2003 in Review

First Quarter

After doing child psych, I was really conflicted. I loved working in the child and adolescent service, but it was so hard. Everyday, I'd come home emotionally drained. Eventually, I decided that I couldn't do child psych, because it got me so angry every day, so frustrated because most of the kids are the way they are because their parents abused them or mistreated them. It was emotionally too much, but I never wanted to be cold to that sort of human suffering. So in the end, child psych was not for me. But it was nothing but fun being on a rotation with M.

Then, OB/Gyn! It started off hellish, but after 4 weeks slaving through surgeries and countless pap and pelvics, I found out that I actually really like OB/Gyn. And I could never do it. Half the women told me to my face they'd never see a male OB/Gyn, and with malpractice costs it'd be a terrible idea. But if I was a woman, I'd do OB/Gyn in a minute.

Second Quarter

For Spring Break, I stayed in town and did nothing. I tried to upgrade my computer, but I ended up wasting a lot of money. Started surgery, and I really enjoyed working in the ER. I called a laundry list of people for the Baskin Robbins free scoop night and only managed to get two people. For free ice cream. How pitiful is that? Went to the museum with F to the museum, then Hooter's afterwards!

Started surgery with M! We were like ill-behaved children. It was the most fun I've had on a rotation in a long time. Then, vascular kicked my ass, and I have to say that no human should have to do that. Memorial Day came and went, and I did not have a date in the meantime. But at least I got to grill. I got drunk, again, in R's basement.

Third Quarter

I worked on my golf swing at the range, only to determine that I suck. Went on a canoe trip and ended up in the ER. My laundry sock streak ended. In the past 4 years, I've only lost 2 socks. The AC broke and we were very warm for a while. Went to the museum with I and R, and sushi! I started climbing again, after a 12 year hiatus. Bought gear, a Nalgene bottle, the works. Learned that I can apply a coat of Rain-X to a front windshield in about 3 minutes.

I went on several trips to look at knives, egged on by F. I finally broke down in December and bought a set of Henckels. I frequented the sauna for a month or two. I found out that my aunt has terminal cancer. I started getting into punk and emo music. I had the damnedest time writing my personal statement, which went through 3 revisions before coming out in its limp form. I had my standard Labor Day grillfest, with the standards in attendance. I spent two months trying to find a decent bowl of naeng-myun. I picked up a new laptop thanks to my old computer's uncanny ability to cease working. And I tried to quit smoking again, and I failed, again. I did go for 5 weeks without, but in the end, I broke down. And in September, I began my quest for apple cider. I changed my haircut, who's to say if that's for the better or worse, or if anyone even noticed. And I came upon the realization, as September came to a close, that I might have Seasonal Affective disorder.

Fourth Quarter

I went to a concert with D, I started cardiology, I bought canvas tote bags, because somewhere along the way, I picked up some eco-nerd into my persona. I discovered Starbucks, only to discover that I prefer a different local coffee house. It IS true then. Starbucks really is good for independent coffee houses by increasing the prospective market. I had my whole big deal about bill splitting, to the point where I treated about $400 worth of meals this year. I bought a new PDA because my old Handspring (wrought with all sorts of problems to begin with) shattered.

I tried to get drunk on Halloween to wash away my troubles, and I failed, and I ended up so depressed the following weekend that I formulated a plan to kill myself, and the only reason I didn't follow through was a pack of cigarettes and a holy day of obligation. In retrospect, I should've gone to the ER and had myself committed. I stopped eating for quite a while, and I lost around 15 lbs as a result. I found that I can actually starve myself down to 1000 kcal a day. I had to force myself to eat. My brake lines went out. Thankfully, I wasn't suicidal at the time. After several long talks with a few close friends, I managed to pull myself from the edge. I am pretty sure now that some component of this is seasonal affective disorder.

I took Step 2, and passed. I swore off drinking to get drunk. Never again. I made the switch from briefs to boxers. I went to visit my dying aunt. I came to the realization that when I climb with R, I always injure myself, and when I climb with I, I always strain something or work something till it's sore. I went with I and R to Thanksgiving at R's, which was the most educational Thanksgiving ever. Me and I had a slumber party. I was talking to some friends and telling them that according to her, I snore like a little boy. Then, silence. It took me 5 minutes to realize the obvious next question: why does she know how you snore? My aunt died. I feel happy about it, and I feel guilty for being happy. Happy that her suffering's over, but how could I feel right hoping that she would die sooner.

I started Neurology. I got to see so much of my college friends, they're such a welcome sight. I saw Handel's Messiah with D, which was an excellent performance. I ruined a sweater. I rediscovered the art of being a gentleman. I wrote a million Christmas cards. I got some touching cards in return. I went South for Christmas and that's pretty much a wrap on the year.

