BO

Lately, I've been experimenting with scents. I'm on a non-clinical rotation, and so I don't need to worry about offending patients with colognes and such. I have been wearing my cologne regularly, and I've even experimented with that Axe body spray stuff (do women really like this stuff? It smells kinda ick).

And maybe it's that I've developed a nose for body odors, but I'm much more appreciative of smells now. I can actually smell perfumes, and find myself enchanted with the smell of a woman. I don't know if this is chicken or egg, but some of the beautiful women I know smell wonderful. Do I like their smell because they're pretty or are they pretty because of the appealing scent?

Anyway, this was all fine and good till someone walked by me and said, "Hey, who stinks?!" And that was pretty much the end of me wearing cologne for a while.

Just so you know, I usually wear Drakkar Noir. I used to wear Davidoff Cool Water. And then the Axe body spray? Interesting, but I think it's kinda bleh. But girls I know tell me they like the smell, proving to me that I have no idea what smells good.

A savvy investor

My mom created a mutual fund account for me for my college tuition. After graduating college, the remainder kind of became my emergency money. I keep it around in case of disaster. It floated me through medical school for things like food and rent. Now that I'm gainfully employed, the money's just sitting around earning a measly 2% interest. I'm keeping up with inflation, and that's about it.

So, after having a financial planner, 2 tax preparers, and a couple friends who work in finance all tell me that I'm an idiot, I've decided finally to reinvest the money out of super safe pointless money markets and back into mutual funds. Here is, briefly, the last 24 hours of my life (try to imagine the clock beeping sound from the TV show "24").

3/28 - 2200: After going through a bunch of Fidelity funds, I find FLVCX which seems to be performing awesomely. I am ready to invest. Bring it on, bitches! Mood: elated.

3/28 - 2201: FLVCX has a minimum $10,000 investment. Shit. Mood: aggravated.

3/28 - 2330: After researching more funds, and finding one with a lower buy in, I find FBALX which isn't the big dog that FLVCX is, but is a decent performer, and has a good 5 year trend, and I'm looking for long term investments anyway. Mood: satisfied.

3/28 - 2335: I'm ready to order. I buy $2,500 into the fund. Mood: anxious.

3/28 - 2338: Instead of transferring from my money market, I just put in the order to buy on margin. SHIT SHIT SHIT SHIT SHIT SHIT SHIT SHIT SHIT. Thank God it's the middle of the night and the market's not open. Mood: I think I just shit my pants.

3/29 - 0015: The order is pending cancellation. I'm too scared to put in a new order while the old one is still sitting there, waiting to be canceled. I go to bed and pray that I don't get a random call from Fidelity in the morning. Mood: trying not to wet myself while I sleep.

3/29 - 1333: The order canceled, thankfully. Now, I do it right and tranfer funds from the money market to the mutual fund. I buy in $2,500. Mood: cautious optimism.

3/29 - 1340: The order is still not filled. There's still plenty of time, but when's this going to happen? Mood: Not so optimistic anymore.

3/29 - 1758: The market's closed now and the order finally filled. But now, I've got a different dilemma. The account value is right. The mutual fund buy is right. But the website shows my FBALX current value to be $0.00, despite having 127.291 shares of it. FUCK FUCK FUCK FUCK FUCK FUCK FUCK FUCK FUCK FUCK. Mood: raving lunatic.

3/29 - 1920: I've managed to convince myself that this is because my order filled at the end of the market day, and the value will post in the morning when the market opens again with the next day's value. I think. I hope? I mean, it's not like my $2,500 just vanished, right? RIGHT? RIGHT?!?!?!?! Mood: currently meets criteria for diagnosis of paranoid schizophrenia.

3/29 - 2230: After reading the small print, I see that it takes another business day to update the value of my new purchase, so there's nothing to worry about, and my money's still there. I set up my bank account so I can make electronic fund transfers to my Fidelity account. This could become trouble. Mood: a little worried that I might spend all my money and go into bankruptcy and get my kneecaps shattered by a big Italian named Guido.

