Minor Functionary of the Underworld

That's me, right there. Guy in the boat. Charon, would be the mythological Greek version. And that there is the River Styx. Essentially.

I mean, at my work, it's not a river, but actually an underground tunnel that goes something like three city blocks, to the Medical Examiner's office. You just keep on going, past some labs, past the rack of HR forms you can fill out to have your paychecks mailed versus direct-deposited, and past the office where we get flu shots. Just the other day, I was taking that walk with a former patient, a person who I can confidently say will never need another flu shot again.

It's a strange thing when your mental "To Do" list has items like "go get a body bag," and "fill a plastic bag with ice, and then tape it over the eyes of a dead person." But hey, that's medicine. A normal day for me is very often... just not. Not by most standards.

It's very sad, most of the time, when someone dies. Some deaths are merciful releases from the sort of existence I wouldn't want for myself or anyone I care about. Some are terrifying in their randomness. None are entirely comprehensible. Me, I find it reassuring simply to know that my last moments on earth will be, among other things, just another part of someone's workday.

It would be cool if someone near me would give that person a coin, though. 'Cause I sure don't get anything except the exercise and the reflective quiet time in a creepy basement tunnel.

...and a grateful nation rejoices

Spotted at Costco, in a dream I had last night, printed in black lettering on a yellow sign, and just in time for the holidays:

COSTCO HAS CURED HAM!

Underneath, it continued:

WE WILL NEVER SUFFER FROM HAM AGAIN!

Sometimes, I just crack myself right the hell up.

The Soundtrack

Hmm. I just found an interesting idea, over at Amber's, and although it's a Web meme and therefore ever so slightly hateful and lame, I'm intrigued. Not to mention, it's 6am on my day off, which means I need to kill an hour until the time I would be getting off work, so I can maintain a sleep schedule for the overnight shifts I have later in the week.

I shall cut n' paste the instructions, so as to save those precious keystrokes. I'm tired, dudes.

If Your Life Was A Movie
Here's how it works:
1. Open your library (iTunes, Winamp, Media Play, iPod, etc.)
2. Put it on shuffle
3. Press play
4. For every question, type the song that's playing
5. When you go to a new question, press the next button
6. Don't lie and try to pretend you're cool.

Okay, so interesting idea, right? Now, immediately upon seeing this, I planned to steal it. In fact, it would be rude of me not to actually read what whatsername has listed for songs. One minute, k?

...

Cool. I don't know about half that music, but that's fine. Cool idea, well-executed.

Anyway, as I was saying, simultaneous to deciding to steal this idea for a blog post of my own, I wondered whether I should mention that I sort of have a soundtrack already. See, I was/am toying with doing something screenwriter-ish with my year out east in school, and that's why the extremely rough treatment I have for that already has, if not a soundtrack, at least a concept and an iTunes playlist.

I do know actual real screenwriters and authors and whatnot, and I myself have some training and a sliver of experience -- just none of the arts-helpful sorts of discipline or ambition. Still. I'm throwing that out there. It might be fun to see whether there's any overlap. However, I won't cheat and use just that playlist, because the thematic unity would be too heartbreakingly awesome.

I will, of course, personalize and refine this exercise by adding way too much commentary. You know how things work around here. Ready? Here goes. Full library. No Mulligans. Hitting 'Play'... now.

Opening Credits:
Anybody Wanna Take Me Home, by Ryan Adams
(Well, this is clearly The Awesome. It's good credits music and everything.)

(Oh, and by the way, may I just take this moment to say I don't endorse or condone what, judging by a look down the list of upcoming scenes, is a fairly boring and far-too-linear biopic structure for this movie? Cool, thanks. Okay, hitting 'Next' now.)

Waking Up:
Jesus on the Radio, by Guster
(Well, sweet. We even get a song in which the first words are "Five AM, March Sixteenth," which is about as literal as a "waking up" song can get. So it's in keeping with the anvilicous strucure. I do love me some Guster, though, and waking up to banjos means it's a bouncy morning.)

First Day of School:
In Like With You, by the Judybats
(Anybody who knew me in my school days, just shut up right now. Next.)

Falling In Love:
Confetti, by the Lemonheads
(Oh, too good. As a child of the 80s and a man of the 90s, this is a Hell Yes. )

Sex Scene:
Wildflowers, by Tom Petty
(Hmm. Okay, sensitive yet driving. Sure, why not?)

Fight Song:
Across the Universe, by the Beatles
(That is just all manner of fucked up. Maybe the flock of birds at the beginning is scared off by me scuffling with schoolyard bullies, or getting mugged, or something. "J'ai Guru Deva, muthafucka! Bamm!")

Breaking Up:
The Zephyr Song, by the Red Hot Chili Peppers
(Hm. Maybe. If I'm turning away at the right moment, and striding toward the camera manfully, while some chick gradually fades into out-of-focus irrelevance. Even still, it's too on-the-nose. You never put a song with the words "fly away" into a breakup scene. Plus the guitar solo is hella lame.)

Prom:
It Takes a Lot to Laugh, It Takes a Train to Cry, by Bob Dylan
(Ummm... all I'll say here is, that would have been a much better prom. And also, I've become confused by the structure all of a sudden. In this movie, I've had sex and violence and we're only now getting to the prom? Jeez, how long is this epic film?)

Life:
Catchy, by Pizzicato Five
(It's in a language I don't speak, it's too long and rather repetitive, and yet there's something about it that makes me want to shake my ass. Also, some woman is sighing heavily in between verses. Yep, that's life all right.)

Mental Breakdown:
(Please be something cool... be something cool... no whammies...)
Here Comes the Groom, by John Wesley Harding
(AH HA HA HA HA HAHA HA! I love you, iTunes! You are a funny, funny program.)

Driving:
She Goes On, by Crowded House
(I always thought of this as a song that would be at someone's funeral. Let's say I'm driving, but I'm preoccupied with somebody dead.)

Flashback:
The Disappointed, by XTC
(Damn, this is getting to be one broken-hearted drag of a movie, man. Bummer.)

Getting Back Together:
High, by the Cure
(Well, okay, then.)

Wedding:
People Love to Watch You Die, by John Wesley Harding
(People, it's official. My iTunes is a bitter, broken, sarcastic bastard. Sorry about that. It's a great song, really, just... hm.)

Birth of A Child:
Gyroscope, by the Dismemberment Plan
(Wow, for just a fraction of a second there, I thought that said "Gynoscope." I think I've nearly stayed up late enough.)

Final Battle:
(Oooh, the climactic final confrontation. Nice. Let's see what we've got... the tension mounts... aaaannd...)
1974, by Ryan Adams
(A hit! A palpable hit! It's guitar-driven, it's aggressive. "The city is an animal, ready to eat..." And bonus points for hearkening back to the opening credit music, too... just like John Wesley Harding is the bloomin' Angel of Doom in this movie, Ryan Adams is the Patron Saint of Kick-Ass. I can deal with that.)

Death Scene:
When it Started, by the Strokes
(I have no complaints about this thoroughly kick-ass closing credits music. I guess maybe in this movie, I died of coolness. By the way, this is the version with "New York City cops, they ain't too smart," so maybe I was gunned down in a hail of bullets, reaching for my cell phone. Or maybe, I had a black iPod, and I was trying to fast-forward myself out of a jam. I bet it was John Wesley Harding's fault, somehow.)

(Yeah, I like that. It's pretty Meta. Like "Adaptation" meets the end of "There's Something About Mary," when Jonathan Richman gets shot through the chest. Fade to black, kids. I'm going to bed.)

Disturbing signs of getting older

I was awakened from a dream this morning by the ringing of the phone. But that was cool with me, because what started as a dream with decent potential to get all sexual had instead turned into a dream that featured a very large buffet of tasty mexican foods. The hell? Even in my dreams, I'd rather attend a cheese-drenched cocktail party than an orgy?

The three-cheese burrito was particularly excellent, it's true; all the nubile college women agreed.

Tasty Sunday

As many of you already know, I am a ginormous fan of the Faust story. For those of you who haven't heard all this before, it's sort of a big deal, in my personal universe. Faust is basically, for me, the mythic underpinning that explains pretty much everything we need to know about living in the modern world. In a major cultural-studies, lit-loser, nerdotron way, I am to Faust in all its incarnations as a minivan full of screaming tween girls are to... uh, I guess that Gerard guy from My Chemical Romance. I hear he's dreamy and broody an' whatnot. The only full-length play I've written, so far, is a Faust play. I even like the Brendan Fraser/ Liz Hurley version of Bedazzled.

In the Goethe version of Faust, the one that defines Romance with a capital R in the Western world, there's this part about the terms of the deal; Mephistopholes agrees to keep supplying Faust with all-you-can-eat worldly awesomeness. The only catch is, if ever there should be a moment that's so perfect, so delicious, so satisfying that Faust wants it to last forever, then boom. Time's up. We're all done dancing.

And what's sweet about it is, that moment doesn't come when they're messing with the spacetime continuum so Faust can bang Helen of Troy; it doesn't come with the sense of accomplishment and pride Faust tends to get when he uses medicine to stop a plague, or when he uses engineering to save a city from being subsumed by the ocean. It happens, finally, when he sees an old couple who have been together forever, working on their cruddy little farm, and being happy together. And Goethe is even nice enough to let Faust off the hook, based on, I guess, having his heart in the right place most of the time. Eventually, in other words, Faust in a sense sort of gets it. You don't need some devil making crap happen for you; you need to be present in the moment. And all the glittery crap the world has to offer you won't make you happy. Can't, in fact.

