsoft is working on to compete with the Wii. Not sure if this is actual footage or if it's merely a concept film, but the implications are huge.

At risk of being dubbed a Luddite, I worry that we are providing the means of eliminating any form of tangible, material contact to anything around us. This seems like some kind of scary, science fictionesque metaphor for the desensitization and devaluation of the human condition. But it's also totally freakin' sweet.

Elections Are About To Suck More Than Usual

2010-01-09T09:25:00.003-06:00

Well, now we'll really be testing the idea that the candidate with the most money wins:

In an article in the New York Times, there is reporting that the Supreme Court has begun to strip away most legislation that limits campaign spending from outside organizations. Other court decisions have paved the way, but it is expected that the Supreme Court will find in favor of Citizens United in the case of Citizens United vs. Federal Election Commission. Citizens United, as you probably don't remember (I didn't), was responsible for a "documentary" that was a propaganda vehicle to blast Hillary Clinton shortly before election time.

While this ruling does not mean that large donors will be able to give untold amounts of money to actual candidates' campaigns (so-called soft money), it does mean that any organization that wants to may essentially have unrestricted spending amounts to launch advertisements and campaign efforts on their own volition, so long as they don't actually say "vote for this person" or "don't vote for this person."

There are many reasons to be upset about this. For selfish reasons, as a fairly liberal person who more often than not (read: always) falls in the Democratic camp, this gives a huge financial advantage to Republican candidates who have far more big business support and can now spend unfettered amounts for advertising/campaigning purposes.

I realize that my personal desire to not see ultraconservatives in office is probably not reason enough for a court to rule one way or another on a case. But there are two other very good reasons why this is going to just keep fucking things up for a pretty lousy system. For one, as much as people point to money as a gesture of "free speech," the reality is that only a small percentage of people really have all the money, so money is actually generally the voice of the few who have the money. This means that maybe 1% of the population, those who have the money to donate to political campaigns (usually big businesses and trade unions and lobby organizations and such) are doing all the talking while the rest of us were silent. You might point to Obama's amazing fund raising activity from small individual donors, but you'd be a fool to think he didn't have other things going for him like big business support and, well, a pretty miserable candidate going up against him. Secondly, and this is really the reason this fund raising loophole should not be expanded, the commercial blitzkrieg that we have to endure during campaign time are already intense, frenzied, and nasty enough. Can you imagine how much more of this we're going to have to tolerate? And you know there's going to be more. Our airwaves are going to turn in to some horrible feces-slinging melee of political rhetoric and finger-pointing. Maybe that will encourage me to spend less time in front of the tube...

Resolute

2010-01-01T21:45:00.003-06:00

New Year's resolutions are something I always make, even as I hypocritically espouse my disinterest in arbitrary changes to my life from arbitrary changes in calendar years. Nonetheless, here are my newest resolutions, which are really pretty much the same as my previous resolutions:

1. Exercise: this is always the case, but now that I've got a pretty solid routine, the dumping of snow isn't quite as preventative from me getting to the gym, no current injuries to nurse, and I'm in the semester of medical school when I actually have evenings and weekends open (and no dissertation or manuscripts to write), I may just be able to keep this one. 120 days for the year to get me my sweet health insurance reimbursement, so let's see if I can keep it (starting tonight!)

2. Food preparation: I really don't enjoy cooking all that much, but what I really hate is shopping for food. Nonetheless, I should try to dedicate at least a little time every weekend to picking up a few fresh vegetables and staples to make simple pastas or rice dishes for at least part of the week. Not holding out a lot of hope for this one.

3. Medical school: over the next three months, I'm doing rotations in areas that I'm strongly considering as rivals to my current favorite of internal medicine (more on this later). I want to have a strong showing in the clinic and on the exams so that I can get good letters of rec (and, you know, learn something) so that maybe getting whatever dream residency is my dream residency might be made a little more simply.

4. Creativity: over the past year, I have felt a progressive decline in my creativity as a direct result of writing a dissertation and going back to medical school. I have ached for the days when I could sit down and write, and my strong showing on reading and studying poetry quickly gave way to realities of graduate school graduation necessities. Hopefully I can pick up some short story/poetry reading on a nightly basis to keep that aspect going, and maybe get into some creative writing again. That and maybe the occasional piano playing. As the year goes on, hopefully I can even add those long overdue banjo lessons so I'm not just playing the two songs I've taught myself.

5. Feng shui: I know Dr. T will argue heavily with me, but I'm going to give a more concerted effort to keeping things at my house a little cleaner. I've been bad about that for a long time, and I think it's getting to be time that I try to tidy up a little more frequently than once every three months.

6. Social time: I think Dr. T and I need to do some more things other than sitting around at home chatting or eating dinner, like going to concerts or movies or inviting friends over or something. Maybe add in more trips to Chi-Town to visit friends and my wonderful family, including the ever-adorable Ewwol! It's tough with her busy job and my constant demands on my time at school, but I think a little adjustment in priorities can be accomplished.

7. Stop watching TV: I've still got my guilty pleasures, but I can limit those to weekends. I think I'm going to cut out the rest, even perhaps my favorite news shows (gasp!).

8. Learn Spanish: must, must, MUST do this. I'll check the funds after my taxes and maybe start looking into Rosetta Stone. Last time it's going to happen, if ever, over this next year and a half.

On Critical Thinking

2009-12-27T10:20:00.003-06:00

I know a lot of people are skeptical of the term "critical thinking," saying that it's casual overuse has devalued it. That being said, I think every one who considers themselves a student should at least watch this video to reinforce what we actually mean by critical thinking. And then, you know, try to apply it and live up to it.

I Give Up

2009-12-17T19:15:00.003-06:00

All right, people. I give up. Even with a strong Democratic Congress and a president who strongly supports (supported?) social justice causes, the health care "reform" effort is dead in the water: from a single-payer/universal health care plan to the severely diluted bastardization of Medicare expansion to 55 and mandatory private insurance purchases for everybody else? Pandering to one or two people such that everybody is left upset by the whole thing?

