Cherry Picks (3.27.07)

March 31, 2007

Once in a while, I read something that reminds me of what I’ve forgotten. Ava Dear is two posts in, cataloging a journey beginning at the first decision to leave an old life for medicine. If the rest of the writing is this good, then we are all in for a treat. Of Nodes and C Underscore.

Decisions can be the once only, nip-it-in-the-bud kind of easy when you already know the why. And I’ve known the why about medicine even before the thought crossed my mind to become a physician.

What I do has gotta be consequential.

It’s gotta matter, writ large, even when it doesn’t feel like it does.

I’ve found the “so what” factor to be so pronounced, so severely a part of business that I can’t go on with that life, no matter the money.

Then there is the feeling when you read someone that is making the same arguments that you are making to the same audience, but he’s just doing it better then you ever did. This is my experience reading Medical Economics by MiamiMed.

Let’s think for a second about the majority of the new “rights” that the United Nations and many individual countries have attempted to confer upon all of humanity. These include things like healthcare and a “living wage.” These things violate the negative rights of others. Because healthcare doesn’t exist naturally, it must be created. To confer healthcare as a positive right, it must be confiscated.

I thought he had dropped off the face of the earth, but the Mexico Medical Student is back and blogging with the best post from last week’s Grand Rounds. 5/4 is so well put together, it makes me feel lazy.

More great ranting by the PandaBear MD.

  1. What Exactly is Wrong With “Patient Care?” You use the phrase like it were some kind of swear word but isn’t this our purpose as residents?
  2. What, exactly, is wrong with the current system of residency training and how would things work in the Pandaverse?
  3. B-b-but Panda, you can’t possibly train a doctor without working him 80 or more hours a week as a resident. Are you saying that we need to extend residency training?

I may be lucky enough to interview for transfer come June and July. This article sums up nicely the mistakes that I routinely make should avoid.

Another great post from Signout. Need to be seen.

It took me only a few minutes to realize that answering May’s question was the least of my concerns: although Rosie had significant delays with stereotypic movements, her mother had deep cognitive deficits of her own that prevented her from understanding the depths of her daughter’s limitations. Although she had only slightly more comprehension than Rosie, it was enough to allow her to express one of her major concerns: “I don’t want her to grow up to be like me.”

A Farrago of Gallimaufries just returned from Spain with pictures and humor. I noticed a bit ago that the number of amateur photographers in medical school seems higher than in other groups. I hope to join the ranks of Farrago and Graham Azon on my current trip.

Gibraltar is absolutely the most beautiful place I have ever been to. I am going to live there one day. Or at least own a home there. Or at least visit again. Or think about visiting. One of those.

Cherry Picks (3.20.2007)

March 20, 2007

thieme.jpgImagine my surprise when the brand new Thieme Atlas of Head and Neuroanatomy arrived in the mail today. I don’t remember ordering this, though the invoice clearly shows that I paid for it online the night that I took the USMLE. This means that I must have been drunk with a credit card, and I decided to order an Anatomy Atlas. Does anyone else do these types of things? Am I the only one? Do I keep it?

Of course I keep it; it’s beautiful. Onto the links.

My Hero, one of the most powerful stories I’ve read in a long time.

But in those dark hours between signing the consent forms and prepping The Missus for surgery, I slipped down to the hospital chapel, locked the door and laid myself bare.

I’ve been shot at and narrowly missed. I’ve been in more than a few situations when the feces have struck the thermal agitator and everyone else was lost in the fog of panic, and I like to think that I rarely lose my cool. I’ve always thought of it as my gift.

But I found out I can be paralyzed by fear. And so on that night, I laid my head on that communion rail and I wept and I made bargains with God and I promised that if He would let my kid live, I’d do anything that He asked.

There’s really no way to set this up without blowing the joke, so I’ll just Cue Jeopardy Music.

Him: “What are you staring at?”
Me: “I’m just waiting. If I’m right, you’re gonna puke any second now.”

A while ago I read an amazing article on trash and recycling and discovered that what we all think we know can be bogus. I like to keep an open mind to things when I don’t know what I’m talking about, and so it is with global warming. After watching The Great Global Warming Swindle (available here through Google Video), I think what most of us think we know is hogwash. Really stretches the mind.

