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

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.

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

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.

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

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.

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.