Minor Functionary of the Underworld

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

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

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

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

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

...and a grateful nation rejoices

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

COSTCO HAS CURED HAM!

Underneath, it continued:

WE WILL NEVER SUFFER FROM HAM AGAIN!

Sometimes, I just crack myself right the hell up.

The Soundtrack

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

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

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

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

...

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Disturbing signs of getting older

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

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

Tasty Sunday

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

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

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

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

Except.

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

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

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

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

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

This post has many titles...

1) Progress.

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

3) I'm in.

4) Febrifuge and The Big Flat Envelope

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

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

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

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

Some sub-bullets:

a) Hey, Chicago. Cool.

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

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

b) So, why this school specifically?

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

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

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

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

something to ponder

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

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

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

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

Hold the Mayo

Is it a bad idea to post while intoxicated?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

freaky-deakies need medical care, too

Dear Admissions Committees,

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

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

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

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

INTERVIEWER

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

FEBRIFUGE

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

Kryptonite.

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

Chicago Style

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

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

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

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

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

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

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

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

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

This old House

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

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

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

Eww, baby, eww

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

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

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

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

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

Out of the Woods... ish

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

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

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

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

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

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

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

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

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

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

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

The Heartbreak

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

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

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

Hm. Hadn't thought of it like that.

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

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

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

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

Me Am Bizarro Best Blogger Ever #1!

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

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

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

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

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