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.