And that, my friends, is how my first 24 hours of being a savvy investor has gone. Once I'm more comfortable with the whole process, I'm going to put more money into investments and try to diversify a little. But (1) I have to stop wetting myself with this trading stuff, and (2) I need to stop buying $200 pens.

Beating a dead horse

I thought that I was done with this whole Terri Schiavo nonsense, but here we are, March 28, 2006, with Nancy Grace on Headline News running an hour of shit with the Schindlers. I am remarkably pissed off. And what pisses me off is that this waste of an hour of national news time. It is sensationalizing something that didn't even blip on medical ethicists radars.

I could rant for hours on this subject, but I will confine my ranting to a few select points. (1) I have not yet been presented with any evidence in the news media that would make me question the diagnosis of persistent vegetative state. Based on the news coverage out there, I would be inclined to believe the court-appointed physicians who concluded PVS.

(2) It is a straight up miracle that she did not die from decubitus ulcers (bed sores). I've seen far more capable patients die from bed sores, and I'm talking on the order of months, not years. In my mind, if her husband managed to keep her bed sore free, that's love.

(3) Being Catholic is not an argument for keeping the feeding tube. As a Catholic, I would not ever want to live like she was living. It is cruel to imprison someone in their body like she was. If it were me, I would've pulled that feeding tube years ago, with my own two hands, fuck the court orders. I feel that medicine as a science has done something God and Nature never intended: we can keep the dead alive. That's not for us to do.

(4) If you think about what it would be like to be in a PVS, without consciousness, without any hope for recovery, without any pain or pleasure, wake or sleep, joy or sadness, without awareness, I'm guessing that you'll agree, it's not a desirable state. It sounds downright awful. I wouldn't wish it on anyone.

So to sum up, PLEASE! This is nuts!

Don't become a doctor #7 - Thankless

During my last clinic, one of my patients thanked me. This was such a rarity that I was taken aback. It had been so long since I'd heard those words from a patient. And my clinic is amazing. My patients actually like to see me. My personal clinic is probably more representative of an actual IM practice than 70% of all IM residency clinics.

A lot of people see good health care as something they are entitled to. I am simply performing a duty that is owed to them. It requires no more thanks than the garbage man or the meter reader. Some feel that for the privilege of learning through them, I should be thanking them rather than vice versa. Some just resent me and don't feel I deserve thanks.

However you get there, it amounts to the same thing: medicine is one of the most thankless jobs out there. It is countless hours of stress and worry, without any palpable reward from the patient except a copay if they have private insurance (which I don't see as a resident).

So, I had to find some satisfaction in the practice of medicine apart from the praise of my patients. I found ways to enjoy every clinic and every patient interaction, without seeking approval or praise from my patients. And it's to the point now where I feel fulfilled with my patient encounters, and I enjoy caring for patients. The thanks, while much appreciated, is not necessary.

If you think this job is a wealth of praise and admiration, think again. Often, despite our best efforts, we receive resentment and enmity rather than anything good-willed. Because all too often, I've taken exceptional care of someone, and been thanked with curses and derision.

The Natural

My attendings in clinic, they think I'm a natural at this outpatient game. My patients rate me extremely high on satisfaction scales. They are in fact vocal about their love for me in clinic. It makes me blush every time. One attending pointed out to me that I'm so good at this because I have such deep empathy and compassion for my patients, and you can't fake that. People can sense it.

If you don't know what the difference between sympathy and empathy is, it's an important split. Sympathy is pity. That's not a bad thing. Pity can be great. Sympathy is how we feel about something someone else is going through. "I feel sorry for him" is a sympathy statement. Empathy is more about walking a mile in someone else's shoes. It's trying to understand what's behind the emotion. "I can see why he'd be sad" is an empathy statement. At its very basics, sympathy is what we feel; empathy is trying to get what another person feels.

For the sake of completeness, compassion is a different entity too. It's too trite to equate compassion and sympathy. They're not the same. Compassion is seeing the suffering of others and wishing to alleviate it in a palpable sense.

