...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...