I know I'm supposed to be paying more attention and being more active, especially as this is the medical field that I'm entering in 1.5 short years. But I just can't bring myself to care. Maybe "care" isn't the right word, probably more like I can't bring myself to get invested. The little time that I spend thinking about it just makes me angry, and I don't like being angry. I know this probably makes me a bad person, but I just can't do it. Sorry.

So I think I'm checking out of politics for a while. It reminds me of how powerless I am to do anything, and also is deeply upsetting on top of that. So congratulations, America. You poured thousands of dollars to make another extremely well-educated person who is too disillusioned to do anything about it.

Auto Tune Once Again Allows Me To Be Lazy

2009-11-16T22:29:00.001-06:00

Yeah, I'm just not into posting right now. But I saw this pretty old Autotune featuring debate in the House of Representatives as well as talk about Michael Jackson's death that was pretty freakin' remarkable. One of their best!

Good Old H2O

2009-11-13T22:16:00.002-06:00

After a rather anti-climactic crashing of a multi-million dollar piece of equipment into the lunar surface, we finally find out that, apparently, it has done its job:

“Indeed yes, we found water,” Anthony Colaprete, the principal investigator for NASA’s Lunar Crater Observation and Sensing Satellite, said in a news conference. “And we didn’t find just a little bit. We found a significant amount.”

Here a recap of what happened, in case you didn't get to see the video live at 5 in the morning like I did:

The satellite, known as Lcross (pronounced L-cross), crashed into a crater near the Moon’s south pole a month ago. The 5,600-miles-per-hour impact carved out a hole 60 to 100 feet wide and kicked up at least 26 gallons of water.
“We got more than just a whiff,” Peter H. Schultz, a professor of geological sciences at Brown University and a co-investigator of the mission, said in a telephone interview. “We practically tasted it with the impact.”

I was a little skeptical about this project, even though the nerd in me thought it was pretty freakin' cool. But now that we have the results, I'm totally stoked. I'm not saying we should do this now, but the set-up of a lunar colony, potentially to serve as a go-between to further manned space exploration, is now within the realm of reality. With water as the limiting factor in those missions, because of its storage logistics, we may have devised a way around it. That is, until all the water we mine out of the moon dries up and it throws off the entire tidal system of Earth due to some freak change in mass effect. But we'll worry about that when the time comes.

The Art of Science

2009-11-13T14:15:00.004-06:00

Maybe I'm a nerd, but I think that science is quite beautiful. There is a common conception that scientists are nerdy, hiding behind microscopes and test tubes, interested only in numbers and facts, and understanding niches and microcosms.

I think there's some truth to that, for sure, and the disciplines in the natural sciences do tend to attract a caliber of people who spend lots of time studying the natural world while losing the bigger picture.

However, many scientists, when in appropriate moods and lightly prodded, are capable of stepping back and examining the beautiful impossibility that is life on our planet and in our galaxy and universe. Science, when you extract its core underpinnings from its infinite data, is as beautiful as the sunset that it seeks to explain.

Talking about science to the lay public, in particular, can sound like free-form verse, its message as finely put together as music. Which is why the downbeat autotuners at "Symphony of Science" have finally found a fitting marriage between the elegance of the scientific explanation and the emotional cadence of the arts. Granted, editing had a lot to do with making these tunes, but Carl Sagan in particular, who is heavily favored in these music videos, brings that gift of scientific storytelling and awe for all-things-universe that make these music videos truly work. A real delight. You can find more videos, and download the tunes, at Symphony of Science.

"A Glorious Dawn" featuring Stephen Hawking

"We Are All Connected" featuring Bill Nye, Richard Feynman, and Neil deGrasse Tyson

Idyllic Paradise Lost

2009-11-12T22:18:00.004-06:00

I'm not going to go into any details here, but something awful happened to one of our colleagues here. Fortunately nothing of serious consequence ended up transpiring and everybody is fine, but it has not only left a bad taste in all of our mouths, but has also resulted in many of us being uprooted from our living situations that we had grown accustomed to, including our new roommate the Surgery D.O. 4th year student who had previously been enjoying a nice large, quiet apartment to himself and now has to live with my roommate and I in a dingy bedroom with people he doesn't know (and, I suspect, does not particularly want to know, despite being a pretty friendly type himself). Furthermore, he goes to bed early (being a student in surgery and all) which cramps my roommate's and my usual routine of staying up late in the living room chatting and studying.

The living situation changes are really just the symptom. The precipitating event, however, has really colored a lot of our lasting impressions of this place. Quite unfortunately, too, because I have very much enjoyed living and working here. So it goes.

Redirection

2009-11-09T21:04:00.002-06:00

Not too much to say today: our census is quieting down as we prepare to take more patients while we're on call tomorrow. Besides that a pretty quiet weekend hanging out, getting some studying done, and watching the Packers bring on the suck. On the plus side, I've been to the gym 11 out of the last 14 days and my knee pains associated with my running are just beginning to fall by the wayside as I strengthen my legs and stretch them out appropriately. Still can't quite run for 30 minutes straight yet without exacerbation, but I'm doing an alternating 2-min-power-walk with 4-min-run and that seems to be working OK. Probably a more realistic approximation of my usual running habits on the soccer pitch. Hopefully I can keep this up when I get back to Mad-Town when I actually have to work longer hours and have more distractions.

So, yeah, not much to tell about. Still enjoying my time in internal medicine, entertaining strong prospects of making her my concubine. And for now, just stoked that Zombies Among Us is posting again.

Not Sure This Captures The Spirit of Evidence-Based Medicine

2009-11-07T19:06:00.002-06:00

I saw this L.A. Times article originally on Pandagon, and I'm kind of baffled how I missed it before. Oh, right. Medical school.

So any way, check this out:

Backed by some of the most powerful members of the Senate, a little-noticed provision in the healthcare overhaul bill would require insurers to consider covering Christian Science prayer treatments as medical expenses.

