What's in a name? A really long post, that's what

Today's post comes to us courtesy of the Reader Mailbag, where a sharp and doubtless lovely person named Barb writes:

OK, so I've got a question for you.

Is there a "proper" form of address for a PA? or is it an individual preference?

I ask because at my husband's neurologist's office the ratio of time spent with the PA to time spent with the doctor is running roughly 25 to 1 in the PA's favor. Calling her by her first name seems somehow not quite right, (too casual and familiar, I think); but calling her Ms {lastname} feels off-kilter, too.

Ahh, yes, Barb, one of the eternal questions of PA-dom. This is just one more way in which the pioneers of the field... how do I say this kindly... kinda screwed us (without meaning to, of course).

The best answer is that it's an individual preference, and if it were me, I'd just go ahead and ask your PA how she feels about it. It could be a non-issue, or you could prompt the kind of long-winded discussion I'm about to launch into. I agree, that using "Ms. ______" in the context feels weird, as though you're talking to a grade-school teacher or you're entertaining a guest in the parlor for tea.

Within the PA profession, there are some even sillier ways to try and be formal, there are ways to just ignore the difference between an MD and a PA, and then there's the first name thing. There's no perfect answer. In my experience, most of the time fellow practitioners of all levels use first names with one another, and patients call everybody "doctor" whether they are one or not.

In the small town where I shadowed a PA for 8 or 10 weeks, everybody in town was on a first-name basis anyway, so those PAs used the trusty first name basis. One guy explained that the weirdest part about practicing medicine in the same small town where you grew up was the collision of the social roles -- guys he had played football with now needed yearly prostate checks; their wives, some of whom he had dated in those high-school days and some of whom had turned him down flat, needed Pap smears. And come to mention it, so did some of their moms. So the small-town factor was bigger than the problem of what to call people.

Even so, I couldn't help noticing that with the MDs, many of the townsfolk seemed reassured by the ability to use the title "Doctor" in speaking with them, probably for the sense of decorum and legitimacy it imparts. After all, when you're in the exam room getting that super-personal exam, I imagine it's easier if you can think of those gloved hands as belonging to "doctor" somebody, rather than "good ol' Bill, the kid who really loved tater tots, and peed his pants in third grade*."

The really nervous patients called the PAs "doctor" too, out of a sense that they basically do the same job. And for all that's about 99% true, it's still incumbent on the PA to gently say, "actually, no, I'm not a doctor. I have a [Master's / Bachelor's / Whatever] degree in Medicine, not a doctorate. So just call me _______, okay?" And I've heard a few versions of that speech, in many settings. After a few years out of school, PAs seem to settle into a mode where they will give it their best shot, and if a patient insists on saying "doctor" anyway, correcting every usage doesn't seem to help.

From its conception, the PA role was always meant to dispense with that kind of formality and social hierarchy. It was the Sixties, after all, and there was a legitimate need to question all the stuff that had built up over the years, around the idea of doctor-hood. No doubt there are situations and people even today, around which rather a lot of that not so desirable, paternalistic, know-it-all identity has built up. On the other side of the coin, fewer of today's patients listen to what somebody says just because they have extra letters after their name... for better and for worse.

PAs were meant to be different in several ways, and that lack of entitlement was one of them. The profession grew in part out of wartime experiences that proved to the grander institution of capital-M Medicine that a competent, hardworking man or woman could be trusted with serious medical stuff even though they'd had less of the advanced hard-sciences-style training -- as long there was a solid foundation in how to think about and how to perform the component tasks of medicine, and as long as the conditions were right. Meaning, if help is available from some Captain not so far away, you can trust a Lieutenant to patch somebody up M*A*S*H style, or treat all the runny noses on base. As a matter of fact, the PA can be trusted to treat 3,000 runny noses and STILL catch that one brain tumor, with the right training. And so that's the training we get.

But for all that, in the planning stages it was decided that we should never really try to cross over into that special, ill-defined, highfalutin' area that marks where official doctor-hood starts. Some of it is politics, of course. Some is a return to the good ol' accessible "country doc" spirit of the earlier 20th century (and Star Trek), and some is a look forward to a more competency-based way of thinking, where a person's title means less than their skills. Over the years this has played out in good ways and bad.

We saw a video in one of our classes last term, demonstrating some ethical dilemmas and providing a point of departure for some really good discussions. One thing everybody commented on was the way the people in white coats were calling one another "PA Smith" and "PA Jones," as in, "I see here in your chart that you spoke to PA Jones about this." Our instructors assured us that we would not have to act like gigantic dorks and call one another "PA" anything. It turns out that's how it's done in the military, bless their hearts, but after all that's an environment where titles give important information and everybody has one. Calling somebody by a first name there might be an embarrassing breach of protocol.

And lastly, I was really fascinated by something I noticed back in my job at the County ER: as the Emergency Med residents got farther and farther in their training, they seemed to appreciate the PAs more and more. The way this manifested sometimes was that the senior residents, the ones about to graduate and go out into the world to become attendings, would be talking with patients and refer to the PAs as "doctor [lastname]." I found this to be pretty weird, but eventually caught on that it was the same kind of shorthand that patients use, where the word "doctor" doesn't mean "person who has completed a terminal degree that's beyond what other fields might consider a grad program," it means "person who completed a program sufficient to allow that person to provide medical care," and even more than that it means "person who provides medical care."

Which is all pretty cool, I suppose, because it means that in some places, the idea of competency over credentials is becoming the reality. And that's nice. But I specifically didn't want to be, and don't want to be, a doctor. So I will be correcting people, both patients and colleagues, at least once.

Hope that answers the question, Barb. Thanks for reading!


* There is no story about any of the nice practitioners in that town peeing themselves. At least, not as far as I know.

I also knew this season of "Heroes" would be lame

Here's me, in October of last year:

"...my pal, future Golden Globe-winning screenwriter (and eventual Hollywood Squares center square) Diablo Cody..."

Here's today's news:

"Besides Cody's screenplay nomination, "Juno" was nominated for best comedy or musical. Star Ellen Page, who portrays a precocious 16-year-old who decides to give up her baby to a yuppie couple, was nominated for best actress in a comedy or musical."

Yes, yes. Those chickens don't hatch until January 13. Duly noted. I'm just saying, is all.

Hollywood Squares 2025 will be rated TV-14, for adult situations, suggestive dialogue, and fantasy violence.

Fairly Legal

I'm not sure if you're aware of the state of the medical Blogosphere, but in the past year or so, there has been a spate of closures of medical-type blogs. To be sure, there are some shining examples of ways in which working health-care types can enlighten, opine, and entertain. Many are a great read, some are intellectually and/or politically challenging -- but I guess it's an endeavor that is not without risk. In these waters, there be sharks. Arrrr.

When I started this little experiment, I was sure to make mention of HIPAA, the medical privacy law, as it applies to blog postings. I'm aware of where the rough outlines of appropriateness start to blur even more than usual... and in fact, I'm one of the few people I know who has actually read the text of the thing. Even so, when it comes to guidance, there's really nothing concrete, and nothing a poor student could call reliable. Because nobody really knows. Like so much of law, once you get into it a little, it's more a conversation than an edict from on high.

No, I'm not closing down the blog. I'm just long-windedly saying that people act like HIPAA provides a clear, bright line, when it really doesn't. The best a guy can do is to keep the conversation going. So, when I started school last summer, I had a conversation.

The handbook for my school seems pretty up-to-date, when it comes to real-world questions. There's a policy about the finer points of how and when alcohol may be served at school events, for example. I am expressly forbidden to use not just school computers but also school bandwidth to download pornography (or, presumably, to upload it). Care is taken to let me know that the use of the school's name and logo is controlled, and there's a procedure to follow, when it comes to getting a possible class t-shirt design approved.

Yet it says nothing about blogs.

My opinion, based on my interpretation of the law, is that writing here is a part of my learning process. It's a tool I use to reflect on the ideas and experiences that will make up the foundation of my training and eventually, my practice. So if I'm doing well, writing here is part of a system that is getting good results. If I'm struggling, the blog might represent a means by which I can identify and address problems I'm having with my own learning process.

As I've said before here, losing out on academic or professional standing because I keep a blog would be mortifying, not least because I like to think of such conflicts as avoidable. I am still (relatively) young and naive as I write this.

So, in the first week or two of classes, I sat down and spoke with the director of my program. I told him that this blog exists. I explained that thematically, it's about the story of how I got from where I was to where I am now. I mentioned that a handful of interested parties, most of them family and friends I talk to in the real world, keep tabs on it, in a loose way. I said that I can't expect it to be totally anonymous, but I make an effort to at least obscure details, and explained to him a few of the minimum things involved in my process for doing that.

He said it's cool. As long as I don't mention individuals by name, and I don't specify the name of the school or be too very detailed about its location, he sees no problem.

So... have no fear that I'm jeopardizing my present or my future. If you've got questions about what "studying medicine on fast-forward" is like, or about the deal with the PA world, give me a shout. It's nice that a core group tries to keep tabs on me this way, and it's always fun when unexpected people pop up, having followed me from more interesting places.