I can't tell you how I ended up with an extra helping of empathy and compassion. My attendings keep telling me that it comes from me naturally. It doesn't. I am the most introverted person I know. I'm practically a hermit. Growing up, I was so shy that I was nearly dysfunctional. I was afraid to ask for ketchup at McDonald's, horribly afraid, tearful and tremulous afraid. I learned to interact with the world in more healthy ways, but in a lot of ways, I'm still that shy little kid.

There's no rule for how to be empathic or how to have compassion. And I have no idea how to learn those things. But if you do have empathy and compassion for your patients, then don't let that go. It's so precious. Because it is our empathy and compassion that let patients know that we are human beings, and that's all most patients want from us.

And I've seen doctors try everything in order to try to seem human to patients. They'll talk about sports or the weather or clothing or cars, or they'll touch patients or make a lot of eye contact. And if you went home to your wife and did this every day, she'd divorce you. My only advice to you on the subject of empathy and compassion is this: be a human. If you can do that, the rest of this doctoring stuff is cake.

My clinic

Sometime during my first year, I came to understand my relationship with my clinic patients. For so long, I'd been trying to be the general, ordering the troops. That was how I saw my clinic interactions. I was largely unsuccessful. I had a lot of noncompliance. I had a lot of problems that you'd expect with any resident clinic. And so, I decided that I needed to change my perception of the doctor/patient relationship.

And what I came to realize is that it's not at all like a general and a soldier. I can order my patients around all I want, but there's no imperative for them to actually follow my commands. Their successes weren't their own, but were mine. Their failures weren't mine, but theirs. They didn't have any control over their care. I did.

Touchdown, uploaded by ohad*.

And since I watch a lot of football, I realized that the doctor/patient relationship is more like a coach and a player. As a coach, I provide strategies, game plans, scouting, and the occasional pep talk. I know the challenges and each week, I prepare the player for competing. I even call the plays. I've got a staff of folks, from assistant coaches to equipment managers, who help to ensure that the players are ready to play. There's all sorts of tools available to help the players. But I'm not playing.

When the game's going, I'm on the sidelines. I try to give advice or coordinate efforts or direct the action, but I'm not playing. I'm just on the sidelines. And the victory doesn't go to me, it goes to the players. And the loss, if the players did their best, is on me. That's the role I have. There is no success of the coach without success of the player.

And even then, I find in my clinic that I have some Peyton Manning's. They can call their own plays, run their own offense, and they just need someone to coordinate the rest of the efforts. They need support, not leadership. And some in my clinic are Terrell Owens's. They don't want to listen to my advice or recommendations, and they fail to succeed on the field.

And so, with my patients, I try to be their medicine coach. I tell them the game plan and give them the strategies. I prep them and encourage. I have them work with the other coaches and staff. I make sure they've got the right equipment. But once they leave the locker room, it's on them to succeed or fail, and they have to want to win. Without the will to win, in sports or in medical care, it's hard to succeed.

Strangely enough, my patients love me. Really. My attending comes in and they shower me with praise. I listen well. I explain things. I address their concerns. I care. My attending told me I'm a natural at clinic because I have empathy and compassion, and those are two things you can't fake with patients.

And much like a coach, my accomplishments, they don't make me proud. I'm more proud of my diabetic patient with an A1C of 6.0 or my hypertensive with a BP of 110/70. Because they're out there on the field. I gave them the tools to win, but they're the winners.

7 years running

On March 20, 1999, I shut down my personal homepage and replaced it with a picture of a barn on fire. Underneath was a link to an online diary of my emotional spew from being dumped by my girlfriend for one of my best friends at the time who had been cultivating this relationship somewhat behind my back.

And since then, I've been blogging for 7 years now. It's hard to believe. Things have changed dramatically since I started. The anonymity requirements for this blog are rather constrictive. My old blog was so... unashamedly open and honest. I still have people stumble upon it quite randomly, to the point where I've deleted it entirely from the internet.