Let me get this straight: in a health care reform bill that is so completely concerned with streamlining medicine to finance only the best-established and absolutely necessary procedures, and considering a large chunk of the debate was reserved for arguments regarding the provisions of abortions (a well-established and important medical procedure), we let a measure like this go through completely unacknowledged and uncontested? Granted, the prayer "procedure" is only about $20-40 per day, but we would still be financing something that has absolutely no evidence supporting its benefit. Prayer is NEVER medically necessary or indicated, and charging the American taxpayers for other people's daily prayers, either for supplementation or, heaven-forbid, primary medical care, is just offensive.

Most of the arguments against this provision focus on the financial issues. But, who else, bioethicist and my main man Dr. Norman Fost (from University of Wisconsin. Woot!), gets the right idea:

Dr. Norman Fost, a pediatrician and medical ethicist at the University of Wisconsin, said the measure went against the goal of reducing healthcare costs by improving evidence-based medical practices. "They want a special exception for people who use unproved treatments, and they also want to get paid for it," he said. "They want people who use prayer to have it just automatically accepted as a legitimate therapy."

I don't know what the status of this provision is, and my guess is that it's probably staying in. But it's so offensive and hypocritical to keep it in, and I kind of wish there had been more effort made to boot it from the final bill.

Jurustic Park

2009-11-05T23:33:00.011-06:00

I wrote about Jurustic Park last week, which I think is now the number one tourist attraction in Marshfield. I knew from the moment I read about it and saw the information on-line that I wanted to go. However, it only holds hours in the spring, summer, and fall, and it wasn't entirely clear whether there would still be access this late in the year. Turns out, there was. My friend MC, MD and I even had the good fortune of getting the grand tour from the owner/artist himself, who ended up being a really wonderful guy. I just thought I'd post some of the many pictures I took from my visit and let you enjoy some of the cool stuff we saw:

This one kind of reminds me of Spider Pig. Except with wings.
Crushing despair. But the dog is so cute!
This one was called "Dandy." Kind of reminds me of...me...
This one hits a little too close to home: did quite a few of these during primary care.
Terrifying awesome raptor. I should get one of these for my living room.
Not sure why this dragon would need a club going into his fight. MC, MD thought he was just asking for a hug.
Monkey or panhandler?
Apparently dogs like to go hunting with double-barrel shotguns.
There were many others, but these are just some of the better ones that turned out. Pretty strange, but pretty awesome. Just the way I like it.

Pretty Much The Best Place In The Whole World

2009-11-04T17:09:00.005-06:00

I must admit, I was pretty skeptical of coming to small-town Wisconsin. Marshfield was dauntingly small, and everything I had heard was that there was nothing to do here, nothing to see. So I thought I would just be a recluse in my room. Turns out, so far, that's far from the truth. Granted, I don't know that I would spend years and years here, but I have found plenty to do so far and imagine that the rest of my two and a half weeks here will yield a similar bounty.

In this tradition, I have found the awesomest place ever, courtesy of information garnered from my current attending. My friend MC, MD and I headed over there today. Here's a picture of the most wonderful place in the whole world:

It's called Weber's Farm Store, associated with Nasonville Dairy Inc., a local farm here producing milk, cheese, and eggs (and, unfortunately for the aesthetics of my picture, under construction). And yes, you see that correctly: that is a drive-thru window to purchase all of the fresh dairy, milk, cheese, egg, maple syrup, and other sundry farm goods that you could ever want. Fresh cheese from a drive-thru: who could possibly ask for more? I got myself a huge block of three-year aged sharp white cheddar and a big bag of fresh cheese curds for the staggeringly low price of seven dollars. Apparently heaven put up shop in Marshfield.

So Wrong. And Yet, So Right

2009-11-03T15:52:00.003-06:00

This is pretty lowbrow for the Onion. But not for the Onion TV!

Victim In Fatal Car Accident Tragically Not Glenn Beck

Our Nation's Newest Export

2009-11-02T22:36:00.004-06:00

I'll take a little respite from my usual medical blogging to go back to another favorite: science blogging!

I saw this article in the NY Times and the headline immediately captured my attention: "Creationism, Without a Young Earth, Emerges in the Islamic World." The article, as you might imagine, expounds upon how the idea of creationism, specifically "Old-Earth" creationism, is starting to capture the minds and imaginations of the Muslim world. According to the article, there was little talk of creationism in any meaningful sense in the Islamic world, although there had been a long creation-history tradition claiming that the world was fashioned in six days (sound familiar?). But in most instances, many Islamic nations interpreted this to be consistent with biological ideas of evolution, especially as the length of time that the days represent is loosely interpreted as possibly lasting thousands of years. However, similar to Christian Creation tradition, the idea of people evolving from primates is incompatible. None of this suggests that we are exporting our ideas of Creationism to the Muslim world, just that they have the same backwards notions of evolution.

What's most interesting is that preliminary studies are finding that more Islamic students who are getting their scientific education in Western countries are skeptical of evolution and evolutionary biology than their counterparts learning science in Islamic nations such as Pakistan and Turkey. More disturbingly, Westernized Islamic students are developing increasingly Young-Earth ideas: a survey found that only half of Islamic students surveyed in a Toronto area school believed that life existed for billions of years, compared to 86% of a similar demographic in Pakistan.

The thought is that believing more strongly in Creationism, particularly Young-Earth Creationism, somehow helps Westernized Islamic students find their cultural ties. Strangely enough, the ideas are actually more extreme than their homeland counterparts. So are these students somehow incorporating our extremist notions of the scientific-religious incompatibility and adapting it to their own? A very strange, and troubling, development indeed.

Depressing

2009-11-01T01:02:00.001-05:00

I just finished watching a documentary on the Discovery Channel called "Gang Wars II." I think that is perhaps one of the most depressing and disturbing things I've seen in a very long time.

Not Cut Out to Be a Doctor

2009-10-31T19:56:00.003-05:00

At least, according to one of my patients.

