I dreamt of luscious hotel entrance to my simple apartment. Outside the world at every entrance, the lobby stretched so wide, you could traverse its length and arrive at entirely different neighborhoods and sub-worlds. and this is delightful, the notion of my humble home, the foundation and enclave, wrapped in grandeur, sweeping staircases, marble floors, silver platters, the bustle of a million maids and butlers in well pressed uniforms, a gorgeous big world, with a safe place in its heart. I dash up the stairs endless palace stairs, and i am small again like the little pig character of children's books, like the little girl who lives in the waldorf astoria, the world of beauty is big and i am joyously scurrying. But i must take a regulation staircase, a back way a fire escape i follow a woman, she gets off on four. I must arrive at six, and there is a severance of the staircase, an Escherian optical puzzle. I cannot get to the next floor.
And i wake.
I am in my brother's bed in my childhood house, the walls are plastered thickly with the gleam of sports cars and buxom women lounging upon them. My head is thick with cementing mucus in hidden crevices, weighing my mind and my skin is so dry with desert air it is crackling. There were other dreams, they are ephemera.
The day ahead seems dull. Somewhere in the larger picture progress must be made--on my medical training, on my research. I am short on money, someone at the university has delayed the check until i report my findings. What have I found? I have been meditating that at 28 I am not really a Young Woman anymore. A youngish woman. Long ago already i was Madame over a Mademoiselle, though i have neither married nor reproduced. I have a man i love, he is gently coy about these things. In the mean time, amid the clinic and the wards, the excel spread sheets and nights of sleepy love, the rolling hormonal sine waves keep time on my ovaries, which are in turn neatly bound and chemically gagged with FDA approved contraception.
Men do not generally face their finiteness for decades, but for women it begins at 35, and it begins in the pelvis (all things begin in the pelvis), then radiates outward.
The school counselor accuses me of escape into abstraction in my philosophizing (or perhaps it is i who accuses, and she who nods). The disciples of the mind think there is a different truth, the one that is bound up in the tangles and rolls of the individual psyche, the particulars of the organisms trajectory, of its shapes and deformities, of the particular drag and gravity in its subjective cosmos, and the course of collisions with other creatures. Perhaps each atomized vector can be integrated and an elegant tale can be told, the story (stories) that will predict the future. Like their brethren in physics, the disciples of psyche chase the mystical with the sober pretense of trading in mundane tools.
Oh this poor isolated animal. The French find the isolation inevitable and pitiable, the americans an aspiration and a celebration. I do not want to be alone. Life begins with a expulsion from another. It begins with separation and a life desperate for union again. The end carries the parabola forward to its inevitably lonely conclusion. But after we are gone, the fungi take us back, and we are reunited with all again. Dénouement, resolution, or catastrophe.
Remarkably un-comforting.
Yesterday my heart broke watching an injured bee, journey steadily across the suburban bathroom floor. Why was there a bumble bee in such an inglorious place? (And why do we hate flies and admire bees? We punish one for ridding the world of feces and rotten meat, and adore the other for cavorting amid the flowers and filling our cups with honey). (Actually this is quite reasonable). (The bees furthermore, are better dressed).
Once i have had my morning coffee, the meditations on death dissolve, like mist in the rising sun. Dreams flee, existential ennui and its attendant abyss constrict to a neat quiet scar line. In the glorious light of the frontal lobe, well fueled by the metabolic storm of caffeine, purpose begins. We trade out the dark shadows of existence, dreamscapes and Dostoevsky for the neat, clipped descriptions of the New England Journal. The disciples of physiology (like those who study spheres, and the mappers of mind) don the heavy cloak of coffee cups and linear regression models and the work of the world continues.
Sunday, October 24, 2010
Thursday, October 14, 2010
Tuesday, October 12, 2010
Foreign Medical Graduate
From Verghese, My Own Country
"I had once tried to reach Dr. Patel, a cardiologist, to see a tough old lady in the E.R. whose heart failure was not yielding to my diuretics and cardiotonics. I called his house and his wife told me he was at 'Urology Patel's' house, and when I called there I learned he and 'Pulmonary Patel' had gone to 'Gastroenterology Patel's' house. Gastroenterology Patel's teen-age daughter, a first-generation Indian-American, told me in a perfect Appalachian accent that she 'reckoned they're over at the Mehtas' playing rummy,' which they were."
An Indian traveling salesman explains how to find a place to eat in a strange town: Count the number of Patels in the phone book and multiply by 60. "That will tell you size of Indian community. . . . Take my word: less than 10 Patels means no Indian restaurant. If more than 10, you call, say you are from India, ask them where to go to eat."
* * *
As Dr. Verghese traces the spread of the [HIV] infection, he also examines its effects on his own attitudes, and on his relationships with his patients. He identifies the less-than-lofty, self-congratulatory "front-rank soldier" pride of doctors who treated AIDS patients in the early days of the epidemic, before the mechanisms of transmission were better understood. As he considers his patients in Tennessee and their willingness to confide in him, he wonders how much it has to do with their relief at finding a doctor who is a foreigner, an outsider. "To come to a doctor's office, even a distant doctor's office, and tell their sexual secrets to a Caucasian face that could just as well have belonged to a preacher, a judge or some other archetypal authority figure in their town, might have been difficult." He is also direct and straightforward about the toll that his involvement with his patients takes on his wife and young children -- and ultimately on him as well, as the patients, one by one, begin to die, as he dreams repeatedly of his own infection and death.
* * *
The story of all these people -- brothers and sisters, parents and children, doctors and patients -- is the story of a small city whose departed sons begin returning, one by one, sick with an infection that even the medical professionals of Johnson City had assumed would never hit close to home. Thus the doctor who sought security and a better life in the American South finds himself treating some of the sons of that South who had fled, searching for safety, acceptance and a fuller, freer life.
It was, as Dr. Verghese ultimately chronicled it for a medical journal, "the story of how a generation of young men, raised to self-hatred, had risen above the definitions that their society and upbringings had used to define them. It was the story of the hard and sometimes lonely journeys they took far from home into a world more complicated than they imagined and far more dangerous than anyone could have known."
"I had once tried to reach Dr. Patel, a cardiologist, to see a tough old lady in the E.R. whose heart failure was not yielding to my diuretics and cardiotonics. I called his house and his wife told me he was at 'Urology Patel's' house, and when I called there I learned he and 'Pulmonary Patel' had gone to 'Gastroenterology Patel's' house. Gastroenterology Patel's teen-age daughter, a first-generation Indian-American, told me in a perfect Appalachian accent that she 'reckoned they're over at the Mehtas' playing rummy,' which they were."
An Indian traveling salesman explains how to find a place to eat in a strange town: Count the number of Patels in the phone book and multiply by 60. "That will tell you size of Indian community. . . . Take my word: less than 10 Patels means no Indian restaurant. If more than 10, you call, say you are from India, ask them where to go to eat."
* * *
As Dr. Verghese traces the spread of the [HIV] infection, he also examines its effects on his own attitudes, and on his relationships with his patients. He identifies the less-than-lofty, self-congratulatory "front-rank soldier" pride of doctors who treated AIDS patients in the early days of the epidemic, before the mechanisms of transmission were better understood. As he considers his patients in Tennessee and their willingness to confide in him, he wonders how much it has to do with their relief at finding a doctor who is a foreigner, an outsider. "To come to a doctor's office, even a distant doctor's office, and tell their sexual secrets to a Caucasian face that could just as well have belonged to a preacher, a judge or some other archetypal authority figure in their town, might have been difficult." He is also direct and straightforward about the toll that his involvement with his patients takes on his wife and young children -- and ultimately on him as well, as the patients, one by one, begin to die, as he dreams repeatedly of his own infection and death.
* * *
The story of all these people -- brothers and sisters, parents and children, doctors and patients -- is the story of a small city whose departed sons begin returning, one by one, sick with an infection that even the medical professionals of Johnson City had assumed would never hit close to home. Thus the doctor who sought security and a better life in the American South finds himself treating some of the sons of that South who had fled, searching for safety, acceptance and a fuller, freer life.
It was, as Dr. Verghese ultimately chronicled it for a medical journal, "the story of how a generation of young men, raised to self-hatred, had risen above the definitions that their society and upbringings had used to define them. It was the story of the hard and sometimes lonely journeys they took far from home into a world more complicated than they imagined and far more dangerous than anyone could have known."
Fluids, Fetuses, Foreign bodies, Feces and Flatus
SCIENTIST AT WORK | DR. ABRAHAM VERGHESE
Physician Revives a Dying Art: The Physical [excerpts]
Dr. Verghese (ver-GEESE) is the senior associate chairman for the theory and practice of medicine at Stanford University. He is also the author of two highly acclaimed memoirs, “My Own Country” and “The Tennis Partner,” and a novel, “Cutting for Stone,” which is now a best seller.
At Stanford, he is on a mission to bring back something he considers a lost art: the physical exam. The old-fashioned touching, looking and listening — the once prized, almost magical skills of the doctor who missed nothing and could swiftly diagnose a peculiar walk, sluggish thyroid or leaky heart valve using just keen eyes, practiced hands and a stethoscope.
Art and medicine may seem disparate worlds, but Dr. Verghese insists that for him they are one. Doctors and writers are both collectors of stories, and he says his two careers have the same joy and the same prerequisite: “infinite curiosity about other people.” He cannot help secretly diagnosing ailments in strangers, or wondering about the lives his patients lead outside the hospital.
“People are endlessly mysterious,” he said in an interview in his office at the medical school, where volumes of poetry share the bookshelves with medical texts, family photos and a collection of reflex hammers.
His sources of inspiration include W. Somerset Maugham and Harrison’s Principles of Internal Medicine. In addition to his medical degree, he has one from the writing workshop at the University of Iowa.
Dr. Verghese trained before M.R.I. or CT existed, in Ethiopia and India, where fancy equipment was scarce and good examination skills were a matter of necessity and pride. He still believes a thorough exam can yield vital information and help doctors figure out which tests to order and which to skip — surely a worthwhile goal as the United States struggles to control health care costs, he said.
A proper exam also earns trust, he said, and serves as a ritual that transforms two strangers into doctor and patient.
“Patients know in a heartbeat if they’re getting a clumsy exam,” he said.
He left Ethiopia at 15 for two years of premedical studies in Madras, India, and then returned to Addis Ababa for medical school. By then his parents, worried about Ethiopia’s stability, had moved to the United States. But he had no desire to leave.
“I loved that land,” he recalled.
The medical training was rigorous. Students spent a year dissecting a cadaver, and then had to pass grueling essay exams.
“It was almost brutal,” he said. “But it left us changed in some fundamental way, like formatting a disk.”
Medical students in the United States today spend far less time studying anatomy — too little to learn it well, he said, shaking his head.
***
He worked in Tennessee during the early days of the AIDS epidemic, before there were any effective treatments. Before AIDS, he said: “I must have been a conceited ass, full of knowledge. AIDS humbled a whole generation.”
He came to know many of his patients and their families. He visited their homes, attended their deaths and their funerals. One patient, near death, awoke when Dr. Verghese arrived, and opened his shirt to be examined one last time.
“It was like an offering,” Dr. Verghese said, with tears in his eyes. “To preside over the bed of a dying man in his last few hours. I listen, I thump, I don’t even know what I’m listening for. But doing it says: ‘I will never leave you. I will not let you die in pain or alone.’ There’s not a test you can offer that does that.”
***
“What’s the most important part of the stethoscope?” They stared at him. “The part between the earpieces.” They moaned.
“Name five things that are better outside the body than in,” he asked, not mentioning that the answer appears in his novel: fluids, fetuses, foreign bodies, feces and flatus.
Dr. Verghese smiled. “I am here to astound you,” he said.
Full NYT Article
The Stanford 25: Exam Techniques Every Doctor Should Know
Physician Revives a Dying Art: The Physical [excerpts]
Dr. Verghese (ver-GEESE) is the senior associate chairman for the theory and practice of medicine at Stanford University. He is also the author of two highly acclaimed memoirs, “My Own Country” and “The Tennis Partner,” and a novel, “Cutting for Stone,” which is now a best seller.
At Stanford, he is on a mission to bring back something he considers a lost art: the physical exam. The old-fashioned touching, looking and listening — the once prized, almost magical skills of the doctor who missed nothing and could swiftly diagnose a peculiar walk, sluggish thyroid or leaky heart valve using just keen eyes, practiced hands and a stethoscope.
Art and medicine may seem disparate worlds, but Dr. Verghese insists that for him they are one. Doctors and writers are both collectors of stories, and he says his two careers have the same joy and the same prerequisite: “infinite curiosity about other people.” He cannot help secretly diagnosing ailments in strangers, or wondering about the lives his patients lead outside the hospital.