Rebuilding burnt bridges

I got a few cards today, and a piece of homemade fruitcake. Now, the cards are always welcome. Man, I love cards. And one card from S was especially sweet. But the fruitcake was entirely unexpected. I was glad, because it came from someone that I haven't talked to in so long, and we parted on such bad terms, and it was nice to hear from her again.

I am not the biggest fan of Christmas. As a holiday, it has more religious significance to me than anything else, but still, it always ends up being a wonderful time of year because I hear from some friends that I haven't heard from in a long time, or I'll get a card and it'll be the nicest thing that I've read. There is an untold amount of love that can be given in card form, and this year, I got so many wonderful cards. If any of you read this site, all your cards are very appreciated, and I want to thank all of you from the bottom of my heart.

Tooting my own horn

There's something funny about crushes, because they're completely nonsensical, but sometimes, something will pop up or remind you, and it's like nothing ever changed. I was thinking about one of my old crushes today as I flipped through my old letters and cards. And all I could think was what a tragedy.

I don't often toot my own horn (that sounds dirty...) but I think we would've been good together. We got along like peaches and cream. We were both so full of foibles and quirks and sharp edges to cut yourself on. We were both so flawed, but flawed like puzzle pieces. It's like, if you have two round spheres, they can never get that close. Only a little bit of their surfaces can ever really touch. But two puzzle pieces, with their odd sides and rough bits, they can interlock. We were like two funny shaped puzzle pieces, trying to find the places where we fit.

But we never locked together. We were like bookends, always being kept apart by one thing or another, and then when we got too close, one of us would put more stuff in between. And only looking back now do I see that we would've been a good fit, but it's a little late now. It's a little late to be digging up the past and trying to relive it. It's a little late to feel bad about it. I have far more immediate things that I can feel bad about.

In a foul mood

I am... temperamental right now. Perhaps that's too gentle a word. I am in a foul mood. I'm not depressed. I'm not sad. I am, for lack of a more descriptive term, angry. And you know what? You people don't deserve me cheery or happy. You haven't earned it. You got cheery me as a matter of course. You got cheery me because I was trying to be cheery me. You didn't have to suffer through moody and depressed me like my friends from high school and college. You didn't have to deal with smoking myself to death me. You never had to witness distraught me or sorrowful me. You didn't have to put up with me through all my shit. You don't deserve to see me cheery. You have no right to see me cheery when you contributed no part to all the work that went behind that.

I've spent so much time trying to be cheery and happy and pleasant, and you know, that's all bullshit, and I'm done with it. I'll be what I want to be and how I want to be and when and where I want to be, and I'm done with trying to please you and humor you and play to you. I have spent far too much of my lifetime acquiring a boatload of fair-weather friends.

I'm ready to move

I feel pretty good today, and I don't have any reason to be so happy. It was yucky outside. The neurology service looks to be... messy. And all in all, it was certainly not the best day I've had. Still, I feel pretty good right now, and maybe it's because I'm confronting things in my life that I've always viewed as internal problems. You know, I've always viewed everything wrong in my life as a deficit, a weakness, a failing. I've never really entertained the possibility that problems in my life may not be within my power to control. How's that for a shocker. And I have every right to be angry with life about that stuff, but as far as hating myself goes, there's not a lot of ammunition there.

I felt so good today that I didn't even entertain the idea of going to student health to see someone for depression. If in one week I can accept that I am a good person, I don't hate myself as much as I thought I did, and that I have every right to be frustrated with my life, and that certain things are beyond my control, then I'm in the fucking home stretch. I'm not trying to be cheerful anymore. I'm trying to be me. I'm trying to be outwardly true to my internal feelings. As I told S, positive steps. Moving in the proper direction. I may not be moving fast or far, but I'm pointed the right way, and that's more than I can say for the last 4 years of my life.

I really wish that I could meet someone to share my life with, not in some grandiose sense, but I wish that I had someone to open up my life to. And not having such a person in my life has been handicapping, because it makes the hard times harder, and it dulls the good times. Friendship is a boat that can only take you so far. I'm not expecting to be married in a year or any such nonsense. I'm simply saying that it would be nice to meet someone that I could trust with my heart. You know, I've spent so much time guarding it, protecting it, keeping it locked away from danger. I just would like the chance to love.

That's an absurd or outrageous desire. It's basic. It's what we all want. And if I can't find what I want here, then it's perfectly reasonable to find somewhere that can accommodate my desires. If no one within 50 miles of this city can appreciate who I am and find in me something special, then I want nothing to do with this city and I'm ready to move the fuck on, because I think it's not an absurd thing to say that I am special and that I have a myriad of good qualities, and that the only absurd thing is that it has been so hard in this damn city to find a woman that would even entertain the notion of dating me. What a load of shit. I'm ready to move today. I should've moved a long time ago.