I was trying to do my physical exam and apparently there was a miscommunication, but it ended mainly with telling me how my patient interactions and demeanor would make me unsuitable for further pursuing this profession. I thought we had a good rapport up to that point, and I still suspect we do, so I was quite taken aback by the comment.

It made me think about this profession that I'm going into in a way I hadn't previously, so I guess I should thank this patient to some degree for taking me down a couple notches and making me feel like a jerk.

For one, there is the element of being a patient in a hospital. Every once in a while, when I go in there at 7 in the morning, often waking them up for the third or fourth time that morning, and ask inane questions and poke and prod them with my physical exam, I think about how annoying it must be to a patient. They're sleeping in a gown, frequently getting blood drawn, no privacy, many strange people manhandling them. Compound on top of that the fact that these people are often sick or in pain or both, and then the fact that the vast majority only have a marginal idea of why they're in the hospital in the first place and usually have no idea when their time in the hospital might be over, and then you start wondering why more patients in a hospital aren't in a really shitty mood.

Secondly, I guess I must consider this as a learning opportunity regarding my bedside manner with patients. I try to be respectful and mindful of their condition, but it's often hard to take everything into account when you're just trying to remember what it is you're supposed to be doing, let alone trying to do everything you need to do in a constrained period of time. And while my medical knowledge will eventually expand to ameliorate the confusion factor, the time factor will only get worse. Even though I don't think I did anything wrong or was disrespectful, I'm willing to at least consider that I perhaps could have done something differently. It makes me at least think about my rapport, whether I agree with the outburst or not.

Finally, and in a similar vein, it also made me consider the changes to their personalities that physicians probably adopt in their younger years in their professional training. This may have been the first time in my relatively short career in which I've endured that kind of tongue-lashing from a patient, and I'm sure it won't be the last. Similarly, I'm sure that other physicians have had complaints about being bad doctors or unsympathetic or any variety of other arguments (I certainly know that from stories patients have told me about other doctors, whether they be wholly justified or not). I think at some point you just kind of have to become numb to that, but at what point are you too numb and discounting of that kind of criticism such that you aren't willing to change if the criticism is valid? Will I at some point just shut myself down to valid criticism, or will I maintain some semblance of recognition of reasonable criticism?

All interesting things. Amazing what one kind of horrible experience can make you think about. Hopefully I am, in fact, "cut out" to do this.

Just Like Lab Meeting

2009-10-30T21:09:00.004-05:00

Today was my first post-call day in internal medicine. Because we had five new admits, we spent a good portion of the morning sitting down with our attending and talking to him about our new patients. In this vein, we each had to present the patients that we personally admitted to the ward and let him know what their story was in a succinct, yet complete manner. Once the information had been presented and questions had been answered, we then proceeded to bounce ideas off each other with regards to what could be going on with the patient, and then tried to decide on what tests needed to be run in order to confirm or modify our diagnosis, as well as determine how confident we would be in our diagnoses and how we would eventually communicate this information to the patient.

This exercise reminded me so profoundly of meetings with my old PI during my benchtop research stint. In those cases, I would frequently bring in data from experiments that I had done, tell the story to my boss, and then we would talk over possible interpretations and what further experiments would need to be done to confirm or refute the hypothesis, or even just modify our hypothesis right then and there. Then it became a matter of doing the experiments and/or developing variations of experiments to address the underlying questions.

No wonder so many MD/PhD candidates go into medicine. I felt so comfortable and at home during this routine part of medicine that it kind of scared me. Granted, I'm nowhere near the expert in internal medicine that I eventually became in cancer biology, but I think once the medical knowledge comes back, the discipline of internal medicine is academic enough for me to enjoy it and, I think, actually be good at it. Problem is that I never had to make any lifesaving decisions during my research years, so I'm wondering if those skills will translate into the medical setting.

First Day On Call

2009-10-29T22:33:00.002-05:00

Well, today was the big day when I took my first call. And I must say it was a little anti-climactic. Though I was supposed to be in until 11 pm tonight, I was essentially done at 6, whereupon I was formally released. I stayed on until 9 in case something interesting came through, but I guess nothing did. At least I got some reading done and am rapidly becoming an expert in both atrial fibrillation and sepsis.

That doesn't mean I didn't see some interesting things today, however, including some rather rare disease processes that don't have any clear etiology (but we're trying to figure those out). Again, can't really go into any details, but suffice it to say that brought some interesting learning cases.

Rarities, Niceties, and Maybe The Beginning of a Beautiful Thing

2009-10-28T22:36:00.003-05:00

The Rarity: I had my first mentor session today with an internist who will be in charge of giving us feedback on interpreting and presenting cases. When we finished meeting with him, he told us he wanted to show us an interesting case. Obviously I can't go into any details about the case in particular, but suffice it to say that I potentially saw my first incredibly rare tumor (we're still running tests to verify, but so far everything we have seen is consistent with the picture). This tumor is one of those things that you hear about all the time in medical school because it's such an unusual finding but never expect to see. And yet, on day 2, we see a patient who has symptoms consistent with it. Don't worry; generally these things can be treated, but it's still an amazing finding and one that will definitely keep with me from here on out, even if I never see it again.

The Nicety: Because my glasses keep slipping off my face on a regular basis, I thought I'd stop in to the optometry office in the hospital to see if I could get them fixed. They now fit amazingly well. Very nice!

The Beginning of a Beautiful Thing: it's day 2 back into my gym routine, and though I'm much more out of shape than I have been, as well as dealing with some weird knee pain when I run that I'm not sure what to do about, I feel like I can maybe realistically get back into a regular exercise schedule.

So far so good. Tomorrow is my first day on call. I'll be curious to see who walks through the door until 11 pm tomorrow.

Becoming Dr. House

2009-10-27T22:52:00.003-05:00

I know some of my loyal readers do not like House, M.D. and, ergo, would not appreciate this comparison (especially as one of these said readers has to live with me), but I'm merely using it to usher in the beginning of my 8-week stint on internal medicine.

