Awwww. Thanks!

Had a very interesting comment the other day. Apparently at least one person in the world thinks I need to talk about myself more.

Not to worry. I'm concentrating on this TV show at the moment because it's kind of a cool opportunity to talk about my career - the one that's just getting going for real, now, after a long and intense period of preparation - in a pop-culture-related way. And I have always been about the pop culture, even in the midst of my transformative journey.

So I will say more about, for instance, moving back to the Twin Cities, and what I'm up to as I get to actually spend time with friends and family. I'll get into what it's like to actually be doing what I've been working toward all this time. But for the moment, I'm kind of in Limbo. I can't start my new job until the state registration paperwork goes through, which gives me time to sit around the house and do nothing. After revving the engine pretty hard for the past four years or so (if you count Post-Bacc time, which I do), it was jarring at first to not have a deadline or an itinerary. I have since gotten over that, and am enjoying being really lazy. I can't even keep up with a weekly show that took a week off for a holiday, but I'm steadfastly refusing to worry too much about it.

This is a change, true, but I don't think it's a permanent one. Much, much earlier posts were about coming to terms with a huge undertaking. Then there were the ones describing what went through my head as I realized I was actually on the road. Now, I've arrived at the other end of that process, and like someone who has just driven cross-country without significant stops, I kind of want to sleep for three days. Maybe open the mail, make some toast. You know, nothing too challenging.

But the message is very appreciated. And I'll get back to my usual navel-gazing in due course. I promise.

Febrifuge, MS, PA

Hey! I graduated!

The law of inverse blogging, or whatever it's called, was in full effect this past couple of months. (Seriously, is there a name for that? The more stuff that happens, the less you feel like/ have time for blogging about it?) Rotation #6 was back home at the very ED where I was a tech, but now I was treating patients and doing the same job as the residents. #7 was an elective in Trauma; I had such fun working my ass off in Michigan that I thought of trauma & critical care as a career option.

Turns out I was a genius for picking this elective, because nothing clears up the rosy glow of a great rotation like doing something similar in a crappier environment. Compared to the group of highly-skilled, generally pretty happy surgeons and kick-ass PAs I'd worked with in Flint, the West Side Chicago crew was overworked, overextended, territorial, and maybe shouldn't have had students around in the first place. It was not awesome, but I learned a ton about the work environment I don't want, and how to recognize it.

Oh. See how much more honest I can be now that I have my diploma?

My final eight weeks was in the suburban ER. I liked the idea of this, because whether it was back home prior to PA school, on my EM rotation, doing surgery in the 'hood, or the Trauma elective, all my ER experience has been in the grim n' gritty urban centers. And the jobs really tend to be in the suburbs.

Again, there's a lot to be gained from seeing things from the other side. I liked the work, and I was pretty good at it. The skills I've developed over this whole thing are the ones that sort of have to come to you organically; one preceptor said I have "street smarts," which I loved to hear. And in the 'burbs, those come in handy, if not very often. Maybe I'll tell you the story about the guy who, no kidding, said "my father is on the board of this hospital." I'll definitely be talking about the TV show that reminds me of.

So I don't know. I love emergency med, and I'd bet I'll wind up there for a long time... but maybe not quite yet. I want to do other things too, and maybe for that all-important First Job After School, I should start in an area where I can do more general, hospital-based work. More on that as we go, too.

Milestones

Sorry I've been so quiet. A lot has happened since the last post, but I've been so wiped out as a result of the activity that I've been less able to write about it.
Here's something that crossed my mind recently...

My 35th birthday, I seem to recall, was spent either packing, or driving out east to start my post-bacc program. My girlfriend (now wife) made the trip with me, but I dropped her at the Albany, NY airport for the first of what would be several times, before I continued on the last little bit to Bennington, Vermont.

On my 36th, I had finished up that one intense year of pre-req courses, having had a few successes, a few painful encounters with my own limitations, and a whole lot of educating on what my life would be like for the next phase of my adventure. I had come out there with a goal, and come back with a plan. In the interim, I had learned a lot, including the difference between the two. Also, I read Diablo's book, I listened to Jonny's record, and I started to see how I could be good at medicine, for real real.