"You are superior to mollusks in every way but looks." -Dogbert

I realized today that I'm the dating world's equivalent to oatmeal, or gruel, or rice cakes, or something devised with the auspices of being good for you, but with such a bland taste that it's practically unpalatable. From now on, I'm going to carry around a packet of brown sugar, and when I get turned down, I'll tear open the packet, sprinkle it on myself and say, "Wait, wait, I'm more appealing now!" Sadly, though, this will do little to combat the fact that I'm still Asian and still in the Midwest, still getting shot down left and right, and still entirely hopeless for finding a date in this city or within a 50 mile radius. I think S is right. I am in desperate need of a move to a state as far away from where I am as humanly possible. I'm like a winter coat in Arizona. Somewhere, someone is in desperate need of me, but certainly not here.

I also realized that Korean food is the best food in the world. I've managed to fill my belly with Korean food with weekend, and I'm very happy about it. I miss my mom's cooking. I miss coming home to a Korean meal, with soup and everything. I miss all the weird little things that my mom did that I cannot replicate. I tried cooking something, and my mom picked me to pieces. More soy sauce. Less sugar. Stir more. Leave it covered. Add more garlic. Arg! I cannot replicate any of my mom's recipes, so my only hope for a life full of nutritious and delicious Korean food is to find some Korean girl who is in desperate need of a green card. If you are such a girl, you should consider e-mailing me. When we meet, you should come bearing soup.

Today was not a good day

I feel like shit today. I guess I wasn't feeling all that great yesterday either, but I didn't think I was this bad. I couldn't eat today. I ate an apple, a granola bar, a cup of OJ, and a handful of chips (~900 kcal). My workout was sorry. But you can only do so much after not working out for 4 weeks.

I wish I could say that there was some precipitating event, something that set me off, but I just woke up feeling shitty today. My light therapy seems to not be doing the trick anymore. And all I can think is that I've still got 3 more weeks before the winter solstice. If this really is seasonal affective disorder, then it's certainly the worst I've had yet, and I still have all of winter to go. I wish at least these bouts of depression had some sort of predictability. I wish there was some rhyme or reason to it. I wish I could make sense of it.

So I think I'm just going to call it quits early tonight. Yes, I realize that 7PM is a pretty early hour to turn in, but maybe I'll feel a little better after some sleep. Maybe I'll get hungry and wake up and eat something. I really don't want to have to start forcing myself to eat again.

A bad time in November

[Editorial note - I am wading through a lot of depressed posts, and I've opted to consolidate them all into one entry, as this is overall quite depressing to read 12/27/10]

I am normally a pretty cheerful person to be around. And I like being cheerful. I like being a person that's fun to be around. And I don't want to be depressed. I don't want to show people all the stuff that I deal with. Who wants all that baggage, and that emotional turmoil, all the stuff that I write here, and then some. I hold back when I write here. I don't talk about a lot of things that trouble me, stuff that I could never write here because I have no idea who's reading this and it's private stuff. But I don't write much about the good stuff either, and it's not like good stuff doesn't happen.

I don't think people want to hear my shit. I don't think people want to see what's underneath. I don't think that anyone wants to hear about my problems. I think people are perfectly content with the cheerful happy version of me. And so that's what they get. Because I don't know what they would do with the moody, having trouble making it through the day, hopeless version. I mean seriously, who would even want to talk to that, or even be nearby? The truth of the matter is that in this universe, there are very few people that care either way whether I'm depressed or not.

I really don't display any of my emotions. I think in the end, people honestly do prefer me cheerful. People would far prefer to hear about how I accidentally grabbed a girl's butt yesterday than about how I broke down and smoked half a pack of cigarettes yesterday, because I finally got to a point over the last couple months where I just fucking needed a cigarette.

Cigarettes are my buffer. You know in chemistry, a buffer is a compound that you can add to a solution in order to prevent radical changes in pH. It has limits, and you can surpass a buffer's ability to maintain a pH, but for the most part, it just smooths everything out. No big highs, no big lows, just even keel. That's what cigarettes are for me. Life becomes much easier to deal with when you can reassure yourself of your impending mortality

So, I bought a pack of cigarettes at this morning, and wow, do I feel about a million times better. Thank you cigarettes, for shaving another few minutes off my life expectancy. If not for my belief in God, I would've killed myself a long time ago. I thought this 'salvation' was because I had a purpose in this lifetime, that God had a plan for me, and thus did not allow me to kill myself, as I would've liked. Perhaps this logical conclusion is entirely lacking. Who ever said God is logical?