Pretty radical stuff, in some ways, for the 1800s. And with only minor tweaks, it works very nicely with Buddhism or Existentialism. In a nutshell, you start me talking about Faust, it will be difficult to shut me up.

Except.

Goethe was maybe not entirely right about certain things. I think it's great to fall in love with the world, from time to time. Carpe yourself some diem. We shouldn't have to think of that as dangerous. Contentment does not have to mean complacency. And when it comes to my own life, I want the world and me to be more than friends, if you follow.

I only bring this up because this afternoon I was walking downtown, in search of a late lunch. I found the burrito place was closed Sundays (which still strikes me as mildly funny in a way I can't quite put my finger on), and so walked a bit up Nicollet Mall. I had a brief conversation with a woman representing the Scientology center there (she: "Let me ask you, do you have any problems?" me: "After Tom Cruise, you guys have more problems than I have...") and then decided to pop in to the Local for a pint and a plate.

I'm not saying the Waldorf Salad with grilled steak is so good you'd sell your soul. But it's close. Especially with a Finnegan's, with the Vikings just winning a game, and with a cool book about Rosalind Franklin to occupy a dude.

The laugh-out-loud awesomeness of the moment would be a little later, as I headed out. I was just in time for the first-annual Minneapolis version of the Running of the Santas. 'Twas a sight to behold, it really was. It's pretty much impossible to be weighed down by the cares of the day or the gremlins of the soul, when a couple hundred Santas are jogging past.

I am seriously going to miss Minneapolis, next year. Then again, I have a feeling stuff like this is going to continue to happen to me...

This post has many titles...

1) Progress.

2) "They signed you, Bill! Now you're a law!"

3) I'm in.

4) Febrifuge and The Big Flat Envelope

You may choose whichever one you like best. The upshot is, this is apparently no longer a blog about getting into PA school. As of yesterday's mail, it's a blog about getting ready to go to PA school. In Chicago. Six months from now.

I'll bullet some of the more salient points in a minute, but before I get too deep, I'd like to tell the story of going out there to the interview (which was less than two weeks ago; it's not like I've been holding back, people). And right now, I have some Tiger Woods PGA Tour golf to take care of. It's urgent. Unavoidable. Can't get out of it. Sorry.

Then later, I have a Bond movie to go see with M. Giant, in observation of a tradition that goes back at least as far as Goldeneye... although I could swear there was some Timothy Dalton back there someplace. Hey, I'm a busy cat. The point is, reliable sources tell me that having fun now is vital to my surviving Year One, which is worse than 4-year-med-school year one by some hard-to-pin-down factor.

Oh, and just so there's not a lot of confusion on this point, let me lay down what the heck a Physician Assistant is, and does. Or wait, let me have the AAPA do it for me.

Some sub-bullets:

a) Hey, Chicago. Cool.

Yes! Plus, although I won't mention the school by name, I think it's sweet that there's a four-year school in the same university. That's because most of the time, that's better for the facilities, the faculty, and the reputation of the program in the local medical community. Way too many of the PA programs I researched were founded in 2000 or later, and belong to schools that had heretofore been largely about non-medical pursuits (nursing is very close, but not the same). I also think it's cool that there are PT students, Pathologist Assistant students, and yes, even the podiatry students around. It's an interesting university, in that of the several hundred people attending, nearly all are grad students. So it'll sort of be a Bizarro Bennington for me.

Note: it's not the University of Chicago. Which is too bad, because in one of the Indiana Jones movies, I'm pretty sure he taught archaeology at U of C. House went to Hopkins and then Michigan; they haven't revealed where the Scrubs people went to school, but it seems Californiform; and I honestly don't care where the one PA I've ever seen on TV went. That's about when ER started sucking.

b) So, why this school specifically?

I already pointed out the diversity of programs, which means not everyone I meet will be doing what I'm doing; I consider this to have been one of my not-so-secret weapons last year in Post-Bac. The facilities are crazy good; wi-fi building, digital projectors, and the best anatomy lab I've ever seen, for serious. There's a flat screen monitor and one of those goo-resistant keyboards like at oil change joints mounted on a bracket above each and every dead body. There's a decent fitness center, and a pimpin' fake office with fake exam rooms, used for fake exams of fake patients. See how my theatre training is going to be useful? Mm-hmm.

Airfare to Chicago is pretty cheap; it's like taking an even more inconvenient bus, really. And I like that the degree my school offers is the Master of PA Practice, which is far cooler than the standard Master of PA Studies. I mean really; I don't want a graduate degree in studying something, I want a graduate degree in doing it. (For the record, the only other school I know of that offers a cooler-sounding PA degree is Yale, which awards the Master of Medical Science. Swanky!)

Okay, enough for now. I'm gonna wear a white coat (sometimes). I'm gonna make (fairly) decent cash. I'm gonna heeeeeeeal the sick. I'm gonna play golf.

In fact, I'm gonna play golf right now. The digital character that sorta looks like me will be trying to make the cut at Pebble Beach this afternoon. Wish him luck.

something to ponder

You know the commercial for Monster.com, where all the people are grooving and happy while ELO's "Do Ya" cranks on the soundtrack? Here's a potentially deep question for you:

Are these people happy because thanks to Monster, they're at work at their perfect job? As in, check out this huge pile of pink foam peanuts in the back of my moving truck! I'm totally going to jump in it! or I love, love, love this orange cardboard tube, and it makes me strut like a dancin' fool! Woooo!

Or, are they happy because thanks to Monster, they just found the perfect job, and they're about to leave the crappy job they work at now? As in, I am totally going to ride my bike around the gallery! Take that, you dicks! or I am so totally done with this stupid road construction, I am going to give the garbage man that hug he's been craving!

Watch carefully next time it's on. Let me know what you think. I have a theory about it.

Hold the Mayo

Is it a bad idea to post while intoxicated?

...Or is that one of those un-answerable, eternal questions? One that's either blindingly obvious, or else so rich with complexity and nuance that it's pointless to try? EDIT: It's okay, as long as you save rather than post, and then edit yourself a few days later.

Anyway. I am officially 2 for 3 on my list of CASPA-application schools. I got the rejection letter today from the school that I always figured was a long-shot, the school that's -- no lie here, kids -- more competitive than some four-year med schools.

(...And if that offends you, then you're likely to be a pre-med, specifically one of the sort I enjoy seeing other people make fun of -- props at this juncture must go out to PA Forums poster Crooz, who has used, and as far as I know may have coined, the term "pre-med-onna").

Hey, it's just math. Nothing to get excited about. I'm not as depressed as I might be. If you're a school, and you get 200-ish applications, and you can accept only 14, then you're taking like 7 percent of your applicants. If your state med school is this picky, then your state has mostly good doctors. Feel free to get sick from time to time.

So I will apparently NOT be training at the U of Wisconsin-LaCrosse/ Mayo Clinic PA program. The letter was very nice, and specifically said that it was a tough process. They only interview 60 for those 14 spots, and they already know plenty of people who would be otherwise excellent candidates just didn't get a spot.

I like to think they mean me. With each glass I empty, it seems more plausible. If anything, I'm stung by not being in the top 60 out of 200-ish. Then again, I have bragged about being the king of the statistical "middle third," because my GPA scrapes the "you must be this tall to ride this ride" line represented by the posted minimum. Mayo actually reads all the applicant files, which is extremely cool. Presumably they give each one a score of some kind as they go through. But even so, finding that 60 has to be more cold-blooded than picking the 60 with the best stories, the most maturity, or whatever.

My suspicion is, you fiddle with the minimum GPA requirement, and see how many of your applicants would "qualify" for an interview with each increase. At least, that's what I would do. Even if that's only part of the equation, it must be a big part. And considering that a GPA minumum that allows me to go forward in the process is by definition one that lets everyone go through... well, that's no help.

Surely they got to a number around 60ish when they used a nice high GPA, a decently high GRE score, and some measure of experience. I probably did well except for the GPA. I'll ask them all about it after January 1st; the letter also said to feel free to consult with them about how to strengthen the old app, just not right now.

So for now, I'm going to start the healing process. In the spirit of "he was no good for you anyway" and other advice my female friends are always giving one another, here is a little about

WHY IT'S OKAY THAT I WON'T BE GOING TO MAYO

1) Gotta wear a suit every day in clinicals (except in the ER): I just don't own that many suits. I mean, I have a vintage thing I love, but it's too shiny for most settings. And I have the new one that is being tailored right now, in prep for the Chicago trip coming up, but ye gods, how many suits does a guy need? I'm not a VP of Marketing and Brand Management, and that's on purpose, dammit. No sir, I want my stupid short white coat and my cargo pants, plus or minus a tie with a button-down shirt. There have been times in my life I've worn more formal attire than was needed, but those were the times I was bullshitting someone.

2) LaCrosse is beautiful... for a weekend. It's no Red Wing if you're into antiques and inns, and it's no Winona if you're into history. In New York terms, it's like Troy, only without the adjacent Albany. It's like any randomly-chosen 10% of Madison. It's... awww, you get the idea. Living in a small town for two years surely goes beyond charming and into "yes, I'd love to do a rotation out of town... anywhere out of town."

