The Life and Musings of a Medical Student

Vegetable and seed oils: Holy Fatness, Batman

2010-04-25T16:12:00.001-07:00

Couldn't resist posting about this article:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2794476/?tool=pubmed

For those not interested in the scientific mumbo-jumbo, the punchline goes like this:
Apparently, seed oils make mice heinously obese over a few generations when compared with mice eating standard mouse-food.

Of note, seed oils are Omega-6 oils, which are essential for health in the right quantities and in the right Omega-3/Omega-6 ratio. For reference, Inuit indians have a much better ration than Americans do and guess what? They have a lot less heart disease than the general population despite that they have a high rate of obesity and a high rate of smoking.. They get all those omega-3's from fish.

What seed oils do you have in your kitchen? Probably any sort of liquid, yellow oil you own is a seed oil. Canola oil is a big one. Generic "vegetable oil" is also a seed oil. If you think about it, this isn't a natural food. When was the last time you sucked on some good old fashioned canola? Or felt like chewing some oily veggie seeds?

It's an interesting article and an interesting idea. It's also prompted me to add vegetable oil to my list of "stuff that almost certainly isn't good for me."

Now, what am I going to bake with instead? Probably coconut oil, though there's a lot of internet hype that you can use applesauce instead. I might try that.

Anyway, back to call...

IMPORTANT UPDATE: I saw this article while on call (obviously), and didn't read through it carefully enough.

Looks like things are NOT so simple as I first assumed. The researchers fed the mice almost pure Omega-6 fats, while almost totally eliminating Omega-3's. Then, 3 generations later, the mice got fat.

In other words, they did NOT feed these mice pure vegetable oil. Canola oil, for example, is about 2:1 Omega-6 to Omega-3. Not pure Omega-6.

So I have more legwork to do in cataloging what fats have what content. From face value, Canola oil looks like it actually might be neutral, rather than heinous.

Thanks to T for emailing me some very relevant questions on the topic after reading my half-baked original post. I'll be looking into this more soon and (if I remember) posting what I find.

Fats Are Not The Same

2010-04-17T15:16:00.000-07:00

So I'm on this kick about coconut oil. It's been a fascinating few weeks learning about food. There's some limited evidence in the literature to suggest that coconut oil is a saturated fat that doesn't cause dyslipidemia (high cholesterol/bad cholesterol), and might even help decrease the waistline in people who have abdominal adiposity (a.k.a. "a gut.")

Coconut oil is composed of a whole bunch of different fats, many of which are "medium length fatty acids," which (again, limited data) have been shown to increase fat metabolism. So hey, that's cool. In all fairness, it is a saturated fat. While I'm personally quickly becoming convinced that saturated fats are just fine and dandy for you when eaten in moderation, not everyone shares this belief (though check out my last post for a reference to a study supporting that saturated fats are NOT bad for you).

What REALLY IS bad for you, though, is trans fat. Probably because trans fat is only made in labs, while all of nature's fats, vegetable or animal, are cis fats which your body knows how to process without causing problems. In fact, "On a per-calorie basis, trans fats appear to increase the risk of CHD [heart disease] more than any other macronutrient, conferring a substantially increased risk at low levels of consumption (1 to 3 percent of total energy intake)," says the New England Journal of Medicine.

So take note that you read the package of anything you buy. You'll be extremely surprised at what has hydrogenated oils in it. Remember: eating hydrogenated oils is like eating a big fat batch of stroke and heart attack juice. Have fun.

And now I'm on call... back to work.

Diet

2010-02-06T14:32:00.000-08:00

I've been reading a lot about diet recently. It seems that everywhere I turn, I see new discoveries in science about how important diet is. Recently, there have been studies published about how omega-3 fatty acids can help prevent psychosis (schizophrenia), how diet effects anxiety and depression, and even that saturated fat doesn't increase your risk of heart disease.

(In all fairness, a lot of this I found on this guy's blog.)

The good news: "Eating Healthy" now includes a much more satisfying menu. Meat, fish, butter, grains, fruits and veggies are all really good for you. In fact, it turns out that most things are good for you -- providing they're not overprocessed, refined, or made in a lab (hydrogenated oils, it turns out, are really bad for you. So much for margarine being a good swap for butter, eh?)

So what are my take home points from my new nutrition/health obsession? (Not all points are referenced above, but all have studies behind them. Comment if anyone's interested... or just peruse that other guy's blog. Like I said, a lot of it came from there.)

Omega 3 fats
- A good Omega-3 / Omega-6 fatty acid ratio is an excellent indicator of hear attack and stroke. Omega 3's are great at decreasing cardiovascular risk. Most Americans have far too little Omega 3 in their diet. (Note: The doc who's blog I just liked to is a cardiologist. I think he's got some great data on Omega 3's, but I don't agree with all of his conclusions.)
- Pastured chickens have several times the Omega 3 in their meat and eggs than grain-fed chickens
- Same goes for pastured beef and dairy
- Fish have a lot of Omega 3's
- Fish oil supplements are a great way to get more Omega 3's in your diet if you're not motivated enough to completely change your grocery and diet habits.

Saturated Fats
- Saturated fats (butter, coconut oil, animal fat) aren't bad for you. In fact, it's better to cook with saturated than unsaturated fats. Unsaturated fats decompose in high heat and can create trans-fats and free radicals (bad).

Carbohydrates
- Refined sugars, flours, and starches are bad for you. They're linked to obesity and diabetes. High fructose corn syrup (highly refined) does bad things to your metabolism.
-Diets that are composed of 30% carb calories are as successful in controlling blood sugars as insulin is in people with diabetes. (This probably -- but not definitely -- means that by eating this type of diet you'll likely never get diabetes in the first place.)
-If you're interested in losing weight, cut refined carbs out of your diet and keep your dietary intake of carbs ~30% or less. (Cutting them all the way out is known as the Atkins' diet, and whil it does work for losing weight, I personally don't think it's healthy.)
-Dietary fiber greatly reduces your risk of heart disease. (Found in fresh fruits and vegetables. Incidentally, fruit juice without pulp acts very similarly to refined sugars. Fresh fruit does not.)

Organic vs. Pastured vs. Not
- At least one study has shown no difference in organic vs. non-organic produce.
However:
- Multiple stuides have shown significant nutritional differences in animal foods (eggs, beef, chicken, dairy) made from free-range or pastured chickens and free-range / grassfed cattle. The 'naturally' fed animals are nutritionally superior, having more Omega 3's and (I buy my veggies at the regular grocery store and my meat at the Organic-Wholesome-Extravaganza store. Only place I could find grassfed beef.)

Anyway, that's the gist of my latest pet topic. If there's anyone reading this who's interested in losing weight or just plain old eating healthier, I'd love to hear what's working/not working for you.

Spare time

2010-01-05T14:50:00.001-08:00

I should be working right now, but I'm distracted and admittedly not that focused. So I've decided to solve America's problems (aren't you glad?), starting with airplane terrorism:

Facts:
-Roughly 14 Million* hours of airplane time were logged in the US in 2008 on commercial flights (personal/business/corporate). (See link)

Assumptions:
-1 armed police officer on board each flight is enough to keep everyone safe from underwear bombers/other wackos.
-The average police officer works 40 hours per week, and gets about 2 weeks off per year, which amounts to 2000 hours per year per officer.
-Each officer will cost $250,000 to get set up and trained. (This is how much it cost to create a job with stimulus money by some estimates -- I think this is too much, but I'll use the number anyway so it's a liberal estimate)

Math:
14M hours / 2000 hours per officer = 7,000 officers
7,000 officers * $250,000 per head = 1.75 Billion dollars

So for less than $2B, we can cover every single flight in the US with an armed police officer in a spiffy badge. They'd be tasked with watching for people who act suspiciously or who meet certain objective criteria (i.e. buy one-way tickets with cash, for example) and then giving them more rigorous screening measures. This neatly avoids mass-profiling (though probably not perfectly), and gives everyone peace of mind WITHOUT subjecting them to crazy screening measures at the airport like individualized CT scanners.

