So precious it must be rationed

Recently, there have been some unusual election results. Surprisingly to me, Canada went with the Conservative party. After seeing what we've done as a nation, you'd think Canada would get smart.

In a complete shock, Hamas won the majority of the new Palestinian parliament, essentially meaning that any hope of dream of Middle East peace is gone now. I'm kind of curious how this will play out, because for all the posturing Hamas has done, Israel is still the butt kicker. Considering the stuff that Israel has done recently, I'm shocked that Hamas isn't being more Israel friendly, but bad blood runs deep, I guess.

But I think the most shocking voting in the new year is the fact that Master P has managed to be on "Dancing with the Stars" for so long. This is criminal. He sucked. I mean wow, bad. I'm glad he got voted off.

I have to admit, I really like ballroom dancing, watching it at least. I haven't done any actual ballroom dancing since... well... 7th grade. But it's so marvelous to watch two people move so beautifully. I have to admit, ABC's got me by the balls on this one.

But my point originally is that democracy and liberty are things that sometimes don't yield desirable results. And quite wisely, many a government in the world does not let people vote for just such reasons. But part of democracy is people living with their choices. And after suffering another week of Master P, America wised up. Now, unfortunately Bush doesn't have to answer to the Friday night results show, but some mistakes take a little longer to fix.


There are certain things you realize about yourself while in the process of completing a residency. Mostly, it's stuff like how much sleep you require to think, or how fast you can eat dinner. Sometimes, however, it's simply understanding your own perceptions better.

The advantage of medicine is that I now have a rather thorough understanding of the human body, from a microscopic to macroscopic level. I can appreciate the knee joint with equal interest as a single hair follicle. I am not afraid to touch things, from a crusted sore to a liver.

And part of all this tactile and visual stimulation has led me to realize some things, such as [shameless male piggishness ensues] what I view as beautiful about the female form. What really catches my eye are curves, subtle curves. I like the curvature of the cervical spine, elongated in women. I like the curve of the top of the shoulder, more prominent in women because of decreased trapezius muscle bulk. I like the curve of the abdomen to the hip, made so by the female pelvis. I like the curve of the buttocks joining the lower extremities. Of course, the curves of cleavage. [shameless male piggishness ends]

And I know this sounds very crass, but I mean beauty in the way that the Venus de Milo is beautiful. It's not erotic, but rather transcendent. It's the idyllic wonder of female beauty. It's not Pam Anderson plastic boobs. It's something far more simple.

I used to do a lot of art, and at one time thought that art was my calling in life. I've got sketchbooks and books littered with drawings. And the one thing I learned in all that artwork is that straight lines are not hard to draw. There is such a thing as a perfectly straight line. A perfect curve, however, is difficult. The balance, the angle, the bend. There is something beautiful about a curve that my eye loves.


Seriously, how can a light-hearted and tasty chocolate candy that melts in your mouth and not in your hand share the same name with morbidity and mortality conference, the most malignant thing a set of residents and attendings can do to each other?

For those of you not in the medical field, M&M is when serious complications and deaths are reviewed in order to see if there was something missed or errors made, and if we can learn from these situations. There are several varieties of M&M conferences, but may be generally broken down into two categories: medicine and surgery.

Surgery M&M, bring some popcorn. I think it'd best be done in an urban movie theatre with a large black audience. I don't mean this in a racist way. My God, I love the black folk, and whenever I want to see a movie the way it should be watched, I wanna see it in the ghetto theatre. Because it's so damned entertaining that you really need a running commentary.

Surgery M&M is vicious. It's a witch hunt initially, trying to find the right person to blame. Once that person is found, he is grilled on why he was so incompetent, because regardless of the cause, it boils down to incompetence. Cause of death was MI due to stress of surgery? Why didn't you crack his chest and do intrathoracic cardiac massage? Invariably, one attending will question the skill or acumen or technique of the attending of record, and that's when the sparks start flying. Only an inane jackass would dare try to do an end to end anastomosis in a case like this. Stuff like that. It really would go better if someone in the back row yelled out, "Oh no he didn't!"

Medicine M&M, that's not nearly as fun. Medicine M&M is when every senior resident and attending chooses to second guess the responsible party. Even though your D-Dimer was negative, you still should have scanned the chest. Weren't you suspicious of the heart rate of 110? The patient's reports of a recent episode of rhinorrhea should have tipped you off to acute bacterial meningitis. The premise of Medicine M&M is that if you did some extra test, used a better medicine, paid a little more attention, the outcome would've been different.