3) Seriously. Mayo? Isn't that a little... I don't know... legitimate and respectable? I'm supposed to be this rebel, this non-traditionalist. I'm the new face of healthcare in America. I can't be, you know, the Man. It's a part of why I saw my mighty-high GRE score and thought "I could apply to Yale!," followed close by with "...but yuck, I don't want to go to Yale." No, it's a normal school for me.

Or even better, one with a history of educating those that other schools maybe didn't feel the need to make room for. More later on why the Chiago school is so cool.

Anyway. I'm good enough. I'm smart enough. And I would have been great at the old temple of tradition. I won't get to say "Mayo" in answer to the question about where I trained, and that's too bad. I think I would have been able to finesse it to where I say "Mayo" but the other person hears "Mayo, you condescending jackass. I know less than you about some things, and more than you about some others, and let's not even go there, mm'kay?"

This way I'll simply have to do the same thing with another name. My new favorite school, the one in Chicago, has a really good name for that, actually.

freaky-deakies need medical care, too

Dear Admissions Committees,

Check how well-rounded I am. Even after a complete 3-to-11:30 shift in the ED, I managed to get home, put on my House outfit (which is eerily similar to what I wear anyhow), and get over to a Halloween party. A party documented by my pal, future Golden Globe-winning screenwriter (and eventual Hollywood Squares center square) Diablo Cody. click for the scoop, Twin Cities insiders!

Taking time to play is vital to the ability to work hard. In my 12 years in Corporate America and the year I spent in my intesive, one-year post-bac program, I learned how important it is to be where you are. Ya know, dude?

Hah, no pictures of me there! My anonymity is safe for one more day.

Now I need to come up with a good answer to that question about "what is your weakness?" So far, I'm not past the idea that it's an unfair and a sort of stupid question, and so my best answer so far seems to be this:

INTERVIEWER

That is very impressive. Tell us about some areas where you're not as strong. What about your weaknesses?

FEBRIFUGE

(Pauses, thoughtfully. Leans forward in his chair. Makes eye contact.)

Kryptonite.

Yeah, I'm working on it. Trixi has turned out to be an unexpectedly rich source of interview prep, and has a decent answer. I'll tell you later. And maybe I'll get over the idea it's a dumb question if I hear some additional good answers. What do you say, in a job interview or whatnot, when asked about your weakness?

Chicago Style

Here's the rundown on "my programs ," aka the schools where I've applied to join the PA training dealio. I won't use their real names here, because I'm superstitious, paranoid, and like making up names.

1) The Best School Evah. This one is affiliated with a nationally-- no wait, internationally-- known four-year medical school and hospital/clinic system. BSE's PA program takes exactly 24 months, with 12 months in classrooms (here's where the 'affiliated' comes in, because it's about 80 miles from the four-year med school) and 12 months on the wards doing clinical training. Let's just say that these clinical sites are niiiiiiiice. Think of the place you'd go if you had all your local docs stumped. Or if you're the ruler of a country. That's the place.

This school is so prestigious, the admissions guy at another school wasn't the slightest bit offended when I said it was my top choice. If I had ego issues of a certain kind, and cared about validation from strangers, I'd want to be an MD, not a PA. But I'll admit, the idea that my dorky short white coat might have this place's patch on it is a sweet one. The name stands for excellence, innovation, and compassionate care... it also serves to shut people up in the "so where did you train?" arms race.

2) Chipotle University. This is a small school in the Southwestern US, mostly known for their nursing program. They make the US News list of "best" schools, so there's a lot to reccommend them. The PA program is sort of new, though, and there's a state school with a med school AND a PA program in the same town, so they snatch up the "best" training sites for clinicals.

However, this was one of the first schools I investigated, and it made my first cut of "places where I already have all the pre-reqs done" when I got into it last winter. And the admissions guy was so great about answering questions and taking time that I got a little drawn in. I had thought the process was supposed to be cutthroat and elbowy; instead, it feels sort of like I'm being head-hunted. This guy sent me an email when my GRE score came through, to say "you did very, very well."

Chipotle invited me to interview. The interview was early in October. I didn't go. They are one of the schools that start up in January, and that was too early for me. Having been away for a year, and then back six months, I couldn't run off for another two years. I missed friends and family too much. I immediately let them know, and asked if I could be considered for January 2008 rather than 2007.

It would be unfair to call them a fall-back or a safety school. I would love to live and train in a warm part of the country, and if things work out so that this becomes the place, I'd be very happy. It is cool that if the summer 2007 schools don't work out, I have half a year rather than a full year to work on the next launch window, but it's not like that was my plan all along. ...or was it?

3) Respected Chicago University of Medicine and Whatnot. This is a North-Side institution not quite 100 years old, with a strong PA program. One of my letter-writers went there. (Oddly, after a few years as a PA, she decided to go for the extra responsibility and pain of full-on doctorhood, and she's now at BSE's four-year school. Funny, eh?) I like everything I know about them, except that I need to take another Chem course to get in, but they seem to like me too. A recent email told me as much.

So, I am about to buy a ticket to Chicago and set up my first interview. That's two for three, for those of you following along at home. And the BSE will be informing all applicants about interviews sometime before the end of the month. Could it be a sweep? Stay tuned...

This old House

Here's the funniest thing I've seen on the Web today:

The blotch on the left is the logo for the fictional Princeton Plainsboro teaching hospital. It's pretty perfect. The sticker is available at some dude's CafePress store, here. Never let it be said I used bandwidth for purely selfish reasons.

Okay, so I'm obsessed with House. Whatever. I'm up to my axillae in the Season One DVDs, and it's as good as a TV-on-DVD favorite as it was as a new show. High praise.

Eww, baby, eww

Tonight, at work, I was in on a childbirth. I got to witness the Miracle of Birth -- the human version, not the State Fair farm-animal version.

Yes, it was magical. I was suffused with a sense of the world being a good, kind, and loving place.

On the other hand, it was not so different from the State Fair version, when you come right down to it. And the bit they did on Scrubs pretty much nails it: in a faux-1950's Health Class filmstrip, JD-as-wise doctor guy intones "you'll fart, pee, and poop in a room full of people." A-yup. There was in fact a lil' bit of that.

So I have to revise my rule about when you smell the poopoo in the trauma room. If it's a trauma patient who has lost bowel control, then yes, that is still a dire neurological finding, and a sign things are Very Bad Indeed. However, the mere fact of a "code brown" does not mean badness; there's a loophole in the rule allowing for childbirth-related dropping of the deuce.

Still a miracle, though. Tiny fingers and toes, etc. Yes yes. I'm not totally jaded.

Out of the Woods... ish

Hey, I'm surviving. The worst of the 10-year flare is over, and I've survived it.

What can I say? I'm a survivor. I'm not gonna give up. I'm not gon' stop. I'm gonna work harder. I'm a survivor. I'm gonna make it. I will survive. Keep on surviving.

It's pretty much just what I do. I learned a few things, in the last couple weeks.

I think I said somewhere earlier that when the time comes, Amgen-Wyeth won't need to send me on golf weekends or anything, considering how much I love their drug Enbrel. What I've learned recently is that without it, I am ska-roooed. So big ups to Enbrel, 50mg BIW SQ. Here we are, four doses later over a week and a half, and we've turned back the clock. Sure, I suspect I have a lingering low-level strep infection (there's pain in my inguinal lymph nodes and throughout my legs, plus this weird guttae rash), but it's like there never was arthritis blimping up my left foot. And that thing was friggin huge, so much that the doc checked for gout just for the hell of it.

Also, I've stopped popping Vicodin and walking with my cane. Just for the record, I was doing the cane and stubble thing in the early '90s, before anyone heard of House, MD. ...Which brings me to my next note: Vicodin kicks ass. No wonder it's habit-forming and easy to abuse; it's easy to abuse those things that you love dearly and want to be a part of you all the time.

Seriously, it's a wonderful drug. You know how sometimes, you'll find yourself thinking about something, without thinking of it? Like your mind wanders away from the subject of its focus, like "I wonder if I left the light on in the bathroom?" or "hey, it's getting cooler in the afternoons; where did I put that scarf that everybody is always saying looks nice?" What Vicodin does is put pain in that category, where things you've lost track of seem to drift away to. Sure, if you concentrate, you can remember where the pain is, and what it's like... but it's not easy, and anyhow why would you want to?

It also left me, at any rate, able to do everything else with reasonable clarity. I got five days of Prednisone to try to arrest the flare (did I mention I saw one of my favorite docs?), and that made me surly. But the Vicodin treated me fairly, and left me more or less in control of my faculties. If one and a half beers dulled pain, that would be Vicodin, basically.

Outstanding. From a neuroscience perspective, I have to give them a good solid A. Would have been a B+, but there's goodwill that comes with doing a "very good" job with "excellent"-level enthusiasm. And so now that I've weaned off my lil' buddies, I am of course hoarding those last few. We loves them, preciouss, and nothing will take them from ussss.

So... yeah. I'm back to work. I don't feel awesome, and I'm fairly scary-looking, if you know where to look. I've had many conversations about psoriasis, and that's fine. Some are the "oooh, honey" variety; yep, it itches, and actually, when it's bad, it hurts. Some are the educational variety; inflammation blah blah tnf-alpha, blah blah cytokines, etc. Some are "hey, my roommate's sister has that," which are sort of cool. I guess. Mehh.