Internal medicine, for those of you who are confused about what exactly that means, is sort of loosely defined as a physician who sees adults and works on multi-organ-system problems by non-surgical means. Now, this definition breaks down a little bit when you consider that many internists will specialize in organ systems (e.g., cardiology, pulmonology, nephrology, etc), but you get the idea.

So after my brutal (time-wise, not as far as intellectual stimulation or personal satisfaction) time on surgery, followed by my 8-week relative vacation on primary care (which warrants an eventual blog post to summarize my feelings about it), I am now in Marshfield at their gargantuan hospital facility doing the first four weeks of my internal medicine rotation before returning to finish up my last month in Mad-Town at the VA Hospital (I LOOOOVEEE working with vets!).

Most of you may be wondering, "where the hell is Marshfield?" Good question, and until about two days ago, I didn't know the answer to that either (turns out Google Maps didn't know either, sending me on a wild-goose chase through Stevens Point and getting me all turned around based on faulty directional information, but I digress). Marshfield is a small, small town with one main road located in Northern/Central Wisconsin, approximately a three-hour drive straight North from Mad-Town. Somehow it has garnered itself a climate system separate from what I'm used to in the balmier regions of the Southcentral part of the state, which makes everything 5-10 degrees colder than I thought it would be. It also is not directly accessible by interstate, and so requires driving for 30+ miles off the interstate through cow-towns and single-road/no-traffic-light villages, with constant warning posted about deer crossings. Needless to say, I spent most of that drive wondering what I had gotten myself into. And driving into Marshfield was of little consolation, seeing how small and secluded the town was.

But then out of nowhere this massive hospital structure just jutted out of the ground, like a volcano erupting in Benny-Hill-time through the tectonic plates. Nonetheless, with a sense of foreboding and trepidation, I anxiously awaited my start date today to see what was going to happen.

Now I had received very mixed reviews about Marshfield and doing an internal medicine rotation here. And I know it's only one day that's passed, but here's my assessment so far:

First, the bad: it's in the middle of nowhere and nothing is around (well, save Jurustic Park, I suppose, which I totally want to go to if I can find the time and they don't close for the season). They are still pretty heavily reliant on paper charts despite attempting to move to more electronic record keeping, and reading poor handwriting is a talent I have not yet developed. We're also expected to be at the hospital 6/7 days, and we take call with our team every 4 days (until 11 pm, granted, but still every 4 days).

Surprisingly, though, the good so far outweighs those bads: the staff and health care providers that I've interacted with so far have been unbelievably hospitable and friendly, and so far my team seems to be pretty chill and well-attuned to having medical students around. My apartment, which is provided for free, is within spitting distance of the hospital, Target, Festival Groceries, and the YMCA, which pretty much makes it the only place in the world so close to so many useful amenities. There is a cushy physicians' lounge where we can go and invade an amazing supply of free cookies, coffee, sodas, and yogurt to our hearts' content. There is a high likelihood that, other than call days, we can get out as early as 3:00 on most days. And, as it turns out, I feel so far completely at home working on an internal medicine hospitalist team. Granted, it's only been one day and I only had a very truncated clinical experience, but I'm loving the little bit of work I've actually done and feel as at home with it as I have on any rotation so far: I knew what kinds of questions to ask and exams to perform, the notes had a logic that made sense to me, and I was actually excited to use my time to read up on my patient and my case discussion series on anemia tomorrow. I mean, I am actually enjoying learning this stuff (while I have enjoyed the other rotations, I have kind of despised doing the reading for them). Could this justifiably be towards the upper end of my residency decisions?

Rockin' My Socks Off

2009-10-18T00:57:00.003-05:00

Dr. T and I decided to go to a show tonight after a relative dry spell of live music. We went to see the dance punk outfit called "The Gossip," and it was totally worth it. They play the kind of music that you feel compelled to dance, or at least bop along, to. The lead singer has an amazing voice, too, although she unfortunately was recovering a cold and so her throat was a little raspy and she couldn't quite sing with the power and the distinction she normally does. Even so, it was pretty impressive what she could still muster and gave her a smoky quality to her voice she doesn't normally possess. In any case, it was a rockin' show, and I would highly recommend catching them if they come your way. I know I will the next time they roll through Mad-Town, hopefully not on the tail of a sore throat. Here's a little video from their earlier album to give you a taste:

The Government Will Ration Health Care! Oh, wait...That's Already Happening

2009-10-14T03:29:00.004-05:00

Crooks and Liars turned me on to this article, recently published in McClatchy:

Many Americans have been putting off doctors' visits, forgoing medical tests and taking expired medications to save money over the past year, according to a new poll by Consumers Union.
The survey by the nonpartisan organization found that 51 percent of Americans have "faced difficult health care choices in the past year."

The argument of government rationing under a public option rings a little hollow when a significant portion of U.S. citizens are already doing that out of necessity. Among the things that people are doing to self-ration include:

The Consumers Union survey of 1,002 adults from Sept. 17 to 20 found that among the ways people have tried to cut back on health care costs:
-- 28 percent put off doctors' visits.
-- 25 percent have been unable to afford medical bills or medication.
-- 22 percent put off medical procedures.
-- 20 percent declined medical tests.
-- 20 percent skipped filling prescriptions.
-- 15 percent took expired medication.
-- 15 percent skipped scheduled dosages of prescriptions.

It's deeply disturbing that this is going on. I think of my own patients that I've seen (and what about those 28% that I don't see?), and how many of them really need these medications to maintain some semblance of health, or how many need to get imaging done to determine what's going on. To think that we are forcing them to make an active choice against doing what's in their best interest regarding their health is sickening.

So what they really mean by "rationing," those opponents of public options, is that they're worried that they are going to have give something up. Because lord knows plenty of people are doing that already.