Discuss.

*Thanks to Chris for pointing out my type -- 14 MILLION hours, not billion.

Merry Christmas!

2009-12-25T09:49:00.000-08:00

Merry Christmas, everyone! Whether you celebrate the holiday or not, I hope it's a day of peace for all of you. I'm mindful of some friends of mine this time of year who are having Christmas in the hospital next to their father, who's quite sick. I hope and pray that they, along with countless others whose holiday circumstance might not be ideal, can still find peace, love, and good will toward men on this day when we celebrate the birth of He who made lame beggars walk and blind men see.

Merry Christmas!

November Update

2009-11-16T12:31:00.001-08:00

Hi all.

Life here in Milwaukee is pretty darn good. It's been a much less busy month this month as I've been on a consult service at the VA, and have thus had time to do things like read Harry Potter, play a small dash of video games (nothing major -- facebook stuff and free online flash games -- but kind of a fun short-term diversion), start to make up a Christmas wish-list, and even work out a little bit.

Working out, I've decided, is a great habit to be in and a hard habit to keep in today's culture. I do marginally well these days, but only if I have low standards. I manage a 12-20 minute workout a couple times per week. And even then, it's only pushups, pullups, and low-weight freeweights.

But hey, I take the stairs at work. That counts for something, right? (I work on the 4th floor of the hospital.)

Lindsay's been doing very well also, the last couple of weeks notwithstanding. Turns out she managed to get Mono in early November, and has had something of a rough go. As of this weekend she was still spiking fevers. Poor thing. To top it off, I thought she had strep throat and got her some antibiotics... which gave her a rash that made her look like a lobster. Great job, Dr. Zundel. (For those who don't know, Mono + Amoxicillin = rash >90% of the time. Not a true drug allergy, and not dangerous. But still miserable.)

She's been an awful good sport about the whole thing, and hasn't blamed me once. I can't help but feel that I married well.

We're also enjoying our new house. It's actually really nice to have a house. I didn't realize, I don't think, how nice it was going to be while I was looking at houses. The fact that I'm not planning on moving any time in the next 3 years is kind of quirkily intoxicating to me. (I moved 5 times over 4 years of med school.)

As for my political thoughts, it's been a good couple of months since I've blogged anything. I'm still ramped up about the health care legislation that's getting kicked around, and can't help but feel that it's going to make things... well, worse. Kind of a 'worse no matter what good does manage to come of it' standpoint. I think doctors, patients, and taxpayers are going to be the ones who really take a hit, here, and not so much special interest groups like insurance companies and drug companies. I bet we see increased tax rates, less access to excellent care (though I bet access to mediocre care will go up), and more expensive insurance for everyone all around. I'd love to be wrong.

The health care industry's problems are just symptoms of a much bigger issue. Because I KNOW you read my blog just so you can know my opinion on issues like this (i.e. issues I'm not even close to an expert on) I thought I'd put some of the core issues in a numbered list below. Enjoy.

1. There are a lot of Americans who want something for nothing. This can be health care, money, jobs, education, or economic or social security. It's a very attractive deal, but unfortunately it has unsustainable social consequences. Generational poverty and the decline of America in general, for instance.
2. There are a lot of American companies who want money a lot more than they want to be ethical or moral. (Insurance companies, I'm looking at you. But it's a lot more generalizable than that.)
3. There are a lot of government officials who either really believe that somehow a bunch of new taxes, rules, and regulations are going to make people happy and everything better, or else represent a population who believe that and don't dare. (as though it would have worked any better with a different set of rules...)
4. The media loves sensationalism rather than factual balanced reporting, perpetuating a state of ignorance and political intolerance among the population. (Know of any balanced news out there? If you do, let me know. I don't. The best I can do is read Foxnews AND CNN to try to get something of a reasonable idea of what people are thinking.)

But enough about all of that. (I wasn't going to get political rants this post... =) Couldn't resist.)

Happy Halloween!

2009-10-31T14:48:00.001-07:00

Halloween is my favorite holiday besides Christmas.

"Harry Potter"-esque magic potion. Total supply cost: $15 or so. Glows in the dark, bubbles, puts off fumes, and perfectly safe to drink. Putting it out on the porch for the trick-or-treaters tonight. Good times. (Photo credit to my highly talented sister-in-law Whitney.)

My family (most of us) love Halloween. My mom being the exception. So, mom, here's a halloween production I think you'll appreciate.

Try JibJab Sendables® eCards today!

Health Care Reform: Summary

2009-08-31T11:30:00.001-07:00

Some suggested I should make a short version of this so people will read it. Here it is.

I think that we should scrap the current system entirely, and remake health care reform like this:

1) Personal Health Fund accounts held by the federal government and funded by individuals should replace insurance as the primary means of paying for non-catastrophic health care costs including clinic visits, drugs, routine surgeries, pregnancies, and minor emergencies. When the money is exhausted, basic health services should be funded out of pocket. This removes much of the moral hazard associated with our current system, and gives persons incentive to choose cost-effective treatments (generic drugs, physical therapy) whenever possible.

These funds would be created by pulling tax-free earnings from individual's paychecks. Currently, over $1.5M is spent on health care per person over the course of their lifetime with personal and employer health care insurance premium contributions. Put that back in people's pockets in the form of PHF's that people can use however they and their doctor see fit. Indigent, unemployed, or disabled persons would have payments placed by the federal government through tax dollars so that these individuals are also spending money from a limited, personally controlled fund. By David Goldhill's math, this amounts to $12,000 per year for a low-income family of four if we abolished Medicaid and instead provided the health dollars to them directly.

This system would redefine 'coverage' to include whatever you and your doctor deem an appropriate treatment at a reasonable cost (it's your money, not the insurance company's). It would put competitive pressure on health care providers and hospitals to provide better health care at lower prices, because under this system people have much more stake in what they pay for, and how much they pay for it.

2) A publicly-funded 'catastrophe' insurance to provide coverage for all burdensome or disabling health conditions that are beyond the control of the individual to avoid or fix. Conditions such as systemic lupus, crohn's disease, rheumatoid arthritis, schizophrenia, bipolar disorder, paraplegia, quadriplegia, parkinson's disease, multiple sclerosis, congenital conditions such as heart disease requiring surgery, mental retardation, familial cancer syndromes, cystic fibrosis, severe trauma and others would have coverage from this public fund. Note that this fund would NOT cover avoidable conditions such as heart disease, diabetes, lung cancers from smoking, etc.

3) Private insurance for additional coverage beyond the catastrophe fund, but with restructuring of the current system. Insurers should be able to charge based on individual risk factors for disease that can be controlled by the individual such as BMI, smoking, drinking, illicit drugs, medical compliance, abuse of the ER, unsafe sex practices, and other lifestyle considerations such as diet and exercise. They should not be able to deny coverage based on pre-existing conditions (the financially worst of which would be covered by the 'catastrophe' fund anyway) or on race, gender, or socioeconomic status. This private insurance would cover things like non-catastrophic emergency care, expensive preventable chronic conditions such as diabetes, non-essential surgeries such as hip replacements, and expensive treatments with small chance of success like some chemotherapies for recurrent cancers (first set would likely fall under 'catastrophe' coverage).