So I'm back to being an ambassador for a medical condition. It's not all awesome, but it's easier knowing that I'm fighting back, and in a smart way. Plus, once this is all over, I'll be in better shape than I've been in for quite some time. We are after all hitting the Enbrel at twice the level I've been at since I started, two-plus years ago.

Hey, I could even be all one color again, someday soon. How cool would that be?

The Heartbreak

"My disease." I hate that phrase. Stupid, imprecise, makes all kinds of assumptions. Just the opposite of what medical language is supposed to be. But I'm talking about my disease today, something I rarely do.

Eight years ago, at the end of undergrad, I discovered that my health coverage had a charming clause that capped not only my out-of-pocket pharmacy expenses, but the amount the plan would pay. I had used it up, because the topical gunk that dealt with my psoriatic lesions (we call 'em "spots" in the trade) happened to be this awesome synthetic vitamin D-3 analogue. Sunshine plus beeswax. Not available in generic, then or now. Sorry, kid, I was told, you're too sick to be covered anymore. So I did my best; I got by with OTC products for a few months, until I had a bad flare-up. Big lesions. Spots on my face, and up to then I almost never had spots on my face for more than a few days in winter. Cracks and fissures. Scales, peeling, crumbs in the bed that were totally unrelated to food. Dragonfly wings all over the house. All very Singing Detective. Desperate, maddening, and absurd.

And I called up my derm at the time, the man who would eventually semi-quasi-not-really retire to Mayo Scottsdale, the elder statesman who would later encourage me to go into medicine myself. This is a man who has a talent for saying simple things at just the moment I have become ready to hear them. He got me hooked up, I don't even remember with what, or how. Maybe it was after I started working at the dot-com, and the founder/CEO (another of my statesmen) started my benefits a month early. The derm-doc affirmed what I had been doing, and got me in for an office visit. Overbooked me, I think, if I remember right. When I said something dim about not wanting to inconvenience him, he said "yes... but you're suffering."

Hm. Hadn't thought of it like that.

Chronic illness is part war, part marriage. You want to fight, but if that's going to be worth anything, the fight can't be everything. You want to live with the situation, but without simply surrendering a whole corner of your life to it. You need to decide for yourself (and you can renegotiate anytime) whether the goal is to eradicate the offending nastiness from your life, or just get through to next month with a decent quality of life and not too much stress. Even the most battle-hardened, treatment-aggressive patient will, if he is paying attention, discover that being "sick" has something to teach. Even the most yielding, Buddha-like survivor knows that living with something is different from curling up in a ball and giving up (particularly if that sort of "living with it" means hitching your star to a poorly-defined symptom complex and a stack of presriptions). But yeah, this definitely sucked. I guess I was in fact suffering from psoriasis, at least at that point.

That was eight years ago. Since then, a rotating combination of cool pharmaceuticals kept me out of that kind of trouble. Since 2004, I've been on Enbrel, which rocks so hard I'll write a post about it alone. I love this recombinant human protein molecule so much, I would totally marry it.

I ran out in July. I have more coming, very soon. I've been off for about 6 or 8 weeks. Today I went to the Urgent Care, and they punted me to the ED. To my workplace. It's bad again. It will be okay, more okay than last time, and sooner. But yeah, it's bad today.

I'll talk more soon, because right now, more than 4 of 10 pain or unending static in my nervous system from itching, I am just too annoyed to blog. I don't like suffering. Particularly my own.

Me Am Bizarro Best Blogger Ever #1!

No, I'm not dead. Overworked, sure, but not to the point where I'm incapable of blogging. Not exactly lazy, either.

I saw some stuff at work that you probably saw on the news. No, wait, that sounded wrong. Nothing I do should ever be on the news. I just mean that some of the cases I was near involved parties that were newsworthy, primarily because of what happened to them. Oh, shut up.

My car is in for repairs. My health is in about the same shape as my car: a whole lot of nothing too serious, just a pain. I have the weekend off for once, and I think I'm getting sick. Dagnabbit.

My app is in; my first interview invitation came back. Speedy, eh? Well, it's for the school that starts in January, so it's about right. The Best School Evah hasn't replied yet, but Chicago School sent me a nice note to say they want $25 and a form, so we can go forward. It's almost like a love note...

Bottom line, I have some nice choices, assuming all of my schools send me love. And how could they not, as awesome as I am? Right? Huh? Okay, then.

sugary goodness

Be with me now: Jelly Belly gourmet jellybeans. Bulk. Four flavors:

1) Juicy Pear
2) Peach
3) Crushed Pineapple
4) Caramel Apple

Not to mention, vodka sour, "free" Internet, the Streets on the iPod, and I'm about to watch "Brick."

Can there be anything better than this? Not too bloody much, I'd say.

blog niblets

1) Annual physical today. It was fun to be able to talk to the med student, knowing I'll be in that exact spot before long. Plus it allowed the student to be able to say stuff like "okay, so I'll talk to Dr. Joe, and see if he wants to throw some pills at you or anything."

For the record, I lost about 10 pounds since last year's physical, and my blood pressure is slightly high. We'll check cholesterol sometime soon. And Dr. Joe still looooooves the ol' hernia check. Damn his iron grip on my gonads. I have no hernia, okay? Gawd!

2) You know how while I was at school I was always going on about some band or another? Yeah, that was not a school-related thing. I have the new Snow Patrol, and it's the best thing since thin-sliced black-pepper smoked turkey. For serious.

3) My car is falling apart. The mufler is finally rusting out so the V6 sounds like a Harley now. The passenger side mirror fell off. The rearview mirror remains floppy on its stalk like some sad injured insect. The driver door handle has stopped working entirely, so one needs to open the window a bit and reach in. Hell of a theft deterrent, though. I guess I need to call the garage down the block and see what they charge for de-FUBAR-ification.

Late nights and antibiotics

I've been quiet lately, because I've been having issues with my giant, swollen, reddened pinna.

That's the outside part of my ear, you degenerates. It's just a matter of time before exposure to MRSA and GRSA and whatever-else-RSA fells us ER warriors. Happens a few times a year, maybe. Usually it's a cold; no big deal. I have an immune system just a tetch less powerful than Wolverine's anyhow. But this time, I must have touched my ear with some bug hitching a ride. Stoopid itchy ears. Tuesday after work I spiked a mild fever, and Wednesday I actually called in sick, with all-over aches and a craving for fistfuls of ibuprofen. By yesterday I was mending but not yet better, so I got the Urgent Care experience.

This will be another topic for another post; it was cool that they recognized me there, and I totally got the VIP version. Land speed record for managed care. But anyway, I have Augmentin tablets that are large enough to kill stuff just by running into it, and I'm back to work. Huzzah.

And, in grad school news, I submitted my app. Funny enough, I thought of the line from the first good Star Wars movie, where Luke talks about "transmitting (his) application to the Academy." That's pretty much what you do. So, the deadlines and the editing? The worrying and fine-tuning? Over with. Now it's out of my hands.

I'll enjoy it, when the flesh-eating bacteria gets out of my system and both my ears are the same size again.

The Tao of the Who

Odd story tonight: I pretty much did a real-life interpretive vignette of the first verse of the Who's "Who Are You."

For those of you not Who-conversant, first of all shame on you, and next, here's what I'm talking about...

I woke up in a Soho doorway,

A policeman knew my name.

He said,

You can go sleep at home tonight,

If you can get up and walk away...

Basically, I came home from Teslagrl's place at 1:30 or 1:45, and because I live where I do, I had to park around the corner. So I walked down 9th street, and prepared to turn left; I can go ahead past the row of "fancy brownstones" that is just like where the Huxtables live, or I can turn left and walk past the complex of buildings that became merged when city redevelopment money turned a cracked-out, condemned brick building into the place I would eventually live. I crossed the street, and decided to stick to the right and go by Chez Huxtable, on account of there being a guy passed out on the sidewalk there.

He was half in the street. A parked car shielded this dude's creased black trousers and shiny loafers from being run over; the upper half of him, clad in a short-sleeved, combed-cotton polo shirt, was up on the sidewalk, and he had his neck sort of cricked at an angle to accomodate the parking meter. Way classy.

He didn't look dead, which was nice. Dead people, mind you, have a look. It's tough to describe; basically if you see a movie and you think, "that dead body is obviously fake; it doesn't look real," then you're probably right, but then again maybe it looks perfect. Actual dead bodies don't look entirely real either. Or they look too real, to be metaphysical about it. Anyway, this guy looked alive. No pools of blood under him, no smears of blood on him. No foamy mouth, no stink of incontinence. Just a guy sleeping under the stars, not a care in the world. Except for being passed out in the middle of the city.

I was carrying a basket with assorted cleaning supplies, stuff I'd left at T-grl's when I was out east, and which she still had two of. I also had a paper bag with a six of Leinie Red and a bottle of Shiraz, but the irony of this was not yet clear.

I said, in that clear, neutral, calm EMT voice, "hey." Then a pause, looking for a fluttering of the eyelids or a movement of an extremity. "Hey, buddy. Are you okay? You're lying on the sidewalk, man." Nuthin.' Not wanting to poke the guy with the toe of my shoe -- a little dignity is important -- I set down my stuff and knelt over him. I gave him the ol' shoulder shake. Then the chest-poke. When you're doing the chest-poke, you're skating on the edge between concerned citizen and EMT.