Bipolar Day

2009-10-09T07:50:00.004-05:00

The last 12 hours have been a little surreal:

1)Working in free clinic yesterday in urgent care, nurses and administrators are coming up to me, when the two other doctors weren't available, to get medical opinions from me, i.e., analyzing and interpreting x-rays, disseminating treatment information to patients over the phone, prescribing drugs (cosigned, of course, and no scheduled ones), ordering lab tests, making referrals. Somehow the expectation of me being a doctor was deeply pervasive and while it was exciting and flattering, I also kinda thought that maybe coming to me for that information wasn't the best idea. Because, seriously, what do I know? I guess just enough to get the patients treated.

2)I woke up this morning to turn on the tube to watch the live lunar explosion (more in #3) only to see a gigantic headline telling me that Obama won the Nobel Peace Prize. And I'm thinking, hey, good for him! He's a smart, compassionate-seeming guy and, besides...U.S.A.! U.S.A.! But then I'm also thinking, he hasn't done anything to warrant that quite yet. 1 year as president, still in Iraq, escalating in Afghanistan, shooting pirates in the face, battling (somewhat unsuccessfully) for progressive change here in the States, and we're giving this man a peace prize for, you know, being an adult and wooing the socks off of world leaders (except for the IOC) and not acting like a complete dipshit like our last president? It just didn't make sense to me. On some level, perhaps they're trying to force his hand to continue a more "peaceful" approach to world politics, and that's a smart move. But I also feel like it cheapens the efforts of many other people who have dedicated their lives to peaceful movements who failed to get recognition this year. Maybe I just don't understand everything that he's done for world peace, but it just seems entirely premature to make this award. Clearly they thought that, too, because the White House seemed totally flabbergasted at the announcement.

3)I watched NASA send a multi-million dollar piece of equipment into the surface of the moon, followed by another piece of equipment that took about a minute of measurements before suffering a similar demise. The scientist in me is completely awestruck by what we might find: water on the surface of the moon. But, at the same time, as much as I advocate for NASA, this just doesn't strike me as the best possible use of our space exploration abilities. I don't know, I'm conflicted on this one. I want to love it, but the random bombardment of a moon just seems so...violent. I really hope that we find something interesting to justify this.

Urgent Care and Free Medical Service

2009-10-07T01:15:00.002-05:00

While on primary care clerkship in La Crosse, each of us have an opportunity, or requirement, to volunteer our services at the local free medical clinic. As it turns out, this is one of the many highlights to doing primary care rotations up in La Crosse, in addition to opportunities to work with very good and very enthusiastic providers in a low pressure setting. We have a free clinic of sorts in Mad-Town, but it's a pretty limited provision of service that we can actually provide, especially given the population and size of the city: the clinic I used to work at in Mad-Town was open one morning a week, was operated by one volunteer doctor at a time, and could generally accommodate no more than 10 patients or so. Medication prescriptions were limited to either what was in the free medicine sample cabinet and/or a lifetime limit of $40 of free prescriptions at the adjacent Walgreens. Lab testing was limited to urinalysis, referrals were few and far between, and don't even think about radiology.

In contrast, the clinic here in La Crosse is a self-sufficient, free-standing clinic, complete with a rotating population of many volunteer physicians, open three days a week to provide service to many tens of people at any given day. They have their own lab, have their own pharmacy, which provides a whole litany of free or cheap medications, and can make immediate radiological referrals to the hospital across the street. It sucks that people have to stand in line for nearly two hours before they get the opportunity to wait for up to 2 additional hours to be seen, but so it goes with free clinics, I suppose. And, as a testament to the character of the patients, not a single one complained about the waiting time and, in fact, was excessively grateful that they were being seen at all, even by a lowly medical student such as myself.

Using that as a segue, the reason I like this free clinic a lot more is that they essentially treat us like residents: we go and see our own patients, write our own notes, draft our own prescriptions (which, not to worry, requires a co-signature and furthermore cannot be written for scheduled drugs), request our own labs and referrals, and work through a plan in relative independence. The workload is so high that they cannot afford to waste an able body on a shadowing experience, so you are thrown into the fray to treat people. So today, and over the next week, I am going to be treating people. Interviewing them, examining them, and actually doing stuff to treat them. Granted, many of the patients are looking for medications by and large, but I did catch a potentially very serious disease in one of my clinics today. That's the fun of urgent care settings: you see anywhere from the routine to the extreme. It's exciting, it's fast-paced, and it can be a lot of detective work on the fly. Don't get me wrong, I've enjoyed my continuity-of-care settings quite a bit, as well, especially as it affords opportunities to hear people's stories in more detail and understand chronic conditions, but there's something to be said for the rush of getting hit with who-knows-what, not to mention the satisfaction of contributing something useful to a population with so few other possibilities or opportunities for service.

Which brings me to our broken, messed up health care system. I love what this clinic is doing, and I adore that I can be helpful and help get people care they would otherwise not be able to access. But c'mon: these people are waiting four hours to see me. ME, a dimwitted medical student with three months clinical experience. How is this OK that we let this happen? How is it that we just accept how little access some people have to health care. All of the people I saw seemed like honest people just trying to make it, trying to do all the right things and what our society dictates of them to lead normal, productive lives. And all they have to show for it is major health problems and only one clinic willing to eschew staff pay to see them.

What made me particularly sad is that these are generally people who are living in poverty, or just above it, largely with various impairments adjusting to society based on upbringing and socioeconomic factors: generally a population that suffers from poor mental health and poor dentition. And guess who we can barely ever refer anybody to? You got it: psychiatry and dentists. I'm not ragging on these practitioners, there's a shortage of people in both fields and I respect that the disease burden is too overwhelming for this community to be able to treat everybody. It's just sad that the primary comorbidities of disease in this population will just have to fester further in most instances.

But I really like the urgent care setting. I wonder what it says about me that, although I have enjoyed nearly everything I've done, probably two of my most favorite experiences so far have been in trauma surgery and in urgent care. I'm wondering if maybe I shouldn't try to squeeze an emergency medicine clerkship in somewhere: the quick action, patchwork physician work may be what's in the cards for me. Too early to tell, but it's an interesting observation. But first we'll see how the next couple days in the free clinic go.