It's kind of a shame, having 4 years of writing that's sealed away. And it was such an interesting time in my life, full of upheaval and terror and shame and self-loathing. It's nice that I've moved on from that, though. Hah!

I really enjoy what this blog has meant to me, in all of its various iterations, for the past 7 years. It's been a place where I could open up and be free, although not so much anymore. But thanks for reading, some of you having stuck with me from the very beginning. I hope that you've been getting something out of this too.

Bare midriffs

Lately, I've been on rotations with a lot of women, and I have been reminded that I have been subjected to the unfairness that is professional dress for too long. Please let me complain a little.

For men, it is clear: doctors and student doctors should wear dress shirts and ties, slacks, nice shoes. For the profession of medicine, professional attire required. I have bucked the trend as much as I could: no tie, sweaters, collarless shirts, all sorts of things to see what I could get away with. Depending on the rotation, even these days, sometimes I have to go in every day dressed to the nines.

But all through medical school, I had to suffer the 'professional' dress of women. And most women are good about dressing. I'm not trying to cast aspersions on all of womankind, just the ones that don't know how to dress well. All through medical school during clinicals, I met girls who considered sleeveless or strappy tops, blouses that were open to the midsternum, sheer or see-through blouses, tops that bared midriff, they considered this professional attire. This is to say nothing about miniskirts or tight skirts, tight or sheer pants, or any number of other professional attire atrocities.

One friend was complaining after rounds that one of her patients was hitting on her. Well, if some 20 something girl falling out of her blouse was bending over and showing the goods off every morning, who wouldn't hit on her?

I think this is probably my whole etiquette thing kicking into a very high gear, but I really believe that professional attire has everything to do with self-respect. Part of dressing the part of doctor is believing that you are a doctor. And that means looking respectable before your patients and colleagues.

Sine qua non

A friend of mine questioned my ICU DNR habits, because in reality, there are some patients that turn around, and for the most part, when DNR orders are written, patients get less care. I wouldn't say poorer or substandard. It's not true. Less care, yes, because we focus away from curative things just by the nature of the DNR order, almost reflexively. It's not overt. It's simple things, like the knowledge that if we take out the ET tube, we're not putting it back in.

I feel very strongly about this, and I think there's a good sine qua non for a patient that needs a code status change: if I can go home and sleep at night and feel good about the result, even when the patient's dead, then that's a good DNR. I did my best, and life is what it is.

If I feel there's still an avenue to pursue or a treatment untried, then I'll try it. If a patient's in the ICU, the rule I use is that there's nothing I won't try in the first 72 hours.

But if it's >72 hours and the patient's knocking on death's door, I'm willing to say I've done my best. And to this day, I only have one regret. It was a patient in neutropenic sepsis. By the time the patient got to the unit, the BP was in the 50's and was seconds away from coding. I couldn't get the patient through to the morning. If I can't get a patient 24 hours, just one damn day, then what am I doing?

The patient hit the unit at 11PM. I asked for a code status change at 3AM. I asked to withdraw care at 5AM. And I went home at 9AM, and once I got home, I started cursing and throwing things. Just 24 hours. I couldn't even do that. What about Xigris, different antibiotics, an antifungal, more aggressive fluids? What I did wasn't malpractice. I took excellent care of her. I doubt that there's anything I could've done to save her. But I didn't care about saving her. I just wanted to give her one more day.

So I think when it comes to DNR, you need to find your line in the sand. Whatever you can live with.

The scramble

For those of you that have no experience in the medical student world, Monday, today, was when the 4th year med students found out if they matched into a residency program. You find out where on Thursday. The reason for this delay is something esoteric and humiliating known as "The Scramble."

The scramble is for those students that did not match into a program. They are then forced to try to find programs with unmatched spots. This is, depending upon the specialty, an exercise in horror. Routinely, you hear things like, "There are two open spots for ER" and they mean two open residency spots for emergency medicine in the entire country. And that's lucky. There's no such thing as open spots in derm or ortho or a lot of specialties.