And so, sitting in church today, I did what I practically do every time I go to church. I ask God, why exactly was my life worth saving. What is it about my existence that was worth the trouble of extending?

Every fiber in my body tells me that I should be happy. I should be content. I should be at a point in my life where shit slides off. I should be happy. But I'm not. I'm just not. And it eats me up inside. It makes me wonder how bad can Hell really be. And how easy it would be to just put an end to it all. You know, I keep going to church because I'm waiting. I'm waiting for God to tell me what it is that makes my life so worth living. I'm waiting to find out what exactly is the point of my continued existence. I don't know that it's worth waiting around to find out.

And you, what's the deal, huh? Why do you always have to be so fake with me? Or is that the real you and you're fake to the rest of the world? You've got all the pieces in front of you, but you refuse to put them together. And you're right. I'm one to talk. I'm full of shit too. But you know what, at least I stared my problems in the eye. You? I don't understand how you can get up in the morning and not cut open your jugular.

You must be medicated, you're so complacent. You sit back and let the train fly off the rails, like nothing is wrong at all, but both you and I know better. We know that everything is wrong, and sometimes, it gets so bad that when anything goes right, that's good enough. But you deserve better than that.

But you'll never look to me for a helping hand or a shoulder to lean on, so y'know what, I'll let this all slide. It's like in AA. You have to admit that you have a problem before anyone can help you. So have a good life, I guess.

The most embarrassing moment of third year

I was thinking back on all the funny moments of my medical school clerkships, and the one that always sticks out is this one girl I saw on Peds. She was like 16. She had a rash on her right flank and abdomen, with itching, that had been there for a week. There was one spot that was big, and there were smaller lesions that followed skin lines. For all you medical students, say it with me: pitryiasis rosea. Anyway, she lifted up her shirt to expose her side and I got a pretty good look at the Herald spot. However, her mother, in the interest of furthering medical knowledge, was unsatisfied with this level of exposure. Perhaps she was a surgeon in a previous life, but she was determined to have complete exposure. So, she walked over and yanked her shirt up past her breast and pulled her shorts down to her pubic bone. And to the mom's credit, I visualized the entire extent and distribution of this girl's rash, from base of right breast to right inguinal region, extending along the back as well. I imagine that I probably turned some odd shade of purple, muttered something, and left.

You know what the scary thing about being a doctor is? You'll be sipping a mocha, and the guy at the table next to you, he clutches his chest and falls to the floor. Someone yells out to call 911 and asks for help, that's you. And when you're sitting on the porch and you see some guy fall off his bike and smack his head on concrete, and he needs help, that's you. And when you see a car swerve off the road and flip a few times, you gotta pull over, because that person needs you.

There's a nice feeling of anonymity before all of this med school stuff. I could watch an ambulance drive by with its lights going and think to myself how glad I was that it had nothing to do with me. I could see an accident and think, I'd better let the professionals handle this. The only problem with that attitude is that in a few months, I'll be the professional. And it'll be 3AM and I'll get a page from a nurse telling me that Mr. D in 5142-2 had a 30 second run of V Tach. And I can't walk away. That's a scary thought.

My type of girl

I've spent a lot of time lately giving thought to something a friend of mine told me. She informed me, routinely, that not only do I have a type (of girl) but that this girl I was chasing after certainly wasn't my type. This sort of set off a series of thoughts, revolving around the question: what is my type? So, it's been years since that statement, and I think that only recently am I in any way grasping what my type is. And it's sort of a sad realization, because now that I know what my type is, it sort of points out all those women that I've known and that have summarily written me off. You know, sometimes knowing what you want is more painful because you are made acutely aware of the fact that you don't have it. Whereas if you don't know what you want, you don't know what you're missing.

Anyway, that's not to say I'm depressed or all 'pity me' or whatever. I just made the observation today. At least I've had plenty of time to think about what is not my type, and that list is pretty extensive. And it's funny, because I always find myself in a funny spot where I'm sure that I should want something, but I don't. It's just not a deal to me in the least. I guess there are perks to knowing what you want. You don't waste your time on what you don't want. Or if you do, you at least have the good sense to know you're being an idiot.

Fuck them too

So, 4 weeks ago, I had my last cigarette. This is something that most people would be proud of. I feel no pride in this whatsoever, because it was terribly easy. I'm not really addicted to nicotine. My deal with cigarettes is that it's how I dealt with a world that seemed to screw me over at just the right times. It was my means of shortening my life, a suicide that would take 40 years.