My 37th was spent driving back home. All my stuff fit in my 4-door car. Well, except for the futon and furniture I'd stashed in my dad's shed, and the books and whatnot I'd left behind in the woman's basement.

I just had another birthday this week. The day started with me arriving to the clinic a little ahead of my supervising MD, so I took the first patient on the list, with the MD following up a little later on. He agreed with my diagnosis, too.

Weird, how fast it all seems to go by. Next year I'll be within days of graduation, and I may even have an idea of where I'll work when school is done.

The Short White Coat

I've had a couple of very nice e-mails, in response to the last post. People want to know when I'll be in town, or what I'm doing when, or generally the whole dealio with the clinical year thing. So here's the two scoops, my raisin brahs:

As of the end of May, after the wedding and once we've returned from Las Vegas, I start up the second year of my two-year program. Basically, now that I've sat in a classroom for a full year, learning a little about everything and a lot about a few things, I now get to run around all day and try to apply it all. This would be the clerkship year.

It's a series of six-week stints in various specialty areas. Because we students (we PA kids are interchangeable with the med students at this point) move from place to place as the year wears on, each of these is called a 'rotation.' As I mentioned earlier, I'll begin by being the student in an Internal Medicine practice not far from where I live. And that means I'll be seeing people with hypertension, diabetes, and everything else that can go awry in the adult human body; the MD will be right behind me.

I'll move on to different practice situations at different locations, in my case covering private offices and hospital departments, in three states. I'll spend time working in Women's Health, Pediatrics, Family Medicine, General Surgery, Emergency Medicine, and then I get to set up an elective rotation. I head back to school periodically, to sit and take a test on the subjects I should have mastered. The year ends with a super-sized eight-week preceptorship, which depending on how you look at it is a chance for a wild fling or a marriage. You can use the time to do something cool and exotic you may not feel like doing for a job the rest of your life, or create a chance to impress some practice group enough that they offer you a job when school is over.

So. I'll be back home just after New Year's 2009, and I still have to figure out what to do with that eight-weeker. For the elective rotation I have lined up something pretty cool... but that's another post.

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."

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.

The view is nicer in middle of the bell curve, anyway

Okay. I've done my first practice test, and it turns out I'm not a biochemistry moron. I got 72%, which sounds like a C until I tell you the class mean is 75%, and the mean is also, somehow, a nice, solid B. (I got an A in statistics, so I know enough to just go ahead and trust that.)

It's like I was saying earlier: this doesn't seem to be the kind of thing where you can possibly survive any length of time if you have to play to win, and give 110%, all the time. This heavy-duty stuff is something you need to respect and work with, not try to conquer. If you think of med-type studies as a game that has to be done with utmost focus and excellence at all times, any simple human failing seems like disaster. And that's no way to live, much less a way to mold the healthcare team of tomorrow. It's a big part of why premeds and med students are sometimes such miserable people, and often so stressed-out and weird.

Here's what I wanted to say in interviews, but never got a chance to: you always hear these driven, ambitious, talented people say, "I'm excited for the chance to compete. I love to compete. I feel I'm very competitive as an applicant for this [school/ job/ reality TV show/ elected office], and I can't wait to prove it." And I call bullshit on that. I think in actuality, what most of these people enjoy so much isn't competing, but winning. They're winners. Always have been. And who doesn't love to win? Winning is great.

The problem is, if someone always wins, the first time they lose will be the first time they've ever lost. The first time it happens to someone like that, they don't know what just took place. The second time, they fall apart. A bad test score, a lousy evaluation, a personality conflict with someone in charge. Your classic Type A student will do just about anything to maintain stability; that's why they study 10 hours a day, worry about insignificant details, kiss ass with near-sociopathic skill, and never go out to the bars. Keeping their etch-a-sketch unshaken is a full-time obsession.

But medicine -- and it's not like I'm all that qualified to talk about this, except inasmuch as I've spent two and a half years clomping around in my Danskos on the factory floor -- is only partly about keeping the remaining events in your day as predictable as possible. It's largely about keeping yourself consistent, quick-thinking, and useful, while the entire rest of your world gets as unpredictable as it feels like being today.