I'll try not to be so terribly cheese-sandwich-ey, but then again the definition of a blog is personal writing that is interesting... to the person writing.

I have a break coming up soon. This could be a good time for me to perk this place the heck up.

In The House

So, we have a new class this term. It's called "Clinical Decision-making." And it is AWESOME.

I am practicing (and hopefully, perfecting) the art of differential diagnosis. You know how on House, about 30 to 60% of any episode is sitting around and thinking about "what it might be?" That's what this class is. Naturally, I frickin' LOVE IT. (And yes, I have already whispered "it's lupus!" to the person sitting next to me.)

It's like being a Cheers fan, and having a class where you're asked to drink beer and insult each other. Or being into Miami Vice, and taking a course where you use the door of your Ferrari as cover in a gun battle where for some reason nobody's wearing socks.

The class happens each week, over a couple of days. On the day of the class, we have to write up our first impressions, and what our next steps would be. That night, the Web portal for the class shows us what the lab results and images and whatnot tell us. If we asked the right things, we can assume we now have those answers, and those go into a write-up that's due the next day. It's really fun, and exactly the kind of thing that I learn from. Back in EMT training, I killed one such hypothetical patient, and still remember those lessons. So far this term, no imaginary sick people have cacked it on my watch. Knock on wood.

So far, I have correctly recognized a Congestive Heart Failure case and a heart attack. Nice to know I can make 2 and 2 equal 4, I'd say. I was too conservative with the CHF'er, and wanted to wait for some labs to come back before getting some meds going. I was sure to say "STOP FUCKING SMOKING," though maybe not in those exact words. For the heart attack, it was presented a little cleverly, such that not everyone in the class saw it as what it was. My treatment plan was maybe a little too cute: it went, "1: CALL 911. 2. Do everything else in the ambulance and/or in the ER." I did go on and explain what 3-7 would be, but only grudgingly.

I also could have done more to treat the irritating chest pain the patient was suffering. Sorry, fake patient. Next time I'll give you some morphine for your ride in the fast boxy truck.

Why yes. Yes, I do enjoy getting the props.

Today in a lecture, we talked about nosocomial infections (infections that people get from BEING in the hospital, as opposed to ones they come in with). There was a PowerPoint slide about a specific factor that accounts for a big proportion of these infections: people with indwelling urinary catheters account for like 80% of all cases.

I raised my hand and asked the lecturer, an MD who specializes in Infectious Disease, "what about the percentage of people who have catheters? What's their likelihood of contracting an infection?" See, what I did there was to turn it around.

This was, apparently, awesome. It kicked off a tangent, a brief and productive one, with everybody in class clacking away at keyboards and scribbling notes. We got some high-yield and helpful info about how stuff works, that wasn't on the original PowerPoint. I got a compliment. "See," said the MD. "That's the kind of thinking that's worth more than just knowing the factual information."

It was a nice boost, and one I needed, because seriously, sometimes the sheer volume of the factual stuff gets ridiculous. I have always been lousy at the "binge and purge" method of studying, and as a result I've dragged myself, kicking and screaming, into these advanced studies. Half the time, forcing myself to study is like getting a toddler to eat cauliflower. I do not get A's on everything, and truth be known, I rarely get A's on anything. But it's okay. As long as I know that they know what I know, it's okay.

It would be cool if there were some type of exchange rate, where props could be converted to points.

Breaks from tradition

Happy Turkey Day, random Intarweb people!

This will be only the second Thanksgiving since I've had the opportunity that I will not be enjoying the thoroughly amazing meal at my dad and stepmom's. I'm really happy to come from a gigantic, loud, slightly nutty family, and I'll miss them. But that's what it's like at the moment -- I need to make strategic decisions about how I saw everyone a month or two ago at stepsis' wedding, and about the mountain of studying I need to do with my very few days off.

Two years ago was the first time I was out of that particular Turkey Day loop; Teslagrl and I were alone in the big farmhouse out in rural NY State, and I made a small bird plus a Tofurkey, and all the trimmings, myself. I was inspired by the great kitchen at the place we were renting, and my housemate's Bittman cookbook.

This year will be spent at the home of friends who live nearby; we get the Thanksgiving experience but without so much of the traveling. Which is nice, as just this morning it has started to snow a little.

Here's a bad sign...

When the first lecturer of the day starts by asking, "who has Tylenol?", and in response to a sea of quizzical looks, he continues, "...because I guarantee you'll have a headache at the end of this."

Um... yay?

My take on the WGA strike

There's a famous story about old Hollywood. It's probably not true, but it illustrates a point, it's too good not to quote, and it probably has a grain of truth. According to the story, Irving Thalberg, the uber-powerful producer, saw The Jazz Singer in 1933 (...so, not the Neil Diamond one...) and sniffed that sound in movies was going to be a passing fad. The point being, some things never change, and today's studio heads also don't seem to have a solid grasp on how things are going to work in the future, no matter how good they may be at operating under the status quo.

Besides, the wounded moguls are full of shit. They argue that DVD sales and Internet streaming are NOT going to be important sources of revenue, but if that's so then they shouldn't care if the residuals earned by creators (use the word "royalties" and think about book authors, if the legal-speak makes you glaze over) went up from 0.04% (where they are now) to 0.08% (where the WGA wants them). If there isn't any money in these avenues, the studios shouldn't care if they had to give up 8%. Or 18. Or 80.

85% of the households in the nation have cable now. Some TV seasons on DVD outsell some movies. There are more PCs than adult humans in the United States. Consumers spend money on TV in ways that didn't exist 20 years ago. Somehow, I'm sure there will be enough to go around, and I'm glad the WGA is taking steps to prevent getting completely screwed. As Aaron Sorkin said in "SportsNight," anybody who can't make money off these opportunities needs to get out of the money-making business.

Done So Far...

Monday: finished the last test for this term in my 'General Med' class; this means I'm 1/3 of the way through the course (it lasts my whole classroom year). This happens to have been a test on the endocrine system.


[ shamelessly hotlinked image of adrenal glands ]

Tuesday: took a test in Statistics.


[ shamelessly hotlinked image of a scatter-plot graph ]

Given my thoroughly awesome Stats class in post-bac, I was not surprised to do well on this one. We actually got the tests back today, the day following the exam. Shocking!

Today, we took one on our Clinical Lab class. Various questions about blood-bank procedures, certain potential blood test results and what they mean, and poop. More than a couple questions on poop.


[ shamelessly hotlinked image of a Hemocult card ]

Currently, I'm studying up for tomorrow's final final, the test on EKG.


[ shamelessly hotlinked image of an EKG printout ]

Oh my god, I'm almost through this crazy-ass term!

Next up: a couple days of this...

[ shamelessly hotlinked image of the Seattle skyline ]

...and, after we return from the break, we start getting into this...

[ shamelessly hotlinked image of a duder in a white coat doing a physical exam ]

The hatches, they must be battened

Finals Week is coming. Prepare for stressy weirdness.

It was a good term though; I'll do a recap when I have a minute to breathe.

I haz playsholdr text

Check this out: http://www.lipsum.com/

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My Web design (and probably a good chunk of my academic writing, and now this blog) will never be quite the same again!

Weird feeling

I'm probably nuts, but to me, that the voice in the new Chevron commercials, the one talking about the power of geothermal energy and how cool it is that an oil company can be "part of the solution," sounds a lot like the voice of REM frontman Michael Stipe.

I can't find anything on the Web about it, and that makes me feel like the person in the first 15 minutes of an old monster movie. There's info about the campaign, PR releases and whatnot, but nothing mentioning who the spokesman is.

It's probably not Stipe -- in the normal course, they only mention the voice actor if it's somebody really famous... and if it's somebody famous, they mention it. But wow, just listen to 'Belong,' and try not to hear the same voice on the commercial.

Which all begs a few questions, some of which contradict one another: one, how good must this geothermal program be, to get Stipe on board? Two, how Gen-X must the advertising people be, to know that some of us would respond to a voice that sounds like Stipe's? Three, how far have Stipe's prospects fallen, if it turns out he's signed up to shill for an oil company? Four, I wonder if a singer can sue if a commercial entity intentionally imitates his speaking voice?

EDIT to add: I like what Tim is sayin' in the comments, about it being Campbell Scott. And lo and behold, the info becomes available when I search using Scott's name.

Trivia Payoff

I read a really cool blog in which a practicing MD reviews episodes of House and evaluates not only the soap opera aspects but also the medicine, giving letter-grade scores in several categories. It's a ton of fun; Scott (the blogger) and I are both totally over the "no way would these people be doing all these tests themselves" stage, so that pleases me. And since he actually knows what he's talking about, where I tend to have a vague sense of an intuition, I can actually learn something every now and then. Definitely worth a look.

But since baseball was on this week, and there was no new House, Scott is doing the second-annual "guess the disease" game. Commenters to the blog are asked to provide a list of ten things that House and his team will either consider and reject, test for, or eventually wind up diagnosing a patient with. There's a scale of points awarded for canny predictions, depending on which of those categories the malady winds up in. Presumably, somehow someone will be keeping score.

