A modest manifesto

We had a little bit of weather out New England way last night, ayuh. A Nor'Easter, they call it. About two to three inches of snow fell, out at the homestead. The sticky, snowball-fight type stuff. Interestingly to this flatlander, the slightly higher elevation we have on our ridge was enough to keep the town itself from seeing much more than on campus, where they only got a dusting.

We'll see about how my Midwestern sensibilities handle the wool-wetting squalls of a proper Upstate NY/ SW Vermont weather system. I can tell you that about two solid weeks of dribbling grayness has left me unimpressed and with a fine head start on my latest bout of Seasonal Affective Screw this, I'm Going to Take a Nap disorder. I did find a fine woolen topcoat at the local Goodwill for $12.99, so the "wool-wetting" thing above is not just an artful phrase.

Speaking of artful phrases, I said I'd divulge the reason I'm so happy-go-lucky lately, and as a matter of fact I did make time to squeeze in the watching of a four-hour Shakespeare documentary over the long weekend (as well as The Big Lebowski and Ninja Scroll). Meanwhile, my classmates slaved like beaten dogs to prepare a stack of work for their courses. And say, come to think of it, I haven't adequately explained why I'm not in those same courses, nor how it is I'm nonetheless their classmate if that's the case.

So, dear reader, sit back for another lengthy story. Not that it's a complex or difficult thing to explain. I'm just so much more laid-back about my pre-med stuff now... or, to be more precise... (needless pause)... my pre-PA stuff.

Yes, these days I've been tooling around the winding mountain roads, the back seat loaded with books on not Organic Chem but Human Anatomy & Physiology. Not Calculus, but Statistics. The weather guy has been predicting rain, the Kaiser Chiefs have been predicting a riot, and I've been feeling like finally instead of "potential," I have a future I am excited about, and a way to get there.

A side note... true, technically I might be able to say I'm a pre-med or I'm headed to "med school" and be correct, because I do plan to apply to a mess of schools, and many at of the top of the list will be schools where the PA program is part of a med school that also trains young MD's (and if I can have a Scrubs moment, going someplace where Young MC is on faculty would be a bonus. Bust a move!). But let's be clear: in this day and age, in the good ol' US of A, the bare fact of it is, you don't gotta be a doctor to practice medicine. And I'm not talking about some 'alternative' thing either. Good old paternalistic, ego-driven, Western know-it-all medicine can be done, and done very well indeed, by Physician Assistants. For dudes like me, that's a concept that is just brimming with intrigue and attraction.

I would have been remiss not to seriously think over my options, once I got on the road and discovered how well "the system" used for training future doctors and I get along... or don't. I might have been too proud or too stubborn to consider the advantages of finding another way... but I wasn't. What sealed it was my thinking long and hard about what I want to do, how and where I want to practice, and then combining that with what I don't want to do, and the things about the job I frankly don't want to have to deal with. It all adds up very nicely to exactly what the PA profession is (according to one way of looking at it). It's practicing medicine without a lot of the intervening stuff that makes docs crazy.

Now, sure, absolutely, you want your doctor to be someone who could conceivably pick up the nuances of Orgo (or Physics or Calculus), sufficiently well to get a decent grade in a course. But having worked in pretty much exactly the place we're all trying to get to, I know how far down the list of important characteristics that really is. You want smart, yes. You want quick-thinking. You want knowledgeable, even encyclopaedic. You want 'able to talk like a person.' You want a lot of things, and so few of them have anything to do with academic achievement, after a while it starts to become scary to think that such a large proportion of doctors started out as kids who got great grades in science courses.

This is not to say that poor achievers have any better shot at becoming good doctors, or that they should. Getting good grades usually means working your ass off, and you need people who can work their asses off, both to be decent students and to be decent actual working physicians. But the thing is, the PA way of doing things isn't all that different, in terms of the things that matter to people (meaning practitioners and patients, a group often overlooked in this whole training thing). Before I get into the guts of it (literally!) in PA school, I'll have to prepare with some of the things pre-meds don't see until med school year one: a buttload of anatomy, physiology, statistics... hey, waitaminnit, those are my courses now. Hmmmm.

I anticipate an objection here: No, it wasn't because I had an academically bumpy Summer. It wasn't even because more terms like that one would assuredly have helped me get lost in the pile, kept me from getting interviews, and made it unlikely I'd get the shot to get into med school in a year, or two, or maybe more. Nor was it any doubt about my ability to get through med school (and do it damn well, as a matter of fact). It's more that I already know what it's like to slog through something that's almost what you want to do.

If the going is tough, that's fine. If it's circuitous and time-consuming and expensive and stressful, that's fine. But only if where you're headed to is where you really want to be. So if you're smart about it, you think a lot about where you want to be. And you don't stop thinking about it, now and then, just because you're on the way to someplace people respect and think is cool. So, I thought about it.

I don't want to own and run a small business. I don't want to head up a department. I don't care (that much) about huge piles of money, or my name being synonymous with a maneuver or a weird-shaped surgical tool. I don't want to pay malpractice premiums higher than my income was when I worked in the corporate sector. I don't want to set policies. I don't want to call all the shots, just those that constitute care for my patients. I don't want to be the only guy within 50 miles who can do something. I don't want it to ever be considered a weakness if I feel I want to consult somebody.