It's like cards. If all you ever play is some five-card version of the game where nothing can start except with Jacks or Better, you'll be folding and folding again all night, like a cheap lawn chair. And I would think that much of the really relevant learning takes place in the process of playing as many hands as you can. Not so many that you run out of chips, but enough that you get past the bare theories and the expected results, and get into learning from your own observations, including your own mistakes. As someone said, good judgement develops with experience -- and experience usually develops from bad judgement.

The kind of training a lot of students put themselves through is simply wrong for development of this skill. Unfortunately, it's the kind of training that gets great results... for now. It gets them in, and it gets them through, to a point. In other words, the stuff I will be great at doesn't come until the end, and people who are great at the beginning stuff drive me nuts.

I don't mean to imply that a half-assed, vodka-soaked approach is in any way superior to, or even as good as, some discipline and hard work. I only stress the distinction because every now and then, I get concerned. This is the time of year when the system is cranked up to uber-competitive mode. Many of my classmates from last year did fine; many are still up in the air. Match Day is coming up, so today's fourth-years are freaking out about getting to become next year's interns. And out there, somewhere, 50-some people are about to become my classmates.

I hope they're cool, and they'll help me with the stuff I'm not naturally adept with. I promise to help them with their videogame skills.

Procrastination nation

I think I've cracked my problem with doing homework. It's work.

Also, like, Biochemistry is hard, dude. OMG LOL.!!!1!

But more than that, it's that I was too-concerned about doing well. As the prof said in the intro lecture, this class is composed entirely of people who have a reason to take Biochem. That is to say, the kids who make up the bottom two-thirds of every normal class are simply not here. 70% is a B here, and nobody who would get less than a C stays around. In other words, it's med school.

And I had been all worked up about how this means the end of my quiet life, and now I have to get all Type A and perfectionist. Weirdly, my slackerish tendencies derive from my desire to be perfect at everything, all the time, instead of a lack of caring. I struggle with something, I find it takes longer than I think it should, and I get all surly. And I don't like being like that. So, the internal logic goes, if I can't grasp the subtleties of alpha helices and binding regions quickly enough, then I'm screwed. I don't want to snap at people, so I may as well just put away the work that's making me feel bad and go play Lego Star Wars for another hour.

Except here's the thing: I need a C or better to pass the class, and proceed to grad school. I need a C or better in each of my classes, while in school. And as I'm fond of saying, I'm a PA student. I'm done competing with the other kids. If I'm learning, and if I'm putting together the pieces of my medical education in a way that helps me and my patients, then I'm doing fine. It's not about being the first in my class, or in the top 10%; it's about becoming the best damn clinician I can be. So I will do the rest of a chapter today, and I'll take the first of the practice tests. And if I get 70%, I'm going to relax and keep going the way I have been.

All I have to do now is enforce that policy with myself. We'll see.

Missing in Action (as well as Inaction)

Biochemistry class has begun to eat my life. And then break down and absorb the constituent pieces of my life, eventually reducing them to a few key classes of chemicals, which are then put through various complicated processes and converted into... knowledge about biochemistry, I guess.

Guitar Hero II has occupied enough of my time and attention that I've seen the little dots of the game screen coming at me when I close my eyes. On the other hand, Teslagrl has bought the first game and her own controller, so soon there will be tales of wild parties involving tiny plastic guitars and copious alcohol. Which will be broken down into a few key classes of chemicals, and put through various complicated processes. Most happily, I've started playing my real guitar more often. Together with my insanely fun effects pedal, it frickin' rules.

I bought some cool new shoes, for incredibly cheap. As much as I am a total dude, I have my moments of being a clothes-horse too. Hopefully, I'm as interesting, astute, and agreeably cranky a clothes horse as Dack from dack.com.

I've been out to see a lil' bit of the rock show scene, and I've chilled with my peeps. A bunch of interesting stuff has happened at work, but as always I can't really get into it, because the stuff that interests me most is frequently the stuff it would get me fired to talk about.

I got to meet Amber for beers. That was awesome. Hopefully there will be more such meetings of the minds; it seems like we could totally get some kind of blog Justice Society thing going. or at least a cheesy, Superfriends version. Long as I'm not Aquaman, that is.

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...

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.

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.

hey, well, that was a year right there, that was

Hm. How about that. I survived. The year is done.