For posterity, and because I like big words, here's my list of conditions I think the writers of House will bring out this season:

1. Blood Transfusion Reaction

2. Arrythmia brought on by energy drink/sports drink

3. Neurogenic Vertigo

4. SLE (Lupus)

5. Teratoma

6. Periodic Paralysis/ “Channelopathy”

7. Polyarteritis Nodosa

8. Polymyalgia Rheumatica

9. Hemolytic Disease of the Newborn

10. Chronic Beryllium Disease

Yes, I had to look a couple of them up. Several came to me from various case studies and other edumacational activities. One or two I found when I searched for obscure, weird stuff.

Medicine is a great field if you like random bits of trivia. For example, I've been hearing all about Virchow's Triad, and I just happened to come across a story about this Virchow character today. He seems to have been a funny guy on top of being a genius; as a liberal member of Germany's Reichstag in the 1880's, he so annoyed Otto Von Bismarck that Bismarck challenged him to a duel once. According to author Sherwin Newland, Virchow subverted the duel entirely by choosing as the weapon... wait for it... scalpels.

Today's theme would be smart-arse doctors, then.

Why I Love Mashups

What happens when a pair of crazy geniuses remix the entirety of Sgt. Pepper's with bits of other Beatles songs, plus Stones, Gary Glitter, Bowie, the Selecter, and god knows what else?

Brilliance, that's what. ccc and Ill Chemist have done this, for some reason. It's called Cracked Pepper. And it's very very cool. I love living in the 21st century.

I'm linking "Hawaii 64," a mix of 'When I'm 64' with Brian Wilson's 'Blue Hawaii' and the Beach Boys' 'Cool, Cool Water,' so Jon hears some of this beautiful insanity.

The complete ingredients list is here, and if you want to listen to more, this would be the link for that.

My favorite track so far? Probably "Struttin' Rita," which combines only three ingredients and freshens them up to the point where things that were always there become new in a whole new way, if you dig.

In a parallel universe, I'm so totally a DJ.

EDIT: Yeah, the links no longer work. Maybe it's a Brigadoon thing, and they only work sometimes.

Current favorite classmate catch-phrase

Someone from my class is fond of saying,

"I know, right?"

I don't know why, exactly, but with the right timing, this just slays me. It's funny, without calling undue attention. It skates over the surface without impeding the rhythm of the humor. It's verbiage that draws the others into the joke, while at the same time reflecting what was just said in a distorted mirror. But aside from MacLuhan-style comedy theory, it's just funny.

In other news, %$#@! the Arizona Diamondbacks.

...not that my fantasies have anything to do with football...

This is fun: I'm kicking ass in my fantasy football league this year.

Well, I'm not winning or anything, but this turns out to be the year my faith in Randy Moss pays off. The points are racking up, I'm presently 4th of 14, and I'm on the way to the top.

In school news, I'm continuing to pass my tests. Later this week, I'll suit up in the little white coat and start talking to real patients for practice, and talking to practice patients for real. We're already getting little clinical-scenario questions that, essentially, end with Dennis Hopper taunting, "...what would you do?"

I've killed only a couple of hypothetical patients. So far.

Today's excuse for not blogging more: pancakes!

Yeah, I'm fine. Sure, school is busy, but I've survived our first couple of "weeks in which you will have several tests, in various classes." I'm falling into something like a groove.

And within a short drive, there are a few places that have really good pancakes. This, above and beyond the most excellent little greasy-spoon diner a couple of blocks away. So really, it's a matter of being busy with school, then busy staying away from school.

I'll try to add to the body of work this week, though. We started our EKG class, I'm already doing well on my research project, and I have a few early responses to "save the date" emails I sent to post-bacc classmates -- which begins to give a window into their med-school experiences so far.

Finally, I'm coming to Minneapolis next weekend, for a whirlwind 36-hour visit.

Do you know Juno?

It's time once again for me to fluff the cushions on which I sit, here in the front section of the Juno bandwagon. (It's not that I'm special, it's that I got on early.)

With the regularity of tornado-siren tests, I've been nattering from time to time about my friend's movie -- about how awesome it is, about how nice it is that someone talented and deserving gets some of that sweet Hollywood money, and about how holy crap it's really being made. And while it was fun, in a vaguely "I told you so" hipsterish way, to talk about this little screenplay written by a member of my Minneapolis drinkin' buddy assemblage, I'm afraid that has to end.

Because this action has gone mainstream, people. Feast your eyeballs on some links as fresh as anything Jimmy Dean has to offer:

The official Fox Searchlight JUNO page

Roger Ebert (yes, THAT Roger Ebert) from Telluride, saying wonderful things (which incidentally jibe very well with my thoughts, and how nice it is to say that).

Juno's Rotten Tomatoes page (100% with 5 reviews, 91 days before the opening).

...and that's that. There's nothing more for me to say, particularly because Fox has a whole publicity machine that reaches, I kid you not, easily twice as many people as read this blog. She belongs to the ages now.

So I'll pretty much just talk about myself all the time, now. You poor suckers.

Thanks to Trash, plus Latest Goofy Blog Meme

Trash was kind enough to point out that grad school grades don't matter. And she's even more right than she knows, since for all intents and purposes, med school is a lot like culinary school. When I'm done, I study for (and take, and pass) a certification exam, and then I'm on a level field with everyone else. Nobody cares what my grades were -- nobody even cares about my GPA, which puts me in even better shape than Trash herself -- they just care how well I can cook.

And apropos of nothing except me being too tired even to waste time properly, here's the latest fun thing I found on the list of blogs I check: courtesy of Shamus from 20-sided (who got it from someone who likely got it from someone, and so on...)

Enter "[your name] needs" into Google, and see what it is you supposedly need. So simple, it's elegant. I see it out there (now that I look) as a list of 10 short bullets, but I'm going to stay in character and make it five things that natter on for longer.

For those of you who were wondering, here's what it is I* seem to be very much in need of:

1. I need aid in regaining my title, lands, and children, stolen from me by my treacherous brother.

2. I need to be seen less on MySpace and more in person, preferably in a bar.

3. I need to jump across the electrical field, and climb up the ladder.

4. As much as we don't want anyone in Iraq or Afghanistan, I need to do my duty.

5. I need to grow up.




* As always, I'm hiding my secret identity, if only because my real name will be linked to my school, my hospital, my practice, etc.

the Patron Saint of my Grade Sheet

I am no champion of mediocrity. As a passionate fan of both the Faust mythos and the Kit Marlowe conspiracy theory, I think there's absolute value in the striving, the tireless windmill-tilting, the reach exceeding the grasp. I try, in as many little ways as possible, to make a habit of excellence.

And yet, if I take pride in anything as I go about this nutty adventure among the academic elite, it's this: That unlike some of my habitually-achieving peers, I have had experience falling short of the loftier kind of grade-related goals. If you have for some weird reason followed this story since I went out east and nervously took up the reins of a university education for the second time, you know I have followed Mark Twain's philosophy, and effectively separated my academic achievement from my learning. More than that, I've detached it from my self-esteem.

It turns out that's really helpful.

The program I'm in requires a minimum score. I need to hit this certain number for each class, in order to pass it. On a more micro level, each component test within each class also has to meet this threshold; getting a 96 on one thing doesn't make it okay to get a 64 on another one, for instance. And I've hit exactly that number twice now; once on the final grade for a course that's finished, and once on a test for a class I'm in now.

I am conflicted about this.

I'm not berating myself, and I refuse to. Shame is a particularly bad motivator for me. For the most part, I'm fine with what I've got here; it means I studied just the perfect amount. And since I dislike studying, that's good. But I really like understanding, is the thing.

And I know that if I really caught on to some of this stuff, I'd be able to show how well and how completely I get it. That's my problem; I take a while to taste every little nugget of info with my whole brain. The end result is good -- the stuff I know, I really know. But until then, this guy will have to be my spirit guide in the world of schoolwork:



And I'll just have to repeat the magic words: "...it's good enough for me."

Less rock, more erythematous, poorly-demarcated lesions

Right now, I'm studying and I'm listening to music. I'm nominating Ryan Adams as my personal soundtrack of the moment...

Everybody's cool, playing rock n' roll
Everybody's cool, playing rock n' roll

I don't feel cool, feel cool at all
I don't feel cool, feel cool at all

It was really fun when I was working the ER Tech job, thinking about how cool the future would be. All I needed to do was to learn... kind of everything... and then I'd be even more at home there, doing even more helpful and cool stuff.

And that's still true. It's only that, wow, doing the schoolwork is so very unlike the experience of doing the work work. I have no doubt it's worth it, or that I can make it through. It's just not fun in the same way. Basically, I'm bad at delayed gratification.

Le sigh...

I love my car, but this is silly. I'm engaged and live with my fiancee now, so Teslagrl's car is an option most of the time. And I commute by train. I literally have started my car twice in the last week, to move it off the "street cleaning today" side of the street... and that's just because it was street-cleaning week.