I've had several friends that have had to scramble, and it's not a pleasant time. You try to steer clear of these folks because the last thing they need is someone rubbing it in their faces. Talk on campuses lulls and the gossip flies like bullets on a battlefield.

To all you 4th years out there, congrats. It's been a long road, and it's time to rest on your laurels. If you're scrambling, you have my sympathies.

Don't become a doctor #6 - Laughing at the pain of others

Recently, my friend West Coast and I were getting a laugh at patient care. He's got a patient who's 400 pounds. We couldn't help but get a few laughs at this patient's expense.

But the thing is, in medicine, we use a lot of dark humor. We laugh a lot at the pain of others, both the patients and our colleagues. The proof in the pudding? Scutmonkey. The author has comics about her horrible med school experiences, and me and WC were falling out of our chairs laughing at it.

In med school, one med student, Handwriting, he was an idiot, but everyone loved him because of his amazing handwriting. One day, we were having a bioethics discussion about delivering bad news, and our prof mentioned that a lot of times we'll use euphemisms for death in the hospital. "Like celestial discharge?" one med student chimed in. Instantly, we were coming up with a ton of such euphemisms: transfer to the pathology service, basement admission (the morgue is usually in the basement), organ donor (motorcyclists who don't wear helmets), ICU cuisine (tube feeding), M&M rounds (my rounds on vascular surgery, where patients died like flies).

Handwriting, he was appalled. His gut reaction: "Well, we shouldn't make fun of these situations. It's wrong." We were all silent, not shamed but outraged. How can we NOT make fun of this? What's the alternative? Go home and cry our eyes out every day?

I had another med school colleague who did just that. I'd see her in the hospital when she was off service, but she was visiting her patients, sometimes for weeks. At first, I thought it was noble to be so attached to her patients. Then I realized that there was no way I could do it. It was like self-inflicted torture.

There was a nice episode of Scrubs that I really liked, and I'm sure I've quoted it before, but the episode was about how they were making fun of the patients in the hospital, and Dr. Cox had this to say:

Lemme guess, you're off to another funeral. ... Turn around. Turn around. You see Dr. Wen in there? He's explaining to that family that something went wrong and that the patient died. He's gonna tell them what happened, he's gonna say he's sorry and then he's going back to work. Do you think anybody else in that room is going back to work today? That is why we distance ourselves, that is why we make jokes. We don't do it because it's fun, we do it so we can get by and sometimes because it's fun. But mostly its the gettin' by thing.

If you find yourself like Handwriting, offended at the thought of laughing at the pain of others, you'd best avoid medicine entirely.

I & D

In my life, I'm so used to being the underdog. I'm so accustomed to being disadvantaged. I'm so used to people thinking less of me, whether it was because they were wealthier than me, or that I was Asian, or that I wasn't Asian enough. I was too short or too fat or something. And I've spent my life proving them wrong. I won awards, I took the hardest classes, I smashed every standardized test, I kicked the shit out of the MCAT, I got into med school, and on graduation day at medical school, a funny thing happened.

You'd think that graduation should be a happy time, but I was scared witless. Walking into the auditorium, I couldn't imagine a greater feeling of panic. I had nothing left to prove. I had no one holding me down.

And it was scary, because I realized then and there that one of the greatest motivating factors I've had in my life is proving other people wrong about me. Nothing made me feel more wonderful than the biting envy of Asian parents who had scoffed at me before now grinding their teeth knowing I was in med school, and their first born was cleaning dishes for $5/hr.

And without anyone holding me down, I felt a little empty, and it was hard to feel the drive to succeed anymore. I'm doing fine now, but there are two things that I've never been able to let go: my low self-esteem, and my bitter resentment.

After so many years and years of being told that I was less, I can't help but believe it. And I didn't see it before, but I do now, and sometimes it tears me up. I'm a doctor, dammit! I've gone to school for 8 years, hold a bachelor's degree and MD, have a job, and I'm damn good at it too. But when I look in the mirror, I can't help but see something less. And now, I can see it in my life, and it burns me that I can treat myself so horribly, that despite what I've done, in my heart I really believe all the doubters. And that just fuels my resentment.