I want to teach a little, write a little, do a little research into things that interest me, and mostly just practice medicine. I want to work on a team, as one of its leaders. And oh yeah, I want to have a life. As a PA, I will be "limited" to practicing, and I'll have to do it as part of a team. I honestly don't see the down-side here.

So around Labor Day, I made the decision. My pre-reqs are for PA school, and the classes are much more directly applicable, which is nice for an impatient and energized student like me. Hey, I like understanding things for their own sake, I really do. But I have a tough time being graded on things when I can't see the connection, and because of limitations of the system I can't be given time and space to find my own. I have a tough time believing that academic performance is an indicator of smarts or ability.

Oddly enough, I'm currently on track for A's in everything. Hmmm.

Hi to Joanne

Gadzooks, I didn't know I had "real" readers! Okay, okay, I'll make sure to say something concrete next week. Right now, school's going on a long weekend hiatus, and TeslaGrrl is coming to visit. I may or may not have time to write.

The preview version is basically this: there's been a slight adjustment in the career trajectory. Everything I've obsessed and fretted about is still relevant, and my vision of what I'll be doing in 10 years is similar, maybe even identical (at least in all the ways that matter to me). Also, my vision of what I'll be doing in five years is about 1400% better than it would have been if nothing had changed.

Knowledgeable pre-meds (and people who followed me here from SDN) already know what I'm talking about, but casual readers will be getting the first of potentially many fireside chats from me about the future of health care, and how to be a clinician while maintaining some semblance of sanity. As of recently, it looks like someone even asked for it.

Seeya next week.

ah, yes, dear reader, the plot thickens...

I am writing (the first draft of this post) from the 'reading room,' which is to say the lounge-y area in the science building which is the semiofficial headquarters for those in my program. I haven't written about school, or anything else, very much lately, and for that I apologize. There must be at least two people who know about and read this thing. Which, come to think of it, makes "dear reader" more apt. The silence will be broken soon, but I'll just ease into it for now by saying that on this particular rainy evening, all my school-type work happens to be caught up. I went to the gym this afternoon, and even sat in the sauna for a bit. Then I got some food, and here I am.

Yes -- I'm caught up with schoolwork, I'm exercising, and I'm writing in this thing again. Clearly there have been some changes.

It's been good to have this time to reflect on the big fat decision I recently made; for a while just after it, every passing day was another chance to celebrate my being so intelligent and self-aware to make this particular judgement call... but it was also that glorious feeling of no longer being stuck. So from here, weeks, nay months, later, I trust it much more. And wow, I was really intelligent and self-aware.

But the telling of this one will take some background, plus I like to imagine there's a sense of drama to these things. Plus I like to believe that more beings read this than merely sp*m-bot$ and part-time workers doing the jobs of said bot$... and and so I'll tease it out a little more. Long story short, everything I've said below about what I'm doing and why is still true, and still the same. The difference is, what I am doing and why has simultaneously changed completely. It's kind of a quantum thing.

To Young M. Small, on the Occasion of His First Birthday

Kiddo,

You are going to have just the most 21st-Century scrapbook ever. Your whole life thus far, or at least bits of it, has/have been the subject of your dad's writing. And although I'm sure someday this will totally mortify you (and send you to some manner of psychotherapy that we losers in 2005 can only imagine), some other, later day you'll be glad because it's really good writing. But whichever way it goes, or when, hey. He's your dad. Can you blame him? At least it's not, say, a closet jammed to the rafters with M. Small crop art.

I've known your dad for approximately 20 years, and your mom for not much less than that. I say 'approximately' partly because I honestly can't recall the exact dates or really years, and partly because it's too freakin' weird to contemplate being this old. Someday you and I will almost certainly talk about the stupid stuff your dad and I (and to a much lesser extent, your mom) said, thought, and did when we were "your age." These stories will not be exclusively for your amusement -- because we did learn a thing or two, here and there -- but I promise right now that I won't be mad if you totally miss my point and just laugh yourself stupid instead. That's some quality uncle-style fun for me, right there.

Anyway, soon enough you'll be able to wield a computer yourself, and whether your money is on genetics or environment, your kung-fu will very probably become very mighty. Please use this power for good, as we have tried to, and not for evil. That said, feel free to even the odds. Post whatever stories you can about your pop's misadventures and weird habits, or any photos you have of him mowing the lawn in black socks, loafers, and bermuda shorts. I can help, if you want.

Also, and don't tell the Internet I said this, but you're way cuter than the kid over at Dooce.com. Happy Birthday, electro-boy!

I heart technology

If you have a blog, you know about this fancy new form of annoyance where a bot will post a 'comment' that's actually spam. If you don't have a blog, there's this thing... that I just described. Give me a break; I'm drinking my morning coffee.

So, it's nice to be obscure and a-visitor-ic enough that I have seen maybe three of these on this blog in the time it's been up. But it's unbelievably sad that I got an email to alert me of the new comment, and even I, who ostensibly see a reason to put stuff here, was surprised.

So, dear reader, I'll try to change that. There's no shortage of stuff to comment on, and as I've mentioned this thing will be a scattershot but hopefully complete record of a process that's interesting to me, anyhow. Not to mention important (to me, anyhow). We'll attempt some more writing soon. I have a raggedy-ass text file on my laptop that serves as a sketch pad, and somehow not having the Web at home (I know! It's just like in pioneer days!) makes it easier to think of and organize stuff for the blog.