“People are endlessly mysterious,” he said in an interview in his office at the medical school, where volumes of poetry share the bookshelves with medical texts, family photos and a collection of reflex hammers.
His sources of inspiration include W. Somerset Maugham and Harrison’s Principles of Internal Medicine. In addition to his medical degree, he has one from the writing workshop at the University of Iowa.
Dr. Verghese trained before M.R.I. or CT existed, in Ethiopia and India, where fancy equipment was scarce and good examination skills were a matter of necessity and pride. He still believes a thorough exam can yield vital information and help doctors figure out which tests to order and which to skip — surely a worthwhile goal as the United States struggles to control health care costs, he said.
A proper exam also earns trust, he said, and serves as a ritual that transforms two strangers into doctor and patient.
“Patients know in a heartbeat if they’re getting a clumsy exam,” he said.
He left Ethiopia at 15 for two years of premedical studies in Madras, India, and then returned to Addis Ababa for medical school. By then his parents, worried about Ethiopia’s stability, had moved to the United States. But he had no desire to leave.
“I loved that land,” he recalled.
The medical training was rigorous. Students spent a year dissecting a cadaver, and then had to pass grueling essay exams.
“It was almost brutal,” he said. “But it left us changed in some fundamental way, like formatting a disk.”
Medical students in the United States today spend far less time studying anatomy — too little to learn it well, he said, shaking his head.
***
He worked in Tennessee during the early days of the AIDS epidemic, before there were any effective treatments. Before AIDS, he said: “I must have been a conceited ass, full of knowledge. AIDS humbled a whole generation.”
He came to know many of his patients and their families. He visited their homes, attended their deaths and their funerals. One patient, near death, awoke when Dr. Verghese arrived, and opened his shirt to be examined one last time.
“It was like an offering,” Dr. Verghese said, with tears in his eyes. “To preside over the bed of a dying man in his last few hours. I listen, I thump, I don’t even know what I’m listening for. But doing it says: ‘I will never leave you. I will not let you die in pain or alone.’ There’s not a test you can offer that does that.”
***
“What’s the most important part of the stethoscope?” They stared at him. “The part between the earpieces.” They moaned.
“Name five things that are better outside the body than in,” he asked, not mentioning that the answer appears in his novel: fluids, fetuses, foreign bodies, feces and flatus.
Dr. Verghese smiled. “I am here to astound you,” he said.
Full NYT Article
The Stanford 25: Exam Techniques Every Doctor Should Know
Monday, October 4, 2010
There are* in fact stupid questions
There are in fact stupid questions. In fact, there are several. Further fact: the majority of things a medical student might say at any given moment will likely fall into the classification of stupid question, even if in other contexts they are reasonable questions. For example "where is the bathroom?" and "How do i stop the patient from biting me?"
Statements can also be stupid questions ("But i do not know how to do a cardiac massage.") as can inquisitive looks and breathing too loudly near the surgeon.
Stupid questions are punishable by smirking, derision, public lashings, private lashings through vivid evaluation remarks ("Please express to your parents my great sympathy for their having birthed a child too stupid to know how to dose diuretics properly" "Your usefulness to the team ranks below latex gloves status post rectal exam but above small puddles of body fluids to the left of the nursing station") and being physically assaulted in the operating theater (using proper sterile precaution) with either very expensive surgical instruments or fecaliths. Please note that any damage incurred to surgical equipment will be added to the student's tuition. Also any patient specimen used as a projectile didactic tool will need to be retrieved by the student and expediently returned to the pathology lab.
In conclusion please arrive to clinic or your respective ward teams knowing everything and kindly avoid making eye contact.
Statements can also be stupid questions ("But i do not know how to do a cardiac massage.") as can inquisitive looks and breathing too loudly near the surgeon.
Stupid questions are punishable by smirking, derision, public lashings, private lashings through vivid evaluation remarks ("Please express to your parents my great sympathy for their having birthed a child too stupid to know how to dose diuretics properly" "Your usefulness to the team ranks below latex gloves status post rectal exam but above small puddles of body fluids to the left of the nursing station") and being physically assaulted in the operating theater (using proper sterile precaution) with either very expensive surgical instruments or fecaliths. Please note that any damage incurred to surgical equipment will be added to the student's tuition. Also any patient specimen used as a projectile didactic tool will need to be retrieved by the student and expediently returned to the pathology lab.
In conclusion please arrive to clinic or your respective ward teams knowing everything and kindly avoid making eye contact.
Monday, September 27, 2010
Thursday, September 23, 2010
The Heart of Medicine
"To practice medicine with good spirit does not mean to be in a place where there is no noise, trouble or hard work. It means to bring your calm and loving heart right into the midst of it."
http://www.theheartofmedicine.org/
http://www.theheartofmedicine.org/
Saturday, September 11, 2010
A Very Beautiful Old Man
HANS KEILSON, a Jewish doctor, psychoanalyst, poet and novelist who fled Nazi Germany.
“I’m 100 years old and 8 months, and the last 8 months have been the hardest.”
A Physician Examines His Novels
Sunday, August 29, 2010
Some Dreams I have, Largely in Order of Priority, From Most to Least
(1) Have a living room
(2) Get a Dog
(3) Get a really nice coffee making machine
(4) Finish medical school
(5) Get Netflix streaming {x} done
(6) Have a dish washer
(7) have a daily commute that is less than 20 min
(8) Have a garden
(9) Finish residency
(10) learn more statistics
(11) get a TV
(12) finally finish reading Proust
(13) win a Nobel Prize
Monday, August 9, 2010
Things i learned while backpacking 14 miles over steep terrain with a 40 lb pack
1. i should probably work out more
2. when faced with the decision of pooping in a hole you have to dig and not pooping for a few days of strenuous activity it is very unwise to choose not to poop
3. Bears are wily, clever, motherfucking super beasts. And scary. Cuddly. but also scary.
4. Mosquitoes do in fact bite brown people of equatorial origin who suspect themselves of having a heretofor unidentified hemoglobinopathy based on absolutely no laboratory or clinical evidence whatsoever.
5. I hate motherfucking mosquitos.
6. i would like to devote my entire scientific career to single handed crushing every mosquito on this planet
7. i would be a great humanitarian hero if i did.
8. I probably won't.
9. Sigh.
10. Hyponatremia is no joke. gatorade can bring back life.
11. deer. kind of creepy.
12. Backpacking. WTF. really? you strap 40 lb to your back and then walk over steep terrain and leave behind centuries even millenia of sacrifice and progress like buildings with walls and indoor plumbing?
13. There is profundity in the pursuit of one's own limitations and how odd it is that in the clarity of daylight and serenity we file our lives in impeccably rational filing systems (work, fun, love) arranged by elegant narrative orderings, but in those dark moments, we find the mind has in fact cross wired everything by a far murkier robust system of visceral domains: despair (the gasping desperate blind rage towards the mountain top, the ghostly 3 am of another gloomy call night pummeled by hunger for sleep), triumph ( the 360 degree view of the California Sierra mountains, the bright light and echo of civilization when stepping outside of a hospital to a noon time healthy bustling San Francisco) and transcendence (the floating away when letting drop 40 lb of either camping equipment or neurosis)
14.Nature totally kicked my ass.
2. when faced with the decision of pooping in a hole you have to dig and not pooping for a few days of strenuous activity it is very unwise to choose not to poop
3. Bears are wily, clever, motherfucking super beasts. And scary. Cuddly. but also scary.
4. Mosquitoes do in fact bite brown people of equatorial origin who suspect themselves of having a heretofor unidentified hemoglobinopathy based on absolutely no laboratory or clinical evidence whatsoever.
5. I hate motherfucking mosquitos.
6. i would like to devote my entire scientific career to single handed crushing every mosquito on this planet
7. i would be a great humanitarian hero if i did.
8. I probably won't.
9. Sigh.
10. Hyponatremia is no joke. gatorade can bring back life.
11. deer. kind of creepy.
12. Backpacking. WTF. really? you strap 40 lb to your back and then walk over steep terrain and leave behind centuries even millenia of sacrifice and progress like buildings with walls and indoor plumbing?
13. There is profundity in the pursuit of one's own limitations and how odd it is that in the clarity of daylight and serenity we file our lives in impeccably rational filing systems (work, fun, love) arranged by elegant narrative orderings, but in those dark moments, we find the mind has in fact cross wired everything by a far murkier robust system of visceral domains: despair (the gasping desperate blind rage towards the mountain top, the ghostly 3 am of another gloomy call night pummeled by hunger for sleep), triumph ( the 360 degree view of the California Sierra mountains, the bright light and echo of civilization when stepping outside of a hospital to a noon time healthy bustling San Francisco) and transcendence (the floating away when letting drop 40 lb of either camping equipment or neurosis)
14.Nature totally kicked my ass.
Monday, July 26, 2010
How I would name the rainbow
Blood that is oxygenated Red
Beta Carotene
Jaundice Yellow
Bile Green
Botched IV Contusion blue
Blood that is deoxygenated Purple
Poop Brown
Necrotizing Fasciitis Black
Beta Carotene
Jaundice Yellow
Bile Green
Botched IV Contusion blue
Blood that is deoxygenated Purple
Poop Brown
Necrotizing Fasciitis Black
Saturday, June 12, 2010
I am on a Diet
Indeed. The D word. such stigma. It conjures...i don't know this: anal retentiveness. vanity. a puritanical disdain for pleasure. It pictures to me the concession to middle age when we have forfeited the incessant consumption of youth and its utter ignorance of consequence and taken up the mantle of the Ice Man Cometh, of promises perpetually made and forever broken, ruthless cycles of New Year's Resolutions, and the fool target of multibillion dollar vultures who use gym membership, shakes composed of saltine cracker debris, methamphetamines, veganism as a shrill cover up for eating disorders, anything anything! to devour you, the gullible, guilt plagued inert outflow product of wanton american greed and the easy way. It is a deadly cliche.
All such things of course reveal the countours and kinks of my own neuroses as much (more) than of my binge-purge society. Meh, what are you going to do.
My body, its a good piece of work. Its only got 27 years and a couple hundred miles on it. After spending the last several years meticulously reviewing all the horrible possibilities of illness and monstrous betrayals of genetics, I have become tremendously grateful for health, and humbled by how quickly it can and does flit away. (Death, dudes. Its totally going to happen). But so far, a little asthma, a touch of neurosis, minor scratches and a rather unfortunate intolerance of this particularly excellent local brand of hot salsa (I'm sooooooorry everyone who had to sit within a 4 foot radius of me during my impassioned 1 year denial of this, but it was so tasty!) but over all good working parts. Lungs fill up with air, heart pumps, limbs move. My body works hard for me, carrying heavy books, sitting long uncomfortable hours squinting at small writing, listening carefully to heart sounds, staying up for 36 hour call shifts, running to both catch and dodge out of the way of violent muni busses, and above all it lets me dance and cuddle people and other delightful somatic activities. So i want to treat it right and make it happy.
And I do that by giving it unlimited access to burritos and beer.
So Dieting. Why would self denial be a good thing? also i hate being told what to do. Even by me.
Alas, the 19 year old triumphant obliviousness that abuse of one's liver and unlimited pizza binges carries on without consequence, has turned out to be less than fact. Some combination of age, hormones,deriving meals from vending machines, the use of food as an anxiolytic and anti depressant, and exchanging 2 hours daily work outs for an activity regimen that consists mostly of seeing how long i can balance a cereal bowl full of soy milk on my burgeoning belly (more challenging than it appears)--these alas, were also subject to the laws of chemistry and physiology and thus the relentless upward march of BMI.
I still love my body and it continues to work hard for me. Aesthetically I like strong ladies with squishy butts and i am digging my squishy butt. But I envisioned the next five years of call nights and vending machines and the trends of my disappearing waistline, that small detail of a robust family history of diabetes and heart disease, my idle advice to patients to 'just change your diet and eating habits and quit smoking and all your diseases will go away!' And eventually i will not be aesthetically pleased. I will make babies and it will worsen with hypothyroidism. I will be a rotund dumpling*. I will have insulin resistance and osteoarthritis.
*The Sri Lankan body destiny - Sri Lankan women come in 3 basic shapes. The most common is very very very tiny. MIA is a classic example. The second most common is Dumpling - big butt, boobs, hips on a short frame. Good for childbearing and and pretty adorable in aunties and grandmas. Least common but most inspirational is the tall athletic Sri Lankan girl who is a compete badass at basketball.
So. Body. I have been spoiling you. We've got to get you in shape. It will be better in the long run. You will thank me later.
Disclaimer: poetic license allows me to discuss body as third person object but i strongly abhor mind-body dualism.