"Hey, guy. You're lying on the sidewalk. What's going on?"

He opened up glassy, drunk eyes. Slight odor of alcohol, but c'mon, you know where I work. No way was he over 0.09. He slurred some type of "leave me alone, I'm fine, who are you and why do you care?" -type blather at me. I explained that a guy lying on the sidewalk at 2am is noteworthy, and said I was concerned about him being okay. I took his pulse. Steady, strong, 80 or 85.

I love the way you can just reach out and grab someone's wrist to feel their pulse, and if you do it right, not only do you learn some helpful information, you also reinforce the notion that you are there to help and you know what you're doing. I've written here before about the theater of medical care, and it's totally applicable on the street.

Along with mild alcohol only, there was no odor of ketones. That was the other first thing I thought of: diabetic who drank a little much and put himself into DKA, or induced a diabetic seizure or syncope. That sounds smart and all, but basically, here's how the medical thing works: when you see a guy lying on the sidewalk, there are many questions. Who is he? How did he get here? Where was he earlier, and who was he with? How come they left him here? How long has he been here?

The only question you actually care about, however, is this one: what caused this guy to be lying here, now? The answer is probably "because he's drunk, and this seemed like a good spot." But it could be lots of stuff. He has a seizure disorder, or diabetes. He hit his head. Someone hit his head for him. He fell just now, from a low-flying and very quiet zeppelin. Things on the list get less and less likely as you go down it.

So he's coming around a little, and he's taking his time doing it, but I explain to him that if I don't see him at least sit up, I'm going to call an ambulance. He sits up. He starts asking questions I can't answer, questions like, "what happened?" I explain that all I know is, I walk along and here he is. He expresses skepticism. I acknowledge that it's weird, but hey, here we are.

We talk a little more. I get some yes/no answers to relevant medical questions. I tell him I work at the hospital, and I can get an ambulance here quickly. (Never mind that anyone with a phone can do the same thing; I'm maintaining control of the scene, dammit.) By now it's pretty clear he's merely drunk, but he's not moving, and I'm not going to just leave him here. I explain that I'm worried about him being hit by a car. Or robbed. Or hauled in to Detox. He tells me he lives a block away, in the swanky high-rise condo building I see out my window. But it starts to look like he can't stand well, much less walk, so I push the button and dial 911. By the time the dispatcher is talking to me, Drunk Guy has done some mental calculus and has sucked it up to an impressive degree.

I talk with the dispatcher for a minute. I explain, in hospital-speak, what's up. I give our location. I report that he's looking able to walk, and says he lives a block away, so we're good. Okay, says the dispatcher, call back if things go otherwise. Drunk Guy has heard my half of this 30-second conversation, and gets the picture -- it's not okay to be asleep on the sidewalk -- and repeats that he lives a block away, and he'll be fine. At which point, we do our little Who Theatre bit; I tell him I'm going in the direction of his building, and I'll walk with him. Let's go.

And we do. He's crap at walking right now, but he's uninjured. He's making sense, in that drunk-guy way. He hasn't had a stroke, or a seizure, or a heart attack. And he's really lucky, because he still has his watch and presumably his wallet. The people he was with presumably had the wrong condo building, and ditched him at the sidewalk. He probably told them he was fine.

And as we're walking, he says to me that the funny thing is, he has a $300,000 condo and a $70,000 car, and he needs me to walk him home. Yep, that's funny. I tell him what's funny to me is that I have this night off in a string of overnight shifts, and here I get me a patient.

I got him to the right side of the street, half a block from the entrance to his complex. It's well-lit, and security-patrolled, and I figured he'd be welcome to pass out on the grass verge there if he likes. Could be a character-builder. And then I went home. I'm looking out my window right now at the complex in question, and all is calm.

I've always liked the common-sense approach of the cop in that song. It's a diagnostic test and a treatment all in one. It's an "if/then" algorithm. So long as Roger Daltrey's character isn't asleep in that doorway for some more serious reason, it's a win-win situation.

This guy had not spent eleven hours in the tin-pan. But lord, there's got to be another way.

Moo hoo, ha ha

Thursday (and the day before, and several of the days before that) were practice tests. I was being cute about revealing the scores on those, because not only were those scores... not bad, but not awesome, but moreover there was a chance that the actual, real GRE test scores would be similar, or worse. So I didn't want to be blabbing about my 540 on the math part and my 650 on the verbal part, because wow would I look like a dork if the scores I'd actually be using turned out lower.

I did the real test yesterday, on Friday. Not to worry. It turned out very well. Thank you to all who helped, supported, or just wished me well and put up with my weird schedule and lack of availability.

You know, now that I am apparently a high achiever, I'll need to re-think my jaded, hipster disregard for people who succeed at stuff. Actually, all I need to do is refine it a little: here's what I've actually been talking about all this time, when I say snotty things about "straight A students" or "those damn pre-meds."

What I hate is an obvious sense of entitlement. When people crow about their awesome GPAs and their stellar experiences and how their dad the cardiothoracic surgeon set them up with a great guy who happens to be the 3rd most blah blah blah. They make us workin'-class kids think we are in danger of being shut out, because we had to work full-time and pay our own way, and that may have eclipsed some of what might make us amazing applicants in our own right. How could an admissions committee possibly know that a 3.3 for us might be more difficult, and more meaningful?

So if my own crowing becomes annoying, please call me on it. And also, please know that I mean it in the spirit of enthusiastic and grateful good-wishes to everyone who helped me get this far. I can't believe my good fortune, and yes I suppose I do feel like I earned it, but it's still a gift. I don't mean to be obnoxious to anyone, except maybe those dillweeds I mentioned earlier. As rare as they are, and seriously I have met very few, they're toxic. People who behave as though it's the most normal thing in the world to be fortunate, and anything less is a character flaw, are a danger to fortune and to character. And I hope to never be one of those people. I know you'll help me make sure of that.

So, are you ready, then? Here goes: I got--

Awwwww; a day later, and now I'm shy about it. I've re-edited this post. Let's just say I got a math score that's much higher than I had expected, based on the practice tests. In Verbal, meanwhile, I figured I'd do well, but I did well enough that I blew away a little goal I'd set for myself, which had seemed possible but not likely.

The combined score is high; the mean of the two scores is high; the difference between the two is actually not horrible. Based on some Web searching, I'm in great shape. That's the thing.

Hello, lamp-post. Whatcha knowin'?

Good evening, Internet. It's a balmy summer night here in the big city. Welcome... to 'Febrifuge After Dark.'

Tonight, we have a lovely skyline view, from here at Studio Dudeio's big window. We have a screwdriver, with good vodka, fresh OJ, and just a splash of pomegranite juice (and incedentally, we're refusing to give this delightful little drink a nasty name; there will be no "bloody screw" or "hematuria" here, thank you very much; in fact, "sunrise screw" is over the limit, that's just how classy we are around here tonight).

We have no particular plan, because today's tasks are accomplished. Shocking, I know, but true.

I also had the day off work, which is nice, because it's been good 'n' weird, down at the ol' ER. I emailed my sis a bit ago, and I think I said something like "it seems anytime some poor guy gets a limb sheared off, or a small child falls three stories, they come to my workplace." Which is true, of course. And that's good, in the sense that the care my workplace offers is bar none the best around, and folks in need get excellent attention. It's also gratifying to be even a small part of that, and humbling to be allowed a place in the ongoing battle between order and chaos.

But dang, a day off from that is a pretty sweet thing. I'll assume you understand.

Today I did more GRE prep. Math math math math. Math. Huzzah. It's to the point where I do verbal because I like looking at high scores for a change. I've become jaded on verbal. I know it's bad, but for now it's a coping mechanism and it's valuable.

For the "Feb About Town" part of today's festivities, I road-tripped down to the exurbs, to get an official transcript sent from the CC where I did my EMT class. Hey, I paid tuition; I got a grade; it was a good grade. Heck yeah, I'm sending that one. In reviewing the CASPA, I realized that all this time, I somehow left off the Vermonty grades. Heh heh heh. The transcript is in, and has been for a while, but CASPA has thus far had nothing to compare them to. Problem fixed. And by the by, this means my illustrious history involves more like 89 college courses. Um... yeah. Non-traditional student here. Hi.

I also did a complete practice GRE today. I will tell you the scores later, if by "later" you mean "once the real one is not only done, but I'm safely accepted into the Best School Evah(tm)." I'm not saying they're bad -- they're not -- but I hope to have scores that, as Eppie Calvin "Nuke" LaLoosh said, "announce my presence with authority." These were more like "this is my first time taking this test in its real format." Thankfully, I know where the hand-holds are as I make my way back up the learning curve, so it'll be quick. This is why we practice, kids.

That's it from the professional and academic side. Now we turn to the social side, where the After Dark crowd likes it. Soon, I'll be over all this test silliness, and on to other things, like: hey, I live downtown. I can see n available parking spaces out my window right now, where n is a positive integer greater than or equal to 3. True, those spaces cost money until 10pm, but from that prime time until 8am, they are as free as sweaty hippie love, my friends.