He's Like The Wind

2009-09-14T21:48:00.002-05:00

R.I.P., Mr. Swayze. Now who will protect us from the Russians, bounce out the drunkards, and teach us pottery, all with balletic grace?

I could have sworn Patrick Swayze gave a wonderful interview on The Daily Show in which his genuineness and his kindness shone through. However, because I can't find it, instead I'll post a fitting MST3K tribute to him:

Med School Transitions

2009-09-02T22:27:00.002-05:00

Well, I'm blogging again, which can only mean one thing: I'm done with my surgery clerkship. And if that wasn't enough, I'm not only done with the most intense of my core rotations, but I have also moved on to what is probably the most laid back of the rotations: primary care. Some thoughts on surgery first, perhaps:

1)I really enjoyed surgery. It brought fast-paced intensity and constant engagement of body and mind that was unsurpassed by anything else I've done in my life. This was even true given the lightness of my schedule due to various absences, be it vacation or paternity leave or otherwise, of the surgical staff on my services, so I can barely fathom what it must be like when the well-oiled machinery that is a surgical staff is at full capacity. And the variety of procedures I saw was very stimulating: I could see a neck space cut open to remove a tiny parathyroid gland on one day and then, the very next day, see a gall bladder removed through a pinky-sized hole in the abdomen, followed by a gigantic opening of somebody's stomach to remove the head of the pancreas, the gallbladder, the distal portion of the stomach and the proximal portion of the duodenum in what is known as the pancreaticoduodenectomy, or the infamous Whipple procedure. Prior to that I saw polyps removed from bladders, tonsils and adenoids removed, scrotums (scroti?) cut into, ureters detached and reattached, bladders constructed out of small bowel, several pound tumors removed from extremities, you name it. It was by far the most intense and one of the most unique experiences of my life, and one that I think I will cherish forever.

2)The surgical staff, and the residents, were a lot nicer and more down-to-earth than their reputations suggest. Granted, there are still some surgeons that bring the intensity, but generally only in the OR. Only on rare occasion did I think that a surgeon was off in la-la land; generally they related well to students and would take a genuine interest in education as well as in the well-being and satisfaction of their patients. And I know that being at an academic center certainly lends a degree of bias, but I was impressed by how stringently they would work to provide as close to evidence-based care as could be done. Granted, this is not easy to do, especially when time is tight (such as when on surgery), but they certainly took best-evidence practice pretty seriously. As a scientist, that certainly warms my heart.

3)That all being said, I don't think I could be a surgeon. Though I know few people are born with dexterity and calm nerves on that level, I'm not so sure that years of practice would do much to change that in my case. Furthermore, the hours and the intensity during those hours very much live up to their reputation. I was thinking about staying for an after-hours Whipple one Friday night, and was relieved afterward that I had decided to go home: the procedure started at 5 pm and went until 3:30 am. Holy crap, and this is not the most unusual of circumstances. I think my body sent me further signs by giving me a roaring case of acid-reflux during my general surgery rotation. Now I'm not one to have ever woken up with reflux symptoms, or to feel nauseous in the morning, but every morning during general surgery upon waking up yet again at 4:00 in the morning to get ready and get into work by 5:00 to read up and pre-round on my patients before presenting them to the residents at 6:00, I felt that acidic tickle in the back of my throat. And, frankly, that is not something that I want to battle for the rest of my life. So surgery is probably out, despite my enthusiasm for what I saw and learned on the rotation.

4)That being said, I really, immensely enjoyed Urology. The plumbing discipline is pretty gut-wrenching to most people, but it's an amazingly varied and interesting discipline, and there is a certain chillness that is unmatched by the general surgical discipline. Clinical management is fun, and the surgeries range in levels of invasiveness and expertise to fit any and everybody's styles. The problem with choosing urology as a career is that it tends to favor the cream of the crop students. And I may be a doctoral person, but I'm no rock star, so that's probably not in the cards. However, urology has a unique matching system, so I suppose that I could potentially go through the match and see what pans out. Who knows? Too early to tell, having done no other rotations.

5)No matter how dedicated you are, there simply is no time to get reading done on this clerkship. Because it's impossible to get exposed to every surgical scenario in 8 weeks to prepare for the final exam, reading is absolutely essential to cover the other fields. Problem is, there simply aren't enough hours in the day to do this. Some of the more disciplined students could cram in 10 minutes here and there for reading, but the vast majority were too stressed during the day to read, and too damn tired at night to do anything besides eat, zonk out, and sleep. I enjoyed watching the surgeries, and I'm too old and too jaded to get worked up about grades and exams, but I think a slight de-emphasis on the final exam would go miles in terms of helping students better adjust to surgery and emphasize the surgical experience that we're supposed to come away with.

6)Some final thoughts on surgery: it's intense, it's strenuous, and though I saw some wonderful interactions between patients and surgeons, is a relatively impersonal discipline, especially compared to what I'm now seeing on primary care. However, there is a certain fulfillment and satisfaction that comes out of just cutting right to the core of the problem and fixing or removing it. And I certainly have a new appreciation of the intensity that surgeons bring to their discipline: it's a useful skill, it's a coping mechanism, it's a way of life. Kudos to them, and kudos to the wonderful surgeons at my school who could leave the intensity at the door when meeting with their patients. And, occasionally, when meeting with their residents and students.

Now I'm on primary care in La Crosse and, needless to say, the pace is a lot different. I had two half-days on Monday and Tuesday, and worked only between 9:15 and 4:30 today. Tomorrow and Friday are half-days again for me, with student time scheduled in to get reading done (something I did not have time to do during my surgery clerkship). Because it's impending fall weather here, and because it's right on the Mississippi, it's a perfect time to take out the old bike and get in some quality exercise time. I'm hoping to not only seriously improve upon my woefully inadequate interviewing, presentation, and physical examination skills, but to also hopefully get my ass back into shape and maintain some semblance of a healthy lifestyle. So far so good: eating smaller portions of healthier food that I have time to prepare, getting lots of sleep, and working out at a nearby gym. I think I am digging this pace here. More later, once I'm a little further into things.