So i began the Halt the BMI Diet this last Monday (only after an amazing weekend camping trip of gluttony and eating an entire bag of Mother's frosted animal cookies--you know, that shit with sprinkles. Hella good). I am hoping to lose 15 pounds over 16 weeks and then reassess how i feel. I hope that it is modest enough that i can figure out how to adapt it to a long term maintenance approach.
My previous attempts at 'eating healthy' has mostly consisted of vague commitments of 'I will eat some vegetables and less pizza'. Currently I am trying to consume net 1500 calories per day, with 1 day a week where I am off diet. If i eat an entire bag of Mother's frosted animal cookies (hella good) on that one day off, it probably will render the rest of the days moot, but i think this might be an important psychological safety valve and allow for longevity of the task. This week i have not quite succeeded, being on average 150 net calories over. I am keeping track with an overall satisfactory iphone ap Lose It. Generally it is a good ap; a disadvantage is that if you eat a lot of sri lankan, ethiopian, or any non-mainstream food, and you must sort of hodge podge it together based on the ingredients. This tracking alone has been revelatory. Despite a biology degree with extensive study of metabolism and several years of medical school and plenty of time advising other* people on how to manage their diets, I was surprised at how poor an intuition I have for the energy density of foods.
For example - hummus. You can eat hella hummus, feel really full and its like, not very much calories. But - granola. Despite its reputation as hippie food, the caloric impact (and glycemic index) is equivalent to eating several crumbled up cookies. Also even if you're like Look at Me I'm Eating a Salad for Lunch! but then you put a shit ton of cheese and nuts and avocados on your salad, it can be the equivalent of eating a pizza. But faced with finite budgeting, it became an exercise in revealing the value of food for me--e.g. I fucking love cheese, nuts and avocados and these taste really good on salad. But granola can suck it. Likewise white rice, which is just a mind boggling calorie sink of tasteless nothingness.
Working out will hopefully also be a big part of this endeavor, but i haven't yet figured out in what way. I have always loved dancing and capoeira and running around in circles for no reason at all, and it is a source of mental health and joy for me. The feeling of blood rushing to my head and the psychological impression of making myself strong and mighty is tremendously satisfying. It is also my experience (and i think documented in many studies) that it also increases my appetite and i am pretty sure i consistently eat more than i burn, so i am not sure it makes much difference in weight. So for now, my exercise activities will continue as they have before--sporadic, for fun & muscle flexing, while i focus on sorting out my meals.
At the end of the day, i love food. It is a source of joy, pleasure, comfort, and a way to commune with others. I do not want to be alienated from this and begin to view it instead as a source of anguish, conflict, or as a barrier to my health and well being. But I think i have already alienated myself from food by slurping it down mindlessly, using it as opiate, inhaling cafeteria breakfast burritos with desperation and flurry. Some of that can't be entirely helped since i have committed to certain goals and a lifestyle (i.e. medical training) that is also a source of meaning and joy. But I hope during the coming months of mostly sitting on my ass and data-analyzing, the Diet will be an exercise in eating more mindfully and thoughtfully.
All such things of course reveal the countours and kinks of my own neuroses as much (more) than of my binge-purge society. Meh, what are you going to do.
My body, its a good piece of work. Its only got 27 years and a couple hundred miles on it. After spending the last several years meticulously reviewing all the horrible possibilities of illness and monstrous betrayals of genetics, I have become tremendously grateful for health, and humbled by how quickly it can and does flit away. (Death, dudes. Its totally going to happen). But so far, a little asthma, a touch of neurosis, minor scratches and a rather unfortunate intolerance of this particularly excellent local brand of hot salsa (I'm sooooooorry everyone who had to sit within a 4 foot radius of me during my impassioned 1 year denial of this, but it was so tasty!) but over all good working parts. Lungs fill up with air, heart pumps, limbs move. My body works hard for me, carrying heavy books, sitting long uncomfortable hours squinting at small writing, listening carefully to heart sounds, staying up for 36 hour call shifts, running to both catch and dodge out of the way of violent muni busses, and above all it lets me dance and cuddle people and other delightful somatic activities. So i want to treat it right and make it happy.
And I do that by giving it unlimited access to burritos and beer.
So Dieting. Why would self denial be a good thing? also i hate being told what to do. Even by me.
Alas, the 19 year old triumphant obliviousness that abuse of one's liver and unlimited pizza binges carries on without consequence, has turned out to be less than fact. Some combination of age, hormones,deriving meals from vending machines, the use of food as an anxiolytic and anti depressant, and exchanging 2 hours daily work outs for an activity regimen that consists mostly of seeing how long i can balance a cereal bowl full of soy milk on my burgeoning belly (more challenging than it appears)--these alas, were also subject to the laws of chemistry and physiology and thus the relentless upward march of BMI.
I still love my body and it continues to work hard for me. Aesthetically I like strong ladies with squishy butts and i am digging my squishy butt. But I envisioned the next five years of call nights and vending machines and the trends of my disappearing waistline, that small detail of a robust family history of diabetes and heart disease, my idle advice to patients to 'just change your diet and eating habits and quit smoking and all your diseases will go away!' And eventually i will not be aesthetically pleased. I will make babies and it will worsen with hypothyroidism. I will be a rotund dumpling*. I will have insulin resistance and osteoarthritis.
*The Sri Lankan body destiny - Sri Lankan women come in 3 basic shapes. The most common is very very very tiny. MIA is a classic example. The second most common is Dumpling - big butt, boobs, hips on a short frame. Good for childbearing and and pretty adorable in aunties and grandmas. Least common but most inspirational is the tall athletic Sri Lankan girl who is a compete badass at basketball.
So. Body. I have been spoiling you. We've got to get you in shape. It will be better in the long run. You will thank me later.
Disclaimer: poetic license allows me to discuss body as third person object but i strongly abhor mind-body dualism.
So i began the Halt the BMI Diet this last Monday (only after an amazing weekend camping trip of gluttony and eating an entire bag of Mother's frosted animal cookies--you know, that shit with sprinkles. Hella good). I am hoping to lose 15 pounds over 16 weeks and then reassess how i feel. I hope that it is modest enough that i can figure out how to adapt it to a long term maintenance approach.
My previous attempts at 'eating healthy' has mostly consisted of vague commitments of 'I will eat some vegetables and less pizza'. Currently I am trying to consume net 1500 calories per day, with 1 day a week where I am off diet. If i eat an entire bag of Mother's frosted animal cookies (hella good) on that one day off, it probably will render the rest of the days moot, but i think this might be an important psychological safety valve and allow for longevity of the task. This week i have not quite succeeded, being on average 150 net calories over. I am keeping track with an overall satisfactory iphone ap Lose It. Generally it is a good ap; a disadvantage is that if you eat a lot of sri lankan, ethiopian, or any non-mainstream food, and you must sort of hodge podge it together based on the ingredients. This tracking alone has been revelatory. Despite a biology degree with extensive study of metabolism and several years of medical school and plenty of time advising other* people on how to manage their diets, I was surprised at how poor an intuition I have for the energy density of foods.
For example - hummus. You can eat hella hummus, feel really full and its like, not very much calories. But - granola. Despite its reputation as hippie food, the caloric impact (and glycemic index) is equivalent to eating several crumbled up cookies. Also even if you're like Look at Me I'm Eating a Salad for Lunch! but then you put a shit ton of cheese and nuts and avocados on your salad, it can be the equivalent of eating a pizza. But faced with finite budgeting, it became an exercise in revealing the value of food for me--e.g. I fucking love cheese, nuts and avocados and these taste really good on salad. But granola can suck it. Likewise white rice, which is just a mind boggling calorie sink of tasteless nothingness.
Working out will hopefully also be a big part of this endeavor, but i haven't yet figured out in what way. I have always loved dancing and capoeira and running around in circles for no reason at all, and it is a source of mental health and joy for me. The feeling of blood rushing to my head and the psychological impression of making myself strong and mighty is tremendously satisfying. It is also my experience (and i think documented in many studies) that it also increases my appetite and i am pretty sure i consistently eat more than i burn, so i am not sure it makes much difference in weight. So for now, my exercise activities will continue as they have before--sporadic, for fun & muscle flexing, while i focus on sorting out my meals.
At the end of the day, i love food. It is a source of joy, pleasure, comfort, and a way to commune with others. I do not want to be alienated from this and begin to view it instead as a source of anguish, conflict, or as a barrier to my health and well being. But I think i have already alienated myself from food by slurping it down mindlessly, using it as opiate, inhaling cafeteria breakfast burritos with desperation and flurry. Some of that can't be entirely helped since i have committed to certain goals and a lifestyle (i.e. medical training) that is also a source of meaning and joy. But I hope during the coming months of mostly sitting on my ass and data-analyzing, the Diet will be an exercise in eating more mindfully and thoughtfully.
Tuesday, June 1, 2010
less money
Due to the fiscal crisis in California, the Office of the Registrar has absorbed reductions in its state-funded budget totalling approximately 29 percent since 2008-09. To avoid reducing essential services, we will increase fees for miscellaneous services such as transcripts and diploma mailing on July 1, 2010. We regret that we must take this action to maintain our services.
Thank you for your understanding.
Sincerely,
Office of the Registrar
Thank you for your understanding.
Sincerely,
Office of the Registrar
Saturday, May 22, 2010
A comparison
Who I would like to picture myself as
Confident, razor witted, curmudgeonly, secretly wise.
with awesome biceps.
Or
Powerful, commanding, seductive.
The boss of stuff.
But mostly i feel
Concerned. Nice. Cutesy. Terrified.
Or bureacratic. Paper tiger. Effete and futile.
But i think, someday, i will learn to flower as myself.
Confident, razor witted, curmudgeonly, secretly wise.
with awesome biceps.
Or
Powerful, commanding, seductive.
The boss of stuff.
But mostly i feel
Concerned. Nice. Cutesy. Terrified.
Or bureacratic. Paper tiger. Effete and futile.
But i think, someday, i will learn to flower as myself.
Friday, May 21, 2010
Things i want a lot but cannot afford
My funding this year is pretty miniscule. And it is coming to my attention that my perpetual hiding in higher education will end one day and i will have loans to pay. A lot of loans. Like, numbers with a great multitude of zeros that follow them. Also that residents don't make much money. (on the other hand since my only other proper jobs have been in cafes, book stores, and grading logic homework, being a resident will be the richest i will have ever been and i am quite excited). Despite this, i have discovered over the last several years that (1) i like nice things (2) that despite what i was otherwise led to believe by Berkeley Bohemia, it can cost quite a bit of resources to experience nice things (time, attention, and money).
Ah, but to live in San Francisco, to be devoted to a great art, to be youngish...so a la Hemingway's Moveable Fest, I will sate my appetite by aromas. To begin, a menu.
Things i desire and cannot afford (in time, attention or money)
1. A haircut
2. To fix Ravelstein the shattered iphone
3. beautiful lingerie
4. a car
5. a parking space to the put the car in
6. a television
7. time to watch a television
8. a knowledge of films
9. a thoughtful fashion sense
10. healthier eating habits
11. regular massages
12. membership to an institution with a sauna
13. children
14. a dog, to watch/herd the children
15. an apartment with a living room
16. a garden
17. a knowledge of Wittgenstein
18. travel to faraway lands and then staying at midrange hotels instead of haggling with broken down hostels with no running water
19. to whisk my sweetie away to a beautiful place with no worries (for a little while)
20. world peace
Ah, but to live in San Francisco, to be devoted to a great art, to be youngish...so a la Hemingway's Moveable Fest, I will sate my appetite by aromas. To begin, a menu.
Things i desire and cannot afford (in time, attention or money)
1. A haircut
2. To fix Ravelstein the shattered iphone
3. beautiful lingerie
4. a car
5. a parking space to the put the car in
6. a television
7. time to watch a television
8. a knowledge of films
9. a thoughtful fashion sense
10. healthier eating habits
11. regular massages
12. membership to an institution with a sauna
13. children
14. a dog, to watch/herd the children
15. an apartment with a living room
16. a garden
17. a knowledge of Wittgenstein
18. travel to faraway lands and then staying at midrange hotels instead of haggling with broken down hostels with no running water
19. to whisk my sweetie away to a beautiful place with no worries (for a little while)
20. world peace
Thursday, May 20, 2010
an overhaul
bc i find it physiologically difficult to study multiple choice questions for more than 10 hours a day, and bc i like to sit in front of my computer instead of engaging in aerobic exercise, and bc i have the time and space to reflect on my training, existence and future (at the expense of you, the taxpayers of California, and me the future loan payer), and above all bc i have a gorgeous sexy new love affair, namely with a shiny 2010 macbookpro (aka Osler's Beast, alas to replace my previous beloved machine, ruthlessly stolen) i am inspired to relaunch a different purpose with my online blathering ("different" as in having one at all).