And so, I'm putting you on notice, Internet. I'm putting out the call. I'm making it known. I live downtown, and I have a weird schedule. I have motive, means, and opportunity to have way more fun than I've been allowing myself, and soon I'll have a break between high-stakes, career-deciding moments. Let's catch up.

In a nutshell, it's like this: I have way more people I talk to on the phone, via email, or whom I see on the odd weekend than I do people who are ready, willing, and able to enjoy this swingin' downtown scene, and I'd like to remedy that somewhat. Because most of you are responsible adults with jobs and whatnot, I'm not going to roust you from your beds on a Wednesday at 11:30 and demand you hit the bars with me. I am a civilized brute, after all.

No, I'm going to issue a challenge. I'm going to throw down a gauntlet. I'm going to run up a flag and see who salutes. Come on downtown, and we'll hang sometime. Who's with me? ...Or are you going to make me bust out a St. Crispin's Day speech?

EDIT TO ADD: One reason for this desired change is that it's been wicked awesome to see my old friends M. Giant and Trash more frequently of late, since Trash is my GRE guru. Having a good excuse to hang with them has got me thinking: I can either come up with equally good reasons to see everyone, or I can just eliminate the need for an excuse altogether. So, to my friends with small children, naturally you need not come to me. I can be a bad influence on your kids just as well at your place.

Things I Bet You Don't Hear At Your Job

1) "...And are they bringing the arm, as well?"

Good news, and bad news

Today I took the little half-length practice GRE (minus essay-writing) that I bought when I bought the book. Smart, I would think, to actually use what one has paid for, right?

I got about 76% of all questions right. Not bad, actually. I see 76% and think, "C, maybe a C+ if the instructor gets me," but no, things don't work quite like that. Trash might be by to comment on just what sort of score that could translate into, but I'm assuming it's "decent, not spectacular."

The fun part is the breakdown of how that 76% comes about. Out of 41 questions in the Verbal and Quantitative sections, I got 31 correct. 10 wrong, in other words.

7 of the 10 were math questions. Things like, if I remembered that the circumference of a circle is two-pi-r, I would have recognized the correct answer. Probably. Maybe. Two of the last three were super-sneaky analogies using words that (gasp!) I didn't know that well, and the final one was a total bastard rip-off word trap contained in a reading comp question. Ha ha, you got me. Oh well.

So, strategically speaking, I should pretty much just practice essays and study math. And hey, it's not like a guy needs much math to practice medicine... right? Dude, I can add, and I can multiply. What else matters? Plus all the cool drugs are one, two, or ten milligrams per kilogram anyhow. That's my story, and I'm sticking to it.

Welcome To The Jungle, indeed

The Fake Doc has a lovely and amusing post on the ecosystem of the hospital jungle, and the creatures one is likely to encounter there. You should read it, and then return to this post, because in the spirit of blatant theft appreciative reinforcement, I think I can offer a couple more animals one might spot:

Carpenter Ants (ER Techs): Constantly busy, able to lift several times their own weight, and frequently unnoticed by the other creatures in the jungle, the Ants take care of things that would be problems, if they were allowed to go unchecked. Ants can be annoying at times, but one should be careful about wishing them gone: if they really were to disappear, disgusting remnants of the daily work of the jungle would litter the landscape in a matter of moments. A wise Grizzly, Hedgehog, or other larger creature will cultivate an alliance with the Ants, because at times of need, the greatest help can come from the smallest of sources.

Otters (unusually competent MS4's): Otters are impressive and comical, all at the same time. They work nearly as hard as the most skilled of Beavers, and have an ability to get along with Beavers that too many other creatures lack. They are almost as quick as Hedgehogs, and only slightly less cute than full-on Bunnies. They are not nearly as powerful as Grizzlies, but what they lack in killing power they make up in agility. Sometimes an Otter can be doing well enough to be mistaken for a Hedgehog; when moving at full speed, the blurred shape of the two creatures is remarkably similar.

Wolves (Physician Assistants): Wolves can function very well alone, but by nature they travel in packs. You will usually find at least one Wolf in each of the busier areas of the forest; sometimes the wolf will be doing the exact same thing as the Bears, Badgers, or even Otters, side-by-side with them. Sometimes the Wolf will be silently stalking something the other animals haven't noticed yet. You may see the odd flash of violence as a Wolf works quickly and efficiently, but more likely the Wolf will simply appear to come and go with no discernible pattern. Often faster, more cunning, and more deadly than the larger, more powerful predators, Wolves will occasionally swoop in and take a tasty bit of meat from the other forest creatures; nothing is more amusing than a Grizzly Bear rumbling up, fully expecting a meal, only to find that the Wolf has already taken care of it.

There are undoubtedly more where those came from, too.

I refuse to accept the evidence that I am old and sad.

Because CASPA not only needs to know everything about my academic history, but needs to know it from several different points of view, I took a little tour yesterday. It was harrowing and disturbing, so naturally it's a story that needs to be told here.

I've gone through my own copies of all my college transcripts and entered every college course I've ever taken; this sounds like no big deal unless you know that I basically drifted around for several years, studying nothing in particular. The idea was to knock off basic requirements like English, Math, and Social Sciences, and to an extent it worked. However, when I went back to the U at the age of 25, finally getting somewhat organized, I had taken a full four years' worth of coursework, and only about a third of it was accepted in transfer.

All in all, the listing on my grad school application has four colleges, spanning 27 academic terms, and 77 courses. This may change slightly as I clarify whether the English course I took while a high-school senior should count. I got U credit for it, so yes... but on the other hand, that would mean I've been in college, on and off, for over 18 years. That just ain't right, because last time I looked, I am not a wealthy and esteemed neurosurgeon.

Yesterday compounded and focused the agony, because I had to arrange official copies to be sent to CASPA, together with the official CASPA form. Not wanting to dick around with faxing or mailing documents, this meant a drive up memory lane. Actually revisiting the various community colleges I attended was pretty hellish; who wants to bask in the misty memories of the C they got in Geography of Western Europe at the local ju-co? And how much worse if it was so long ago, you can't actually remember all that much about being there in the first place?

Long story short, somewhere among the current crop of freshmen at Anoka-Ramsey, there is almost surely someone who would have been born when I was a freshman at Anoka-Ramsey CC.

Breakfast: awesome :: Standardized tests: not

Back in the day (i.e., two months ago) my neighborhood greasy spoon was the Blue Benn, a diner famous in diner circles.

Now that I'm ensconced downtown, my new neighborhood greasy spoon is the Band Box. Awww, yeah. I think it's fair to say that your pal Feb has the gift of awesome breakfast joints.

Best of all, the BB is truly in my neighborhood. I can walk there in minutes. And as much as I rock at cooking breakfast my own damn self, I can't touch the home fries at the Band Box. They're made the right way, which is time-consuming and annoying unless you're cooking on a commercial grill, in bulk.

It's a damn fine thing to be able to get off work at 7am, walk to a holy shrine of bacon n' cakes, and then walk home with a full belly to sleep the day away.

The latest snag in my little plan to lead the perfect life would be this little thing here:

Name: [ febrifuge ]
Program: GRE TESTING
Exam: GRE-GREAM-GRE GENERAL TEST
Appointment Date: 11-Aug-2006
Appointment Time: 12:00 (12:00 PM)

Cue the dramatic music. Dun dun daaaaaaah...

You can't spell 'egregious' without G-R-E

Because the admissions deadline of the Best School Evah(tm) is so much earlier than the deadlines of most of my other potential schools, I've had to think a little about whether to turn on the juice and get ready for the test in time for BSE's deadline, or just let them go and concentrate on all the others as a group.

And then I started studying for the thing.

Hey, you know what? It's going to be okay. Sure, there's a boat-load of math for me to review and/or learn, but the GRE is more than anything a test of a person's ability to take standardized tests like the GRE. And I'm starting to think I could be very good indeed at that skill, just now in my little personal adventure.

So I'm doing it. I'll take the test in a little less than four weeks, is the plan. The worst that can happen is a really, terribly, awfully lousy score. In which case I can take the thing again, a month or six weeks later.

Green warrior needs food. Badly.

It was halfway through the shift, and I had just a few minutes before switching over to another area of the ED. Things had been completely nuts in the acute-care area; out of 16 beds, 13 of them were people waiting for admission to the hospital. The other day, I'd helped some fresh new 3rd-year med students find the library, and when I said I'd see them sooner or later down in my department, they commented that all their patients came from the ED anyway. Today, this seemed like it might be literally true.

Before I leave an area, I always ask "so, before I go, is there anything I should take care of as a last-minute thing?" This makes me kind of a dork, I know, but it's the kind of thing I'll encourage when I'm giving orders to techs. Because this day was pretty bad, I wound up with two assignments to take care of in one fell swoop: take a patient upstairs to the cardiac short-stay area, and run over to another building to the radiology department, where the ED's "big boy chair" -- the extra-wide wheelchair -- had been somehow left. No sweat. Since I'm going to be running all over hell anyway, I thought, why not make a detour and come back with the chair? All it takes is some forethought and planning, plus some good decision-making along the way. So I brought the patient up, and got her situated in her room...

6th Floor, Green building - elevators
You are standing in the elevator lobby of the Green building. An empty patient cart is with you. The cardiac unit is behind you. To the left and right are parts of the hospital you don't care about right now. The elevator doors are in front of you. The elevator doors open.