Also, most of these insurance covered treatments should require a percentage-based payment from the patient's PHF, thus ensuring that we don't go back to our current state of spending other people's money on health care (again, 'moral hazard.')

4) Tort reform that provides lawsuit immunity to physicians except in cases involving gross negligence. Other malpractice claims would be put before a panel of physicians empowered with the ability to enforce disciplinary actions on the malpracticing physician such as suspension or revocation of medical licensure, remedial training, or fines. Patients injured by medical malpractice would be eligible to receive care financed from the 'catastrophe' fund. Thus, malpracticing physicians are held accountable, and patient's needs are met.

So that sums it up. Under this system, everyone gets access to primary care via their PHF money, kids are covered by PHF money provided by parents, the 'uninsured' would still have PHF money provided by the government as well as catastrophic coverage, overall health costs will go down as people are forced to be cost-aware (limited funds) and providers are forced to be cost-transparent to compete for business. Additionally, Americans would re-learn that being unhealthy is expensive, generating increased responsibility for personal health via financial incentive.

The downside? Huge transitional costs as people are taxed to fund the current medicare system (which would eventually be phased-down or phased-out entirely-- but you couldn't do it immediately and leave non-PHF seniors with no coverage at all) while simultaneously being required to put PHF money away for their own personal health care, resistance from hospitals and drug companies who benefit from the price-opaqueness of the current system, and the unwillingness of the American people to abandon the current system where people with good insurance feel extremely safe. (Because they're not spending their own money if something happens to them.)

Comments? Thoughts?

Health Care Reform: Solutions I like

2009-08-28T11:34:00.000-07:00

Background to all of this can be read in my first, second, and third posts on health care reform. Think I'm writing about this too much? I do too.

I've touched on why health care in America is expensive, inefficient, and unfair. Fortunately, as some random guy on the internet with access to free blog publishing should, I'm going to tell the world what I think we should do about it.

And, because I feel like it, I'm going to do it by comparing two systems: health care and transportation.

In terms of transportation, most people in America own one or more private automobiles so they can get around. This isn't a bad place to start when explaining how we should run the health care model. People have car insurance, and people pay for their own gas. People who drive recklessly get penalized for it (assuming they get caught or get in accidents) by paying higher premiums for insurance and/or getting ticketed by law enforcement officers. If you lose your license or can't afford a car you can still get around... you just have to ride the bus. Overall, there's a high level of responsibility in this system. I think that's healthy.

In terms of health care reform, we need to move more towards that kind of system in order to keep the level of quality we have and still control prices, while affording freedom to manage our own health and choose our own doctors. So here's the three-part (and a side-note) system I propose*:

Part I: We should implement a system of personal health funds for every individual as the first-line of health insurance. A PHF would be financial account tied to your social security number, and held by the federal government. These PHF's should be fed from individuals paychecks, tax free. This money can then be used to purchase things that people need for basic health maintenance like medications and doctor's visits, and even minor or routine surgeries like broken bones or getting your appendix out. Dental care and vision checkups could also tap into this fund. When the money is gone, you have to foot the cost out of pocket (though you could still pay for it tax-free).

"That's terrible!" you think "What about the poor people or the unemployed who don't have money to put in an PHF? What about the people with terrible, chronic health problems? What about the people who need semi-emergent major surgeries or have complications like post-surgical infections? What about the elderly who have extreme health costs because of age? What about all of the people with unavoidable and expensive conditions like Crohn's disease? Or those who are born with genetic diseases? There's no way this would work for them!"

Hold on. Take a deep breath. Hear me out, here. We can take good care of them, too. Better care than we do now, I think. Keep reading, and see if you agree with me or not. (No obligation to. If you don't, leave a comment and let me know, eh?) So why do it this way? Because it ensures everyone has access to care, and the means to pay for it if they're responsible with what they have.

If people are spending their OWN money, they're careful with it. They care how much things cost. They don't just want the most expensive or most radical treatment available. It also encourages long-term responsibility for your own health maintenance because being unhealthy is -- as America is learning -- extremely expensive. That's something that people will only really seriously care about if they're dealing with it firsthand.

Conversely, how long do you think it'll take drug companies, hospitals, and high-paid medical specialists to start lowering prices if all of their customers suddenly start asking how much things cost? How many irate patients with large bills would it take for physicians to start seriously considering whether or not they should have ordered all of those lab tests? Not very long, I'd argue.

Some people point to elective, non-covered surgeries like Lasik to showcase this effect. The price of Lasik has dropped dramatically in the short time since the technology was developed largely because providers have been competing with each other's prices. How much does an appendectomy cost at the hospital I work at? I have no idea, and I'd argue most doctor's who work there don't either. We never see the cost of the treatments we prescribe until someone without insurance can't pay for it, or an insurance company balks. That's got to change.

Another benefit of the PHF's is that anything you need is covered -- as long as you have the money for it. This will remove the insurance company's meddling "That requires prior authorization so we're not covering it!" and "We don't cover that because it's too expensive!" cards. If you're willing to foot the cost -- and if your doctor is willing to write you a prescription for you to do so -- it's now fair game.

Part II: Catastrophic coverage for everyone, because it's just not nice to let people who are truly unlucky (vs. irresponsible) go bankrupt for health-related reasons. So what constitutes a catastrophe? Basically, it's a situation that adversely affects your life to the point where you can't pay for it either because you're disabled, the costs of the treatment far exceed what we would reasonably expect the average person to pay, or the preventative costs of any circumstance beyond your control that has high potential to put you in either situation in the future. This covers things like:

1) Mental health issues such as schizophrenia or bipolar disorder.
2) Severe trauma such as car crashes, severe burns, or gunshot wounds.
3) Chronic and debilitating conditions with no known prevention. Crohn's disease, lupus, rheumatoid arthritis, paraplegia, cerebral palsy, multiple sclerosis, and others all fall into this category.

This is probably going to be expensive, but I just don't see another reasonable option, here. The fact of the matter is, a lot of this is already picked up by the general public directly (Uncle Sam pays for dialysis, no questions asked) or indirectly (the uninsured person in a car accident) in the form of hospitals making up for obligatory free care by charging people with insurance more. Besides, coming down with a significantly life-altering medical condition kind of stinks, don't you think? I feel bad enough for people like that to collectively give them a portion of my paycheck.

Part III: Private insurance for everything else, including elective surgeries, expensive or advanced drug therapies, non-emergent complications of common conditions like diabetes, heart disease, and obesity, cutting-edge imaging studies such as PET scans or non-emergent MRI's, and expensive treatments with little chance of success or only marginal benefit such as some types of chemotherapy.

What's the point, you might ask? What good is insurance if true catastrophe's are already covered by the government? Well, a lot, if the cutoff for the government catastrophe insurance is quite high-- say $25,000-$50,000 or so. The fact of the matter is, as a society we can't pay for everything for everyone. It's just not possible to do-- which is why the Europeans ration care. (Which I don’t like the idea of.) So we may need to set the catastrophe insurance level high enough that this type of system is sustainable, and that may mean increased individual risk when compared to a single-payer, universal high-coverage system. It also means increased flexibility, personal control, and broader options available for those who want them and can pay for them. And it controls costs by free-market prices, not by restricting care.