I have, right now in front of me, my post-baccalaureate certificate. As promised, it is indeed suitable for framing (although what kind of hippie alterna-college prints diplomas portrait-style?) It looks just like the diplomas the seniors got. I know this, because during my year here I went a little native, and got to be friends with quite a few seniors. I'm also coming home with my worldly belongings in my car, just as I did on the way out, except this time there will be the addition of what I would estimate to be thousands of dollars' worth of art... which cost me $27 total.

It's a sad time, as we look back, as we do various things for "the last time." As we say goodbye to people. But it's also exciting, because having survived this crucible, there's a sense that we can get on with the larger plan, and pretty much rock it like a hurricane. I have a grad school to check out tomorrow, in fact. It's something like four hours away but it'll be a simple little New England day trip. Then I'll go home and pack. Then, I'll start the 22-hour drive back to the Midwest, back to my regular life, already in progress.

So, before we go, here are a few landmarks. Some little episodic things that are worth a nod now, in the post-game wrap-up.

In the Category of Always:

* I learned that I always do better if I take the time to analyze not only the question being asked, but how it's being asked.

A wise man told me, in my very first term here, that the key to academic success is to "fill in the fuckin' blank." Which is to say, be sure you know what "they" are looking for, because "they" may not recognize your possibly-correct-but-differently-slanted answer, and they certainly don't owe you any leeway. Be sure that the things you know come out looking and sounding like things you know. (This has been perhaps the hardest skill for me to develop, but I figure that's fair because it's also the most important.)

* I always think more clearly and do better academically if I specifically take the time to socialize.

Yes, at times that has meant driving home at 5AM. Or passing out in a dorm room. But one of my professors echoed a lesson I learned in the corporate world: if you're a natural procrastinator, or you have a short attention span, scheduling your work is going to be extremely difficult, and you'll wind up with a lot of work yet to do. What you do is to schedule your play; that way, you let the work assume that flexible, shapeless pattern where it falls into the many cracks in between blocks of fun, rather than the reverse. You see?

I have this amazing new ability to go to bed at 2 (or 3, or 5) and then get up a mere 4 to 5 hours later, feeling refreshed. It's a little weird. Also in that vein, on those fun nights, it's not a bad idea to drink half a liter of Gatorade before bed, and down the other half upon getting up.

* I was always grateful for the chance to have this experience. I live in a ridiculously beautiful setting, and although maybe I'm dragging my feet to go home a little, I know teslagrl understands.

Even when it was stressful, or stupidly stressful, or just so absurdly stressful that it had to be some sick existential joke, I was very aware of how lucky I am to be, if not so blessed by natural skill and brains as to say "able," at least sufficiently self-aware and tenacious as to be "willing" to come out here and do this. I'm livin' the dream, for reals.

The only other thing that cost me $40,000 that was this rewarding was my divorce. (Zinnng!)

* I always kept the hot tub clean and the pH balanced. If I learned nothing else about chemistry (and the Prof might very well believe that to be true), I learned how to do that. I even got a special award at our year-end picnic for it. Heh.

In the Category of Never

* The passing out in a dorm room thing only happened once, actually. I was never quite as much fun as I claimed to be. But that's better for all involved, really.

* I never felt old. I was the oldest student in the school not pursuing a "real" master's, I think. And I was older than at least two faculty members.

Oh, sure, once or twice I was mistaken for random campus-crashing outsiders. Or faculty. But on the whole, "the kids" were accepting and very cool. And when I found the black-wearing, #27-smoking arts crowd, I was once more among my true people. It was like undergrad, except now I was working on science, which turns out to be as meaningful and yet impenetrable as my grad student friends thought their radical theater of the 1930's stuff was. Turnabout is pretty sweet.

I just had a birthday, so now I feel old.

* I never once spoke seriously about giving up. I'm not sure if I ever joked about it, except for being mock-excited about podiatry ("the career of the future"). And I still tell the Drummer I'll come visit him when he's in school in the Caymans.

Regrets? I've had a few. But then again, too few to mention. More later, maybe from the road.

Red In Tooth And Claw

Last Monday night on my way home, I hit a deer. I realize that recent posts have been all about the fun I've been having, and/or the stress of getting the rest of my life in order, but it's not that I'm self-involved.

