Day 4

First rounds this morning. Start at 6 am. The ICU is still a little bit scary. Doesn't end til 930 am. People seem disgruntled that the med students (us) are not doing what they are supposed to be doing, even though they realize we do not know what we are supposed to be doing.

We are supposed to be removing and replacing surgical dressings. We have to figure out how to do this by tomorrow at 6 am.

The rounds go until 930 am. The senior resident is dashing and charming and it is amazing how intimately he knows each of the 40 patients. The interns are post call and irate. We stay out of their way.

The clinic is over flowing. They are depending on us to keep the flow, even though at this point we cause more delay than speed. There is only one attending. Patients wait for 3 or 4 hours shivering in their gowns.

I examine a mans genitals with great authority. He has an enormous hernia and a painful swelling of his testicles. His penis is retracted. He is an ex-con, a "street warrior," his skin scarred and bruised from knife fights and heroin skin popping. He has an odd affect, a mood disorder. He follows my directions. I examine him with gloves. When i return the attending examines him without gloves and has me do the same.

I watch a pretty nurse practitioner who is about my age, expertly pull a drain from a man's stomach. She is someone like me--a normal person, a young person--but her hands and her brain are like magic. She helps me figure things out and i am grateful for her patience.

We do not end for several hours. At 2 i realize it has already been an 8 hour day.

I receive an email from a star graduating student who responds to my fretting about the future. She tells me not to fret. I believe her. She tells me to work really really hard. I believe her.

Day 3

Grand rounds are boring

Found out board scores. Yay i passed. Sob, my score is lame.

Fret about future.

Thrown into clinic. Handed charts. Examine. Attending is mildly frightening. Patient gets off cell phone when i enter; "can't talk, the doctor is here." He meant me?! Attending turns out to be kind of really cool. Learn more in 2 hours then in 2 weeks. Survive.

Home. Fret about future. Decide to push on.

Day 2

More orientation. Does not begin till 10, even though i woke up at 6 and tomorrow i will wake up at 430.

there is still much hope in the air.

feel like the hardest part of med school is letting go of one's particularities of previous identities--namely, that of ditzy intellectual, which was a fun role to try to develope. its not as funny to have a ditzy doctor. its kind of scary. but changing such a thing brings up profound difficult questions of identity, habitus, and change. did i once develope such a role as one puts on garb, an arbitrary pair of pants found in the free bin--or did it seem a good way to deal with the fact that i have terrible short term memory? Is it essence or is it mere garb one puts on and off a deeper essence? is there no essence at all, this illusion of self?!

no time for difficult questions! have to review abdominal vasculature.

Goals

General Goals

The overall goal of this clerkship is to provide the environment needed to have you develop into a humane, sympathetic, knowledgeable and sophisticated physician. Further, our aim is to teach you to apply the background in pathophysiology you acquired in the pre-clinical years to the diagnosis and management of surgical patients.

Specific Goals

Toward this end, the faculty will expect that you will learn to:

Obtain a complete history and perform an accurate physical examination in approximately one hour.

Formulate a differential diagnosis after obtaining a history and examining a patient.

Devise a scheme of reasonable and appropriate laboratory and other diagnostic tests leading to the establishment of a diagnosis; become familiar with the availability, cost, and limitations of laboratory and other diagnostic procedures.

Formulate a plan of therapeutic management for the patient; if surgical procedures are included in the plan, be familiar with the risks and alternatives.

Be able to represent the clinical information to others in a coherent, succinct manner.

Acquire and expand on a core of surgical knowledge, including developing an awareness of sources of information, their limitations and scientific merit.

Develop a sophisticated clinical judgment, applying your knowledge of pathophysiology to clinical surgery.

Learn to interact and deal with professional and nonprofessional personnel, patients and their families encompassing social, ethical, psychological and medical aspects of such interactions.

Irreconcilable Aesthetic Differences

I like girls with biceps, beautiful girls with pretty smiles and rippling arms, i love girls with big hips and poochy bellies and the sound of singing, off key alone, harmonious when shouted, all of us together to the sound of simple instruments, the sort that must be struck.

I love breasts. I love the breasts of women, big giant full breasts described in metaphor, a variety of full figured summer fruit found throughout numerous geographical regions, and i love small tender breasts lean soft and pointy like flower buds, also found in a variety of ecological niches, even very harsh ones. I love the breasts of old women, when everything has dried away and hardened, the breasts of old women are still soft, even when they hang over tripping hearts, brittle ribs, when there there are worrisome calcified tumors, that sit like ominous pebbles, amid plump moss and velvet fragile skin.

What is beautiful is sweat, smelly sticky endlessly flowing salty damp cool sweat on hot skin, puddles on the floor, drenching sheets

What is beautiful is urine, smelly pussy yellow brown red and bloody, urine the secret of the soul, the window of the humors, frothy urine full of secrets, full of stories. What is beautiful is blood, dangerous sanguine, blood is still full of ghosts (they are called viruses now), and is still thick and dizzying and terrifying and life and death can be foretold in the vile.

Beauty, what is beautiful, do you love me, do you find me beautiful, this is what i find beautiful. Things like flowers, and sunrises, and an adorable list of multiple daily things that surround us but go unnoticed unless we are intoxicated. Also--things that are seemingly ugly, but on further inspection, and with the right soundtrack are also very beautiful, like the items of urban decay and industrial waste and secret worlds like prisons, hospitals, bohemia and crackheads on 16th street. Also--lovers and things that have to do with love. That is very beautiful. So too is youth, healthy food, mathematical patterns in nature, well engineered machines, you and your self esteem, small children and their mothers.

I also agree that red lipstick and young men with well defined and graceful bottoms are also very beautiful. Also, young men with glasses and computer programming skills, all though this is less commonly shared. Several types of well decorated pastries and most of the major works by Immanuel Kant--those too.

And you?