But I'm learning how to deal with life again. I'm figuring out that my life's been in neutral for so long that I've been rolling backwards. It's time to get things in gear again. I know this sounds incredibly stupid. I feel stupid for typing it, but here goes. Why am I so down on myself? Honestly, despite my tremendous string of failure, I'm a good guy. I'm pleasant, courteous, kind-hearted. I'm honest, eager, driven. I'm not ugly or freakish. I take good care of myself. I am, all in all, a pretty decent guy. Why should I worry so much about dating and women and all that jazz? Honestly, if no women in this city or this state can see their way to dating me, fuck them. If no women in this city or this state can see themselves dating some Asian guy, fuck them too.

Why should I get all worked up about the hangups of other people? Why should I torture myself over what is essentially someone else's problem? Heck, I'm not going to lose another second of sleep over this shit. You know, if no one can appreciate me, I shouldn't have to change myself or lower my standards. That's bullshit. And if it takes another 26 years of my life to find someone that appreciates me for who I am, then so be it.

It's amazing how much more empowered one can be when one concedes reproduction.

San Diego must be nice this time of year

I'm finally submitting my ERAS application. It took me long enough. I'm applying to an obscene number of programs, especially since I'm very much leaning towards staying right where I am. It was funny today. I had two different attendings tell me that they didn't even need to see my app. One attending asked when I was interviewing. I told him that I hadn't even submitted my application yet. He kind of laughed and said for me, it wasn't necessary.

I would like to stay here for residency. There are all sorts of reasons I shouldn't stay here. It's always a good idea to train at a different location so that you can see a variety of conditions and managements. It'd be nice to go to a program where I can get a nice fellowship and a good faculty position. It'd be nice to work at an institution that runs more efficiently. But what it boils down to for me is that if I stay here, I know it's going to be another 3 years where my romantic future will go bbbpllbffplt.

I'd like to believe that it wouldn't make a difference where I am. I'd like to believe in fate and destiny and finding that perfect person for you. Except I know that fate and destiny and all that stuff is bullshit. I know that if I plan on procreating, I have to go to the East or West Coast. But I can't stand the idea. I can't stand the thought that my ability to attract another human being is entirely dependent on geography.

You know, it's amazing just how low you can set your sights in life. I used to think that what I wanted was someone who was perfect for me, who could understand me, who loved me, who I could share my life with. At this point in my life, my romantic aspirations total to this: I'm looking for a girl who will let me feel her up occasionally.

Finding your calling

The perks to being on a consultation service are getting to see very bizarre things that you'd otherwise never see. You see things like Lown-Ganong-Levine (LGL) syndrome. That's a one in a million. Of course, it's bad for the patient. LGL is a pre-excitation syndrome similar to WPW, except there are no delta waves on the EKG. Essentially, you have to have one hell of a clinical suspicion to find it.

My scleroderma patient from last year is in house again. I want to pop in and say hi, but I feel bad. I mean, I have no relationship with her. It's not my place to pop in. Sometimes, medicine is so confusing. I spend so much time caring, but then when they're off my service, I have to force myself not to care.

Today, while my attending was writing his note, I asked one of the surgery residents about another patient we'd done a consult on. My attending turned to me, and listened to me blather on about this guy because he'd made such an impression on me. I can't help it sometimes. I really like patients. I like meeting them, taking care of them, patching them up, trying to help them out. All that time in pathology and radiology, it can't even touch the feeling of meeting someone and helping them get better. I can't imagine doing something like radiology for my life.

But that's the cool thing about medicine. We somehow find our way to the right spot. I managed to find my way to internal medicine. While all my friends are interested in cardiology or rheumatology, or things like radiology or ortho, I find myself more and more driven towards general internal medicine. The funny thing? Some people tell me that I must be crazy. Internists are a dying breed. Internists are being eaten out from above and below. Internists are slowly becoming either hospitalists or else glorified family docs. And then, the idea of doing academic medicine, that's just nuts.

But on the other side, I get so many good responses sometimes. You know, I had one attending tell me that I should definitely do academics, because teaching is a desire that few people have. Most academic physicians teach enough to be faculty, but their primary aim is research. Even the chairman is research driven, and I think the chair is one of the best teachers in the department. The thing is though, I get so pumped over simple things. I get flat out excited about showing someone how to write up an H&P. I taught one student the basics of EKGs and it was just fun. You know, THAT is finding your purpose in life. THAT is finding your calling. You know you're in the clear when you spend 30 minutes of your life teaching someone a piece of information they may forget in 5 minutes, but you feel good about it.

I really hope that I will eventually find myself in academic medicine. I probably won't be at one of the star institutions, because I don't want to waste my time with benchwork or strict research. I can't write a grant to save my life. What I want is the teaching. Let the other guys do all the research. I want to get my hands on some third years and show them what medicine means to me.