My ideological preference for this is based in the idea that an individual can either be safe or free to choose to do things his or her own way, but not both. One necessarily precludes the other, simply because not all persons will choose to do things safely.

Despite being insured, everyone should be required to pay a certain percentage of the costs out of pocket or their PHF (say 15-20%), and insurance companies need to have a brand new set of rules laid out regarding who they can deny coverage to, and who they can raise or lower rates on. Specifically, insurance coverage should be priced based on the same types of controllable criteria that car insurance is.

Being medically compliant should lower rates, just like drivers with clean records (no accidents or tickets) have lower rates. Having a healthy lifestyle, including avoidance of smoking, drinking, drugs, and high-risk sexual behavior should lower your health insurance rates. Regular exercise and healthy eating should lower your rates as well.

Conversely, rates should go up for people who have high-risk or unhealthy lifestyles. Rates should also be increased for people who are noncompliant (i.e. don't listen to their doctors) or who abuse the system (i.e. frequent ER visits for non-emergent problems). Things that insurance companies should NOT be allowed to modify rates for include race, genetic conditions, economic class, the region you live in, or (the biggie) pre-existing no-fault conditions. The rationale for this is that you should largely be able to control your rates through your behavior, just like with the current car-insurance model.

So this will translate into an insurance profile that looks something like this: "55 year old male, compliant with medications and doctors' advice, 3 emergency room visits in the last year, BMI of 28, smokes 1 pack per day, 40 year smoking history, drinks alcohol moderately(2-3 drinks on most weekends), no history of street drugs or STD's, past medical history of diabetes, high blood pressure, and coronary artery disease.”

This resembles "25 year old male with one recent speeding ticket (73mph, speed limit of 65), one accident in the past year, drives a Honda civic."

In other words, the insurance companies don't know (or, at least, aren't allowed to take into consideration) that you have lupus. Or a heart disorder that you've had from birth. This gives the insurance companies enough information to put you into a general category and assess a rough risk-to-profit picture, but not enough information to deny you coverage because you have a struck-by-lightning style unlucky health history of being born with only one lung. Of course, people with diabetes and heart disease will be more willing to sign up for this sort of thing, but that’s to be expected. Like people who drive Ferrari’s, they’re higher risk.

Then, just to make sure that the insurance companies don't monopolize and price gouge, you do two things: eliminate the tax break for employer-based insurance (or even better, add on individual tax-breaks for purchasing your own), and open up state borders to insurance companies in other states. Again, this is how it works with car insurance -- and as a result the insurers compete with each other for customers via advertising (the Geico Gecko, anyone?), discount rates for people who drive safely, and lower prices overall.

So now let's fill in a couple of holes (I’m sure I’ve missed some. Feel free to point them out.)

1) Poor or disabled or temporarily unemployed persons would have payments put into their PHF's every month from the government, just as though they were working. These payments would ensure that there is funding for the economically disadvantaged when they have health problems, and would also allow access to primary care. This is, essentially, the 'public transportation' portion of the primary care part of the equation, and I'd argue it's much better than the 'no insurance at all' model that we have today. (Remember that catastrophic costs would be picked up by the taxpayer's buck.)

Admittedly there's still risk involved, but for better or worse that's how almost everything in life works. The downside to this is that someone who doesn't have supplemental insurance and who isn't frugal enough or who has an unexpected high-cost health problem not qualifying as a catastrophe (e.g. appendicitis) could be in some debt. Again, this is not unlike other aspects of real life.

2) Disabled persons would have the cost of medical care related to their primary disability covered by the program. Depending on the degree of disability, other health care issues may or may not be covered. For instance, the person with mental retardation would probably have the cost of their diabetes treatment covered if they're not competent to care for themselves adequately, whereas the person on disability because of chronic severe back pain probably would not. While it stinks to have low back pain and I feel for those people, I'm not going to give them free care for things that they (and most everyone) should take a personal stake in paying for and controlling. (Keep in mind, they'll have PHF's, too.)

3) As above, insurance companies can compete across state lines. Also as stated above, the current health-insurance tax breaks need to shift to being individual based instead of employer based.

4) Chronic, expensive, but preventable conditions such as diabetes and heart disease should be managed with personal money -- not public money. The PHF should provide sufficient funds to cover basic (i.e. not necessarily the best, but reasonably effective) and inexpensive treatments. Currently, you can get a broad list of high-quality generic prescription drugs through Target and/or Wallgreens for 3-4$/month per prescription. In America, that's pretty darn affordable to anyone but the absolute poorest of the poor. And even then, one has to ask what're they spending the money that they do have on? If the PHF system were implemented, more and more drugs would be added to this list -- probably rapidly. Additionally, the size of the market share lost would force drug companies to choose between the current high-price/low volume profit model to a high-volume/lower price model.

5) Last but not least, Tort reform. I like Krauthammer on this one. Have a panel of physicians sit together and decide whether or not to strip the medical license of those persons deemed sufficiently negligent to do so. That’ll get a physician’s attention—I promise. Meanwhile, persons injured by physicians (an unfortunate risk that’ll never be completely eliminated) should be compensated out of the ‘catastrophe’ fund I’ve detailed above.

*Very little of this is truly original. It's mostly a hodge-podge of things I've picked up from reading multiple-people's opinions. A lot of it from David Goldhill, though I don't agree with all of his ideas.

Capitalism

2009-08-26T06:14:00.000-07:00

I wish I'd written this. It gets to the reasons behind the current convouluted financial situation. It emphasizes what I think are the real reasons, and which are simple enough for just about anyone to understand. And you don't even have to know what the term "toxic assets" means.

Great article. I couldn't agree more.

Health Care Reform: Reasons Behind Excess Costs

2009-08-21T12:46:00.000-07:00

This is the third bit of ranting on health care reform that I've written. Parts one and two should probably be read first.

Why on earth is health care in America so expensive? This is the question we should answer before we try to make it cost less, don't you think? So let's look at the system through the eyes of someone with health insurance: our imaginary friend Bob the Engineer.

Bob, like most people, gets health insurance from his job. He has some choice in his health insurance, and can pick from a couple of different plans. These plans are (only semi-hypothetically) a high deductable but low monthly payment plan, a low deductable but high monthly payment plan, and a catastrophe-only HSA-based plan (also low monthly payment).

These plans are all through the same insurance provider-- someone who has bargained with Bob's employer ("Transparent Aluminum Engineering") to be the exclusive health care provider to all of the employees in the company. Because Engineering is a competetive field, Bob has good health insurance coverage. In fact, because Bob is risk-averse, he decided to purchase the low deductable plan with a high monthly fee.

Bob also drives a 2004 Acura to and from work, and has car insurance for his vehicle. I'll come back to the car later.

Bob has asthma, and needs to buy two inhalers per month at a total cost of about $300. It's not a problem because -- fortunately for Bob -- the inhalers cost him about $20 apiece and his insurance picks up the rest.

Then, one fateful day, Bob gets in a car accident and gets taken to the ER by ambulance with a perforated bowel from his seat belt (I've seen this). He has his surgery, gets admitted to the hospital floor, and goes home after about 4-5 days feeling pretty darn good.

A few weeks later, the hospital bill comes in the mail -- Bob (like most people) checks to see how much he owes. It's about $2500. Expensive, but manageable since he has a good job. The rest of the bill, of course, gets picked up by his insurance and so Bob doesn't really care that the total costs for his care were right around $35,000. Good thing he got the low-deductable plan, right?