> Push cart into elevator

Elevator (6th floor Green)
You are in the elevator. The doors you came through are behind you. There is a second set of doors ahead of you. There is a bank of buttons on the elevator wall. An empty patient cart is with you.

> Push button

You must specify which button you wish to press.

> Push 5R

Elevator (5th floor Red)
The elevator doors ahead of you open.

> Push cart out of elevator

5th floor, Red building - elevators
You are standing in the elevator lobby of the Red building. The elevators are behind you. To your left is a hallway that leads to offices. Ahead is a long hallway. To your right is a row of high windows that look out on the city. An empty patient cart is with you.

> Push cart forward

5th floor, Red building
You are walking down a long hallway. Behind you is the elevator lobby. To the left is another set of elevators. To the right is the Purple building. Ahead there is a set of locked doors. An empty patient cart is with you.

> Walk forward

5th floor, Red building
You are standing at a set of locked doors. Behind you is a long hallway. An empty patient cart is standing in the hallway. There is nothing to the left. To the right, there is a door to the stairs.

> Stairs

Do you want to walk up the stairs, or down the stairs?

> Down

4th floor, Red building
Behind you is a door to the stairs. To your left is a long hallway. To your right is a set of locked doors. There is nothing ahead of you.

> Left

4th floor, Red building
You are walking down a long hallway. Ahead of you is the elevator lobby. To your right is another set of elevators. To your left is the Purple building. Behind you is a set of locked doors.

> Left

4th floor, Purple building
You walk down a long, narrow hallway. At the end, there is a set of locked doors. To your left, there is a bank of elevators. A sleep-deprived resident is shuffling by. He takes no particular notice of your presence.

> Open door

You need an ID badge to open this door.

> Inventory

In your pockets and on your person, you have:

Trauma shears
A DRG PureTone Classic stethoscope with SafeSeal diaphragm and gel-filled earpieces
Two sets of purple non-latex gloves
A cheap ballpoint pen
Your hospital ID badge

> Use badge on door

The ID reader blinks from red to green, and then back to red, rapidly. Your ID is not coded to open this door.

> Resident

You look blankly at the resident, and before you can speak he looks at you through half-lidded eyes and says, "it's locked. You have to go around."

> Slap resident

You can't do that here.

> Kick resident

You can't do that here.

> Defenestrate resident

You can't do that here. Also, there are no windows nearby.

> Left

4th floor, Purple building (elevators)
You are facing a bank of elevators. To your left and a little behind you is a set of locked doors. There is nothing behind you. To your right is another set of doors.

> Right

4th floor, Purple building (Radiology doors)
You are facing a set of doors that lead to the main Radiology area for the hospital. At this hour, the department appears to be deserted. You can see the wheelchair through the glass portion of the door.

> Open doors

You need an ID badge to open this door.

> Use badge on doors

The ID reader blinks from red to green, and the doors open.

> Forward

4th floor, Purple building (Radiology)
You are in the main Radiology area for the hospital. At this hour, the department appears to be deserted. A large wheelchair is here.

> Take chair

You get behind the chair and wheel it in front of you.

> Thank Jeebus it's about damn time

You can't do that here.



(Yes, my dear sister in KC, that title is a shout-out to you.)

Today's Splash of Brilliance

The Webtender

This handy Web site has every drink recipe its users have ever heard of, plus many (too many) they have supposedly created themselves. Back circa 1997, when I was transcribing Ortho Surgery clinic notes and discovering this wonderful new WWW thing, I found a site devoted to bringing back cocktails (and to criticizing "shots," which the authors found to be a cancer on the esteem that civilized drinking had spent so much time building up, a growing blight that needed eradication, and soon). That's where I came across the Delilah, my all-time favorite hard-liquor drink:

• 1.5 oz Gin (pref. Bombay Sapphire)
• 0.5 oz Cointreau (triple sec will do)
• Juice of one half lemon, freshly squeezed

Add to shaker filled with ice. Shake hard; serve up.

By the by, if I were to adopt a motto for my life, I could do a lot worse than "shake hard; serve up."

The Webtender does indeed have Delilah listed, and gets the recipe right. This was a cocktail popular in the 1930's and 1940's, as best I can recall, and I see today it's also known by the name White Lady (named after a poisonous spider, if Wiki is to be believed). One site says Delilah "is basically a Sidecar, but with gin instead of brandy."

Yeah, okay, and by that same token, Minneapolis is basically Seattle, but in the Midwest rather that the Pacific Northwest. There are three frickin' ingredients, caballero. Of course there are things that go with gin as well as brandy; you know how much similarity that brings to the two drinks? To quote Douglas Adams, "none at all."

Perhaps the handiest, yet most-flawed feature of Webtender is the "In My Bar" section, where you can select from a pick-list of ingredients. Highlight everything you have on hand, and the Webtender will tell you what you can make with it.

Like many Web-based tools that rely on user-submitted info, this nifty app is a long way from perfect. There are way too many recipes that use, say, Crystal Light. There are too many duplicate listings (okay, a true Cuba Libre has diet cola, but do we seriously care whether we have one brand of ginger ale or another?). One gets the idea that a team of intrepid editors could turn this sucker into something mighty, though.

And as many combinations as there must be, nobody saw this coming: I'm drinking banana liqueur and cream soda... and it's not only pretty tasty, it's not listed. Maybe I'll call it "fuzzy monkey" or something. It's good, but not good enough to be called "the Febrifuge;" for that I'd need to fine-tune those Blue Curacao things I was making the first time I was in college.

* If anyone knows what that pro-cocktail, anti-shot site was, and whether it's still in existence, please let me know.

jack of all trades

Just some random things, from recent shifts:

• I disconnected and flushed out an IV in a dude's frickin' external jugular vein.

It turns out you look extra-hard for air bubbles when you're eight centimeters away from the brain. I know, I know: like all veins, the jugular goes toward the heart and therefore away from the brain. In the moment, though, you sort of question everything, and imagine this could be the one guy in 10,000,000 who has some weird anatomical variation, and it might actually be in the artery. And if you've seen enough made-for-cable movies, you know: you can totally kill a dude like that.

• I got to be an auxilliary foot-rest for a paraplegic patient.

This takes a little explaining. See, the patient came in via ambulance, so his own chair wasn't there. The transport company sent a guy with the lamest chair evah, one with no foot-rests at all. So rather than the patient suffering the indignity (and possible injury) of having his feet tucked under and dragging, I just walked backwards in front of him, looking for all the world like a mobile shoe-shine boy.

It was hella stupid, from the point of view of "send the right equipment, ya losers." The patient was annoyed that I had to deal with it, and I was annoyed that the patient had to deal with it. We concentrated our mutual hate on the dude who brought the chair, and that was sort of cathartic. I like to think he, in turn, learned a valuable lesson about life, and therefore everyone wins. If not, then screw the company he works for. Bahhhh.

• I was a carpenter.

I love how we have all this high-tech stuff, and when somebody needs to go home with a cane, we grab one from the Ortho closet, and adjust it to size. Ahhh, but why should that be strange, you ask? Well, they're regular, old-school, wooden canes. Which means we grab the cane, then grab the hand saw hanging right there, and we go on in to see the patient.

Which means you have a choice; you can talk to the patient beforehand and tell them what you're doing, or you can be evil and just stroll into the room with this SAW in your hand. I was my usual gracious self, so the patient had been forewarned. I entered the room and said, "yep -- that leg will have to come off," but he just laughed. Sometimes I am way too easy on people.

UPDATE 7/11: Two canes in two days. I guess my job is merely that odd. There's nothing special about busting out the saw at all.

I do find it kind of charming that someone took a marker to the wide part of the sawblade, and in big block letters wrote "ORTHO." As if we would use it anywhere else. Even better, though, is that a second person's handwriting added "Cane Saw" nearby. I am fighting the temptation to write on the other side, "AMPUTATION SAW" or "OL' RUSTY."

moving up in the world

The perks of being a full-time ER monkey are pretty sweet. To wit, today I picked up (and took home and washed, because I'm like that) my three new sets of scrubs. Paid for by the hospital.

That's right, kids! Not only do I never have to wear a tie, not only do I get to wear what are basically pajamas with handy cargo pockets, but I don't even have to buy them myself.

I mean... well yeah, I have to pay to park, when I work afternoon/evenings. And yeah, I get no discount whatsoever at the cafeteria, much less get my ID badge charged up with fun bucks like the residents do. No, I can't just waltz away with suture materials to practice with, and speaking of the ID badge, I have to use it to leave some areas, and to get into others. But here's how much fun I'm having, knowing I'm committed to being in this environment: the scrubs thing feels as though it makes the rest worth it.

I'm not unrealistic. Any job, no matter how cool, will sometimes feel like a job. If you're lucky, it feels like good work. If it doesn't feel like work at all, then either it's not that hard a job, or maybe you're just not doing it right. In my experience, if it doesn't feel like work, it doesn't feel like fun, either. Anyway. I have had a sufficient number of shifts back in the ER since my glorious return that I have been reminded of how it's work for the full eight hours. But also of how much I love it.

I get paid a pretty sad pittance, really, but I get to see and to be a part of some very cool moments. I've done the thing where I count to three and then a bunch of people move a person. I'm nerd enough to still think that's cool. I get to witness how awesome some parents are with some kids, and see the good in people when they help one another.