I am searching now meticulously through examples of other doctor and medical student blogs and finding many good things, to my pleasure and joy. I will hand pick some eventually. for now i will share this from Axis Deviation.
25 Things I Didn't Do Before I Entered Medicine
Wake up before 8am.
Go to sleep after 2am.
Look forward to sleeping nearly every night.
Wear a shirt and tie to work.
Shave more than three times a week.
Stick my finger up peoples' butts.
Ask people how many people they’ve slept with.
Ask men to tell me about their erectile dysfunction.
Ask for men to show me their penis.
Dread seeing vaginas.
Be able to tell police officers what to do (in the hospital, at least).
Talk with police officers.
Talk with prisoners.
Slam the phone on people.
Hate pagers.
Hate anything that beeps.
Drink at home, alone.
Want to drink this much.
Be thankful I am alive.
Hope that certain people would die.
Struggle for money.
Dream of money.
Despise people with money.
Despise people.
Wish I didn't enter medicine.
I am searching now meticulously through examples of other doctor and medical student blogs and finding many good things, to my pleasure and joy. I will hand pick some eventually. for now i will share this from Axis Deviation.
25 Things I Didn't Do Before I Entered Medicine
Wake up before 8am.
Go to sleep after 2am.
Look forward to sleeping nearly every night.
Wear a shirt and tie to work.
Shave more than three times a week.
Stick my finger up peoples' butts.
Ask people how many people they’ve slept with.
Ask men to tell me about their erectile dysfunction.
Ask for men to show me their penis.
Dread seeing vaginas.
Be able to tell police officers what to do (in the hospital, at least).
Talk with police officers.
Talk with prisoners.
Slam the phone on people.
Hate pagers.
Hate anything that beeps.
Drink at home, alone.
Want to drink this much.
Be thankful I am alive.
Hope that certain people would die.
Struggle for money.
Dream of money.
Despise people with money.
Despise people.
Wish I didn't enter medicine.
studying
Studying for the second boards has so far been profoundly different from the first boards. One reason is because i am not also hyperventilating in an attempt to finish and properly format a master's thesis. Yet another is that all these abstract lists of previously nebulous and nonsense strings of fact have profound meaning.
Third year was hard for lots of reasons, not least of which is constantly being surrounded by death, suffering and dramatic events. This is of course the point, as the entire existence of the job depends on people getting run over by cars and having heart attacks. I suppose the training is so long so that after several years of seeing it, instead of weeping and gasping at the sight of hemorrhage or the slow overtake of a human life by a monstrous cancer, as a normal healthy human being should, instead one is competent technician and numb enough to do something useful. Technician in the broadest sense--to be able to insert a swan ganz catheter into the right place to speak and drug away an impending suicide attempt to break devastating news with compassion. All very difficult techniques.
The technique matters. The knowledge matters. The most important thing i did third year i suppose was observe. And the funny thing about having such intense imprinting of the memory given its tremendous affective weight and existential gut kick, is that the most odd facts have seared themselves into my brain. Cocksakie virus is the number one infectious cause of myocarditis = 38 year old man in the ICU, h/o of hodgkin's, heart failure, delayed biopsy, his powerful muscular chest strung with endless tubes and wires, his aghast stoic young wife sits by in pink sweat pants. He dies the next week. Never treat sinus tachycardia= M&M rounds with the senior resident who did precisely that in the midnight transfer, a 32 yo woman decompensating from sepsis, shot up with beta blockers, the resident presents the facts with a steady strong voice, but i see her crying in the hall later. Aminoglycoside nephropathy, serotonin syndrome, cardiac tamponade -- how odd these are, how real, how their string of greek and latin artifice become such moments of terror, anguish...and potential triumph.
the multiple choice test is suddenly a richer, more interesting thing.
Third year was hard for lots of reasons, not least of which is constantly being surrounded by death, suffering and dramatic events. This is of course the point, as the entire existence of the job depends on people getting run over by cars and having heart attacks. I suppose the training is so long so that after several years of seeing it, instead of weeping and gasping at the sight of hemorrhage or the slow overtake of a human life by a monstrous cancer, as a normal healthy human being should, instead one is competent technician and numb enough to do something useful. Technician in the broadest sense--to be able to insert a swan ganz catheter into the right place to speak and drug away an impending suicide attempt to break devastating news with compassion. All very difficult techniques.
The technique matters. The knowledge matters. The most important thing i did third year i suppose was observe. And the funny thing about having such intense imprinting of the memory given its tremendous affective weight and existential gut kick, is that the most odd facts have seared themselves into my brain. Cocksakie virus is the number one infectious cause of myocarditis = 38 year old man in the ICU, h/o of hodgkin's, heart failure, delayed biopsy, his powerful muscular chest strung with endless tubes and wires, his aghast stoic young wife sits by in pink sweat pants. He dies the next week. Never treat sinus tachycardia= M&M rounds with the senior resident who did precisely that in the midnight transfer, a 32 yo woman decompensating from sepsis, shot up with beta blockers, the resident presents the facts with a steady strong voice, but i see her crying in the hall later. Aminoglycoside nephropathy, serotonin syndrome, cardiac tamponade -- how odd these are, how real, how their string of greek and latin artifice become such moments of terror, anguish...and potential triumph.
the multiple choice test is suddenly a richer, more interesting thing.
Friday, May 14, 2010
What to do next
Here are some career fantasies:
(1) Finish medical school
(2) Finish residency
and then?
I think i am in love with HIV. It is too rich, too big. It is horrible, ruthless. It attacks us through our love lives. It is wiping out, has wiped out an entire generation, entire societies. It travels with tuberculosis. It revolutioned immunology. It is a disease of gay men, of Africa, Haiti, of hemophiliacs and children who had no choice.
The glory days of HIV in San Francisco, the sheer terror and fear of a deadly miasma that takes the young and bohemain, the time for great courage, the time of surgeons drenched in poisoned blood, came and went. now the battle is quieter, it is tedious, but it still there. Now it is a battle of pharmaceutical patents and global distribution of testing equipment, of chipping away at lymphoma and heightened rates of diabetes and salvaging kidneys in old age.
So then. what would i do? get work. Begin working.
(1) Finish medical school
(2) Finish residency
and then?
I think i am in love with HIV. It is too rich, too big. It is horrible, ruthless. It attacks us through our love lives. It is wiping out, has wiped out an entire generation, entire societies. It travels with tuberculosis. It revolutioned immunology. It is a disease of gay men, of Africa, Haiti, of hemophiliacs and children who had no choice.
The glory days of HIV in San Francisco, the sheer terror and fear of a deadly miasma that takes the young and bohemain, the time for great courage, the time of surgeons drenched in poisoned blood, came and went. now the battle is quieter, it is tedious, but it still there. Now it is a battle of pharmaceutical patents and global distribution of testing equipment, of chipping away at lymphoma and heightened rates of diabetes and salvaging kidneys in old age.
So then. what would i do? get work. Begin working.
Monday, May 10, 2010
A new oath
A few weekends ago, i went to a day long retreat of medical students in some nearby forest. I joked it was a hippie get away for medical types. Indeed, we arrived at an old building embedded in a bay area secluded forest, decorated with healing wheels and crystals and our facilitators were gentle and soft spoken. But the building in its regular life most often hosted retreats for those dying of cancer. And our facilitators were a palliative care physician and nurse, whose daily work was in hospice, in guiding fellow humans to their end of day, ensuring that foley catheters were functioning and that morphine was sufficient; but also that people might die with dignity in the company of those with compassion and humility in the face of the greatest abyss.
I went because i was hurting, hurting for myself, i knew that car ride through winding Hwy 1 with my classmates would be therapy i was desperately thirsty for, to salve the hurt that was mostly in my ego. I had finished my clerkship year of medical school and the year previous that had careened wildly through my master's write up. I was exhausted, overstimulated, and felt desperately inadequate. I spent the year in a fishbowl, perpetually under evaluation, and i in turn watched the patients in another embedded fishbowl, while they did godless things, like bleed, give birth, suffer, die, come to life again. An onslaught of human triumph and tragedy and very little sleep in between. I felt shattered and confused. I felt alone.
I cannot describe all the beautiful things about that day amid the quiet trees and these other people winding through their own journey. But i was salvaged indeed, and i was glad to work again. A nice exercise we did towards the end was make our own sort of Hippocratic oath, which was then sort of edited together. I found it very moving, that these future surgeons and emergency room docs and psychiatrists and general practititioners (some to be interned as soon as June) were so soulful, and i was inspired by their passion for their work. Here is are some snippets, as well as the collected oath we formed:
Personal MISSION STATEMENTS
v v v
Help me to approach every patient with patience, even if I am exhausted and overworked.
Guide me to remain sincere, sensitive, and humanistic in my practice despite how many patients with similar presentations I have seen
v v v
Help me let go of fears, prejudices and distractions, so that I can be truly present with patients
Help me apply technical skills within the context of trust and compassion
Help me make decisions that support healing of the whole patient, and not merely fixing of parts
v v v
May my work be an artistic expression
May it be a practice of grace
May it be a movement of justice
May my work be a dance towards self
May it be a reflective reading of the poetic prose of human experience
v v v
Help me to listen—to hear the story, to understand what is being asked
Help me to see—to observe carefully and unveil the truth
Give me the knowledge and patience to teach so that the people I care for can care for themselves and others
Help me to touch—to feel, to discover but also to mend and reassure
Teach me to find and share peace in the face of sickness, death and life
v v v
Help me to hear with my mind and heart
Help me to stand in power
Help me to remain compassionate, present and invested
Give me strength to know when to keep going and when to stop
v v v
Help me to care for myself as I care for others
Guide me as I develop wisdom to go along with knowledge
v v v
Help me to be courageous in walking with patients in their suffering
Help me to serve with relentless hope and compassion
Help me to be confident and authentic in who I am as a physician
Help me to be innovative in how I provide care
v v v
Hold me long enough so I know I can stay or go anytime
Keep my eyes open to that moment when patients are ready to really feel what is going on
Calm me
Remind me that I always can choose
v v v
Collective:
Guide me to remain sincere, sensitive, and humanistic in my practice despite how many patients with similar presentations I have seen
Help me let go of fears, prejudices and distractions, so that I can be truly present with patients
May it be a reflective reading of the poetic prose of human experience
Give me the knowledge and patience to teach so that the people I care for can care for themselves and others
Remember to always be present, honest, and human
Help me to hear with my mind and heart
Guide me towards balance professionally and personally
Help me to be present to each person I encounter, with humanity
Help me to be confident and authentic in who I am as a physician
Calm me.
I went because i was hurting, hurting for myself, i knew that car ride through winding Hwy 1 with my classmates would be therapy i was desperately thirsty for, to salve the hurt that was mostly in my ego. I had finished my clerkship year of medical school and the year previous that had careened wildly through my master's write up. I was exhausted, overstimulated, and felt desperately inadequate. I spent the year in a fishbowl, perpetually under evaluation, and i in turn watched the patients in another embedded fishbowl, while they did godless things, like bleed, give birth, suffer, die, come to life again. An onslaught of human triumph and tragedy and very little sleep in between. I felt shattered and confused. I felt alone.
I cannot describe all the beautiful things about that day amid the quiet trees and these other people winding through their own journey. But i was salvaged indeed, and i was glad to work again. A nice exercise we did towards the end was make our own sort of Hippocratic oath, which was then sort of edited together. I found it very moving, that these future surgeons and emergency room docs and psychiatrists and general practititioners (some to be interned as soon as June) were so soulful, and i was inspired by their passion for their work. Here is are some snippets, as well as the collected oath we formed:
Personal MISSION STATEMENTS
v v v
Help me to approach every patient with patience, even if I am exhausted and overworked.
Guide me to remain sincere, sensitive, and humanistic in my practice despite how many patients with similar presentations I have seen
v v v
Help me let go of fears, prejudices and distractions, so that I can be truly present with patients
Help me apply technical skills within the context of trust and compassion
Help me make decisions that support healing of the whole patient, and not merely fixing of parts
v v v
May my work be an artistic expression
May it be a practice of grace
May it be a movement of justice
May my work be a dance towards self
May it be a reflective reading of the poetic prose of human experience
v v v
Help me to listen—to hear the story, to understand what is being asked
Help me to see—to observe carefully and unveil the truth
Give me the knowledge and patience to teach so that the people I care for can care for themselves and others
Help me to touch—to feel, to discover but also to mend and reassure
Teach me to find and share peace in the face of sickness, death and life
v v v
Help me to hear with my mind and heart
Help me to stand in power
Help me to remain compassionate, present and invested
Give me strength to know when to keep going and when to stop
v v v
Help me to care for myself as I care for others
Guide me as I develop wisdom to go along with knowledge
v v v
Help me to be courageous in walking with patients in their suffering
Help me to serve with relentless hope and compassion
Help me to be confident and authentic in who I am as a physician
Help me to be innovative in how I provide care
v v v
Hold me long enough so I know I can stay or go anytime
Keep my eyes open to that moment when patients are ready to really feel what is going on
Calm me
Remind me that I always can choose
v v v
Collective:
Guide me to remain sincere, sensitive, and humanistic in my practice despite how many patients with similar presentations I have seen
Help me let go of fears, prejudices and distractions, so that I can be truly present with patients
May it be a reflective reading of the poetic prose of human experience
Give me the knowledge and patience to teach so that the people I care for can care for themselves and others
Remember to always be present, honest, and human
Help me to hear with my mind and heart
Guide me towards balance professionally and personally
Help me to be present to each person I encounter, with humanity
Help me to be confident and authentic in who I am as a physician
Calm me.