One sure way to know I don't really need it is that since it went all freaky and broken and refuses to obey simple instructions, I've been able to adjust quite happily to not using it.

So... wanna buy a car? (This used to be a Craigslist link, but the car sold and the listing expired.)

I have some pretty significant ennui about ditching the VW. It's been fussy and expensive, but it was my first "grown up" car. It was my first non-junker car since the divorce, mid-1990s, and the new car we'd bought way back then was a damn Geo Metro, for cryin' out loud. My Passat has twice as many cylinders. It's honestly true to say that

Geo Metro : VW Passat :: VW Passat : Jaguar XJ12

This is the car that gave me independence, symbolically. It gave me power (of the "horse-" variety) I had never had before. It gave me a whole list of things I didn't know I really liked in a car, and won't do without in the future, if I can help it. It took me out east, to school, and helped me start this new chapter of my life. It was the car I always drove, for as long as my future wife has known me. After a string of crappy 'college cars,' this was the one that made me feel legitimate showing up to a business function (or a first date), and it was the most fun to drive. It's just that gradually, it turned into a college car, albeit a nice one.

So that's how I'm billing it on Craigslist.

And whatever I get next, about two years from now, that sucker will have a really $!#@ good warranty.

At least it's organized chaos

Here's what I have going on in the Fall term:

General Medicine & Infectious Disease
-- a huge, year-long course that covers... kind of everything. Right now it's Neurology... plus infectious disease. Ask me about the many different classes of antibiotics! (On second thought, don't. Not yet.)

Pharmacology
-- merely a two-quarter-long course. One more arena in which I can demonstrate a lack of excellence in memorizing enormous quantities of data. (Although, having taken Microbiology, Biochemistry, Cell Bio, and what turns out to have been a very decent Physiology course already, this isn't that bad. Not yet.)

Interviewing and Documentation
-- where we learn to do stuff like write up a clinic note (like the ones I typed as a transcriptionist) and do an interview (like the hundreds I witnessed in the ER). I like this class.

Psychosocial Aspects of Care
-- where we, essentially, learn not to be a-holes whilst speaking with patients and administering care. Fun class.

Research and Statistics
-- where we remember that being in a Masters program entails a special kind of pain. I need to decide whether to a) jump onboard a faculty member's research, b) convince a faculty member to sponsor (read: be the first author of) research I come up with myself, or c) just do a series of smaller papers on anything I want. I am actually struggling with this, because I have areas I'd like to do publishable research in, and my school has really good resources. Plus I wrote a lot of papers in undergrad.

Clinical Laboratory
-- which does not take place in a lab, but a classroom. This one is all about all the tests we might order, and how they work. So far it's been "fun stuff you kind find out from a cup of urine."

Complementary and Alternative Medicine
-- where we, essentially, learn not to be so obnoxiously patriarchal and stick-up-the-bum about the alleged superiority of Western scientific medicine. A nice touchstone and reality check.

Intro to EKG
-- given the size of this list, and the fact that Winter term starts in November(!) with a whole new slate of punishments, I figure I can be really truly good at one course per term. I've decided this one will be my good course for Fall. EKGs rock.

Am I insane? Not yet, but ask me again in a few weeks.

How do I keep it all together? How do I keep from going completely sideways?

Oh, I have my ways.

Med School Microcosm

Sigh...

95%


And meanwhile...

Yes, I'm being blog-lazy by reprinting stuff, but it's all about efficiency these days.

Now there can be no doubt

The sorting hat says that I belong in Gryffindor!

Said Gryffindor, "We'll teach all those with brave deeds to their name."

Students of Gryffindor are typically brave, daring, and chivalrous.
Famous members include Harry, Ron, Hermione, Albus Dumbledore (head of Hogwarts), and Minerva McGonagall (head of Gryffindor).

Take the most scientific Harry Potter
Quiz ever created.

Get Sorted Now!

Harry Potter and the L-1 Dermatome

No spoilers here. I will not discuss the book yet.

I read it in a little under 36 hours, taking frequent brief breaks to eat, sleep, pee, and do homework. (Weird, how the work is done so much more efficiently when it's done as a break from something fun I get to return to. I might re-read the whole damn series now.)

I just want to point out that for the last eight weeks, I've been learning about stuff that has amusingly Potteresque nomenclature. Take a pen or pencil in your dominant hand, and flourish it with a sweeping motion, ending in a point directly out and away from your body, and yell out an Anatomy term. Then you'll see what I mean. Here are some to get you started:

Infundibulum!
Intercostalis!
Semispinalis!
Vastus Medialus!

Being hit with the gubernaculum charm would likely be no damn fun, if it did what I suspect. "Toxic Megacolon" sounds like a large, noxious creature that might live in the Forbidden Forest. You could store your spare tubercles in a vesicouterine pouch, assuming they had them in stock at Flourish & Blotts. Rectus Capitus might be the new Defense Against the Dark Arts teacher. It just goes on and on.

And I've figured out why. Rowling uses such decent fake-Latin in the books that it captures the sometimes just plain goofy-assed nature of actual Latin names. One example: There's a bit of the tibia, the shin-bone, where certain thigh muscles attach. Three muscles attach there, you see, so you get this triangular, webbed effect. I think it looks kind of like a duck's foot. If it didn't have a name already, I'd call it "the duck foot."

The actual, official, proper scholarly name for this little structure? Pes Anserinus. Sounds impressive, right?

Until you realize it's Latin for "Goose's Foot." Oh yeah, so much more professional than the thing I said, with the duck. Definitely.

And that's why I don't feel the least bit disrespectful, waving my pen in the air and repeating funny-sounding terms to the guy sitting next to me in lectures.

Plus, by now I can do a pretty decent levatores costarum spell.

Overheard in the Anatomy Lab

"Thanks, [Feb], for showing me your penis!"

It's pelvis and perineum week. My friends have a female cadaver, so they needed to check out what in the medical world we call 'the dude parts.' And my guy has some fine anatomy going on. We've spent enough time in this class now, about ten weeks or so, that we've really started taking ownership of our learning experience. That's reflected in the way we talk about cadavers as though they were books, or any other learning tool.

Naturally, I told the girls they were welcome to come by and check out my penis anytime they want.

Finally, something important to talk about

Here's a diverting little hypothetical, courtesy of one of the messageboards I frequent:

Assume you have been offered your dream job (that is, the dream version of your job, or else the job you really want to do). The catch is, you need to choose from only two possible job sites. One is in Gotham City, and the other is in Metropolis. Which would you choose, and why?

Obviously, there are some stark differences. How much you like sunlight, for instance, will probably be a factor. As would whether you prefer to carry cash on your person, outdoors, ever. Your feelings about the occasional superhero/ supervillain fight spilling over into your building and destroying a fair bit of it should probably come into play as well. There a pros and cons either way.

As for me, I found it was kind of an easy choice because I'd have to be working in one of the two ED's. No way am I going to deal with the Joker's deadly laughing gas, or some fiendish nano-virus engineered by the Riddler. I'm going Metropolis, hands down. Let the superintelligent gorilla commandos and trans-dimensional shockwaves fall where they may.

Plus, I bet the cafeteria food is nicer at Metropolis Memorial. That's just a guess, but it's an educated one.

So, how about you?

EDIT: Guess we got our answer on that one, eh?

Have I Mentioned...

a) My own personal theory about what happens at the end of the Harry Potter saga?

or

b) How much I love Keith Olbermann?

No? Really? Hmm.

Well, it's a good thing I can do both at once, because I need to be efficient these days... and also, it just so happens he has the exact same theory.

Spoilers, sort of, but only if Olbermann and I are right. Which we both think we are.

My Cadaver is More Fun Than I Am

...lately.

Sorry about the radio silence. I'm planning to dedicate some time soon for a post about my new room-temperature friend; I think you'll like him. He's got a good heart, and we try not to let it dry out. He's not quite all there anymore, if you get my drift, but it's okay because we're keeping track of all the bits we take out.

I also wanted to put in some words on the subject of medical blogs, and all the controversy in that little world lately. By the time I get around to it, maybe there will be a whole new quasi-scandal to get excited about.

For those keeping score, I have now done my first written test and my first lab practical in Clinical Anatomy. Both, I believe, went well enough. There's a way of looking at my program that boils down to a Pass/Fail paradigm. I kind of like looking at it in that way.

It's getting late, and I have some stuff to go over before tomorrow, so check back on the weekend. Approximately.

A little present from your uncle Feb

People, listen up. You need to go see this movie. Seriously. (Minneapolis people: it's at the Uptown this very week.)

We were going to see Knocked Up (and we will, sooner or later). But it's my birthday, and dinner happened to be finished at an inconvenient point between showtimes for the big Hollywood comedy... so I used my Birthday Power™ to go see Once.

I shit you not: I haven't seen a better movie in years. Everything I hate about big dumb musicals stays a world away from this story, and yet somehow everything that's awesome about them finds its way in. It's very strange, and -- here's an adjective I haven't used about a movie in a while -- surprising. Go. Then come back and tell me how right I was.