That is to say, this is a blog, so yes, of course it's self-involved. It's the captured thoughts of a writer doing whatever he feels like, at the moment he feels it. That's the nature of the beast. But the nature of this other beast has been on my mind lately, and it's taken a few days to ponder. So here's the story.

I was coming home, having wrapped up the first part of my first draft of my essay. I worked in the coffee-shop-esque part of the student center for a while after leaving the Hall of Science, because nothing is less productive than three post-baccs with individual laptops and WiFi at 10pm. But by 10:40, with one mocha on-board, I was ready to head.

10 or 15 minutes later, I was tooling along the winding, mountainous road I enjoy so, so very much in my V6, and I noticed: hey look, some deer. I see deer all the friggin' time out here. They were majestic and special at first, and I didn't believe it when native New Englanders said they would soon become a nuisance, like raccoons but with more body mass. Now, I totally get it. But that's skipping ahead.

I saw three of 'em over on the right side, in somebody's yard, and they stayed still as I ripped by. Good deer. And now I was on alert, because apparently it was a good night to be a out and about for our local cervine-American* population.

A few miles later, after slowing to 40 through the little town with the volunteer fire station, I came back up to 55 or so, and as I crested a hill I saw another one, about a hundred yards ahead and down the hill, standing in the other lane, close to the shoulder. Hmmmm. I slowed down. It had tan fur, about the color of my Carhartt jacket.

It was facing the other way, and looked at my car over its shoulder. The long axis of the rectangle formed by the deer's hooves pointed diagonally away from me and across the road. It started out acting more or less intelligently, taking a tentative step straight forward and off the road in the other lane, as I slowed down on my approach. I thought for a moment it was going to be okay.

Then, the dumb beast apparently decided the grade was too steep on that side -- they leap something like 15 feet over, onto, and out of the embankments on either side of my road all the time, up at the farm, so this one was either crazy or just a total wuss -- and decided to dash directly in front of me instead. All I could think was "no no no no no," as my reflexes took over.

If I hadn't slowed down, maybe I would have plowed into it with the kind of force you hear about, Emergency Department-grade force, the kind that brings people into my workplace on a long spine board, escorted by medics bearing Polaroids of starred windshields and indented A-columns**. Its head might have been even with my left headlight, and the speed would have bounced its body right up over the hood and on top of me, the lone occupant of the car, with only a thin film of glass between us. That image, frankly, I don't need -- but the one I got sucked pretty badly, too. In the imaginary scenario, at least the deer's neck might have been broken instantly, painlessly, mercifully.

Instead, what we both got was a textbook-perfect broadside. Obviously, my part of it was scary and depressing, but painless and ultimately harmless. I don't even think my tires squealed, and my airbag didn't deploy. I nailed the deer's right side flatly: its shoulder and hip fit perfectly in the space between my headlights. The plastic front grill shattered, and the hood buckled only slightly; this must have been at about 40 mph. I stopped, hit the blinkers, and turned on my cell phone. The deer had skidded, bounced really, forward and over, finally making it to the ditch on my side of the road, and went about five feet downward and 25 feet away, where it stopped and laid down.

I called 911; I was fine. Controlled stop. No issues among the humans involved. The dispatcher had a category in his computer program for "car/deer accident," and got me through to the New York State Patrol.

It was the saddest thing in the world, hearing the tall grass thrash around and then become quiet, as the deer discovered it couldn't move well. I was afraid it was dying right there and then. I shined my ludicrously-bright tactical light toward the faint orange glow of its eyes, and saw it was breathing, but had a bloody hind leg. Since my white car was a little dented but spotless, I knew this was probably a secondary injury from sharp broken bone cutting the deer's hip from the inside. I switched off the light when the deer seemed to think I was coming down there and started thrashing again, its legs making swimming motions on the grass.

My car was only cosmetically scrunched, and had tufts of hair in a corner of the hood closure. The VW insignia in the center of the grill was gone, never to be seen again. My real damage was hopefully just as minor, but it's psychic, because I stayed with the poor thing until the trooper arrived. I talked to it. I apologized, over and over again. I kept my voice even and tried to calm it, from my place up on the embankment. It was either a female or an adolescent male, with big radio-dish ears, and black markings on its face. Eventually, an SUV with cherry lights came up the hill, passed, and turned around.