There's so much resentment in my heart, from secretaries and paper pushers to God Himself. I've spent so long stoking that resentment, and now, I don't want to let it go. Why should I? I've been treated like shit in my life by more people than I care to remember. I've suffered. They haven't earned my forgiveness.

My friend West Coast (I don't know when I decided to give everyone nicknames, but hey, what the hell), he's very wise sometimes. "No one's paying you to carry that around." He gave me a book. The book is about forgiveness. I'm supposed to forgive people: God, my father, all those shitty little prep school bastards. I don't want to. Why should I? I don't want to grow as a person anymore. I've done that enough.

The one true thing about personal growth is that it is exceptionally painful and arduous. It is like lancing a boil. If you've never incised and drained an abscess, have fun. The area is sore and indurated, actively inflamed. The scalpel blade, although so tiny and so sharp, hurts like a branding iron. Then, you have to squeeze the pus out, and it's enough to make a grown man wimper to watch. And 3 days later, it's better and life moves on.

My resentment hasn't come to a head yet. Maybe when it does, my life will come crashing around me, but for now, I'll let it fester. And I'll read the book, and see if maybe there's hope for me yet.

You f***ing Democrats

Now with Alito on the court, and the growing possibility of a heavily religiously conservative (this new shit version of the Republican party, not traditional conservatism) Supreme Court, states are lining up to chip away at Roe v. Wade, and in the case of South Dakota, attack it with a shotgun. This is, more or less, ridiculous. I can't think of anything more appalling than the current trend of this country to make everyone conform to Christianity's view of things, or at least fundamental Christian beliefs.

So I'll say it right now to make things clear. I am Catholic, and a seriously practicing one at that. I abhor the entire idea of abortion, to the point where we had a patient that needed an abortion for medical reasons and all my friends tiptoed around me because they thought I'd be offended. I think it's morally reprehensible. But since when is that a reason for something to be illegal? There are lots of things that are horrible and legal. Abortion's not exceptional in that sense.

Last I checked, more than a ton of Supreme Court rulings have consistently found abortion to be protected. It is legal. And I may not like it or even approve of it, but if it's law, and if the Constitution of the United States is behind it, then I'll be damned if I sit quietly while some jerks piss all over it.

The most appalling thing to me is that we're doing nothing to prevent abortions. This is no better than the war on drugs. It doesn't address causes. We have kids out there who honest to God don't know to use condoms. They come to me, and I have to be the one to break the bad news that those sores, that's Herpes, and that nausea and vomiting in the morning, that's being knocked up. Please! This is criminal! And you know that with these ass backwards, fundamentalist, sanctimonious super-Christians, it's only a matter of time before they try to outlaw what I can tell a patient.

Listen up, there's a difference between religion and politics. There's a reason for the separation between church and state, and maybe if we were a majority other than Christianity, you'd understand why. At it stands right now, we're moving closer and closer to Theocracy, and I blame the Democrats.

That's right, you heard me, the Democrats. You motherfuckers let this happen. You watched halfwit after halfwit being elected by the Republicans, and you barely put up a fight. And now, we've got a fucking moron for president who'd sign a law requiring chastity belts if it was passed by Congress. And what did the Democratic Party do? You sat on your hands and put up for scrutiny the most ideologically vacant candidates possible. You lost all your vision. You let the Republicans become the Christian party, as if Christianity has a political party.

And you have the FUCKING GALL to talk about Hillary in 2008. If this thing in 2008 ends up Frist vs Hillary, I promise you that I am voting for ANY third party candidate I can find, because that would be proof enough to me that both major political parties are completely useless.

And if I should wake up on the first Wednesday after the first Tuesday in November 2008 to find out about President Frist, I will grab every representative of the Democratic Party I can find and beat them for letting their party go to shit and letting another Republican moron run our country further into religious zealotry.