...it was the opposite of Ninja-like, actually.

Today we cut our cadaver's heart out of his thoracic cavity. It was bitchin'.

My hands. Human heart. Whoa.

There's a lot to talk about, kids, and maybe this weekend I'll have some time. It'll require some thought to properly frame the thoughts and emotions that I've been experiencing in the first few days of anatomy lab.

One thing's for sure, though: today's events definitely tugged on someboody's heartstrings, har har har.

Life Lessons from American Idol

Oh yeah... so that's why I don't really watch. I saw the beginning, with the Minneapolis auditions and the horrid singers, and I saw the final few weeks. I'm happy for Jordin, inasmuch as she has genuine talent and charisma, plus now a car and a record contract and I think the winner gets some money or something. But it's sad to think she'll be another serf toiling in the soul-crushing fields where crap pop music is grown from the dry and rocky soil. Clarkson and Underwood, if they're lucky, may survive long enough to become cringe-worthy self-parodies like Bette Midler. Taylor Hicks was pretty good, but it wouldn't hurt to bring him in to a neurologist. Just in case.

Oh, so that's that Haley chick everyone is sure will appear in Playboy soon. I see... and yes.

Whoa, Green Day. How did a powerful and mature rock band wander onto this show? And, wait, how did a powerful and mature rock band grow up out of Green Day? Damn.

In my house, "This Is My Now" has become a great all-purpose punch line.

"How come you drank the rest of the orange juice and didn't leave any for me?"
"Why are you still up, and surfing the Internet?"
"What makes you so sure it's not going to rain tomorrow?"

Because, baby: This Is My Now.

Today at orientation, our program director said one of the cooler things I've ever heard in all my reading and talking about medical education. I'm paraphrasing.

You know how in some classes, the professor says to look to your right, and look to your left, and think about how at the end of the class, one of those two people -- or maybe you -- will not be there? Yeah, well, we don't do that. You're done competing. You're all very smart. We had about 1000 applicants, and there are between 50 and 60 of you. So you're the top 5 or 6 percent. Now it's time to work, and there so much to do there is not enough time to waste it with competing. Look at the person to your right, and the person to your left. Two years from now, you're all going to finish, and you're going to help one another to get there.

See, that's a reality show I'd be into. Except lacking competition, it would be a little tough to explain, or to follow.

A case of the Mondays has been scheduled for Thursday

So, I am all excited to start school. Except for the first day. Day after tomorrow.

I'm in my little study-nook area, where untold amazing things will start to pour into my noggin soon. It's late, but I power-napped today... just because I could. So it's me, a cup o' tea, and Teslagrl's younger and weirder cat, who is apparently diggin' the wood floor because she's rubbing her back on it. So this is what they get up to at night. No wonder they rest up for it all day.

I have most of my forms filled out; the school I was at last year will be sending some immunization stuff, and the school where I did the distance Biochemistry course will send a transcript just as soon as they get the request for it. I read the online orientation info and the student handbook. I have begun to feel like a medical student.

For the Biochem, by the way, I got my usual chemistry grade. Which is to say, I'm a little better than average, but it's clear I'll never be an actual chemist. I always heave a big sad wet sigh of regret when I find that out, but somehow I soldier on.

I know where and when to catch my train on Thursday morning. I cajoled the Future Wife into giving me some cash so I can buy a ticket and everything. (All I had to do was promise not to call her "mommy" when I ask for stuff like that.)

I even have a classmate living a mere four or five blocks away. This will be my daily commuting (and studying) buddy. I guess she'll need some kind of blog code name, but I don't know her well enough for one to present itself yet.

When I left my former job, one of my cohorts in the maroon-scrub-wearing ranks of the ER techs gave me a present: she had gone school shopping for me following the template of shopping for her kids. It was sweet, and wicked useful. Now I have notebooks and pens and a bitchin' stack of note cards, and a box to put 'em in.

I even got myself some new shoes, after about a year of listening to everybody yap about how great Nike Shox are -- and about five seconds after realizing that actually, clogs still look really ugly to me, and anyway in my new lifestyle I'll be sitting down, sometimes.

So, why am I not completely pumped? Why am I a little "mehh" about this orientation day thing? They're providing food, after all.

It's because aside from a tour and some introductions, most of the day will be team-building exercises. Ewwwwww.

I spent twelve years in the corporate world. During some of the most fun years, I was one of those corporate trainers. Although I had my cranial vault firmly incarcerated a fair piece inside my own rectal vestibule, even the younger and far stupider version of me could tell that some of that forced jocularity is just wrong. I know, we have a limited time to stop being 50 to 60 individual schmoes and become a class. We'll have some heavy cadaver-lab stuff to deal with, as a class, as soon as next week. We need to learn a little about who's next to us in the classroom and at the tank. It's a necessary evil. But it's still evil.

Some glimpses of the day, based on photos I saw as part of the tour when I interviewed, and now in the handbook, make me suspect company-picnic-style physical challenges. Didja see "The Office" a couple weeks ago?

I will most assuredly have to say something about it later. But if I don't, it's because it was too horrible to recount, and I've chosen to just move on and concentrate on something more pleasant... like my dead guy.

North-siiiide!

I live in Evanston now. It's pretty stellar.

There will be a whole lot more about all this. The place is a disaster at the moment; right now we have boxes for art, boxes for about half the furniture, and because Future Wife started working in the Chicago office today and the cats are sleeping, I have boxes for company.

And of course you, my sweet, sweet Internet.

But this is my last few days off -- actual, true days off with no responsibilities -- for quite a while, so I'm taking it easy. I may be showered before the Cubs take on the White Sox this afternoon. I may head to Target later on. I may take a nap.

It's rough, being the future of healthcare in America. But I'm just the guy to do it.

Changing Your Life

Back in the day, circa 1994, somehow boxer briefs became a subject of great interest in my home.

This was several homes ago -- way, way back when I was a married guy (or, as I prefer to think of it now, practicing for the day I would eventually be married for real). We were playing landlords to a good friend of the ex, who had become my bud as well. He lived in the guest room, kind of like a nerdy version of Fonzie, to our incredibly young, uptight, and not-at-all self-aware Mr. And Mrs. C.

Can it be true that boxer briefs only came into widespread usage 10 to 15 years ago? Because that's the underwear of choice in Feb World, and it's been that way since... well, since just about that time. This buddy's girlfriend had bought him a pair, and for a few days he couldn't shut up about how great they were. "They'll change your life," he said. It became something of a catch-phrase. And when I got some of my own, suddenly there were two idiots talking about underwear. But the thing is, it was true. Changed my life.

A little. In a very limited way. But still, it counts. And it should be noted that this was like 10 to 12 years before Garden State. Yes, Zach Braff, the Shins also changed my life, a little. But they weren't the first, I'm saying.

It's weird, because as the narrative of my life went on, it almost became a motif. I met others who had similarly strong opinions. One woman I briefly dated declared her love for thong underwear with the snappy phrase "every step's a pleasure." She was, in hindsight, maybe not the best match (or, to be pithy, she was crazy), but she was evidently right -- I recognized the same sort of minor transformation must have happened somewhere in her history.

It's not all about underwear, though. A few other key events and exposure to certain paragons of excellence have "changed my life" in that way, and recalibrated my ideas about the way things should be. Pulp Fiction. Pearl Jam. Having a sunroof in my car. Learning to bake bread. Working in the ER.

I'm in this mood right now because I decided to go a little nuts with my tax return money. I was in Target looking at all the mouthwash flavors, and decided that the acrid sizzling of my poor, sad gums was maybe not even worth it... when I spotted the citrus flavor. I figured if ever I have the ability to just blow $3.29, this would be the time.

Citrus mouthwash might just change my life, yo.

Oh, and also: my Biochem final is done. I'm moving to Chicago on Monday. And grad school starts two weeks from today.

Pajamas to Work

Yeah, I've been quiet. Stuff happens when you're cramming three weeks' worth of class into two weeks, working eleven out of fourteen days, and moving to Chicago. Just wait; a month from now, I'll be talking about being in school, and this whole bloggity-blog thing should get much more entertaining.

The other day, I got home from work and had someplace to be right away, so I changed into jeans and a new t-shirt, ready to go out. In the process, I realized my attire was actually a little less comfortable. And back in the day, "casual Fridays" were what we lived for. Oh, the folly of the business world.

Panda Bear, MD deserves big ups for speaking the truth on the subject of scrubs as work clothing. As I sit here, working on the last few chapters of my Biochem class and getting various ducks in various rows pre-move, I muse about the settings in which I might be working. I might wear a collared shirt if I'm in a fancy-schmancy clinic where I'd have to wear a white coat, but I'll wear a tie only under extreme duress. I might actually try to insert some fine print into employment contracts saying I don't have to wear no steenkin' necktie if I don't wanna.

Not right out of school, most likely, but that does sound like the kind of thing I'd do.