And at the end of the day, when you look at yourself in the mirror, it's nice to know that you did good. Who else gets to go home and say to himself, I didn't give them a fish, but I taught them how.

Teaching rounds

Don't you just HATE when you know something, but something in your head is convinced that you must be wrong, so you go against everything in your body and say the answer you know is wrong, but you manage to convince yourself it may be right. Well, I did that today. I read an EKG ALL WRONG, and I know better, dammit. I know fucking better than that. C'mon. You gotta step up to the plate. This ain't the bush leagues no more.

It's funny when I work out. My workout is an exercise in self-deprecation. It's all, 'What are you doing? Get this fucking weight up. Get it up. You're a wimp. You're a piece of shit. You're nothing. You're small time. Get that FUCKING weight up.' I've only lost 3 lbs since the end of surgery. That's 3 lbs in 3 months, but I'll tell you what, I'm probably as healthy as I've ever been in my life. I feel like a million dollars. I feel like I'm finally not a hypocrite when I tell my patients to eat healthy and exercise.

I have never had so much fun as I have had in the past couple weeks teaching 3rd years. I can't think of anything that has thrilled me as much as teaching someone about medicine. What a wonderful reward it is that one cannot help someone else without helping oneself. If ever I had a goal in life, it's academic medicine. The doctors I've worked with tell me that I'm an oddity. Who wants to do general internal medicine in an academic setting? That's nuts. And moreover, I don't want the research, but I want to teach! I must be crazy. Well, folks, if crazy is teaching and loving it, then crazy I am.

I have some friends that tell me that they'd like someone like me as their primary care doctor. I find that amusing, because that's a pretty awesome responsibility. However, I certainly can understand what they're saying, because I think the same thing about some people that I know. I think, wow, it doesn't matter if they're not the smartest or best. They've got the drive. They've got the talent to be a fantastic doctor. They've got the heart to do this for all the right reasons. I think if I had to choose a new primary care doc from the guys in my class, it'd be a pretty easy choice.

I read through my evaluations from my medicine rotation, and I felt good because I felt that all the evaluations were pretty thoughtful. I know this because they all gave me high marks in professionalism and rapport. It's true. I'm not the smartest. I don't do a good job with data collection. I don't always think things through. But I'll tell you what. Every single one of my patients recognize me, know what service I'm working on, and aren't surprised when we come by to round. They all know more about their conditions than when they came in, and I still remember most of my interesting patients by name. Now, I just got to get that whole diagnosis and treatment stuff down...

Consulting service

Why do people consult without doing the basic work? I mean, you call in the experts when you don't know what's going on. You shouldn't need to call in the experts to hold your hand through the basic steps. We all go through medical school. We all know the basic stuff. You know, if you consult a cardiology service and you don't do an EKG, you should be shot. I don't feel guilty at all paging the shit out of these surgery residents. They consult my service without telling us why, without telling us what surgery they're going to do, without telling us when they're taking the patient to surgery, without telling us anything. Two consults I did today were consults on empty charts. What's the point of that? I have to do all the work. I'm doing THEIR work. It's aggravating.

When I was on vascular surgery and we were consulted by medicine services, we'd come by and there would be blood cultures ordered, chest x-rays shot, and all the appropriate labwork done. Now that I'm on a medicine service being consulted by everyone else, it's appalling how shoddy the consults are. You know, I was consulted yesterday basically for a 'Please find the old records and read them.' We did nothing except request old charts. I guess Friday is always a bad day in the hospital. Oh well.

The thing is though that consultation is a request to another physician formally to help with the treatment of a complicated patient. It's admitting that you need some assistance. That is the purpose of consultation. It's not to offload work. It's not to have someone else doing the stuff you don't want to do. It's not to have someone pat you on the back. I get frustrated when people write for consults and they don't want a consult. They want to have someone else do the work, or they want someone to congratulate them. I am interested in neither. Having done several consultation services, I've come to the conclusion that the ideal consult is one where the work is already done. It's not that I'm lazy. It's that it's flat out rude to make someone redo all the work that's already been done (or do all the work that should've already been done). It's rude to consult someone and make that person reinvent the wheel just to figure out what's going on.

One of my friends is a resident. When I was on vascular, he was on the heme/onc medicine service, and he consulted us over a possibly infected port that we'd put in. I go down to do the consult, and he's already done a chest x-ray, blood cultures, wound cultures, CBC and BMP. All my attending had to decide was if he wanted it out, and when and where to do it. Of course, it would come out. That's what a consult should be. I told my friend that the consult I did with him was the perfect consult, the ideal way a consultation service and an admitting service should interact. It shouldn't be going up to the floor, finding a chart with a sloppy and scant H+P with no old charts and nothing else in the chart except nursing notes. Half the time, I find myself asking why we were consulted. There's no reason provided.