Don't get me wrong, I've got nothing against the Democrat voter. My beef is with the politicians running the party who've let us all down.

And as for the Republican Party, you're not getting off easy here. I have never been so ashamed IN MY LIFE as I am about the fact that I've voted Republican. I wish my friends had beat me within an inch of my life on voting day so that I couldn't have made such a tremendously stupid decision. At least then, I could sleep at night knowing I didn't vote for you asswipes.

Don't become a doctor #5 - Thou shalt not opine

One of my colleagues asked me to write him a script for Augmentin a while back, which I did without a second thought. A week later, I found out he was in the hospital with a serious infection, and that the Amox/Clav I wrote was pissing on a forest fire. I was kicking myself all day.

Once you're a doctor, you'll find that people will continually ask for your professional opinion, which is fine when they're your patients and you've examined them and can best determine their plan of care. But it's very dangerous if that opinion is given out casually. The danger is that you could completely miss the mark, like I did with my Augmentin, or risk being completely wrong, like good old Dr Frist on the subject of Terri Schiavo.

Senator Frist had proclaimed her not to be in a persistent vegetative state, based on the 1 minute video we have all seen. Now, Senator Hatch or Biden or Kennedy or Clinton or any other senator could have said the same thing, but with Frist, he's a doctor. That's his professional opinion. That's not rhetoric. That's diagnosis. I don't know how he can still call himself a doctor, because he should've known better.

Most of the time, it's not such an overt display. We will make an offhand comment or some remark, and that carries amazing weight. It determines what shampoo someone will buy or whether to eat more broccoli, or most notably, whether to sue another doctor.

The numbers show that one of the most powerful factors in patients bringing malpractice litigation forward is doctor B telling the patient that doctor A was wrong. This is simply irresponsible. People think that when we say that we should refrain from these comments, we are trying to protect our own (which is a legitimate reason in and of itself, but certainly morally questionable). I disagree. The simple fact of the matter is that you weren't there. You didn't see what doctor A saw. You can't put yourself in his shoes.

Honestly, I think that a lot of people go into medicine because they have this vision of the rabbi rather than the healer. What I mean is that in the Jewish community, a rabbi is a teacher and a scholar. People come to him and ask his advice or knowledge. He offers a piece of scriptural wisdom to support his point.

The same cannot be done in medicine because it's dangerous. We don't have the authority of God to fall back on when we have bad outcomes. I seldom if ever give out free medical advice, even to family, because I am professionally liable for that advice, and my conclusions bear serious weight, but are based on limited data. Your professional opinion is not something to just throw around or wear on your sleeve. Unless you want to sell your soul to some foot cream company.

So if you want to go into medicine for the admiration and having people seek your opinion, please reconsider. It's a dangerous game.

BTW - I'm still on vacation.

A rare book review: Lynne Truss's "Talk to the Hand"

Recently, I've just finished the book Talk to the Hand by Lynne Truss, famed author of Eats, Shoots & Leaves. That book took a hard line, zero tolerance approach to punctuation. It was a charming read, which I found especially enjoyable because I have strong punctuation-related opinions as well.

But reading through her latest opus, I have to admit I find it rather pedantic. It's a continual complaint about what's horrible in society and the possible causes. I had hoped for dry British wit, but instead, it's a laundry list of annoyances, with poorly supported evidence.

The resounding comment in my mind, as I read through this thing, was, "Why does it bother her so much anyway?" On TV, there is a series of commercials where there will be a bunch of people staring at a piece of litter, and finally someone else walks by, picks it up, and puts it in the garbage. That is my reply to this book.

I've written far too much on manners and etiquette, and I won't force any more of that on you, but I will leave off with a comment. Most women say that they want to be treated like a lady. I think that these days, chivalry and gentlemanly arts are on the decline thanks to the feminist movement and a variety of social factors. That's the world we live in. However, we are all not above some common courtesy. And if you are a lady and wish to be treated like one, then please remember as well that most men wish to be treated like a gentleman. We could all use better manners.

By the way, I'm still on vacation.