The next week at work, our accident-prone friend manages to inhale the eraser of his pencil when he sneezed and coughed at the same time. He's having a bit of trouble breathing and he's coughing uncontrollably so he gets shipped to the ER again to have things taken care of. Upon arrival to the ER, he's taken care of by a new ER doc who's slightly paranoid about getting sued. So, after Bob gets a chest X-ray which shows the eraser (apparently it's radiopaque) in his right mainstem bronchus, the ER doc checks out Bob's info. She see's that he has great insurance, and decides that she should cover all of her bases to make sure that she hasn't missed anything. She begins ordering tests for tuberculosis, pneumonia, blood counts, chemistry, and Bob's thyroid.

She also discovers that Bob skipped breakfast this morning and hasn't had anything to eat today (besides the eraser, which doesn't count) and orders a fasting lipid panel on him because if he DOES have high cholesterol, she doesn't want to miss it.
Meanwhile, Bob leans over the side of the bed in a raging fit of coughing, and manages to hork up the eraser on his own. Phew. That's a relief.

After hearing the good news, the ER doc, just to make sure that Bob does NOT still have eraser in his lungs, orders a CT of his chest. Nevermind that the eraser was in one piece when it came out, anything that remains will be too small to find in his lungs anyway, and you can see the eraser on a plain chest X-ray just fine. The chest CT helps both Bob and the ER doc feel better about getting the eraser out of his lungs.

The CT shows no eraser in his lungs anymore. He's cured. On top of that, all of his laboratory tests come back negative, so that's good news too. He goes home without further incident.

Now, Bob gets another bill in the mail for his ER visit the next week: $8,000 total, including the CT scan and all of the lab tests. He was there for about three hours. Pretty expensive, but Bob doesn't care -- his part of the payment is... free. Completely free. Because he has AWESOME health insurance and has reached his deductible for the year, anything beyond the first $2500 is picked up by his insurance company. Bob's life is awesome. And the ER doc got sued by the guy in the room NEXT to Bob's -- but it was okay for her because she'd ordered all of those tests for the guy next door, too!

And life rocks for everyone. Except... not really. We spend one out of every six dollars of work that our country makes (1/6th of GDP) on health care.

So why do we spend so much money on health insurance in this country? Because, at almost every point in the system, strong incentives exist to spend more money, with very little incentive to spend less. Let's recap:

1) Bob's company gets tax breaks for all money spent on healthcare. Imagine how many corvettes there would be on the road if companies could buy cars for employees with tax-free money. Why wouldn't they? The employees love it, and it'd be cheaper than raising the employees salary to pay for it themselves. A pre-tax $10,000 per year health care plan is worth MUCH more to Bob than $5,000 cash is post-tax. Besides the fact that half of the money goes the government, buying insurance as a private individual is much more expensive, if not downright impossible.

2) Health "Insurance" isn't actually the same type of thing as car insurance. Bob has car insurance, and hopes he never has to use it to replace his car. It doesn't buy gas (a long-term, constant expense not unlike Bob's asthma inhalers), he doesn't make an insurance claim when he needs new tires (but he would if his wife had a baby-- nevermind that they had 8-9 months to plan for the expense of having the baby) and -- for the most part -- Bob hopes that his $100 per month to his car insurance company never, ever comes back to him. He's buying peace of mind, not car maintainance. Yet, with health insurance, he's buying all of his healthcare -- no matter how much it costs -- for one, neat, clean monthly fee.

3) Due to reason number 2), people feel entitled to get whatever they need (or want) for their own health maintainance without paying extra for it (other than miniscule co-pays.) This entitlement encourages employers to purchase plans with extreme coverage -- like Bob's, where he doesn't pay a dime beyond a certain amount -- because they're attractive to employees. Nobody wants to be told that health care should cost them more because they're overweight, don't exercise, go to the ER often for things that aren't emergencies (or for emergencies that could have been avoided), and don't take their medications like their doctor tells them to. Yet, if you drive recklessly, crash your car, and don't obey the traffic laws like the police tell you to, nobody's suprised when their auto insurance goes up. I bet if you got auto-insurance through your job and they paid your speeding tickets, you'd drive a bit more recklessly, don't you think?

4) Because of reasons 2) and 3), most people in America (>80%) have good health insurance with broad coverage. This means that hospitals have no need to compete with each other on prices -- their individual customers don't really care what something costs, because (it seems) someone else is picking up the bill. If you need an MRI for your back to see if you need surgery, do you shop around for the cheapest place for a scan if you have good insurance? No. Why should you? It doesn't cost you any more no matter where you go. So you choose the closest, or highest rated hospital that your plan covers. You choose the Ferrari of health care because... well, you can. (The actual term for this sort of situation is called "Moral Hazard.")

5) Doctors are encouraged to spend money to protect themselves from lawsuits. On average in the US, every single doctor is sued multiple times through the course of their career. In medical school, I was taught to play defensively in the medical field -- document EVERYTHING extensively, order whatever tests I need to MAKE SURE that I've covered everything that could possibly be wrong and write my notes such that anyone (i.e. a patient's lawyer) who opens the chart to see if I am a potential target for a lawsuit knows that I have covered all of my bases, and that it'd be more trouble than it's worth to try to sue me.

5b) Some estimates out there say that 25% of all health care costs go to defensive medicine and malpractice. I believe it. I've seen an ER doctor order a CT scan of a child's head (probably $1000) when she was clinically fine (she HAD hit her head and had a goose egg-- but I did too when I was a kid, and I never got a CT scan). The doc's reasoning? "I'm near positive that little girl is fine right now. But if she goes out the door and hits her head again and THEN she has a brain bleed, I could be sued for missing it the first time because I can't prove that she doesn't have one now. And who knows if her parents will tell the truth about her hitting her head again?"

5c) Malpractice insurance is sought after by doctors because the hypothetical malignant mother of the child in 5b all too often wins a lawsuit and is awarded millions and millions of dollars. I don't have that much money, and I don't want to go bankrupt because I tried to help someone and possibly made a human mistake and they sue me. So I'll be buying malpractice insurance at whatever price they ask for it until this problem is solved.

5d) I'll also be spending endless hours charting things in immaculate detail so I'm protected if I DO ever get sued. Time is money. Lots of time charting is expensive. In summary, we have a system that rewards those that spend more, removes responsibility for paying for things from the individuals receiving the services, and removes cost-accountability from doctors working with patients. No wonder it's so expensive.
The good part of it -- the reason it persists -- is because the American people like to feel safe. We like knowing that no matter what happens, we're going to be okay and someone's going to pay for anything and everything we need. I can appreciate that. We just need a better way of doing it.

Health Care Reform: Expense

2009-08-13T18:56:00.000-07:00

**Before I get too much futher, I should admit openly that I certainly hope to hear from people who have different ideas and opinions on this issue than I do. Intelligent debate is something that we have far too little of in the media right now, so I have to try to get what I can in places like my blog. Let me know what you think, eh?

One of the great problems in today's healthcare system is that a major health problem has the potential to consume your financial life. If you're in a serious car accident and require multiple reconstructive surgeries, hospitalizations, and rehabilitation, it's not very difficult to run up a million dollars or more of medical bills. Very few people could afford that, and no insurance company wants to bear the costs of such ruinously heavy expense. I don't really blame them.