Earworms

2009-08-14T18:23:00.002-05:00

An earworm is defined as a portion of a song that becomes lodged within one's memory, such that you hear it over and over again. I read the neurologist Oliver Sack's book "Musicophilia," in which he even struggles to explain this phenomenon that so many people have at one time or another been susceptible to, and settles on involuntary musical imagery. It's not pathological, as so many people have experienced this, but nobody has really offered a satisfying explanation for why we get songs stuck in our heads or, for that matter, why some people are particularly susceptible to the earworms.

I mention this, because I have had a song stuck in my head for quite a while. Perhaps it has to do with Dr. T being out of town for the last week:

My new, good friend from med school, by contrast, had the following song stuck in her head:

I had never heard that song before and was entertained to no end by it. Although it kind of reminds me of Tyrone Green's beat poem:

Slap Chop Remixed

2009-08-02T12:55:00.001-05:00

I like the dance scenes interspersed. The hot, new club sensation!

I Think I Can Probably Write About This Now

2009-07-27T23:13:00.004-05:00

About two weeks ago, on Thursday July 16th, Dr. T's cat Oz succumbed to complications with cancer. He had been looking less than spritely for a while, but we thought that maybe he was slowing down at the sort of ripe age of eleven. However, when he started rapidly losing weight and then failing to control his bowels, we started to suspect there was a problem. Too bad we were too late, though, and even herculean efforts to surgically determine the diagnosis of his problems were not enough to keep him alive.

I never really got the final diagnosis, although mast cell leukemia was suspected, but I suppose it doesn't really matter at this point.

I always had a bit of a love-hate relationship with the cat: I'm allergic to cats, he generally eyed me with suspicion (especially when he first moved in and urinated on several things that bore my smell), and, I would consistently insist to Dr. T, he would climb up to me when she wasn't looking or around and whisper death threats into my ear. That being said, we developed a bit of a bond as time went on, mostly as the designated early riser who would provide a lap and a source of petting and attention in the mornings, but also as an eventual source of companionship and comfort for him. Dr. T was always his favorite, but he did eventually allow me into the family. And in the end, all curmudgeonly behavior aside, I really did appreciate having him around and making his acquaintance.

So to our dear, deceased cat, here are a couple of pictures in remembrance. It was nice knowing you, old buddy. May you be basking in the sun, chirping at birds outside the window, and urinating on furniture somewhere in alternate reality now.

Bad Start to an Otherwise Fabulous Day

2009-07-08T23:45:00.003-05:00

So, as most of you probably know, the successful completion and defense of my dissertation was not the final straw in my educational endeavors. As of this last Monday, I have now officially jump-started my previously dormant career in medicine and have matriculated back into medical school as third year student. Monday was an overall orientation to clinical clerkships, while Tuesday was the oft-overwhelming introduction into the surgical clerkship, in particular. Today was my first day on the surgical service, which I am starting with a two-week rotation in Urology. As it turns out, my urology rotation could not have started any worse if I had planned it...

During our surgical clerkship orientation, it was repeatedly stressed that the biggest way to leave a terrible impression on residents and faculty is to come to the OR completely unprepared. As it turned out, however, my first day on service was going to be in the OR with patients that I did not know (i.e., what they were being operated for and what the root of disease was). As a usually conscionable person, I woke up extra early to beat my residents into the hospital (we round at 6 a.m.) to look up my patients, get my scrubs for the OR, and be ready for the day dressed in appropriate attire and armed with at least cursory knowledge of the day. With an hour set aside before the residents rounded, I was set to accomplish everything I set out to do.

Small problem, though. Somewhere between gaining card-access to the hospital and reaching the staircase up to the scrub locker room, I lost my ID badge. Don't know how, but all I know is that it was gone. I proceeded to spend a half an hour retracing my steps to find my badge with no success. Thoughts of leaving the worst first impression of any medical student ever ran through my mind: no identification, inappropriate attire for the OR (just my slacks and a ratty shirt), as well as a complete lack of knowledge about what I was going to be doing combined to be the ultimate terrible medical student.

However, things have a way of working out, whereupon I found an old friend of mine from my previous run in med school to lend me a pair of scrubs, after which I found my badge on a staircase ledge that a good Samaritan picked up and displayed on the banister. Then it turned out that the conference I thought I had to attend was for residents only, leaving me a whole hour to follow up on my surgical patients prior to entering the OR. What started as a disaster ended up being a wonderful day in the OR: I jived extremely well (in my opinion) with the surgical attending that I observed who apparently has a bad reputation with medical students, even successfully (or adequately) answering some of the medical questions he posed to me. I also had a wonderful time on rounds with the residents and the other medical students and felt like I might after all be able to actually cut it during these next two years despite my long absence from anything medicine.

A lot of residents and med students alike assure me that bitterness and cynicism will set in, but I'm finding it a little hard to believe. I'm so excited to be doing something different, and acutely aware that this may be the only time I ever get to see or interact with patients on this level, that I'm planning on having a great time along the way. Eight weeks on surgery, just a couple months ago, seemed like an eternity. But now I'm sort of starting to wonder whether this time won't be flying by too quickly. We'll see what tomorrow brings!

Signs of Trystero

2009-06-28T13:02:00.003-05:00

Last night I was working very late in the lab (hopefully for the last time), and the whiteboard in the hallway outside my office was oddly adorned. Usually this whiteboard is filled with information regarding what the lab next to mine has to order, but this time all it had was a single small image of a trumpet. So I added what I deemed an appropriate reference.

The Ninjas of Rock on Video!

2009-06-23T12:39:00.002-05:00

Hello all,

In case you missed the rockin' show, my friend Torque from our haiku band The Five Seven Fives posted a video from one of our shows for all to enjoy (or despise). Feel free to check the clip out here. Or I guess you can just watch it here.

History of the World Part I

Families to feed,
To pretty for poverty,
Buy our album now.

(no seriously, I've got albums for sale).