Blackwhite. I do love the Panda Bear’s rants.

George Orwell in his classic dystopian novel 1984 invents a nightmarish world where, in the time of Big Brother, the very language was being modified to prevent both the expression of dissent and its conception. In the novel, the Party sought not only to eradicate words that could lead to the discussion of thoughtcrime but to prevent even the possibility of it.

In a similar manner, residents lack the conceptual vocabulary to protest their obvious mistreatment and, because they are unable to frame the debate in any other terms but that of the establishment’s brand of Newspeak, they are reduced to sheepishly shuffling their feet and muttering vague self-centered sounding complaints.

Cherry Picks (3.10.2007)

March 10, 2007

Meh. I have this imagined responsibility that I should point people towards things I read in the week that are worth sharing. If you don’t read at least a few of these, then we have to work through some trust issues.

Until you’ve had someone yell at you for getting it wrong, it’s hard to really understand how well a question can be asked. The Dinosaur does not have that problem. On trying to ellicit a sexual history from a patient:

By the way: males starting about age 14 are asked, “Do you use condoms when you have sex?” thus forcing the explicit answer, “I don’t have sex.” I call it the “Have you stopped beating your wife yet?” approach.

The Tremulous Punditosphere
Fascinating synopsis of the divide in ability (and accountability) between pundits in the mainstream media versus those in the blogosphere.

Problem is, these are subjective criteria. What typically happens in the MSM is that, by some quite mysterious process, an editor or publisher decides that some particular person with opinions would make a good pundit, whether its because of the sparkle of their prose or the cut of their jib. A column or regular TV appearances are granted. And then, amazingly, they’re in forever. Rarely are columnists fired for not making sense; once they claim that status, they tend to keep it, no matter how pointless or uninformed their work turns out to be. It’s as if the NBA drafted players straight out of high school, but then they never had to play a game; they all just received long-term contracts, with salaries based on how good they look during lay-up drills and dunk contests. Maureen Dowd will be taking up space on the New York Times Op-Ed pages for decades to come.

Burnout: Embers
Sid Schwab is a favorite read of mine, and this adds to his catalogue.

The medical director of my clinic once gave me a book on burnout. I never read it. Didn’t have the time or energy.

Because a young reader considering a career in surgery referred to stories he’s heard of depressed and disappointed surgeons and asked for my thoughts, I’ll try to address it. Parenthetically, I’ve heard from more than a few readers that my blog and/or book has inspired them to consider surgery as a career. Don’t know whether to smile proudly, or shoot myself.

His rant continues beautifully in the second post, Burnout: Fanning the Flames.

So much of reading blogs is to live that “other life” and the Ambulance Driver doesn’t disappoint with yet another post about the fantastic pranks he’s pulled:

A wise man would concoct a lie. A creative fellow would contrive a plausible story. A careful man would consider his words before delivering an answer.

I blurted out the truth.

Ah HA HA HA! The Panda Bear kills me. This post is really three-in-one as he covers Mr. Kelso, hospital call for residents, and the Church of Patient Care. All of it good, all of it funny.

“So, Mr. Kelso, what brings you to see us today?”

From top to bottom Mr. Kelso is a walking pathology textbook. An impossible combination of signs, symptoms, and disease who is probably only alive because his many comorbidities haven’t decided which will have the honor of finally dispatching him.

Two great index cards from one of my favorite blogs, Indexed.

Maggie at From the Archives is uncommonly honest and insightful. I really liked what she had to say in 100% Thermonuclear Protection.

I want to trust people and I don’t want to be scared or suspicious. Being low level scared would be a constant drain. It would cost me some slight mental processing to be assessing risk. It would take energy to feed the nervousness. It would be weigh slightly on the don’t-do-things side of the scale, where sloth and inertia are already plenty heavy. Years ago I decided that I am not scared. I believe in probabilities, I decided, and scary people are rare.

And finally, As If Inside the Earth by Signout:

Looking at his blood test results during a quiet moment in the hospital tonight, I can see that he is dying.

Through the computer screen, he is as far away from me as I was from him on that day, when he opened the conversation that I quickly closed. If I had listened to the meaning of his words and his unmuffled voice, maybe I would have heard what he was asking me–if it was OK for him to let himself go.

I should have taken off the stethoscope.