It's for reasons like these that I do support a limited form of universal coverage. In fact, the government already pays for certain medical treatments no-questions-asked, such as dialysis and hospice care. I think that's a good thing. While having Uncle Sam foot the bill for certain extremely expensive circumstances certainly won't help with the overall cost of health care (i.e. 1/6th of GDP), it'd certainly remove much of the burden from individual families that have a disproportionate healthcare need. I think this is an enlightened position to take -- bearing certain burdens as a society benefits us as a whole.

Now, what do I think falls into the category of "The Government should step in?" A very few things:

-Chronic mental health issues such as schizophrenia

-Catastrophic events such as life-threatening trauma, ectopic pregnancies, strokes, and possibly other emergency surgeries or services.

-Chronic, severe, unavoidable and debilitating medical conditions such as lupus, crohn's disease, multiple sclerosis, and parkinson's disease

Now, what do all of these things have in common? They're conditions that can render a person unable to care for themselves or their families, are extremely expensive, and (call me a cynic) they're very difficult to fake and are extremely unattractive in terms of lifestyle change. i.e. very, very few people would intentionally drive their car into a brick wall at 60mph just so they could have a free trip through the hospital as a spinal cord injury patient. Therefore, the potential for abuse of this part of the system is very low.

Now, you ask, what about other, equally debilitating conditions such as type II diabetes, high blood pressure, heart disease, and obesity?

Minimal public coverage only. I oppose bailing people out of situations that they could have avoided themselves had they taken the opportunity to do so. It's expensive, and a losing battle. Human nature is such that fixing a problem for someone else that they could have fixed themselves rarely actually fixes the problem.

That may sound heartless at first, but it's not. It's practical. Not only are these conditions extremely common and extremely expensive to treat, they're avoidable. Really, they are.

Besides that, these people are hardly without options. Currently, you can get generic blood pressure, cholesterol, and diabetes medications for $3-4/month each WITHOUT insurance at Target or Walgreens. It's not state-of-the-art, cutting-edge stuff, but it works pretty darn well and it's dirt cheap. If you can't afford 50 cents per day to get the five different medications that you need, you should spend less of your money on whatever you're spending it on. Ditch your cell phone, maybe?

Now, here's one other thing that I DO support -- universal access to primary care physicians, physician assistants, or nurse practitioners. In fact, I think NP's and PA's are awesome. I see an NP instead of a doctor at least 80% of the time I head to the doctor's office, and they know their stuff and do a good job. (At least, they do where I go to get my primary care.) They're also much cheaper than doctors.

One of the primary reasons that I support universal primary care is so that ER doctors can, with confidence and impunity, begin kicking people out of the emergency rooms who don't need to be there, and sending them off to follow up with a primary care provider. Rationing ER visits is, I think, absolutely appropriate. If we, as a society, start kicking people out of the ER who go there inappropriately, people will learn to stop going there inappropriately.

The above health care subsidies benefit the rest of us who don't go to the ER inappropriately, but occasionally need hospital care.

I work at a hospital that services the inner city of Milwaukee. I have seen a LOT of people come into the emergency room who don't need to be there. They get treated there, because they don't have anywhere else to go and the ER doctors are bound by duty (Hippocratic Oath) to treat these patients as they will not be recieved elsewhere. They plug up the ER and take up resources that they don't medically need, and it's extremely inefficient. There's also a lot of trauma (gunshots, stabbings, car crashes) that gets routed to the hospital, and much of the time those people don't have insurance to pay for their extremely expensive life-saving care.

So, when my friend Eric got sick with the flu, got dehydrated, and ended up going to the ER so he could get some IV fluids in him (he got three liters of saline before he was fully hydrated again), the emergency room charged his insurance company over $3,000. Maybe $300 of that was actually Eric's care, by my estimation. (Ten minutes of the doctor's time + 3 bags of sterile saline at maybe $10 a bag + IV and tubing for another $20, plus the ER bed, nurses time, etc.) The rest of it went towards the surgery for the hypothetical guy in the next room over who'd been shot in the lung and had to have an emergent pneumonectomy.

If that guy who got shot would have been covered by Uncle Sam, the hospital wouldn't have had to gouge Eric to make up that cost and stay in business.

The pro's of the above scenario are that we meet the criteria of expanding coverage for the uninsured as well as decrease the individualized costs of heavy health burdens for victims of serious illness, injury, or disease. So that's good.

The cons are that it expands the government's share of the healthcare pie, and will end up INCREASING the amount of money spent on healthcare by the federal government, which translates to increasing taxes. Because I hate taxes, I'd better come up with something soon that'll cover some of the above proposal's gargantuan costs. Never fear. I have more verbose, only-semi-original opinions on all of this stuff. Stay tuned.

Health Care Intro

2009-08-13T17:31:00.001-07:00

As an MD, I feel like I should blog about my thoughts on this, so I'm going to. (Sorry, Ronnie. No post about the new house just yet.)

American healthcare is excellent by any standard-- we have the most advanced drugs, tests, treatments, and we come out with new innovations at an astonishing rate. We have the longest life expectancy after being diagnosed with cancer or other serious illnesses, have shorter waits for surgeries and diagnostic scans, and are generally (80+ percent of folks) satisfied with the healthcare we get.

America's HEALTH, however, is not excellent. As a macro-generalization, Americans have unhealthy eating habits, poor exercise habits, and are overwieght. We also do our fair share of drinking and smoking, which are bad habits to get into if you want to live a long, healthy life. Not only that, we're busy and stressed and yet impressively physically inactive all at the same time.

Americans are also rich compared to people in other countries. We have an incredible standard of living, far surpassing what it was even 50 years ago here. We arguably have more disposable income now than at any other time in the history of humanity.

Thus, unsuprisingly, we spend more on healthcare than any other industrialized nation, and (also unsuprisingly) we learn the hard way that we can't buy our bodies back into good health.

This has sparked a national debate about what we need to do as a nation to cut costs, expand access, and keep the same level of care that we have now.

The Current System has the following traits:

-Excellent health care

-Innovative technologies

-High levels of choice in providers

-High satisfaction ratings

-Short wait times

-Extremely expensive

-Highly inefficient

-Uninsured persons have minimal/no access to care

President Obama's health care plan would attempt to fix the inherent problems of high expense, lack of efficiency, and uneven coverage.

'High Expense' refers not only to personal expense -- people who come down with major health problems with or without insurance can very easily end up bankrupt as they try to save themselves or their loved ones -- but also national expense, with health care taking up approximately 1/6th of the United State's GDP.

'Lack of Efficiency' comes into play as extremely expensive interventions are employed for only incremental benefit over less expensive alternatives. It also comes into play as health insurance companies require a high overhead to run, and when doctors order uneccessary tests. It's also inefficient and expensive for people to use emergency rooms as primary care providers.

'Uneven Coverage' refers to the ability of those with health insurance to get almost any treatment, test, or surgery that they need (or even want), while those without insurance lack basic fundamental health care.

So, the question then becomes "How do we, as a nation, decrease expense, increase efficiency, and increase coverage?"

I think it's at least theoretically possible, though I disagree with the 'big government' proposals of the current administration. The next couple of blog posts will discuss what I think we should do about the problems.

America vs. China (eating)

2009-08-04T16:05:00.000-07:00

So my mother in law asked me how the Chinese people stay so thin, given that they fry so much of the food they eat. It was a great question, and I've been thinking about my answer for two months. Here is my (verbose, as usual) answer, neatly categorized into sections:

1. Meat. Meat in China is made from the same animals as it is in the United States. Beef, Chicken, Pork, and seafood are the mainstays. However, the meat in china is in much smaller portions than it is in the US. (Read: no steak.) Also, it's not uncommon for the meat to have bones in it. This actually matters, because one of the factors in how much you eat at a sitting is how fast you eat it. If you eat slowly, you get full on less food. Taking meat off the bones takes time, so you eat more slowly.