Sunday, May 9, 2010
Monday, April 26, 2010
Dude! Bruce Lee! Dude!
One of my life long idols is my grandfather. He was a school teacher, had a master's of fine arts, was handsome, loved by the ladies, a fellow of virtue and known to win all the fights in his youth. He owned a motorcycle. And his hero? Bruce Lee.
It cannot be overemphasizedd how cool Bruce Lee is. He is so cool!
This guy was phenomenal. Who on earth has been fitter? here is a listing of his feats:
Lee's striking speed from three feet with his hands down by his side reached five hundredths of a second.
Lee could take in one arm a 75 lb barbell from a standing position with the barbell held flush against his chest and slowly stick his arms out locking them, holding the barbell there for 20 seconds.
Lee's combat movements were at times too fast to be captured on film for clear slow motion replay using the traditional 24 frames per second of that era, so many scenes were shot in 32 frames per second for better clarity.
In a speed demonstration, Lee could snatch a dime off a person's open palm before they could close it, and leave a penny behind.
Lee would hold an elevated v-sit position for 30 minutes or longer.
Lee could throw grains of rice up into the air and then catch them in mid-flight using chopsticks.
Lee could thrust his fingers through unopened cans of Coca-Cola. (This was when soft drinks cans were made of steel much thicker than today's aluminum cans).
Lee performed one-hand push-ups using only the thumb and index finger.
Lee performed 50 reps of one-arm chin-ups.
Lee could break wooden boards 6 inches (15 cm) thick.
Lee could cause a 200-lb (90.72 kg) bag to fly towards and thump the ceiling with a sidekick.
Lee performed a sidekick while training with James Coburn and broke a 150 lb (68 kg) punching bag.
In a move that has been dubbed "Dragon Flag", Lee could perform leg lifts with only his shoulder blades resting on the edge of a bench and suspend his legs and torso horizontal midair.
A. Badass. Motherfucker.
That's really all I have to say.
.
It cannot be overemphasizedd how cool Bruce Lee is. He is so cool!
This guy was phenomenal. Who on earth has been fitter? here is a listing of his feats:
Lee's striking speed from three feet with his hands down by his side reached five hundredths of a second.
Lee could take in one arm a 75 lb barbell from a standing position with the barbell held flush against his chest and slowly stick his arms out locking them, holding the barbell there for 20 seconds.
Lee's combat movements were at times too fast to be captured on film for clear slow motion replay using the traditional 24 frames per second of that era, so many scenes were shot in 32 frames per second for better clarity.
In a speed demonstration, Lee could snatch a dime off a person's open palm before they could close it, and leave a penny behind.
Lee would hold an elevated v-sit position for 30 minutes or longer.
Lee could throw grains of rice up into the air and then catch them in mid-flight using chopsticks.
Lee could thrust his fingers through unopened cans of Coca-Cola. (This was when soft drinks cans were made of steel much thicker than today's aluminum cans).
Lee performed one-hand push-ups using only the thumb and index finger.
Lee performed 50 reps of one-arm chin-ups.
Lee could break wooden boards 6 inches (15 cm) thick.
Lee could cause a 200-lb (90.72 kg) bag to fly towards and thump the ceiling with a sidekick.
Lee performed a sidekick while training with James Coburn and broke a 150 lb (68 kg) punching bag.
In a move that has been dubbed "Dragon Flag", Lee could perform leg lifts with only his shoulder blades resting on the edge of a bench and suspend his legs and torso horizontal midair.
A. Badass. Motherfucker.
That's really all I have to say.
.
Summary points of health care reform
A nice summary
(1) Expands coverage to about 33 million people by 2014 (50% private, 50% public support); 95% eligible Americans would be covered: 83% now
(2) Does this by a combination of expanding Medicaid coverage, mandating that all individuals be covered (with certain exemptions), and mandating that private businesses cover workers for firms with >200 employees (WalMart issue)
(3) Estimated costs of $965 billion/10 years
(4) Pays for expansion by combination of increased revenues and cost containment
(5) Lets states create insurance exchanges to broaden and cheapen insurance options for those not covered
(6) Extensive and income-adjusted subsidies for low income families
(7) Penalizes employers that don’t provide coverage
(8) Expands Medicaid coverage to all under 65 population with incomes <133% of Federal Poverty Level
(9) Require states to maintain CHIP thru 2015
(10) Increases taxes on high income persons, beginning 2011
(11) Cracks down on Medical Savings Accounts, “Cadillac insurance plans” and Medicare Advantage Plans (to get new coverage $)
(12) Some charges to health insurance plans and pharma
(13) Health insurance reform
--Eliminates preexisting conditions
--Jawbones insurance plans re “loss ratio” (>85%)
--Kids can stay on parents’ plans until age 26
--Eliminates lifetime expenditure caps
--Covers prevention services
--Gradually closes the doughnut hole for Medicare Part D
From Steven A. Schroeder, MD from talk: Revisiting American Health Policy: Why Change Comes so Hard
(1) Expands coverage to about 33 million people by 2014 (50% private, 50% public support); 95% eligible Americans would be covered: 83% now
(2) Does this by a combination of expanding Medicaid coverage, mandating that all individuals be covered (with certain exemptions), and mandating that private businesses cover workers for firms with >200 employees (WalMart issue)
(3) Estimated costs of $965 billion/10 years
(4) Pays for expansion by combination of increased revenues and cost containment
(5) Lets states create insurance exchanges to broaden and cheapen insurance options for those not covered
(6) Extensive and income-adjusted subsidies for low income families
(7) Penalizes employers that don’t provide coverage
(8) Expands Medicaid coverage to all under 65 population with incomes <133% of Federal Poverty Level
(9) Require states to maintain CHIP thru 2015
(10) Increases taxes on high income persons, beginning 2011
(11) Cracks down on Medical Savings Accounts, “Cadillac insurance plans” and Medicare Advantage Plans (to get new coverage $)
(12) Some charges to health insurance plans and pharma
(13) Health insurance reform
--Eliminates preexisting conditions
--Jawbones insurance plans re “loss ratio” (>85%)
--Kids can stay on parents’ plans until age 26
--Eliminates lifetime expenditure caps
--Covers prevention services
--Gradually closes the doughnut hole for Medicare Part D
From Steven A. Schroeder, MD from talk: Revisiting American Health Policy: Why Change Comes so Hard
Thursday, April 22, 2010
A great distance
"You cannot be a happy go lucky stoner and be a resident at the same time," a beloved friend chides. He is still himself but there is the intern's fatigue about him.
I am looking at this website: http://bohememusings.blogspot.com/
Although the young woman is much more stylish than i ever had much inclination to, her prattlings about cake and prettiness are eerily similar the sort of thing that filled my journals at 22, with the additional insouciant reference to Heidegger or LSD or some other nonsense. I read it now with marvel and a feeling of...coldness, such creatures exist? such beauty, such frivolity, imperviousness to the misery and blood and shit of this world? I suppose they are called young women.
So is it really med school that has numbed it all up, or is the inevitable revelation of decay?
The only constancy appears to be cake. I suppose the beauty persists, pervades, moves and seeps from lace and plastic bangles, to the detritus of daily life.
I am looking at this website: http://bohememusings.blogspot.com/
Although the young woman is much more stylish than i ever had much inclination to, her prattlings about cake and prettiness are eerily similar the sort of thing that filled my journals at 22, with the additional insouciant reference to Heidegger or LSD or some other nonsense. I read it now with marvel and a feeling of...coldness, such creatures exist? such beauty, such frivolity, imperviousness to the misery and blood and shit of this world? I suppose they are called young women.
So is it really med school that has numbed it all up, or is the inevitable revelation of decay?
The only constancy appears to be cake. I suppose the beauty persists, pervades, moves and seeps from lace and plastic bangles, to the detritus of daily life.
Monday, April 19, 2010
Tomorrow we begin again
k. its a Nike commercial. But u know, its good. i like it.
Sometimes you need a soundtrack.
Sometimes you need a soundtrack.
Saturday, April 17, 2010
The swirling inside
Fascinating
The B.N.P. says it stands for many things, but chief among them is an implacable belief that Britain belongs to indigenous white Britons. Until a judge struck down the provision last month, the party had a whites-only membership policy. It favors an immediate end to immigration and the repatriation of people of foreign descent.
In 2006, the party won 12 of the 51 seats on the Barking and Dagenham Council, its strongest showing anywhere in the country. This time, it hopes to secure 14 more seats, enough to take control of the council, its 300 million pound annual budget and its 9,300 employees...
“I’m not a racist, but they’re letting so many of them in,” complained Bill Greed, 66, speaking of foreigners. “They come and sign on for benefits. A lot of the children in schools don’t even speak English. There’s so many illegal ones that the government can’t even find all of them.”
The B.N.P.? “I agree with what they’re saying, but not with how they go about it,” Mr. Greed said.
Mick W., a 20-year-old maintenance worker who did not want to give his last name because he is employed by the Borough Council, said his family waited a decade for decent public housing while immigrants with large families leapfrogged ahead.“I don’t mind the ones who come and get a job,” he said, “but all they do is claim, claim, claim.”
From NY TimesVoters’ Concerns on Immigration Spin British Campaign
And i think i understand this. I can empathize, this cautiously worded frustration of one's own neighborhood, limited resources now distributed over larger denominators of outsiders. And surely here, in this other land, we are all immigrants, and a little bit self conscious no, of what we are taking, no?
And yet. And yet .What is it, the berkeley education, perhaps? And yet, i, the devoted anglophile, who gazed longingly at the filthy Thames as a child and heart swelled with utter love for the gilded smoggy face of the London towers and curls up at night with Bertrand Russell, who thinks affectionately of all things british, fetishist of Newton and tweed and has been thoroughly chained and colonized in the English language to obliteration of whatever tropical deviance there might have once been...a great snarling rises and says Shut the Fuck Up. The gold on your clock faces is from the mines of brown nations, you have built your empire with guns, your delicate tea cups are filled with the sweat of my distant grandparents, you deliberately incited war and broke the backs of millions to build a wealth the world had heretofore never seen and now you grumble when the gates break down.
But this is not fair of course. All of the wealth did not go to the Barking burroughs. And the english were very good at abusing those within their society as well as those in distant lands. And here i am, a plump little fruit of colonization, enjoying a saturday morning in the distant protestant bastion of California, drinking coffee from columbia and pasteurized milk. The sins of our fathers can so quickly dissolve in the crisscrossing lines.
The B.N.P. says it stands for many things, but chief among them is an implacable belief that Britain belongs to indigenous white Britons. Until a judge struck down the provision last month, the party had a whites-only membership policy. It favors an immediate end to immigration and the repatriation of people of foreign descent.
In 2006, the party won 12 of the 51 seats on the Barking and Dagenham Council, its strongest showing anywhere in the country. This time, it hopes to secure 14 more seats, enough to take control of the council, its 300 million pound annual budget and its 9,300 employees...
“I’m not a racist, but they’re letting so many of them in,” complained Bill Greed, 66, speaking of foreigners. “They come and sign on for benefits. A lot of the children in schools don’t even speak English. There’s so many illegal ones that the government can’t even find all of them.”
The B.N.P.? “I agree with what they’re saying, but not with how they go about it,” Mr. Greed said.
Mick W., a 20-year-old maintenance worker who did not want to give his last name because he is employed by the Borough Council, said his family waited a decade for decent public housing while immigrants with large families leapfrogged ahead.“I don’t mind the ones who come and get a job,” he said, “but all they do is claim, claim, claim.”
From NY TimesVoters’ Concerns on Immigration Spin British Campaign
And i think i understand this. I can empathize, this cautiously worded frustration of one's own neighborhood, limited resources now distributed over larger denominators of outsiders. And surely here, in this other land, we are all immigrants, and a little bit self conscious no, of what we are taking, no?