I was talking with the Future Wife about this very subject a few days back, having changed my shirt after realizing I had some tiny (as in pencil-mark-dot-sized) spots of a) vomit, b) blood, or c) both on my gray tshirt. I'm not so squeamish as PB sounds; I pre-treated the spots and threw the shirt in my regular home laundry. I've been exposed to all manner of flying goo for my three years as an ER tech, and so any job that poses a risk will be one where I scrub it up and don't look back.

I should however mention that I scoff a little at people who work in the file room or front desk of some swanky downtown dermatologist's office, have zero contact with patients beyond the usual pleasanties at check-in, and yet get to wear scrubs. Don't get me wrong; I would too, if I had a desk job and my employer let me, but in my opinion, it's a little poseur-ish.

Champion of Justice

There's been this silver SUV parked in the apartment building's lot lately. The manager had told me there were painters coming and going for a while, but that was over with weeks ago. Yet the thing kept coming back like a fuel-inefficient bad penny. There's a bulletin board inside the building where the manager tacked a note stating that the MPD would be on the lookout for any cars parked in the lot without a permit, but that had no effect. I suspect the interloper was a friend of someone who lives here, or maybe just someone who hates to pay for parking. The SUV had no parking permit sticker, and tended to be right up along the row of signs reading 'FIRE ZONE' and 'NO PARKING ANY TIME.'

Except the other day, when I returned from my future wife's to find it parked in my spot.

I'm a generally easygoing and forgiving sort; in real life I don't usually get worked up as much as it might appear from reading my brain-spew here. But after I found a street spot and walked back home, I was ready to smack a bitch up, as they say. Or maybe slash some tires, or install some new after-market options. With a brick.

On further reflection, as a pending charge for vandalism isn't something that would help me much in PA school, I settled on the tamer, but by Minnesota standards still pretty aggressive, approach of "nasty note on the windshield." This, after the nice man at Gopher Towing explained that unless I was the apartment manager, I couldn't actually call them to yank a car out of the apartment's lot. At the moment, witty retorts about how Mark Yudof never needed to sign off on their fascist tactics all over the U of M campus circa 1996 did not occur to me. Alas.

So I fired up the printer, and created a flyer that proclaimed in big block letters that if this vehicle was seen in this lot one more time, towage would ensue. No fire lane, no stealing parking spots from residents. Grrraaah!

I walked my handiwork down, and slapped it under the SUV's windshield, hoping for an alarm to go off to draw the owner out, so I could confront the evil-doer in person. Again, alas. Then I went back up to my studio, which has a window overlooking the parking lot.

Ten minutes later, I noticed the offending silver SUV pulling in. It turns out my spot had been taken by yet another, unrelated silver SUV. This prompted a brief Homer Simpson moment. Then I rebounded, and threw my jacket around my shoulders as I picked up my keys and charged out the door. Vengeance would be mine!

I totally busted the guy in the SUV. Now that I looked at it, the thing was boxier than the one in my spot, and this was clearly our frequent visitor. He even pulled into his usual spot. I got the nastygram back from the new SUV, and assessed the situation. One guy, still in the car. I walked over to the driver's side, and he lowered the window suspiciously. I can't vouch for the expression on my face, but judging by the tone I heard in my own voice, it may have been the same hard-assed demeanor we use in the ED when our patience with belligerent drunks is juuuust about over, and physical and/or chemical restraint is one phone call away. The "I'm trying to help you, but you still have the power to mess it up for yourself" one.

I asked if the gentleman was planning to park there. I called him "sir." I explained that if the gentleman intended to wait in his vehicle -- I used the word "vehicle" like three times, god help me -- that would be no problem, but made it clear this was not a parking spot. This was a fire lane. Further, I explained, it's a problem for the people on this end of the lot who need to get in and out of their assigned spots, if anything is blocking their way. Finally, I told him about the sign that management had posted inside, and the looming threat of MPD intervention. I closed with the "it's your choice" tactic: do what you want, but you should know that if you leave this vehicle here, there's a chance it won't be here when you get back.

He nodded, and said "okay" a lot, and as I turned to go back to minding my own damn business, he asked "who are you, by the way?"

I did not say, "F%$@ you, is who I am." Nor did I say "somebody with a parking permit I paid for, asshat." If I had done either, it would have sounded awesome. Very David Mamet. I just shrugged, and said "I'm just somebody who lives here, and needs to get his car in and out of this lot sometimes."

By the time I got back upstairs, the SUV was gone. I didn't see when it happened, but a while later when I looked out the window, the other SUV was gone as well. I like to think the earth shook with Viking rage, just a little, and whomever had decided that my spot being empty all night and all morning was their invitation to use it had sensed in the air that they had overstayed their welcome.

The Reckonynge

I just completed my financial aid application stuff for PA school. I also recently took stock of everything I've spent so far in my college career. Wow. That's a lot of double cheeseburgers, people.

Let me put it this way... what I spent on my original undergrad degree -- which covers the roll of fin-aid derived quarters that fueled an all-day "Rampage" marathon at the junior college, all the way to the diploma the U of MN printed with my name spelled wrong -- is about equal to what a 2003 Mercedes SL would run me today, on eBay Motors.

Last year's post-bacc adventure, meanwhile, with the rolling green vistas and the continual looming threat of failure, more than doubled that. The new portion of the loan total ups the ante by a approximately the cost of, for example, this Maserati Spyder or this Dodge Viper RT/10.

And am I deterred? Am I overwhelmed? Hell, no! I need to keep going. Eventually, a year's pay will come close to what I owe in loans, and at that point, in theory, there's a way to make decent payments while still enjoying the perks that come with a decent income level. And anyway, flippin' burgers won't feed this here bulldog, nossir.

So what I just signed up for is another vintage 1967 Dodge Dart Magnum or, for something a little more fun, TWO brand-new BMW R1200 motorcycles.

Of course, by the time you click these, the prices are likely to have shot way up. I would merely respond that I worked in the financial aid division of a grad school for long enough to feel okay about that, as an expression of how much this crap costs.

March Madness

I really like the month of March. It's the month when things turn around. Sure, there's mud, the clouds roll in, and last fall's trash gets rediscovered, but March is about making the transition from potential to actual. So, yeah, thematically, I'm saying.

March is also the title of Michael Penn's first album. It's uneven as hell, and taken individually, maybe 1/3 of the tracks are skip-worthy. As a whole, though, it's awesome, and it's emblematic of that late-80s, early-90s pop that I grew up on. If you don't like "No Myth," you don't like pop music.

Fun trivia factoid: when you get married in Minnesota, you sign a document that lets you put your name prior, and your name after. In theory, you can name yourself anything you want (i.e., you get a free name change with the fee to file your marriage license).

There was a time, way back when, when I toyed with the idea of making March my last name. My real last name is not exactly hard to say, but for a pretty simple grouping of phonemes, it seems disproportionately hard for people to hear correctly, or spell. If I weren't trying to keep myself a little bit anonymous on here, I'd treat you to some amusing mis-hearings, and maybe you'd agree that it was worth thinking about becoming something else. My ex-spouse from that same late-80s, early-90s period was way into "Little Women," so there was potentially a shot at being Mr. March. Later, I was tempted to use it as a whole starting-over thing. March. One syllable. Conveys strength and directness. Almost impossible to mess up.

But ultimately, I'm glad I didn't. My Scandinavian name has character, and it forces me to slow down and look people in the eye when I say it, so they don't screw it up. Still, sometimes I wonder how different life would have been, if I'd gone through with a name change.

And anyway, at the moment March is feeling like a long-ass month. I'm ready to move on already, and have more of those 80-degree days. Out like a lazy lamb with nothing in particular to do, I tell ya...

Blog Niblets

1. Because it Does, That's Why

As an add-on to the rant about grammar and troublesome job titles, I should have mentioned that at the end of my academic tour of duty out East last year, I arranged a visit to a PA program in one of those New Englandy states. It was a nice, if twisty and time-consuming, drive from the Farmhouse, and the town was small but cool. A minor-league baseball team plays there, which pushed my Bull Durham goodwill button and made me want to like the program.

I wound up taking it off my list of "maybe" schools, for a few different reasons. The whole school occupied one building, a squat office-type space that might have just as easily housed an insurance firm. The PA program had been added four to seven years prior, yet the signs in the parking lot still read "_____ School of Pharmacy and Nursing," which I took to be one of those small things that can signal a school's lack of attention to other, more important things. And most importantly, because in the talk about the cirriculum, the faculty member in charge had gone back and forth between the terms "Physician Assistant" and "Physician's Assistant" several times.

I just thought that was thoroughly weird.

2. Who's The Ringer?

This weekend, we attended a housewarming party. The couple hosting have a PS2, and got Guitar Hero a few weeks back. I had told Teslagrl that I would probably not play much, since I had my obsessed period and beat the game, etc., and basically I'd gone through that progression a month or so ahead of where the host was in his own GH journey. If you've had this game wreck your bedtime, you know what I mean. If not, just imagine I've read the new Harry Potter book before he's had a chance. I didn't want to be all showin' up the host or giving stuff away. I was going to let him enjoy his game, his way.

That is, until we arrived and his 16-year-old nephew was shredding it up on the Hard level. I sort of got appointed the grownups' representative.