I really enjoy working with students. But I do get frustrated by people who are gifted with a big ole brain, and refuse to use it. You know, one of my surgery attendings put it to me. I told him I didn't know the answer to his question, and he refused to accept that. "No, you're smarter than that. You don't get off that easy." and he grilled me, and I got the answer, and it was the best learning experience I've ever had. And it was because he made me rise up to another level. And I'm not really asking anyone to even do that.

A sad day

I have my mix of good and bad days. Sunday was not a good day. It started off by waking up at 6AM after going to bed at 4AM because I couldn't sleep. I lay in bed till 9AM, when I decided that I would indeed get changed and go to church. This was a mistake on my part. I should've stayed home. If there's one place that reminds you just how alone in the world you are, it's church. My church is entirely filled with families. The only people in church by themselves are widows, widowers, and me. Then, for some reason, I got to thinking, and start weeping in public. I got all teary-eyed and I couldn't stop. It was just a multitude of things that just sort of added up all at a bad time.

Part of what got me was thinking about my family who've passed away, and about a lot of my patients who have not fared so well. How unfair that is. How unfair that all the patients who are kind and generous and friendly and I would love to see every morning on rounds for the rest of my life, it's these people that end up dying from something terrible. That's not fair. You live your life and you be the best person you can be, and all that good karma, all that noble living, it affords you no dignity. How cruel does life really have to be, that to be robbed of it should be so ugly.

Part of what got me today was the fact that I've abandoned my dreams for myself. I've given up on things that I thought were my future. And it's always a sad day when you abandon your dreams. It's always a downer to realize that your life is nothing like you thought it would be, and not in that good way. If you asked me 10 years ago where I'd be now, this wouldn't be it. My life has turned out not at all liked I had planned or hoped. And now I'm just coasting. I'm not even trying anymore. In all things, I put in a mediocre effort. Why should I try. Trying has not gotten me anywhere in the past. With strong or poor effort, I get the same result, and often a result I didn't want anyway.

And part of what got me today was just being lonely. Just knowing that I've spent so much of my life alone. Just knowing that I've never been able to share my heart with another person. You know, I've lived my life pretty much entirely based on two fears: (1) the fear that my life is meaningless and pointless, and (2) the fear of being alone. And it seems like no matter how I stack up the cards, I've just played into my fears, because I am alone, and my life is meaningless and pointless. I used to believe in destiny, in fate. I believed that there really was a person that was 'meant' for you. I feel that I must be unlovable. I can't come up with a better explanation. I can't think of a better reason as to why I should meet with so much failure. I'm entirely without hope in this matter now. I have no aspirations of a wife and kids and a house in the burbs. I have no aspirations at all.

I really don't know what keeps me going. I'm not motivated or inspired. I'm just coasting, and maybe it's just that I'm still riding some momentum from my teen years. I don't know. And I think the cruelest irony of religion is the idea that if your life sucks, you're not allowed to end it. I'm not sure I'm going to go to church next week. Or the week after that. I've only ever missed church a few times a year, and that's a streak that's been going on since I was a kid. I'm not sure I've ever missed church for two weeks in a row. But the last time I went to confession was five years ago. I was told by my priest that I was angry with God. I told him (not in so many words) that he was full of shit. Well, it took me a few years to realize just how angry with God I really was. How angry I was that I could have a life I hated so much, without any ability to end it. How angry I was that my life was without meaning or purpose. And nothing's changed. That is perhaps the worst part. I stare into the mirror and still, the guy staring back at me is the same teenage kid who had to try so very hard just to make it through the day, who had to cling onto anything just to keep from thinking about killing himself. That kid, he needed saving. He needed direction and purpose and hope. Me? Ten years too late.

The finer points of apple cider

You know that perhaps you take apple cider a little too seriously when you convince yourself that you can taste the difference between regular apple cider and UV irradiated apple cider. I purchased some good old fashioned apple cider and was pleasantly rewarded. It should go without saying that you're drinking unpasteurized apple cider. The pasteurization process essentially kills the natural taste and body of apple cider. I'm talking fresh out of the press. The lack of pasteurization is a bit of a roll of the dice. It comes with the knowledge that there are risks involved. However, I have yet to meet someone that orders filet mignon well done. If you're going to play everything safe, you might as well do nothing at all.