Medicine M&M is so hell bent on teaching people something, but in the end, the only lesson you walk away with is that you're glad it wasn't you. I'm practically a veteran of M&M's at this point. I've done more than my fair share. I didn't really do anything wrong per se, but everyone feels better when they can find my flaws.

Because there's something very reassuring when you can walk out of a conference talking about the untimely death of a person and say to yourself, if it was me, I would've done this, and the patient would still be alive. That's fucking comforting. Better than a warm glass of milk.

I don't mind doing Medicine M&M's, because I know that the learning value is not for me. It's not the scolding of a Surgery M&M. There's no veiled insult. It's like a morality play. The story has a message at the end, like always remember to consider pulmonary embolism as a cause for mild elevation of troponin in a patient with chest pain. But the part of M&M I enjoy most is when my attendings ask questions, and I agree. Like one time, one of my attendings asked, "So, why did it take so long to change the code status in this patient?" Why indeed.

Not really

I was thinking about this girl, and it occurred to me that I didn't really know her at all. Of course, I knew her, but not in that meaningful way. I knew her habits and her likes and dislikes, but know? I didn't know. I didn't know her hopes and fears, her ambitions and hinderances. I didn't really know her.

But what made things so convincing was how well I knew about her. It's strange how well you can appreciate the trappings of a person, but not the inner apparatus. It's like a building you pass by every day, but never look inside. And that's what made things so... difficult in the end. I knew too much about this girl.

So well known that when she rejected me, I couldn't understand why. I mean, other girls have rejected me, and I've had varying responses, but confusion was a new sensation. Because I thought that I understood her. I thought that she made sense to me, deeply.

But did I really know her? Not really. I just knew the shell. And I'm not bitter, no sir. That's life. Sometimes it's crumbs, and I can't really complain, because I never came out of my shell either.


I'm buying plane tickets for my V A C A T I O N ! I know, sounds so wonderful, but really, I don't have that much planned. Visiting family mostly. I have rather fond memories of going to Mexico during med school. After so much stress and panic and worry and hardship, that vacation was well-deserved. But now, vacation seems like more trouble than it's worth.

I don't have anyone to vacation with, and that's the problem these days. I mean, yeah, any time away from the hospital is good time. Fantastic. But vacation spent with family's not really vacation. It's more like filial piety, Confucius coming to kick me in the ass.

So, since I'll be in the Southwest anyway, I decided to take a couple days in Las Vegas. I'm not a big gambler or partygoer, but a couple days in a strange town with free alcohol? Sounds good to me. And it'll be warmer than the Midwest.

I just wish I had someone to vacation with, you know, to spend the time. And I think, in the back of my neurotic little brain, there are some cute girls I know who would seriously consider an offer to spend a couple days in Vegas. And wow, that would be nice. It'd be a vacation from my life.

But part of being in internal medicine is being pretty skeptical. And the skeptic in me is rather sure that the only female company I could have in Vegas would be the kind of company that I'd have to pay for by the hour.

How to escape an ambush

My old boss when I was a computer consultant in college, he was an ex-Marine. He didn't play around. When in life you have a boss, try not to have one that's a Marine. Although, if you're big into efficiency and productivity, marines ain't bad to work for.

Anyway, I was talking to him one day, and he was telling me about ambushes. The thing about an ambush is that if you try to run away, there's no escape. The "kill zone" extends along routes of escape, so even if you run away, you're still going to die.

The only way to escape an ambush is to charge straight into it. If you think about it strategically, it makes sense. You expose yourself to only one attacker rather than crossfire. But it's scary as shit, huh? Who charges into an ambush (other than marines)?

But the funny thing about life is that it's pretty much the same. There are things in your life that will simply jump on top of you and fuck you over, and your best bet for surviving it is to charge straight at it and try to kick its ass. And so, that was my approach to units. The unit in the hospital is the proverbial kill zone.

And there's nothing so horrible as having multiple patients trying to die at the same time, and looking around the place and realizing that I am the one person responsible for all of their lives. And running away is no good. So, all you can do is charge straight ahead.


I realized today that I don't have a best friend anymore. Oh, I have friends, great friends, but no one that I'd call at midnight and go out for sandwiches with. I don't have anyone that I'd stay up till 3 AM instant messaging. No one that I'd road trip with on a whim.

Part of that is circumstance. All my friends live pretty far away, at least an hour. That puts a damper on things, for sure. But part of it is a different kind of distance. My best friends in high school, I've lost touch with most of them. And it's not the same anymore.