We started out being social, and I stuck with my intentions. I took over only to assist with some kiddoes who wanted to play, despite being younger than the recommended age on the box. I think the peanut in question is about four or five, and she recruited me to push the fret buttons while she strummed the notes. I set up the two-player mode, so she and her sister could play (with me as "special rock advisor" to the younger one). The older one revealed herself to be genuinely good, which is a little eerie. I thought people under 10 were supposed to lack the hand-eye skills for that. You can't actually fail a song in that two-player mode, which made it a good choice for them.

Parents and friends watching tiny girls rocking out to the Ramones is a very amusing scene, let me tell you. There are, I trust, some good photos.

But that set up the two-player face-off paradigm. Much later, after a lot of controller-passing, did the nephew and I had our inevitable rock battle.

I crushed him.

I've liked games well enough for a long time, but never been good enough at one to beat a real live teenager. It was a big moment.

3. Nice of Me to Notice

I'm writing up my notice letter for work. I like to say it's my retirement from the nursing assistant/ medical assistant world. There might be a party, or at least a happy hour. Potentially AARP-themed.

Does anybody need any scrubs? I have a couple sets I'll keep for anatomy lab, but I have several and can't imagine I'll have a lot of use for maroon ones. Maybe I'll sell them to my co-workers, or outfit some of my new classmates.

4. Bio-Synthesis

Last week I did the biochemistry chapter on the TCA cycle, aka the Krebs Cycle. This is the core of it, everyone's least favorite part of their least favorite class. It's reassuring, and kind of fun, do ask working doctors what they remember about it, which is what I was doing a week ago. Now that I've finished it, I'm finally starting to feel like I'm going to be okay at this. Chemistry plays fair, after all; stuff that's true stays true, and once you get something, you can use it to make sense of other things. And I'm lucky in that this class is geared toward people who will practice medicine, and stuff that's chemically interesting but clinically irrelevant is skipped over.

Most crucially, biochemistry answers the implicit question that has historically stood in the way of my love of this kind of class: why should I care about this crap?

Because, my dears, if these processes don't work, you effin' die. It really puts oxidative phosphorylation in a different sort of a light.

Points for Grammar

I'll continue my budding rant about excellence vs. mediocrity, which is designed to turn into one about politics, soon. For now, I'm just going to whine about this idea of my career path being "Physician's Assistant."

The focus of my white-hot burning rage isn't the people who innocently use the wrong term. It's not really even the lack of careful thought that would reveal to any sane and intelligent person that if you go to school for eight years to be a doctor, you don't go to school for six years to be some doctor's "assistant." No, the problem I have is with the general fatigue we all seem to have suffered, which makes it all the easier to shrug our shoulders and be wrong about stuff without caring.

Oh, look, I guess this is the rant about mediocrity. Cool.

I'm going to keep politely correcting people. Accent on politely. I won't be deeply and personally offended, I won't hold it against you if you do it, and I'm not going to go out of my way to interrupt the flow of conversation to back up and fix the mistake. But I'm also not going to let it slide, if it can be helped.

Not for reasons of ego; if my ego were really that sensitive, I'd probably think it was worth it to do the time and get an MD. More because Judas Priest, people, the profession has been around since the 1970's, and the AAPA has somehow done such a horrible job of publicizing it that it falls to those of us who will actually be, you know, doing it to explain what it even is.

My job right now, the one where I work in the Emergency Department and get paid less than I did in 1998 as an office temp, that's an "assistant" job. I'm a nursing assistant, I'm a medical assistant, whatever you want to call it. In Ye Olde Days, I would have been called an "orderly." Which is kind of a cool title, because it reflects my function well. The ER gets disorderly in a hurry, and I help fight back the forces of entropy. Yes, I wipe some butts (although thank god I don't work in a nursing home). I push stretchers around to xray and up to the inpatient floors. I fetch stuff, I clean stuff, I stock things so they are there when clinical people need them. I generally make other people's jobs easier. And yeah, I get to do some cool stuff as well.

So I am the assistant to the nurses and to the physicians. Gramatically, I am right now a "Nurse's Assistant," and I am a "Physician's Assistant." (Okay, really I'm a "physicians' assistant," but go with me here.) I would never call myself that, because it would just make the confusion worse, but the point is the butt-wiping stretcher-pusher is the apostrophe-S assistant. The PA is somebody that sees patients and practices medicine.

The word "Assistant" is built right in to "Physician Assistant," so it's a logical and reasonable thing, if you're encountering the phrase for the first time, to assume there's a fair bit of assisting going on. "So do you pass instruments to the surgeon, and close up at the end of the surgery?" "That's like a resident, right?" Arrrrgh! But as I say, I can't get too wound up about it. It makes sense to think that.

After all, executive assistants are there to assist executives. Production assistants run around film sets, assisting people with random stuff that has to do with production. And physician assitants... practice medicine. Great. Thanks. Awesome.

In a nutshell, we "assist" physicians in kinda-sorta the same way a law firm's junior associates "assist" the senior partners. We do essentially the same job; true, the major cases and the really uber-high-stakes stuff will tend to go to the higher-ups, but that's fine because more training and more experience means you should handle more pressure. By handling a chunk of the cases ourselves, including mostly the stuff that comes in every day, with a little fun stuff mixed in, we reduce the workload. That's a mighty fine way to assist.

How awesome would it be if you had someone at your job who did the same thing you do (at a level a little under yours), and all you had to do was answer the occasional question or give some advice? This person does, let's say, 40% of your total work, and they do it as well as you do. Would you call that person your assistant?

Yeah, it's confusing, and yeah, it's vaguely insulting that the wrong idea persists. I saw a PA recently at the Target Clinic, for removal of some stitches, and as we were talking, I remarked that the poster outside in the little waiting area had an apostrohpe-S. She said "yeah, you kind of have to get used to constant little insults." Ohh, yay.

So if I've explained this to you already, sorry to be repetitive. I'd love to stop having to be.

Hmm...

I'm not sure I like my last couple of posts. But hang in there with me; I'm attempting to build to a larger point, one that needs a little stumbling room, to get where it's supposed to go. And that point is not meant to be cheese-sandwich-y and self-absorbed, nor grandiose and mighty. It's the gremlin of blogging, is the thing. It seems like the choices often come down to talking about the world in general and sounding like a crank, or talking about your own tiny corner of it and sounding like a short-sighted schmoe. Either way, there are times when dude, you're taking yourself very seriously.


But hey, this thing is meant to be about progress, so give it a couple weeks. When I have time to write more, the progression should start to become more clear. Besides, there's a word for people who wait to express a single thought, until after their message is thoughtfully considered and completely crafted: politicians.

Yuck.

Be Excellent to Each Other (pt. 1)

I just got back from the laundry room in my building, where I moved two loads of wash into the two dryers. There's a sign on the wall there, reading "Be Prompt and Courteous," and then some language about getting your crap out of other people's way and not making them wait for the machines to be free. I don't know exactly what it says because the phrase "Prompt and Courteous" reminds me of a grade-school report card, and makes me smile.

But I have to admit to something that might be insufferable; in the back of my mind, there's the feeling that the sign really isn't meant for me, you see, but rather for the others who don't already feel an intrinsic motivation to move the laundry along.

I know self-congratulation is a pretty toolish quality, so I hope I can talk about this without appearing to go too far to the dark side. I spent a fair chunk of my younger life being deathly afraid of being a screw-up, and this led to an overcompensating smugness when it came to the few things I felt I had under control. I like to think I'm past that.

And then I think, hell, it's time to relax about that historical noise. It's going to be my job to take care of people who literally can't take care of themselves. Of course I should care about being excellent at... well, really, anything. I should notice the stuff I'm good at, as well as the stuff I'm not. I should work to get as much on the "good" list as I possibly can. It's basic, and ought to be obvious, and everybody should be doing it. Right?

I'm damn good at laundry. No over-filling, none of the thumpity-thumpity noise of an unbalanced tub. No clumps of detergent on the wet clothes, or lint on the dry ones. The wash cycle takes 26 minutes, according to the machine. I bet it was 28 when I happened to get up and go back there. I have an awesome internal clock.

I do the same thing with microwave food. I get up and cross the room in time for the beeeep, without having looked at the display. Obviously this is handy in those situations where someone asks, for example, "how long until the ambulance gets here?"

I really believe in my heart of hearts that I fold t-shirts the best possible way that human hands can fold them.

I think that other people must surely notice and admire that I take care to tweeze the stupid little hairs that sometimes grow around the outsides of my ears.

I wrecked the clutch in the car I drove when I was a teenager, because I misunderstood the fundamentals. Having learned my lesson, I believe that my current car has lasted to 102,000 miles because of my effective and talented application of the manual transmission. Which is, it should be said, far superior to an automatic transmission in every way.

I have a slight stutter that comes out when I'm tired or stressed, but in general I have excellent diction. My written grammar and spelling are nearly flawless.