I also managed to eat some Korean food. It's been forever. It felt so good to be eating Korean again, it's like something that I put aside and now rediscovered. I wish I cold eat Korean food every day, but I can't. My stomach and my budget can't take it. Well, actually, I guess when I'm a doctor, there's nothing stopping me from eating out every night, which I may as well do, since my social life is on such a roll. And by roll, I mean roll down a steep hill with a cliff at the end. Especially since I have entirely given up. I mean, before, I at least had some hope. You know, the kind of 'Oh maybe someday' sort of stuff. I'm just out of it now. I've conceded. I'm trying to decide if it's a valid idea to waste all your money on frivolous things if you don't have a wife or kids. I mean, what would I be saving up for, other than retirement? Nothing. So, let's blow it all. As soon as I'm out of residency, I'm going to live like a king.

I really want a cigarette, but I'm being good. I'm telling myself that a cigarette won't make my life any better. It won't bring meaning or fulfillment. It won't solve my problems. However, there's always a little voice in my head arguing the point: it'll make my life shorter though. And well, that little voice has got some pretty good logic. People congratulate me on quitting smoking. What congratulations? I quit because I thought maybe it would make a difference in my life. And it has. Now, my life expectancy is inching upwards, while my life goals get pitched one by one out the window.

In the end, I get the feeling that I took a wrong turn somewhere, and it's far too late to turn around and double back. And I'm not doing such a hot job finding my way back on track. So maybe this is going to be one hell of a long and boring drive ahead of me.

I only read chexers during banker's hours

I realize that it takes a certain type of person to go into radiology. That person is not me. I completely zone out when I look at MRI's. There are just too many damn images. I can't make heads or tails of it. Chest X-Rays are still a complete mystery. The only thing I've learned is that I know what probably normal looks like. But when I'm having a good day, I can really get into radiology. When I'm having a bad day, it's like being eaten alive by guppies. I need to work with people.

One of my attendings pointed out something rather astute. All the time, people say 'foci' such as 'a foci of infection' or 'a foci of signal intensity.' This is entirely incorrect. Foci is the plural of focus. By saying foci, it implies multiple areas. Tell this to your attending the next time someone uses foci. I can't be held responsible for the repercussions.

One last bit about the hospital. I feel a lot better about radiology now that I've seen countless numbers of residents and attendings completely flounder on a film and have to bring it to one of the radiology attendings. All this time, I thought that I was such a suboptimal person for not being able to read a CXR, but lo and behold, no one can read the damn things. I've probably never mentioned this, but we have taken to pronouncing every lettered abbreviation. An example is "Cat" scan, which is a CT (computed tomography) scan. So, instead of being the ER, it's the "err". We've had a difference of opinion on the chest x-ray (CXR). At first, it was "kix'er". This was amusing. However, while on rounds, without thinking, I referred to a CXR as a "chexer". This agreed with me much more. And thus, I refer to CXR's as Chexers. Of course, not to my attendings. They think I'm weird enough.

My current attending keeps accusing me of being a banker. He looks at me and is like, 'We work till 5PM here, sir. Not like your banker hours.' Do I come off like a banker? I think not. Ironically, I checked up on some of my friends in grade school. Something like half of them work at some bank or financial institution. I'm the only one from my 8th grade class that went into medicine.

The hot nurse

Every hospital has one hot nurse, a nurse that is attractive and catches all the stares. She's got residents wrapped around her finger. This is, by and large, a product of the system. But it's true. My hospital is no different. We have such a nurse in the ICU that draws a surprising amount of attention. People kept telling me about her, so when I finally met her, I had a good laugh. I had two patients that were under her care, so I had ample opportunity to talk to her, but really, I didn't make much of it, because I wasn't trying.

I know, you're thinking to yourself that if you have to sit through another rant, you'll beat yourself to death with a squeaky hammer. But really, it's not that. I mean, who's to say if that didn't factor into her (or more likely my) thinking, but the truth of the matter is that I had about as much chance with this girl as a Ford Festiva in the Paris-Dakar rally.

I learned long ago that I attract about as much attention as a bowl of oatmeal (and have a similar consistency). I joke (almost incessantly) that all I need is some girl, a couple bottles of tequila, and a state where you can get married drunk. I'm not going to win any beauty contests. I would be very afraid of how I'd do on sites like hotornot.com and the like. So, over time, I've learned that I've got to put out extra stuff, kick my game up a notch just to get noticed. That is faaaaaar more inspired than I actually am.

I would think that after almost 5 years of pitiful failure, I'd have tried just about everything I was willing to try in order to trick convince a girl to go out with me. Well, not everything, but just about enough. I've finally decided enough is enough! Holy crap, I'm done. Let the ladies come to me. Haven't I done enough pursuing for a lifetime? Is it entirely unreasonable to sit back and say it's time people started chasing after me? Probably, but who knows. At this point, I'll take what I can get. And when they brush me off as a loser, I'll point my finger at them and say, "That's DOCTOR loser to you!"