And yet. And yet .What is it, the berkeley education, perhaps? And yet, i, the devoted anglophile, who gazed longingly at the filthy Thames as a child and heart swelled with utter love for the gilded smoggy face of the London towers and curls up at night with Bertrand Russell, who thinks affectionately of all things british, fetishist of Newton and tweed and has been thoroughly chained and colonized in the English language to obliteration of whatever tropical deviance there might have once been...a great snarling rises and says Shut the Fuck Up. The gold on your clock faces is from the mines of brown nations, you have built your empire with guns, your delicate tea cups are filled with the sweat of my distant grandparents, you deliberately incited war and broke the backs of millions to build a wealth the world had heretofore never seen and now you grumble when the gates break down.
But this is not fair of course. All of the wealth did not go to the Barking burroughs. And the english were very good at abusing those within their society as well as those in distant lands. And here i am, a plump little fruit of colonization, enjoying a saturday morning in the distant protestant bastion of California, drinking coffee from columbia and pasteurized milk. The sins of our fathers can so quickly dissolve in the crisscrossing lines.
Wednesday, April 14, 2010
Conveying the Art
Junior Physician: "How did you get such good judgement?"
Senior Physician: "Good experience."
(Long Pause)
Junior Physician: "How did you get such good experience?"
Senior Physician: "Bad judgement."
Senior Physician: "Good experience."
(Long Pause)
Junior Physician: "How did you get such good experience?"
Senior Physician: "Bad judgement."
Tuesday, April 13, 2010
The One to Blame
Describing the path of medical training (or most schedules of work in American society) the notion of working 90 hours a week (benevolently reduced from the previously typical 120 hours) or showing up to work 6 am Monday morning and leaving at 2 pm on Tuesday morning, and all the while handling several sharp objects, toxic medications, and various tubes jammed into the actual veins and bowels of very ill fellow human beings--well its all sort of odd. Doctors in training are of course made of the very same veins and bowels, and have those same pesky requirements of other mammals, namely sleep, food, and the occasion to stop standing. In the medical profession such inconveniences are consoled by profusely attending/manipulating those other* needs of social mammals: acceptance, hierarchy, self importance and a good boy! pat on the head.
It all seemed very strange and i like most sensible people (including Congress) was skeptical of this tradition. [j/k neither I nor Congress nor most people are very sensible at all, but it is no less a reasonable stance]. I was then very shocked to realize the origin of this barbaric method of training that seemed oblivious to the triumphs of industrial society and the invention of the weekend, was invented by no other than my long hero, the pathologist and great teacher, Dr. William Osler.
"Perhaps Osler's greatest contribution to medicine was to insist that students learned from seeing and talking to patients and the establishment of the medical residency. This latter idea spread across the English-speaking world and remains in place today in most teaching hospitals. Through this system, doctors in training make up much of a hospital's medical staff. The success of his residency system depended, in large part, on its pyramidal structure with many interns, fewer assistant residents and a single chief resident, who originally occupied that position for years. While at Hopkins Osler established the full-time, sleep-in residency system whereby staff physicians lived in the Administration Building of the Hospital. As established, the residency was open-ended, and long tenure was the rule. Doctors spent as long as seven or eight years as residents, during which time they led a restricted, almost monastic life.
He liked to say, "He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all." He is also remembered for saying, "If you listen carefully to the patient they will tell you the diagnosis" which emphasises the importance of taking a good history.
The contribution to medical education of which he was proudest was his idea of clinical clerkship — having third- and fourth-year students work with patients on the wards. He pioneered the practice of bedside teaching making rounds with a handful of students, demonstrating what one student referred to as his method of "incomparably thorough physical examination." Soon after arriving in Baltimore Osler insisted that his medical students attend at bedside early in their training: by their third year they were taking patient histories, performing physicals and doing lab tests examining secretions, blood and excreta.
He diminished the role of didactic lectures and once said he hoped his tombstone would say only, "He brought medical students into the wards for bedside teaching." He also said, "I desire no other epitaph … than the statement that I taught medical students in the wards, as I regard this as by far the most useful and important work I have been called upon to do." Osler fundamentally changed medical teaching in the United States, and his influence spread to medical schools across the globe."
Monday, April 12, 2010
The prisoner in every man
"It is generally thought that common-sense is practical. It is practical only in a short-term view. Common-sense declares that it is foolish to bite the hand that feeds you. But it is foolish only up to the moment when you realize that you might be fed very much better. In the long-term view common-sense is passive because it is based on the acceptance of an outdated view of the possible. The body of common0sense has to accrue too slowly. All its propositions have to be proved so many times before they can become unquestionable, i.e. traditional. When they become traditional they gain oracular authority. Hence the strong element of superstition always evident in 'practical' common-sense.
"Common-sense is part of the home-made ideology of those who have been deprived of fundamental learning, of those who have been kept ignorant. This ideology is compounded from different sources: items that have survived from religion, items of empirical knowledge, items of protective skepticism, items culled for comfort from the superficial learning that is* supplied. But the point is that common-sense can never teach itself, can never advance beyond its own limits, for as soon as the lack of fundamental learning has been made good, all items become questionable and the whole function of common-sense is destroyed. Common-sense can only exist as a category insofar as it can be distinguished from the spirit of enquiry, from philosophy.
"Common-sense is essentially static. It belongs to the ideology, of those who are socially passive, never understanding what or who has made their situation as it is. But it represents only a part--and often a small part--of their character. These same poeple say or do many things which are an affront to their own common-sense. And whent hey justify something by saying 'It's only common-sense', this is frequently an apology for denying or betraying some of their deepest feelings or instincts...
"There is another reason why they sense that Sassall's way of thinking is a privilege, but as a reason it is less rational. Once it might have been considered magical. He confesses to fear without fear. He finds all impulses natural--or understandable. He remembers what it is like to be a child. He has no respect for any title as such. He can enter into other people's dreams or nightmares. He can lose his temper and then talk about the true reasons, as opposed to the excuse, for why he did so. His ability to do such things connect him with aspects of experience which have to do be either ignored or denied by common-sense. Thus his 'license ' challenges the prisoner in every one of his listeners."
From John Berger, "A Fortunate Man"
"Common-sense is part of the home-made ideology of those who have been deprived of fundamental learning, of those who have been kept ignorant. This ideology is compounded from different sources: items that have survived from religion, items of empirical knowledge, items of protective skepticism, items culled for comfort from the superficial learning that is* supplied. But the point is that common-sense can never teach itself, can never advance beyond its own limits, for as soon as the lack of fundamental learning has been made good, all items become questionable and the whole function of common-sense is destroyed. Common-sense can only exist as a category insofar as it can be distinguished from the spirit of enquiry, from philosophy.
"Common-sense is essentially static. It belongs to the ideology, of those who are socially passive, never understanding what or who has made their situation as it is. But it represents only a part--and often a small part--of their character. These same poeple say or do many things which are an affront to their own common-sense. And whent hey justify something by saying 'It's only common-sense', this is frequently an apology for denying or betraying some of their deepest feelings or instincts...
"There is another reason why they sense that Sassall's way of thinking is a privilege, but as a reason it is less rational. Once it might have been considered magical. He confesses to fear without fear. He finds all impulses natural--or understandable. He remembers what it is like to be a child. He has no respect for any title as such. He can enter into other people's dreams or nightmares. He can lose his temper and then talk about the true reasons, as opposed to the excuse, for why he did so. His ability to do such things connect him with aspects of experience which have to do be either ignored or denied by common-sense. Thus his 'license ' challenges the prisoner in every one of his listeners."
From John Berger, "A Fortunate Man"
Sunday, April 4, 2010
On Primary Care
I think the appeal of primary care which i didn't appreciate until i saw patients have really bad or no primary care is that it appeals to the editor in people. The power of the word is not the word itself, but like sculpture, all the words removed. Like the good news story with impeccably gathered facts, the complicated patient has a million and one rabbit holes to be lost in, and sometimes they are worth pursuing with full investigative and management gear on. But sometimes not, and if you let all the jumble sit there as it is, you lose the point all together. And so it becomes the fine art of editing--reducing medications, streamlining self care plans, construing an elegant model of health that engages the patient, yourself and all the other people invested in this person's well being. Medicine has always prided itself in the elegance and cleverness of its diagnostics, but it seems to me (at least in American medicine) this idea of the elegant therapeutics is still relatively new (perhaps the Cubans have long been far ahead?), what with the forced hand by economic factors and the revelation that you can't put 80 year old people on 27 different medications and think thats going to be totally innocuous.
Wednesday, March 24, 2010
I have been think about it like this
I used to think that I was a hard worker. But I am pretty sure i have never worked as hard as i have worked for the last two years. And the realization that i will work even harder in the future is very frightening. And the reflection that there are people all over the world who work even harder than this and are less rewarded, and less comfortable--this is humbling. But then, it makes me feel, maybe we are all in this together. And then the work has meaning, and the hardness has meaning. And purpose, this feels good.
Thursday, March 11, 2010
The Immortal life of Henrietta Lacks
I still can't believe how amazing this is.
The Immortal Life of Henrietta Lacks (aka HeLa): The history and ethics of research on human biological materials
Henrietta Lacks, known to scientists as HeLa, was a poor Southern tobacco farmer who worked the same land as her slave ancestors, yet her cells—taken without her knowledge—became one of the most important tools in medicine. The first “immortal” human cells grown in culture, they are still alive today, though she has been dead for more than sixty years. If you could pile all HeLa cells ever grown onto a scale, they’d weigh more than 50 million metric tons—as much as a hundred Empire State Buildings. HeLa cells were vital for developing the polio vaccine; uncovered secrets of cancer, viruses, and the effects of the atom bomb; helped lead to important advances like in vitro fertilization, cloning, and gene mapping; and have been bought and sold by the billions—yet Henrietta Lacks remains virtually unknown, buried in an unmarked grave.
Henrietta’s family did not learn of her “immortality” until more than twenty years after her death, when scientists investigating HeLa began using her husband and children in research without informed consent. And though the cells had launched a multimillion-dollar industry that sells human biological materials, her family never saw any of the profits. The story of the Lacks family—past and present—is inextricably connected to the dark history of experimentation on African Americans, the birth of bioethics, and the legal battles over whether we control the stuff we are made of. For more information, visit www.rebeccaskloot.com
§ See a full description of the book here: http://www.rebeccaskloot.com.
§ Also see the author's blog to learn more about the book and the author’s approach.
§ Listen to Ms. Skloot's interviews on NPR's on Fresh Air and Science Friday.
§ The New York Times featured the book here and reviewed it here.
§ Read an excerpt from the book here.
The Immortal Life of Henrietta Lacks (aka HeLa): The history and ethics of research on human biological materials
Henrietta Lacks, known to scientists as HeLa, was a poor Southern tobacco farmer who worked the same land as her slave ancestors, yet her cells—taken without her knowledge—became one of the most important tools in medicine. The first “immortal” human cells grown in culture, they are still alive today, though she has been dead for more than sixty years. If you could pile all HeLa cells ever grown onto a scale, they’d weigh more than 50 million metric tons—as much as a hundred Empire State Buildings. HeLa cells were vital for developing the polio vaccine; uncovered secrets of cancer, viruses, and the effects of the atom bomb; helped lead to important advances like in vitro fertilization, cloning, and gene mapping; and have been bought and sold by the billions—yet Henrietta Lacks remains virtually unknown, buried in an unmarked grave.
Henrietta’s family did not learn of her “immortality” until more than twenty years after her death, when scientists investigating HeLa began using her husband and children in research without informed consent. And though the cells had launched a multimillion-dollar industry that sells human biological materials, her family never saw any of the profits. The story of the Lacks family—past and present—is inextricably connected to the dark history of experimentation on African Americans, the birth of bioethics, and the legal battles over whether we control the stuff we are made of. For more information, visit www.rebeccaskloot.com
§ See a full description of the book here: http://www.rebeccaskloot.com.
§ Also see the author's blog to learn more about the book and the author’s approach.
§ Listen to Ms. Skloot's interviews on NPR's on Fresh Air and Science Friday.
§ The New York Times featured the book here and reviewed it here.
§ Read an excerpt from the book here.