The trooper, a smallish, 30-something woman with a remarkably Midwestern demeanor, verified that I was okay, and I told her what had happened. I indicated where the deer was. After a moment, she got out of her car, paused to retrieve and put on her Smokey hat, and we started walking. She told me how she'd seen deer all over the place that night. We talked about how often this kind of thing happens, and I said I'd figured a near-miss would pretty much have to happen eventually, considering the sheer numbers of the things on and near our property. The trooper kept going, down into the ditch, and the back part of my brain sort of gave me a little tap on the shoulder, saying "naah. Stay here." So I stopped at the top of the embankment above the deer, as she continued.

I didn't expect we were going to splint the deer's leg and take it to a petting zoo; there is obviously a reason the State Patrol responds to these calls and the local volley-fire guys don't. And furthermore, I know (and knew) perfectly well what that reason is. But it was still a shock of sorts when the trooper walked calmly down into the ditch, still talking to me, and drew her weapon in mid-sentence.

It would be logical to think the expression "pop a cap" is just the bravado of street thugs and rappers who want to sound worldly and unimpressed by dangerous things. But the weird thing is, it's accurate. If you've heard a .45 caliber handgun fired, and/or fired one yourself, you know. It doesn't boom, it doesn't go "pa-whoomp" like in the movies; it pops. It sounds exactly like one of your more powerful firecrackers, sure, but nothing worse than what you can buy on the roadside in some of our more civilized states.

I last discharged a handgun something like 15 years ago. The first thing that surprised me was the heft of the thing. The second was the sharpness and bite of that unexpected noise, and the kick was close behind that. It's not back, like a hunting rifle; it's straight up, as if the gun is trying to escape you. It feels to me like holding the beginnings of a summer thunderstorm in your two cupped hands. For me, this power-to-size effect comes across as a basic, instinctual, almost preternatural sense of wrongness. The order of things is either altered, or maybe just mocked, by this apparatus of springs and levers that doesn't seem to belong in the world.

The point is, I did know, and I agreed completely and fervently, when after the first shot, the trooper sighed with regret and true sympathy, saying, "man, these .45's just don't have the right kind of power. You really need a magnum."

And so she shot the deer a second time, again in the head, to still its twitching front legs. She kept the gun raised, in case it would need a third before we would be able to say we had been merciful.



* Cervine: adj. Deer-related. Like "porcine" is for pigs, "murine" is for mice, and "bovine" is for cows. I heart the Internet for letting me find that. I used to know an awesome horse-racing guy, and he half-jokingly refused to call the horses "horses." They were always "the equine athletes."

** A-Column: n. The part of the frame of the car that is the front corner between the windshield and the forward part of the driver- and passenger-door windows. The B column is between the front and back windows, and if you don't have a truck you probably have a C column too, where the back window meets the frame.

falling in love

I frequently fall in love. Intense, sudden, gratifying, silly, humbling, often temporary, though the temporariness turns out to be a help most of the time. I fall in love with ideas, images, words, inanimate objects, and occasionally, people. The people part tends to last a whole lot longer (hi, sweetie!).

You could dial back the language a little, and simply say I'm a fan of lots of little things and events, or I'm enthusiastic about the experiences I have, and the way I process stimuli. Or you could go basic, and say that I'm generally very happy with how things are going; that I love life. But as true as all the above is, saying it like that would leave out the sense of immediacy, and the messy, evanescent poetry that I feel when I'm, say, driving on a twisty mountain road, with the iPod playing something good and the warmth shining through the sunroof. That's the setting, and the action is I'm shifting from fourth to fifth while the road settles down under it all and reclines, finished with its few moments of the gyrating, swaying hippy dance some of the roads do here -- bam, that's the instant; I'm a little bit in love with life. The thing with me is that I fall just a tiny bit in love with the moment, and thus with the car, the weather, the trees, the music, road, the sun. Man, I love the sun. And I'm even more smitten with the moon; so much so it's damn near to monk-drowning levels. Don't even get me started.

So one of the great things about being here in New England pursuing this program is that I have opened up exponentially both my opportunities to fall in love in this way, and probably my capacity to do it. Sure, I worry sometimes that I may be extending my adolescence to an unhealthy degree, but then again maybe I'm holding on to that poetic side, in a very smart and useful way. Maybe this will become a core skill as I get into my chosen profession, and meander ever deeper into the responsible, focused, more complete kind of adulthood.