And I get to reinforce the idea that the people who do the EM-doctor job are people just like me. By personality, if not by education and training, I could have been either one of the people in this little exchange:

ER Doc: This guy seems like he should be okay to go to detox, right?
ER Tech: Ehh... [indicates a specimen cup full of urine with a scary red tinge]
ER Doc: D'oh!
ER Tech: Yeah.

coulda been cool

The thing people tend not to get about Emergency Medicine is this: it's not about diagnosing what's wrong. I mean, yeah, 99.9% of the time, our people can tell what's up, they can find the problem behind the problem, and they have a plan that will in fact fix it. But when it comes down to it, that's actually what primary care is about. The ER is not supposed to be a source of primary care, and it will never be an optimal one. We're... well, it's a big issue, but suffice to say, we're not about that. Emergency is instead about finding out what is not causing someone's symptoms.

Headache? Hmm. Could be a simple tension headache. Or maybe a sinus headache. Or maybe, a DEADLY BRAIN TUMOR. Go to your friendly local clinic, and they'll be sensible about what it probably is. They'll test you for the most likely causes, and if it turns out it's not one of those , they'll start busting out the more expensive tests, looking for the weirder things. This approach catches more things sooner, and wastes as little resources as possible. Almost all the time.

Meanwhile, in the ED, our list of potential causes -- our differential diagnosis -- starts with the scary shit, and works downward from there. It treats time as the king-daddy most important resource, which is absolutely true, in the most emergent cases. Chest pain, shortness of breath, dizziness: not uncommon things, and probably not serious. Except when they're really serious.

This, by the way, is why so many things seem to take so long in the emergency department: if it can wait, it will, because there's probably something else going on that really shouldn't wait.

So for that headache, we knock the deadly tumor off the list first. We can check off stroke or other hemmorhage soon after, if not with the same test. And soon, we know what the headache is not. We may or may not yet know what it is, and that's the point. Honestly, at a certain point it ceases to be important, within the realm of emergency care. It becomes the kind of headache that the emergency room is simply not well-equipped to handle.

Anyway, long story short, when a resident said to me recently, "I have no idea what's causing her symptoms," that was not a bad thing. In fact, since he could say exactly why it wasn't malaria, or encephalitis, or any of a number of other things on the list, it was probably good news.

My shift ended before I got to hear the end of the story, so I can't pass it along. I just know it's not malaria. Which of course is good, because nobody needs malaria (and too many people have it). It would have been a neat thing to be able to say, though.

blog niblets, historical edition

Okay, because it's been a few days since I've posted, because I want to keep up the flow of ideas, because I'm always talking about how I'm going to get around to telling some cool ER stories, and finally because I'm always obsessing about how to do that while also respecting confidentiality, here's what we're going to do today: I now present to you a list of very short-but-true little factoids. The following things happened to me at some point within the past three years or so, although the non-clinical stuff goes back farther. Note: the few identifiying details that might be present are subject to change, so you'd never figure out who, when, or where, don't even try.

* The first time I set foot in an emergency department as a patient, I very nearly, as my British friends say, pulled. I struck up a pleasant conversation in the waiting room with someone who I think was there with her friend. My swollen glands and constant pain were not enough to keep me from turning on the charm.

This was an early experience that cemented two ideas for me: one, I'm even more charming and attractive when I'm in the healthcare environment (which is weird, because way back then I was only an erstwhile transcriptionist, and was still in deep denial about the idea that I'd ever want to practice medicine myself). Two, upon thinking about it, something about hitting on chicks in a hospital, or having chicks hit on you in a hospital, is just plain weird. The professional detatchment thing would later turn out to be easy for me, and maybe this is part of why.

It would be a cooler story if I got those digits, though... it woulda been nice to have a better self-image back then. And besides, my strep was gone in like a week.

* The first time I set foot in an emergency department as a student, I observed an attempted suicide case. The patient would turn out okay medically. The note was sitting out on the countertop. I don't remember it word-for-word, but I remember how it felt to read, and how clear the writing was. Here's where I learned about the reverent, church-like feeling of being witness to the extremes of human experience; how people's bodies and the artifacts of their lives are laid out for view.

Now that one of my job responsibilities is gathering and packaging trauma patients' clothing and personal belonings, it's hard not to think of this clinical, dispassionate view in chaotic, passionate times. We take care of that stuff, man. We document piles of clothing and the contents of pockets like archival materials, and handle them like just-purchased Christmas presents.

The one time I, in my capacity as a lowly tech, walked upstairs to sit in the surgery waiting room and talk to the family of an accident victim was to explain to them that their family member's clothing had been so thoroughly cut by our shears, and was so saturated with his blood, that I felt they would agree it was better to throw it away. Red-eyed and waiting for news from the OR, they considered what it would have been like to open a brown paper bag and see their loved one's stuff like that, and told me thanks for thinking of it, of them, in that way. I'm glad I was right in this case, because the hospital's rule is right, in general: that decision was just plain not mine. If it had turned out they'd wanted the shredded, soggy stuff, I would have gone searching in medical waste.

* I'm pretty good at reading X-rays, although I need to get over this thing where I spend significant time looking at the wrong part of the picture entirely.

* I've been offered the opportunity to do all manner of things with needles and blades that I probably shouldn't do quite yet. I've turned those down, but I do know how to put a dislocated finger back in place.

* I was an EMT for just shy of three years, and I carry a bag in my car with splints, bandages, scissors, and basic things. I stopped by the side of the road as the first responder to an accident, last winter, while I was out east. I didn't use anything from the bag except a pair of purple gloves, but speaking as a guy with a four-year acting degree behind me, I'll tell you what: those gloves, plus the shoulder strap of the bag slung across your chest? The knowing what to say, and what to do? That shit is theater. Pure and simple. And it helps people. All I had to do was talk, really, until the volunteer rescue squad came. Those guys were basically me, plus of course years of experience, plus a big truck with all the necessariy equipment and cool lights.

But the theater is the most important part of the equation.

I agreed to what, now?

I can't say I've figured out my work schedule, but I did talk through it, and write out a little calendar-slash-chart thing to give myself a visual.

Hunh.

3pm to 11pm tomorrow (well, today I guess), and the same again Thursday. Cool; I can check out a bunch of apartments tomorrow (well, today I guess) before work. Friday I have off; that's sweet. And then Saturday it's 11pm to 7am (wait -- is that Friday night at 11pm to 7am Saturday, or is it the last hour of Saturday into Sunday, and then the last hour of Sunday into Monday?).

Then I start the actual pattern at the beginning, and the first Sunday of the pay period I always have off (except for the 7 hours of Sunday I work because I started a shift at 11pm on Saturday, of course). The middle of the week varies a little, because I'm only guaranteed eight shifts in a two-week period, and they could be evenings (3 to 11) or nights (11 to 7).

Hunh.

I guess it's good that I'm a night owl. Unless it's really, really bad. And also, which box has my scrubs in it? Oh crap. Gotta go find those.

Too Legit to Quit

Happy news today; I'm being upgraded to just lazy and homeless, as opposed to being Teslagrl's lazy, homeless, unemployed boyfriend. I stopped by the hospital on a recent morning, to attend the weekly emergency dept. conference thingy. I drank the coffee, I ate the bagel and cream cheese. I saw some people I hadn't seen in a while.

Something about me (or them, or the spot we presently occupy in the yearly schedule) must have changed, because when I went home over winter break, people were like, "oh. You've been gone?" Whereas today, I got handshakes and friendly greetings from various staff, faculty, RNs, and residents. Maybe it's because during the last year, I may have doubled or tripled my actual knowledge base, and now radiate a sense of reduced dumb-assedness. Maybe.

In any case, I sat through the third-year residents' presentations of their "scholarly" work; some of said work was really good, and either will be or has recently been published in medical journals. Some was... well, let's just say that anyone in my Micro tutorial could have PowerPointed circles around a couple of these folks. Have no fear, sick and injured of the Twin Cities. They're good doctors, and their presenting skills are unimportant; it's just that they happen to be not-so-stellar in this case. My take-home message was, "dang, I guess all that stuff I did at that weirdo college will pay off in more ways than I know about."

And I tracked down my boss, a very busy guy who tends not to return a phone call unless he has an answer to the question being asked. Which is difficult for me, since I spent all that time in the world of "gosh, sir, we still haven't located that document, so if you'd like to send it again, you should feel free, or if you'd prefer I can just check in with you on Friday and let you know where we stand."

In this case at least, the suspenseful way isn't too bad, because we went pretty rapidly from "so hey, what do you have for open patterns?" to "it's about the same pay as part-time, maybe a little more; you'll be earning benefits; and orientation is on Monday." The only potential kink is that I'll be working shifts that are either 3pm -11pm, or else 11pm - 7am.

Still, I can work my other daily activities and socializing around the hours, and indeed I'll need to hone this skill if I'm going to work in Emergency Med the rest of my life. Plus I've learned to live on not very much sleep. Plus my sense of what time of day is appropriate for working has been completely scrambled by Bennington anyhow.

And speaking of 'scrambled,' there will be days when I get off work at 7:30am, and go directly to the little diner a block from the hospital. Sleep til 2pm, study GRE stuff. If it's a work night I take a nap. If not, I go out. Could be worse.