Sunday, February 28, 2010
Summary of things that were fun in fresno
Things i did
(1) getting to know classmates
(2) driving, easy parking
(3) Stay in a Victorian bed and breakfast in Reedley, CA
(4) drive up a mountain in Kings Canyon National Park (even if it was too snowy and i couldn't go further without snow tires)
(5) Thrift stores in Reedley, ca (excellent selection)
(6) The Tower District: thrift stores, antique stores, cafes, book stores that are never open, la boheme de Fresno
(7) Eat Ribs at Famous Dave's
(8) Basque food (apparently there is a very old Basque community in Fresno)
(9) Write some haikus
(10) Go to Target a lot
Things i wish i did
(1) Go to Yosemite
(2) Go to flea markets and farmer's market
(3) Go to the hmong war memorial
(4) Go the public library to learn more about local sites and history
(5) Go to the underground gardens (http://www.undergroundgardens.info/Tours.html)
(6) Drink more
(7) camp in the foothills
(8) practice Spanish
(9) succeed in finding the local capoeira group
(10) visit an evangelical mega-church
Some resources
Fresno Famous: http://www.fresnofamous.com/node/90
NY Times travel: http://travel2.nytimes.com/2006/05/05/travel/escapes/05hours.html
(1) getting to know classmates
(2) driving, easy parking
(3) Stay in a Victorian bed and breakfast in Reedley, CA
(4) drive up a mountain in Kings Canyon National Park (even if it was too snowy and i couldn't go further without snow tires)
(5) Thrift stores in Reedley, ca (excellent selection)
(6) The Tower District: thrift stores, antique stores, cafes, book stores that are never open, la boheme de Fresno
(7) Eat Ribs at Famous Dave's
(8) Basque food (apparently there is a very old Basque community in Fresno)
(9) Write some haikus
(10) Go to Target a lot
Things i wish i did
(1) Go to Yosemite
(2) Go to flea markets and farmer's market
(3) Go to the hmong war memorial
(4) Go the public library to learn more about local sites and history
(5) Go to the underground gardens (http://www.undergroundgardens.info/Tours.html)
(6) Drink more
(7) camp in the foothills
(8) practice Spanish
(9) succeed in finding the local capoeira group
(10) visit an evangelical mega-church
Some resources
Fresno Famous: http://www.fresnofamous.com/node/90
NY Times travel: http://travel2.nytimes.com/2006/05/05/travel/escapes/05hours.html
Saturday, February 27, 2010
Goodbye, Fres-YES
I am the last remaining person at the med student compound. Outside it is raining heavily and there is the eerie central valley fog that is as mighty as anything that has rolled over the Pacific to devour San Francisco, but much creepier because, where does it come from? It settles from the sky, rises from the ground, and i am in a hidden forgotten land. A land rife with every known restaurant chain store known to man, but hidden no less.
7 weeks of my training in neruology and psychiatry in these rich agricultural lands have been completed. I have been here before, i know i saw such a small thin slice of this world. But like most natural phenomonon each slice and sub slice contains an infinity of complexity as well as paperwork.
In reflection, i have learned to improve my neurological exam and psychiatric assessment. I can consistently elicit a brachioradialis reflex, i can better judge intent for suicidality, i can recognize emergency overdoses of anticonvulsants, antipsychotics and anti depressants, and what to do (in theory) for status epilectus (but in fact, i would probably hyperventilate and hide behind a resident, shouting "ATIVAn"). In fact, most problems appear to be addressed with ativan, and very bad ones with ativan and haldol. I know the procedure for legally hospitalizing someone in a psychiatric facility against their will.
More broadly i have watched the pain of veterans, and feel greater empathy for the jingoism of Red America. Warriors, willing and unwilling alike, appear to be made of the same stuff of everyone else, mostly fragile human flesh, including the fragile souls--neurotransmitters and all. Their mangled limbs and head trauma, their PTSD and alcoholism, sprung from World War II, from last year in Afghanistan. A few were never put back together again. And those for whom the wars was the good times, and it was a life time of hard manual labor, that was what relentlessly ripped away at their nerves and tendons their might sinews now collapsing at age 55, the oxes and mighty bears of our society now cringing from perpetual pain, and the betrayal of their lungs and heart. Young and old, all men, used up by and for our ferocious society. The ones that were ok--well they had wives. Wives of fragile flesh, frail and leathered, tediously listing their husband's medications, heartily wheeling his obese body through narrow halls, observing his forgetfullness, his saddness, his incontinence that he was too ashamed to describe himself. We discuss this amid the aging creeking VA halls, plastered with mighty photographs of bomber jets, flags, the president's picture. Perhaps this is the greatest therapy of all. The reminder that the pain and sacrifice had meaning. That these were the glories of battle wounds, and not the mere decrepitude assigned to all mortals.
And i have watched the coldness of hospitals, and i have shamefully relished it. The clinic, the clinical, the analysis of the most devastating tragedies. So you want to kill yourself? Tell me about that. So you are on dialysis and you are afraid to die? So you are 30, beautiful, strong, smart and suddenly woke up with hemiparalysis and been diagnosed with HIV this morning? So you have 48% Total Body Surface Area burns and face multiple operations? So during your entire childhood you were sexually abused brutally and your family refused to help you? So all your children died in this automobile accident that has also completely mangled you? So you have lost your job, your wife, the vision in your left eye due to diabetes and are now impotent? So you have a few months to live from your metastatic cancer? So you are afraid of death and pain and loss?
How does that make you feel?
Yes you can ask these things while looking people in the eye. Sometimes, you might even help.
In the city of Fresno, there many daily triumphs and tragedies. On the final day a shoot out between cops and a rural compound brings down 3 officers and fills the ICUs wall to wall with red eyed cops and their devastated partners, children, brothers, sisters. But you walk out again from the front doors and you believe like everyone else beyond those walls, that you will live forever.
7 weeks of my training in neruology and psychiatry in these rich agricultural lands have been completed. I have been here before, i know i saw such a small thin slice of this world. But like most natural phenomonon each slice and sub slice contains an infinity of complexity as well as paperwork.
In reflection, i have learned to improve my neurological exam and psychiatric assessment. I can consistently elicit a brachioradialis reflex, i can better judge intent for suicidality, i can recognize emergency overdoses of anticonvulsants, antipsychotics and anti depressants, and what to do (in theory) for status epilectus (but in fact, i would probably hyperventilate and hide behind a resident, shouting "ATIVAn"). In fact, most problems appear to be addressed with ativan, and very bad ones with ativan and haldol. I know the procedure for legally hospitalizing someone in a psychiatric facility against their will.
More broadly i have watched the pain of veterans, and feel greater empathy for the jingoism of Red America. Warriors, willing and unwilling alike, appear to be made of the same stuff of everyone else, mostly fragile human flesh, including the fragile souls--neurotransmitters and all. Their mangled limbs and head trauma, their PTSD and alcoholism, sprung from World War II, from last year in Afghanistan. A few were never put back together again. And those for whom the wars was the good times, and it was a life time of hard manual labor, that was what relentlessly ripped away at their nerves and tendons their might sinews now collapsing at age 55, the oxes and mighty bears of our society now cringing from perpetual pain, and the betrayal of their lungs and heart. Young and old, all men, used up by and for our ferocious society. The ones that were ok--well they had wives. Wives of fragile flesh, frail and leathered, tediously listing their husband's medications, heartily wheeling his obese body through narrow halls, observing his forgetfullness, his saddness, his incontinence that he was too ashamed to describe himself. We discuss this amid the aging creeking VA halls, plastered with mighty photographs of bomber jets, flags, the president's picture. Perhaps this is the greatest therapy of all. The reminder that the pain and sacrifice had meaning. That these were the glories of battle wounds, and not the mere decrepitude assigned to all mortals.
And i have watched the coldness of hospitals, and i have shamefully relished it. The clinic, the clinical, the analysis of the most devastating tragedies. So you want to kill yourself? Tell me about that. So you are on dialysis and you are afraid to die? So you are 30, beautiful, strong, smart and suddenly woke up with hemiparalysis and been diagnosed with HIV this morning? So you have 48% Total Body Surface Area burns and face multiple operations? So during your entire childhood you were sexually abused brutally and your family refused to help you? So all your children died in this automobile accident that has also completely mangled you? So you have lost your job, your wife, the vision in your left eye due to diabetes and are now impotent? So you have a few months to live from your metastatic cancer? So you are afraid of death and pain and loss?
How does that make you feel?
Yes you can ask these things while looking people in the eye. Sometimes, you might even help.
In the city of Fresno, there many daily triumphs and tragedies. On the final day a shoot out between cops and a rural compound brings down 3 officers and fills the ICUs wall to wall with red eyed cops and their devastated partners, children, brothers, sisters. But you walk out again from the front doors and you believe like everyone else beyond those walls, that you will live forever.
Tuesday, February 9, 2010
Signs of health
If you listen to a single Lady Gaga tract on a loop for over 40 minutes everything can STILL BE FINE.
The Chapter on How To Listen
Overt experience: "He yelled at me"
Covert experience: "Thoughts about death come out of nowhere and flood my mind"
Overt experience: "I spend about three hours every night in some bar"
Covert experience: "Before she comes over I plan everything I'm going to say."
Overt experience (expressed): "I got very angry and shouted at her"
Covert experience (felt, but not expressed): "I was delighted that he failed, but I didn't let on."
Covert experience: "Thoughts about death come out of nowhere and flood my mind"
Overt experience: "I spend about three hours every night in some bar"
Covert experience: "Before she comes over I plan everything I'm going to say."
Overt experience (expressed): "I got very angry and shouted at her"
Covert experience (felt, but not expressed): "I was delighted that he failed, but I didn't let on."
Monday, February 8, 2010
In the morning, the mad house
They keep the psychiatric department in the basement. At night i read teenaged novels on vampires and high school romance. In the morning i ask cavalierly about childhood sexual abuse, the precise description of the bleeding pigs they hallucinate on their hospital gowns, the million and one ways they have tried to off themselves. This man says another man is waiting for him, and every night for a month he packs his bags until the morning his family found their sweet and smiling grandfather was lying in the yard his throat slashed with his own pocket knife. Another woman tries to overdose on the trazadone prescribed to her dog. And yet another yet another, he must be kept from yanking out his lines, he thinks they are snakes, then he licks his blood. And a dignfied grandmother fondles herself in front of her astonished children.
And they are so normal, and it is so clinical, they are you are me, my mother your uncle, the mad are among us, we merge and we flux we check in and out at the front desk, we all have demons, some are quieter than others.
And these horrors are not so horrific at all, everything is endured, and cleanly consumed in the beeping and the flurry of nurses, and neatly filed charts, with brightly colored tags, like little ants we have made a place for everything, at least for a little while.
And they are so normal, and it is so clinical, they are you are me, my mother your uncle, the mad are among us, we merge and we flux we check in and out at the front desk, we all have demons, some are quieter than others.
And these horrors are not so horrific at all, everything is endured, and cleanly consumed in the beeping and the flurry of nurses, and neatly filed charts, with brightly colored tags, like little ants we have made a place for everything, at least for a little while.
Sunday, January 24, 2010
Monday, January 18, 2010
Sunday, January 17, 2010
Escapism
When i was 16, i found it to be rather annoying. Age 21-23 were only mildly less angsty, but far more thrilling.
I was profoundly uppity. How disgraceful, i thought, were backward looking people. Youth is a frivolity. May I let it be with grace may i not fear responsibility nor cling to juniors department clothing. Great sorrow must be faced, the work of the world attended to, and excessive, higher quality alcohol consumed
But the work of the world is as tedious as it is exquisite. 16 is an annoying time. But its virtue is not yet realizing how annoying all the other years are as well. Thank goodness wanton escapism serves to last us the decades.
Friday, January 15, 2010
The Right Stuff
This very bloody morning as i am bumbling around my dark room confused as to what city i am in (Fresno) or why i am in a carpeted room (University housing) or who is that dark body in the distance (roomate), and i think to myself, you know what--all those personality tests are WRONG. I am introvert. I want to be alone. I am neurotic. I want be a misanthropic hum bugging micro-scholar and pshaw to being a warm blooded creature.
I finally sat down to read the paper a mere 40 minutes later, and as the coffee melts the ice in in my veins (and withdrawal in my brain), the NY Times apparently writes an article called: "Do you have the 'Right Stuff' to be a Doctor".
This is of course a sore spot. For all intents and purposes, if i just keep showing up for the next 4-6 years, the state of California will in fact license me as a physician. But what a big bloody if. Showing up is hard, particularly when its between 4-6 am.
The article proceeds to outline a study that indicated that personality testing was a better predictor of how well students did than other variables, like MCAT.
"The investigators found that the results of the personality test had a striking correlation with the students’ performance. Neuroticism, or an individual’s likelihood of becoming emotionally upset, was a constant predictor of a student’s poor academic performance and even attrition. Being conscientious, on the other hand, was a particularly important predictor of success throughout medical school. And the importance of openness and agreeableness increased over time, though neither did as significantly as extraversion. Extraverts invariably struggled early on but ended up excelling as their training entailed less time in the classroom and more time with patients."