Heck, maybe the fight that broke out on the sidewalk outside the local bar where Teslagrrl and I were singing karaoke a couple weeks back was just a spilling over of that kind of love. It's my theory that more people want to be expressive than know how to be, so when the John Cougar is flowing as freely as the beer, things can happen. Fuses get lit, ya-yas come out, steam gets let off. Eventually shakin' your doughy butt, nodding your baseball cap, and yelling "yeah!" isn't enough anymore; you need something more powerfully poetic. Sadly, the most poetic and expressive tool in some guys' repertoire is throwing a punch. I suppose that does, technically, count as making a connection with someone. So there you go.

I'm going on about this now thanks to a recent post* on Diablo's blog, with a sweet and generous devotional to her hubby (who by the way, is a frickin' rock star not just literally, but figuratively). Is that too sincere? Shit, I mean it's a soppy and clearly Jaeger-fueled mash note. Some might say Diablo being sweet is surely some manner of evil plot, but I know better. In her singular style, the writing is frank, funny, and disarming, and then makes a face at you and grabs its crotch. Or yours. Basically her prose is, in my universe anyway, Terri Garr in a leather catsuit -- and that is just about the BEST COMPLIMENT POSSIBLE. Okay, maybe I'm a little in love with the writing now too. Put it on the list.

So, yes. New England autumn. Driving. Love. Things like that. It's by no means comprehensive, but to give you a better sense of what I'm talking about, here is a list of some of the things I have fallen in love with recently: my wool topcoat, Atmosphere's new album, stovetop percolator coffee, about 50% of the designs in the student fashion show I saw on Monday night, about 75% of the models in the fashion show, the normal standard distribution (a Statistics thing), White Russians mixed and served in pint glasses, my midterm grades, winning at Scrabble, and the crisp snap of November air.

I am also in love with my girlfriend, which I have to say is a very good thing indeed. As I mentioned, she was here a couple of weeks ago. I can't even remember what we were talking about, or why we were laughing, but we were. I'm sure it was very funny. Actually, screw that, we don't even need a reason, but the point is I'd said something funny in response to something she'd said that was funny, and her explanation of whatever goofy thing it was that she had said was to say "hey, I'm in love." And that's when I forgot what she'd been talking about, and just sort of marvelled at the whole thing.

Today, it strikes me that this is what I miss most, and what I miss out on the most, owing to our being 1000 miles apart. I lack for opportunities to fall in love with little things that have to do with her. This seems horribly unfair. It's fine when we do re-connect; we just pick right up where we were. But in the meantime, dang. Distance, boy. I don't know. What you gonna do?

Hey, that may have just become relevant to the ongoing saga of the non-traditional educational process. Sweet! If I just throw in the words "long-distance relationship," this post might even come up when med students and pre-med students search. Though PA students are, of course, better-looking and more fun, I have to make sure to put that in there as well.

* The slatternly fishwife should fix the photo in the post, because I've seen it and it's adorable.

A modest manifesto

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What Occupies Me

At the bottom of the tax form, after your signature, you're asked to list your "occupation." I have always wondered, where does this information go? And where is it supposed to come from?

Recently, getting ready for the big move, I had a look at my tax forms from the past few years. Sure, job titles are good, but I don't always stick to them. The year I earned a $100 honorarium for being part of the "guest ensemble" (that's "chorus" to most of us) in a 3-month-long production at my favorite theater, I was also starting my job at the cool company (the one I just left after 7 years to go out East, back to school). That year, I listed my occupation as "Actor."

2004 was the year I started working at the hospital, in November. I was an "EMT" that year, and the next, if I'm remembering correctly. All of which is true, but maybe not entirely descriptive of where I spent most of my working hours. I was happy to be associated with the cool company, but as the years went on the day-to-day enthusiasm ebbed and flowed over time. Toward the middle there, I might have put "hapless cube-monkey" if I thought I could.

So I guess I will be a "student" soon, and that's both clear and accurate. It feels good to have no conflict to resolve. Just one more indicator, I guess, that it's time to do this.