2. The Fat is different. Chinese cooking routinely calls for vegetables and meats to be fried, either together or separately. Unlike America, however, they usually use a light vegetable oil to fry things in, rather than using butter. Butter is flavorful and fattening, and tends to stick to the food a little better than a light cooking oil will. Also, soaking something in light cooking oil tastes kind of gross (while anything soaked in butter will probably taste great) so there's incentive to minimize the oil left on the food after frying. Also, they don't bread the things they fry (i.e. give it a carbohydrate coating to soak up extra grease.)

3. Dairy products. Asians don't eat dairy products like Americans do. In fact, a good chunk of asians (90% in some places, if you believe Wikipedia) are lactose intolerant. Cheese, butter, and milk are therefore all much more rare than here. Dairy products are designed by Mother Nature to be helpful in doubling the size of young mammals in the shortest time possible so they can get big and strong. Grown mammals in America, however, absorb dairy almost as well as infants -- and if you consume a lot of dairy, the high-fat, high-protein, easily digested and easily absorbed foodstuff will help you grow in size as well.

4. Chopsticks vs. forks vs. hamburgers. Asians use chopsticks. Anyone who's eaten with chopsticks knows that you have to take smaller bites than you do with a fork, knife, and spoon. (Heck, if you feel like it, you can put a whole steak on a fork, right?). Thus, when using chopsticks, eating takes longer and (as mentioned above) you eat less per sitting. Some American meals are designed to be eaten with no utensils at all, such as hamburgers and other sandwiches. This translates to having the ability to take HUGE bites of stuff and pound it down your throat as quickly as your esophagus can carry it (no bones in a hamburger, either.)

5. Vegetables aplenty vs. scarce veggies. Americans don't eat as many vegetables as asians do. The core of most Chinese meals is rice with vegetables and a bit of meat for flavoring. Americans prefer thicker, hardier, usually higher calorie starches (bread or potatoes --baked or mashed -- with butter are very common) than rice, and usually the vegetables are marginalized in American meals. (i.e. the teeny portion of peas sitting next to the 16 oz steak, or the single lettuce leaf on the hamburger)

6. Rice is filling, but not for the calories it gives you. Rice expands in your stomach, so if you eat slowly (i.e. with chopsticks and meat with the bones still on) the rice has time to expand in your stomach and help you feel full. See the mashed potato comparison in number 5 for the American starches of choice, which do not expand.

7. Smaller bowls vs. large plates. In China, they use rice bowls.

See how much food you can put in them? I bet you can't fit a steak (okay, maybe a small one). It's very common to go back for seconds, or even thirds or fourths in China, but the basis of your seconds, thirds, and fourths is mostly rice with a bit of vegetables and meat on top to flavor/texture the rice. Filling up your bowl takes time (see 'eating slowly,' above) but more than that, you're much less likely to overeat just because you feel obligated to clean your bowl out so as not to waste any leftover food. In my case, I routinely clean my whole plate so as not to waste food, and then my wife has me finish of HER plate so SHE doesn't waste food. Of course, we both took way too much food to begin with since we were hungry when we sat down to eat.

8. No cups of liquid during dinner. The Chinese don't wash anything down with a swig of milk, soda, or even water. They drink after they've eaten. This decreases the amount of calories you take in because your stomach doesn't start emptying quite so fast -- you haven't helped it by dissolving all of your food in added liquid. Interestingly, this is one of the hard-and-fast rules that patients who undergo gastric bypass are told to live by. If you wash all of your food down, you get it out of your stomach faster and therefore the fact that your stomach has been artifically bisected and put back together to be a quarter of its original size doesn't slow you down. i.e. you might as well not have gotten the surgery.

9. Liquids at the table are low cal (brothy soup) vs. high-cal (soda/milk/juice). While they don't have a glass at a place setting, there is often liquid available if you need it in the form of a brothy soup. It's usually pretty bland, with a small chunk of meat and (again) some veggies of one kind or another.

10. Low sugar sweets. There is no such thing as "too sweet" for desserts in America. When I was in Taiwan, I gave an american Starburst candy to a chinese friend of mine, who could barely chew it. I suspect it gave her physical pain to choke it down. When I asked how she liked it, she said "Waaay too sweet." In America, we load up our desserts and candy with so much processed sugar that it's really quite impressive, and unpalatable to those not accustomed to it. Moral of the story? Eat less sugar. Cut the sugar in dessert recipes by 1/3 or more and you'll probably still be able to eat it no problem.

Anyway, there are probably more dietary reasons that I can't think of at the moment. And, of course, this leaves off the lifestyle part of the equation, which Americans also lose out miserably to the Chinese in terms of health. (In Beijing, by about 6:30 in the morning the parks are FULL of old people doing Tai Chi. In America, people consider themselves as having exercised if they simply go walking in the park.) But I don't want to rant about that tonight. It's late.

(Note: both pictures shamelessly pilliaged from the internet without permission.)

Call, for dummies.

2009-07-09T16:04:00.001-07:00

I had opportunity last night to be on call for the first time in my medical career. I'm not counting med school -- that was 'pretend' call. Just as long, but not half so stressful as the real thing.

For those of you who don't know what being 'on call' means, here's a quick synopsis: when you get sick and go to the hospital, there is ALWAYS a doctor at that hospital who's job is to take care of you. Any time, day or night, someone with an MD or DO at the end of their name has your name on a list. If something happens and you need a doctor, that's the guy or gal who gets the call from the nurse. They're the person who shows up if you do something stupid, like rupture your spleen, or otherwise try to die. You are their responsibility.

During normal business hours, the doctor taking care of you if you're hospitalized is Your Doctor. You might know them from outside the hospital, or have been referred to them by a friend, or maybe they were just assigned to you after you got hit by that car -- it doesn't matter. You're their responsibility. As Your Doctor has a life, however, including a significant other, maybe kids, a house, hobbies, etc., they can't always be immediately available to take care of you if you decide that you'd like to try not breathing for a while and see how it goes. When Your Doctor (Dr. A) goes home for the day, or for the weekend, he or she talks to one of their colleagues (Dr. B.) and passes your name, basic medical information, story, and treatment plan on so that Dr. B can take care of you while Dr. A is boating on the lake. Dr. B is now 'on call' until your doctor gets back or someone relieves them. Obviously, the idea is that if your kidney explodes while Dr. A is water skiing, you're covered: Dr. B can come to your rescue.

At the hospital I work at, we have six different medical teams (12 interns) who all have a handful of patients. At the end of the day, one of us acts as Dr. B for about 8-9 of the other interns (Dr. A's) and gets passed about 40 patients for the night. This is no big deal if your patients are healthy, sleep through the night, and have nothing seriously medically wrong with them -- but of course people like that don't belong in the hospital. Instead, your patients include old folks who get confused/go crazy at night, people who's lungs are finicky, people who like to have heart attacks, and people who are just generally otherwise in bad shape and might try to die suddenly. Also, nurses like to call and ask doctors questions in the middle of the night. You don't get much sleep on call, especially when you add in the during the course of the night you have to admit five brand new patients from the ER, take a medical history on them, examine them, and decide what you're going to do to take care of them while they're in the hospital.