There is a caveat of course: “If a medical school is all about graduating great researchers, then I would tell them not to weigh the results of the personality test that heavily,” Dr. Ones said. “But if you want doctors who are practitioners, valued members in terms of serving greater public, then you have to pay close attention to these results.” Research monkeys need not be nice, or really even sober. Just very OCD.
That was upsetting as i was just beginning to really embrace my future as a curmudgeon.
I finally sat down to read the paper a mere 40 minutes later, and as the coffee melts the ice in in my veins (and withdrawal in my brain), the NY Times apparently writes an article called: "Do you have the 'Right Stuff' to be a Doctor".
This is of course a sore spot. For all intents and purposes, if i just keep showing up for the next 4-6 years, the state of California will in fact license me as a physician. But what a big bloody if. Showing up is hard, particularly when its between 4-6 am.
The article proceeds to outline a study that indicated that personality testing was a better predictor of how well students did than other variables, like MCAT.
"The investigators found that the results of the personality test had a striking correlation with the students’ performance. Neuroticism, or an individual’s likelihood of becoming emotionally upset, was a constant predictor of a student’s poor academic performance and even attrition. Being conscientious, on the other hand, was a particularly important predictor of success throughout medical school. And the importance of openness and agreeableness increased over time, though neither did as significantly as extraversion. Extraverts invariably struggled early on but ended up excelling as their training entailed less time in the classroom and more time with patients."
There is a caveat of course: “If a medical school is all about graduating great researchers, then I would tell them not to weigh the results of the personality test that heavily,” Dr. Ones said. “But if you want doctors who are practitioners, valued members in terms of serving greater public, then you have to pay close attention to these results.” Research monkeys need not be nice, or really even sober. Just very OCD.
That was upsetting as i was just beginning to really embrace my future as a curmudgeon.
Thursday, January 14, 2010
Wednesday, January 13, 2010
Tuesday, January 12, 2010
Mood Indigo, p III
From The New York Times
Behind the promotion of Western ideas of mental health and healing lie a variety of cultural assumptions about human nature. Westerners share, for instance, evolving beliefs about what type of life event is likely to make one psychologically traumatized, and we agree that venting emotions by talking is more healthy than stoic silence. We’ve come to agree that the human mind is rather fragile and that it is best to consider many emotional experiences and mental states as illnesses that require professional intervention. (The National Institute of Mental Health reports that a quarter of Americans have diagnosable mental illnesses each year.) The ideas we export often have at their heart a particularly American brand of hyperintrospection — a penchant for “psychologizing” daily existence. These ideas remain deeply influenced by the Cartesian split between the mind and the body, the Freudian duality between the conscious and unconscious, as well as the many self-help philosophies and schools of therapy that have encouraged Americans to separate the health of the individual from the health of the group...
All cultures struggle with intractable mental illnesses with varying degrees of compassion and cruelty, equanimity and fear. Looking at ourselves through the eyes of those living in places where madness and psychological trauma are still embedded in complex religious and cultural narratives, however, we get a glimpse of ourselves as an increasingly insecure and fearful people. Some philosophers and psychiatrists have suggested that we are investing our great wealth in researching and treating mental illness — medicalizing ever larger swaths of human experience — because we have rather suddenly lost older belief systems that once gave meaning and context to mental suffering.
Behind the promotion of Western ideas of mental health and healing lie a variety of cultural assumptions about human nature. Westerners share, for instance, evolving beliefs about what type of life event is likely to make one psychologically traumatized, and we agree that venting emotions by talking is more healthy than stoic silence. We’ve come to agree that the human mind is rather fragile and that it is best to consider many emotional experiences and mental states as illnesses that require professional intervention. (The National Institute of Mental Health reports that a quarter of Americans have diagnosable mental illnesses each year.) The ideas we export often have at their heart a particularly American brand of hyperintrospection — a penchant for “psychologizing” daily existence. These ideas remain deeply influenced by the Cartesian split between the mind and the body, the Freudian duality between the conscious and unconscious, as well as the many self-help philosophies and schools of therapy that have encouraged Americans to separate the health of the individual from the health of the group...
All cultures struggle with intractable mental illnesses with varying degrees of compassion and cruelty, equanimity and fear. Looking at ourselves through the eyes of those living in places where madness and psychological trauma are still embedded in complex religious and cultural narratives, however, we get a glimpse of ourselves as an increasingly insecure and fearful people. Some philosophers and psychiatrists have suggested that we are investing our great wealth in researching and treating mental illness — medicalizing ever larger swaths of human experience — because we have rather suddenly lost older belief systems that once gave meaning and context to mental suffering.
White Coat, Mood Indigo
From New England Journal
"Although rates of depression among students entering medical school is similar to that among other people, the prevalence increases disproportionaly over the course of medical school"
"Why does being a medical student increase the risk of depression? Raymond believes that students’ coping strategies and
personal health deteriorate as they progress through medical school. Students “see themselves going into a very narrow tunnel,” she said. “A lot of the depression we see halfway through the [first] year — it’s a reaction to having constricted themselves down to studying these subjects in a very intense way. It’s pretty unidimensional.”
Symptoms of depression in medical students can be difficult to distinguish from the effects of the stress inherent in student life. Students often dismiss their feelings of despondency as a normal emotional response to medical school, where they live from test to test and don't take time for themselves.
"It's hard to ask about depression in medical students, because you ask about sleep, and all medical students aren't sleeping," explained Angela Nuzzarello, a psychiatrist and dean of students at Northwestern University's Feinberg School of Medicine in Chicago. "They are overwhelmed, they are working hard, and they aren't having fun socially. . . . Of course they are fatigued."
The emotional and academic challenges involved in becoming a physician wear on students. Their initial encounters with illness and death may unmask psychological vulnerabilities. Such encounters often resonate with unresolved episodes of loss or trauma in the student's past or come as a shock to those who have had little experience with death. The treatment of death as a part of the daily routine may appear cold and calculating to students, who may fear becoming emotionally detached. Some become overwhelmed by the emotional toll of caring for others.
Students may become depressed at any point in medical school, but Gartrell has found that the period of greatest distress occurs during the third and fourth years, when students rotate through the hospitals and clinics. "In the clinical years, there's just far greater commitment of time, plus as match pressure begins to emerge, it's an extremely stressful time for a lot of people," she said. Students are often separated from friends and classmates and must work with a constantly changing set of residents and attending physicians, which contributes to their sense of isolation. Gartrell said that many of the female students she sees are worried that the mounting demands of training and clinical practice will not allow them time to find a partner, marry, and have children. Haynes noted that the increase in sleep deprivation during rotations may also expose mood disorders."
"Although rates of depression among students entering medical school is similar to that among other people, the prevalence increases disproportionaly over the course of medical school"
"Why does being a medical student increase the risk of depression? Raymond believes that students’ coping strategies and
personal health deteriorate as they progress through medical school. Students “see themselves going into a very narrow tunnel,” she said. “A lot of the depression we see halfway through the [first] year — it’s a reaction to having constricted themselves down to studying these subjects in a very intense way. It’s pretty unidimensional.”
Symptoms of depression in medical students can be difficult to distinguish from the effects of the stress inherent in student life. Students often dismiss their feelings of despondency as a normal emotional response to medical school, where they live from test to test and don't take time for themselves.
"It's hard to ask about depression in medical students, because you ask about sleep, and all medical students aren't sleeping," explained Angela Nuzzarello, a psychiatrist and dean of students at Northwestern University's Feinberg School of Medicine in Chicago. "They are overwhelmed, they are working hard, and they aren't having fun socially. . . . Of course they are fatigued."
The emotional and academic challenges involved in becoming a physician wear on students. Their initial encounters with illness and death may unmask psychological vulnerabilities. Such encounters often resonate with unresolved episodes of loss or trauma in the student's past or come as a shock to those who have had little experience with death. The treatment of death as a part of the daily routine may appear cold and calculating to students, who may fear becoming emotionally detached. Some become overwhelmed by the emotional toll of caring for others.
Students may become depressed at any point in medical school, but Gartrell has found that the period of greatest distress occurs during the third and fourth years, when students rotate through the hospitals and clinics. "In the clinical years, there's just far greater commitment of time, plus as match pressure begins to emerge, it's an extremely stressful time for a lot of people," she said. Students are often separated from friends and classmates and must work with a constantly changing set of residents and attending physicians, which contributes to their sense of isolation. Gartrell said that many of the female students she sees are worried that the mounting demands of training and clinical practice will not allow them time to find a partner, marry, and have children. Haynes noted that the increase in sleep deprivation during rotations may also expose mood disorders."
Monday, January 11, 2010
Thursday, January 7, 2010
Storming
Hrm
" 'The art of any art is the art of obsession,' she said. 'This is not something that people in general tend to understand. They encourage you to be well-rounded, which bemuses me in a society that tends to reward the specialists – the obsessives – those who decided to excel at one thing instead of becoming good at a hundred or competent at a thousand.' "
In another note, the psychiatry professor ruminated outloud to the lecture hall full of med studnets,"Yes most of you have class C personality disorders, thats probably how you have got this far in your training."
per wikipedia:
Cluster C (anxious or fearful disorders)
Avoidant personality disorder (DSM-IV code 301.82): social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation and avoidance of social interaction.
Dependent personality disorder (DSM-IV code 301.6): pervasive psychological dependence on other people.
Obsessive-compulsive personality disorder (not the same as obsessive-compulsive disorder) (DSM-IV code 301.4): characterized by rigid conformity to rules, moral codes and excessive orderliness.
Debated with M the merit of 10,000 hours, while he casually took apart his electric keyboard and reconstructed it.
" 'The art of any art is the art of obsession,' she said. 'This is not something that people in general tend to understand. They encourage you to be well-rounded, which bemuses me in a society that tends to reward the specialists – the obsessives – those who decided to excel at one thing instead of becoming good at a hundred or competent at a thousand.' "
In another note, the psychiatry professor ruminated outloud to the lecture hall full of med studnets,"Yes most of you have class C personality disorders, thats probably how you have got this far in your training."
per wikipedia:
Cluster C (anxious or fearful disorders)
Avoidant personality disorder (DSM-IV code 301.82): social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation and avoidance of social interaction.
Dependent personality disorder (DSM-IV code 301.6): pervasive psychological dependence on other people.
Obsessive-compulsive personality disorder (not the same as obsessive-compulsive disorder) (DSM-IV code 301.4): characterized by rigid conformity to rules, moral codes and excessive orderliness.
Debated with M the merit of 10,000 hours, while he casually took apart his electric keyboard and reconstructed it.
Sunday, January 3, 2010
Journeys
From: NY Times
Every year in October, when the Nobel Prizes in chemistry, physics and medicine or physiology are announced, the predictable parade of American honorees is reported on television and in the papers with a combination of patriotic glee and almost total befuddlement about the nature of the work being honored. Hardly anyone pauses to think about the educational system that has been so fabulously productive in turning out scientists in this country. It is a system limited to about 120 research institutions, and at the upper, rarefied reaches of that system are the elite universities. As James Anderson, chairman of Harvard's chemistry department, puts it: ''The students here are spectacularly good, very bright, very committed. They want to win Nobel Prizes, and some of them will, and some of them want to do it before they're 30.''
Graduate study in the sciences, however, is a very unsentimental education. It requires the intellectual evolution from undergrad who can ace tests of textbook knowledge to original thinker who can initiate and execute research about which the textbooks have yet to be written. What is less often acknowledged is that this intense education involves an equally arduous psychological transition, almost a second rebellious adolescence. The passage from callow, eager-to-please first-year student in awe of an often-famous faculty adviser to confident, independent-minded researcher willing to challenge, and sometimes defy, a mentor is a requisite part of the journey.
Every year in October, when the Nobel Prizes in chemistry, physics and medicine or physiology are announced, the predictable parade of American honorees is reported on television and in the papers with a combination of patriotic glee and almost total befuddlement about the nature of the work being honored. Hardly anyone pauses to think about the educational system that has been so fabulously productive in turning out scientists in this country. It is a system limited to about 120 research institutions, and at the upper, rarefied reaches of that system are the elite universities. As James Anderson, chairman of Harvard's chemistry department, puts it: ''The students here are spectacularly good, very bright, very committed. They want to win Nobel Prizes, and some of them will, and some of them want to do it before they're 30.''
Graduate study in the sciences, however, is a very unsentimental education. It requires the intellectual evolution from undergrad who can ace tests of textbook knowledge to original thinker who can initiate and execute research about which the textbooks have yet to be written. What is less often acknowledged is that this intense education involves an equally arduous psychological transition, almost a second rebellious adolescence. The passage from callow, eager-to-please first-year student in awe of an often-famous faculty adviser to confident, independent-minded researcher willing to challenge, and sometimes defy, a mentor is a requisite part of the journey.
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