I miss those days, playing cards till 5 AM and going out to breakfast, or going to Taco Bell at 2 AM after watching movies or *shudder* anime. That kind of stuff, it's friendship that you can't have once you've got a job and responsibility. And then, it's tough to make friends once you're a doc. Not many people can sympathize with spending 3 hours trying to keep someone alive so family can come by and change code status.

I miss my friends, and I miss being that kind of friend. And I remember in high school having a pack of friends, and we did everything together. They've all got lives now, and so do I, and it's just not the same anymore. And that's life I guess.

The bearer of bad news

I had a day in the units a while back where I had family meeting after family meeting after family meeting. I changed the code status of 4 patients in one day. It was draining. I do a good job. Every nurse and doctor and social worker that helps me through one of these family meetings always thanks me for doing such a good job.

And part of that is conveying to the family what we know and what we think without crushing them. It's a process. It's gently telling people that we don't think mom is going to pull through. We think, if it was our mom, we'd start to think about calling it quits. It's trying to be subtle while smacking someone with a sledge hammer.

It's an art, delivering horrible news. And after 4 in a day, I was drained. I couldn't do another. And I passed up a few other families because I couldn't look them in the eye and do it again. I couldn't shake the hand of another tearful son or husband or wife or daughter and shit all over their hopes and wishes. I couldn't have someone else thank me for killing their loved one.

I think that the nurses and everyone thanks me so profusely for doing this because they are so very glad that they did not have to do the hard part. They can just back me up, toe the line, offer tissues and support, knowing that when the family thinks back to the death of their loved ones, they'll think of me, whether as a hero or heel.

Admired from afar

There's a nurse at the hospital, and I'll be damned if she isn't just my type. She made me realize, finally, that I do indeed have a type. After years of trying to figure it out, looking at her, I see all the crushes I've had, like they've all lined up in her. A little aloofness, a dash of sarcasm, a hint of a smile, and this and that.

My type is a fair face, a devilish wit, a little grimace that hides a gorgeous smile which only comes out rarely. She's smart and sarcastic, and she gives as good as she can take. She doesn't yield an inch. She doesn't hide behind makeup and fancy clothes. She tries to hide her beauty.

And I catch myself every now and then staring at her ass, and I have to tell myself, "Bad doctor! Bad! Thou shalt not ogle the nurses." But what can I say, she's hot. Anyway, I told myself long ago that I wasn't going to get mixed up in all this kind of thing.

Especially since I know my type, and my type is not something that I have a good track record with. A lot of silly crushes and heartache and pain. My type doesn't like me, and maybe that's a part of it too.

And so, I'll stay away from the forbidden fruit, because I know me all too well, and I know what I'm capable of. It's my imagination, my fantasy that I become enamored with, not reality. And I wish it was real, but wishing doesn't make it so.

I know, I know, it's my own fault really

Tonight I did some cooking and cleaning, and when I came home to my empty apartment, I turned on the TV just so I could hear some noise and I set a place at the table just so I could feel like I was going through the motions of civility.

I left the hospital today hoping that someone would talk to me, have a chat with me beyond the weather and how the local teams are doing. I'd like someone to ask me how my day was and wait for a real answer.

The problem with living a solitary existence is that when you're lonely, there's no recourse. And sometimes, it's nice to have someone give a shit about how your day went. And I have some clinic patients who are real troublemakers, but I give them 30 minutes of my life, let them unload all their worries and fears and concerns on me, just to get it off their chest. And they feel better, and they do better.

Sometimes, it's wonderful to have someone listen, and that's a beautiful thing. And I wish I had someone like that. And it's sad that people are paying to see me for something as simple as that.


One of my friends, he's fond of regaling me of the sexual indiscretions of his youth. It's an amusing history, certainly. But it's hard for me to grasp or comprehend, mainly because I have no basis for comparison. I've never had sex. I've never even had something questionable where one could debate what activites constitute sex.

I guess I should feel bad about this. At least, that's how I think I should feel about it. In reality, it doesn't really bother me much. I grew up pretty straight-laced Catholic, and in the great buffet that is Catholicism, I somehow managed to put a heaping serving of 'no pre-marital sex' on my plate.

I think the thing that bothers me more than my amazing lack of reproductive success is that it's been so long since I've been open with someone. You know, it's a tough life when you've got no one to confide in, and that kind of hurts sometimes. Sex, you can buy that. Intimacy's not for sale though.