This is not to say that I look down on people who turn their underpants pink by forgetting about a red sock, or people who kill their engines at a stoplight. Looking down on others is a horrible quality, and only the worst sort of people engage in such things.

And it's not like I don't have plenty of things I let slide. I should floss, but I don't, usually. I eat way too much frozen food. I procrastinate, and work on things in order of interest instead of order of importance. Like anybody, I can forget what really matters and get all caught up in my own ideas about what's happening around me. I think too damn much (...but you're reading my blog, so we both get a giant "duhh" on that one).

I'm a long way from perfect, and I'm not even excellent at all the things I want to be excellent about. It's just that I try, and I keep trying, and things continue to matter to me. I really think the world in general would be a much better place, if only a greater number of people gave a crap about actually doing well. What we do most of the time is to struggle just to get to "good enough." We stop before we get to "good." ...And then we collapse in a heap, only to complain about it ten minutes later.

My life happens to have diverted me to several points where "good enough" just wasn't good enough anymore. And when you've had that lesson bonked into your head repeatedly, it changes your point of view.

There's a line in Tallageda Nights, a generally un-excellent movie, where Ricky Bobby declaims his opinion on this very subject by telling an interviewer that he gets up in the morning, and pisses excellence.

I just checked on the dictionary definition of "declaim" and the spelling of "Talladega." See, I care about stuff.

Which is a part of why I proposed to Teslagrl. I'll tell you all about that in the next few days...

Now Hear This

The other day, I was working in the critical care/ trauma room -- the part of the department where the TV-like stuff happens. I did some more CPR this week, actually (and I'd like to thank another patient for not dying in our care). This time was trickier, because this person started out with Pulseless Electrical Activity (Paramedics say PEA stands for "push Epi, Asshole!") which turned to atrial fibrillation and back again more than once. The patient did indeed get a bucket of atropine, and enough shocks to drive George Clooney's car to Vegas, by the time all was said and done. I couldn't tell what tempo I was compressing at, because this person's heart went from 82 beats to 145, and then ran itself at 140-some for the next hour. I think I was doing about 100 beats, but who knows?

One of the first-years claims that Queen's "Another One Bites the Dust" has a tempo of 100 beats per minute. I like the idea of humming that as you're compressing somebody's ribs; it's morbid, but snappy, and if it's true, it's useful. But I'm not convinced; I thought 100 was a nice Sousa march tempo. Anybody out there know? I was in junior high band, but if I scour my neurons for that info, I'm afraid something more recent, which might show up on a test, could fall out.

EDIT: A quick Google search tells me that it's about 110 bpm. Sweet! Still morbid, so maybe another song would be better. Or learning to not hum it out loud.

Another fun moment in that room was having a pit boss* borrow my stethoscope twice. Hey, I've been the Human IV Stand, holding a bag of fluid up like the Statue of Liberty. I've been the Human Retractor in the OR, doing work that can otherwise only be done by a little metal contraption with screws and clamps. Why not be an equipment-carrier for somebody I actually like, right?

So I was in the critical room, doing my tech stuff; we get patients exposed, hook them up to monitoring, and make sure blood gets drawn and sent to the lab. We activate the pagers for consulting teams (and try to be polite but firm when some dork from Pediatrics or Medicine calls back rather than seeing the number on the pager and just coming down, the way everybody is supposed to. No, I can't have a conversation about this now. First, I'm not a doc, and second if I don't have time, you can bet they don't, either). The doc needed to listen to the patient's lungs, and swiveled his head around until he saw me. "Hey, can I borrow this...?" he said, lifting my scope while I maneuvered a syringe full of blood into tubes. "Sure," I said. "That's basically why it's there."

And what's weird is, that's true.

None of the stuff I do on a daily basis really requires me to carry a stethoscope. Once out of every 50 or so blood pressure readings, my little computerized machine on a wheeled stand can't get a good reading, so I do it the old-fashioned way, with the hand-pumped cuff and the stetho-thingy. But really, I could keep it in my locker, or just borrow one of the nurses'. Slinging it around my neck is pretty much just a costuming move. It makes me look "medical" to non-English speakers, little old ladies, and irrationally anxious people of all ages and ethnic backgrounds.

Sometimes I'll get tired of it, and leave the thing at home. At the end of the day, I'll wonder if I needed it, and the answer is "nope." This goes on for about a week, max, and then there will be a day when it really would have been useful to have the damn thing. If I were scope-less last week, the pit boss would have found one on somebody else in the room. But hey, one of the best things about mine is that I probably won't need it. Oddly enough, it would seem that's a good reason to carry it.

Another will, I suspect, reveal itself in school, when we get to the class where they show you how to interview and examine patients. I still see students get a little flustered and nervous when they take their stethoscope out of a pocket and tentatively step toward a patient. If I'm to the point where I'm sick of carrying an item around, surely that means I'm way past that point of view, right?

The trauma shears still rule, though. I'm constantly cutting stuff.





* The pit boss is the third-year resident, which is to say a doc in their final year of residency training, and therefore someone who will soon be out in the world, working as a staff physician in emergency medicine. Maybe they'll work in a teaching center like the one where I work (kind of a "Top Gun" kind of a thing), or maybe they'll kick back in some small-town ER where they're the only person in a 200-mile radius who can stabilize and package patients for a helicopter ride, after they've tussled with a nasty piece of farm equipment, or just had too much eggs benedict for the past 30 years. Probably something in between.

The pit is the area where the docs keep their computers and books, their Xray reading screens, and it's where they hold their discussions about what to do next. So the pit boss is the nominal person in charge. There's a staff doc overseeing the area, too, but part of completing training is getting to the point where the staff start giving you opinions and advice instead of instructions.

Blog Niblets

1. A Tip o' the Hat

A couple of visits ago, I left my Team Ortho baseball cap behind at the M. Giant household. I got it a little less than two years ago, when I shadowed an ortho surgeon friend of mine. Before the scrubbing-in part of the day was the setting-down-my-stuff part of the day, so we started in the doctors' tiny offices. One of my friend's office-mates is the guy who is in charge of recruiting for the "team," which is a combination fundraising and public outreach entity. Every Ironman event and triathlon within a few hundred miles usually has a Team Ortho contingent, in snazzy blue and white bullseye jerseys. The recruiter guy introduced himself, and pretty much right after "hello" was "you look like a Medium." This confused me, until I was thrown a free shirt and the aforementioned ball cap -- all I had to in return do was promise to check my calendar for good times for me to swim, run, or bike a great distance longer than I otherwise would, or realistically could. I checked. I checked twice, in fact. There were none.

Last time I was down at the Giant homestead, I inquired about the hat, and MG said, "oh... that was yours?" It seems M. Small has adopted it into his compendium of random cool stuff. This is a kid who can derive hours of enjoyment from the plastic spindle-thingy that outdoor Xmas lights are strung on, and so it's a pretty good compliment. Besides, maybe he'll be a triathlete someday, and at the very least he can spread the public awareness. People notice stuff on adorable moppets in a way they don't, on surly Nordic ER techs. So, seeing as how my hat is in a better place now, I switched to the ball cap I had stashed in the closet: the NASA one.

This one I got at the Kennedy Space Center, in Florida, when Teslagrl and I went down there later that same year. I am something of a space freak. The rocket garden, with its recreated shells of Atlases and Saturns, command modules, and a LEM you can crawl around in was like holy ground to me. I got a little choked up at the recreation of the Apollo 11 launch. Ron Howard can make crappy movies the rest of his life and Apollo 13 will still be on my top 10 all-time list.

And today, at work, I discovered the NASA hat has ironic hipster cache now, too. A co-worker asked me, "where's your diaper?" Heh heh. Thanks, love-crazy astronaut! You've made space cool again... kind of.

2. Guitar Anti-Hero

I hate this kid. Eight years old, and he pwns a song on Expert I can barely handle on 'Hard.' I got to see the original Star Wars in the theater 13 times, though, so nyaaah. I'd love to say the video is somehow faked, but that would be sour grapes on my part.

3. This is why they invented the Internet

Speaking of YouTube, I guess last year's most fun video is this year's most kickass meme. I guess I really am growing up, if high school kids actually look somewhat cool for even a minute.

4. This week's medical mystery

So, the kid with the five-week case of hiccups finally got relief? Awesome. And although there was no story as such, Friday's Strib had a little blurb that said the 15-year-old was crediting a chiropractor, an acupuncturist, and a hypnotist (more about that, in the link above). Sure, fine, cool. No love for the medical establishment. We're used to it; we don't need outpourings of gratitude. Besides, it's not like the establishment has weird ideas about curing intractable hiccups... like, say... digital rectal massage.

Yessir, nothing balances the q'ui, aligns the shakras, or increases the flow of your positive energymeridians like the old fashioned gloved digit up the ol' pooper. It's peer-reviewed Western medical journals, baby. Read it and weep. Some days, the Q-ray bracelet has nothing on our side. Those are fun days.

And if I ever have hiccups lasting that long, and it turns out the "intern year salute" is what brings them to an end, I'll probably credit something else, my own damn self. That, or just smirk mischeviously at Katie Couric when she asks me about it...