Since you have your OWN work to do, you show up at about 7:00ish in the morning on the day that you're on call, do your own work for the day, and then collect patients from the other interns starting at about 4:00pm. They go home, and you take over as Dr. B for all of their patients overnight. Then, the next morning, you (again) have your own work to do before you can go (you also just admitted five new patients, remember?) so you stay until noon to finish things up before you can head out. Total time in house: 30 hours straight, give or take. Time spent sleeping: 2 hours, if you're darn lucky. (I got 90 minutes last night and felt really good about it.)

Why do doctors do this? Because we're not creative enough to find a better way. This works, it's kind of a right of passage, you learn a lot on the fly (example of an educational page you might recieve on call: "Dr. Zundel, the patient in bed 12 is pulling out her IV, swearing, hallucinating, and trying to bite the nursing staff. Please call back --Nurse Jane Doe, 3:15am"), and it means that most of the time (eleven of every twelve nights, in my case) you get to go home at the end of your (12 hour) day and pretend you're normal for the evening. So it has its perks.

Just for kicks, I'd like to briefly contrast a call shift with a 'normal job' (i.e. 40-60 hours / week):

1. Being on call is a full time job. No, really -- it is . Some 'normal job' employers offer full-time benefits at 32 hours per week. That's one call shift.

2. In a 'normal job,' it's sometimes hard to remember where you parked. Now try remembering where you parked yesterday.

3. If you have to stay late in a 'normal job' you might end up going home after dinner. If you stay late on call, it means you get to go home after lunch. Sounds nice, right?

4. It's amazing how many more calories you burn if, instead of sleeping for eight hours, you walk up and down hallways, staircases, and run to patient's rooms all night.

3. "It's easy to lose track of things when you've been up all night." If you used that excuse at a 'normal job' it might get you canned. As a doctor, though, you get bonus points for being tough.

6. 'Normal job' time is divided neatly into 'yesterday,' 'today,' 'tomorrow,' and other less definite terms like 'next week.' 'Tomorrow' kind of gets muddy when you're on call. Sometimes I'm not really sure when I mean when I say it.

With all of that said, I had a great call, learned a lot, and -- though I'm kind of tired today -- I think I'll be a better much better doctor for having had experiences like this.

Quick Update

2009-06-26T11:49:00.000-07:00

Hi guys.

Much has transpired in life since my last post: I've matched for residency (Internal Medicine for a year, then three years of Anesthesia -- both at Froedtert Hospital here in Milwaukee), we bought a house (pictures later), we painted the house, got new carpet, moved in, had a week in Utah (well, Linds had to work, so she got 2.5 days. Being an attorney is harder than being a doctor, I think. Billable hours are extremely unforgiving.), and now we're back, trying to get unpacked, and I'm trying to get everything together for residency before I start next week. On that note, I'd like to thank my loving, selfless, always-available mother for going out of her way to overnight me my passport -- which I could have sworn I had here in Milwaukee -- from Salt Lake City. Thanks mom. The federal government makes me prove that I'm a US citizen before they let me be a doctor. And a driver's licence doesn't cut it.

Life is good. Really good. I'm happy, things are going my way, I have a wonderful wife, a beautiful home (we found a great house at a great price), and I have nothing to complain about.

Anyway, I've got to go get some things done. I'm going to try to blog more regularly -- shorter updates, but more of them, kind of like Whitney.

Tracy's 2008 Recap

2009-01-02T07:31:00.000-08:00

Happy New Year!

Well, 2008 has been, quite possibly, the most eventful year in my life to date. I finished my third year of medical school, (I graduate in May), chose my medical specialty (Anesthesiology), got engaged, and most importantly, got married to an amazing woman whom I love very much.

My blogging in the past few months has been somewhat lackluster. That's partially because I've gotten married and been extremely distracted, and partially because I've been keeping in touch with friends via Facebook. Facebook, I've found, can eat as much or as little of your time as you have to devote to it. It's primary worth, in my opinion, comes from being able to keep track of friends and family with a few clicks. I learned about my cousin's engagement before my mother did (which is probably a first -- I rely on her for all of my family news) simply because Samantha had something on her facebook profile. But I digress. Suffice to say that, while Facebook is fun, it doesn't allow for the sheer volume of expression that a blog does. So I'm hoping to move away from Facebook and come back to blogging a little bit.

In line with that goal, I've decided it's high time I published some of the photos from the wedding. These are amateur photos taken by Aaron, Whitney, or others. The professional photographs will be added later. (There's supposedly a CD of them coming -- I could download them singly and add them, but that'd be a pain. So I'll hold out for a couple more weeks.)

So, in honor of the event, I thought I'd (finally) blog about it a little bit. Here we go.

The day before the wedding we had a big dinner for the two families to be able to get to know each other a little bit.

Here's a shot of my sister and my Uncle Butch (who came all the way from Utah despite the fact that we had an open house in Utah scheduled for the following week).

Here's a shot of the dad's (mine, Lindsay's) and a couple of my new sibling's in law (Jeff, Whitney).

... and some more of the crew (Linds, myself, lindsay's mom, my mom).

Here's my brother Aaron. The beard is a recent development, and (I think, anyway) looks good on him. Credit for most of these shots goes to him.

Everyone got along very well, especially the dads. Mike (left) and John (right) managed to have a good conversation throughout the entire dinner. Which is saying something, as they'd never said a word to each other prior to that evening and since the dinner took a grossly long time. The service at Bacchus that night, for whatever reason, was much slower than usual.

My beautiful bride. Isn't she cute?

The Brothers Zundel (minus Chris, who's on a mission right now). This is at the hotel after the dinner. We look good, don't we?

This is probably the most embarassing shot of myself that I have. So, of course, I had to include it. I have no idea what we think we're doing. Moving on...

This is Lindsay and I exiting the temple. I look pretty happy, don't I? That's because I am. Just in case any of the single guys reading this were wondering, I highly recommend getting married to a beautiful, kind, loving, giving, intelligent, spiritual woman. In fact, I was so ridiculously happy that I couldn't help but feel like I was somehow getting away with something. It's like when you're a kid, and someone offers you a cookie for no good reason at all. And it's a great cookie. And you have to giggle about it, because there's just no other way to express how ridiculously happy you are about your good fortune.

See? What'd I tell you. I'm totally snickering about it. The best cookie ever. (Or something like that.)

Anyway, Happy New Year, everyone! I hope you all had as great a year as I did. I'd write more on this, but I'm out of time. (I'm in Florida for new year's and it's almost beach time. Yes, my life rocks.) There will be more wedding stuff soon. (Consider these last two pics a sneak peak).

Random Tidbits of My day

2008-12-11T09:29:00.000-08:00

It's been a day of random tidbits. I kind of hope it continues, as I'm getting a kick out of it.

Things that have happened so far today:

1. Lindsay and I discovered a cube of frozen cheese on my windshield. Parmesan, to be precise. It's approximately half the size of my fist. I'm still at a loss as to who (or what) would leave dairy products on my car overnight, and even more at a loss as to what the purpose behind it could possibly be.

2. As I was getting dressed, I discovered that my new pants (khaki's. B-day present from the amazing wife) still have a tag on them. This wouldn't be all that random since they're new, except that I've been wearing them for two days. I'm such a stud.

In other news, the Wedding Update post (part I, anyway) is in the works. Watch for it later today or early next week. Right now, I gotta run some errands.

One Month of Marriage Update

2008-11-18T13:25:00.000-08:00

Hi folks.

I swear I'll be putting up more pictures of our wedding on here... as soon as I get some of them. I'm actually really looking forward to it -- I mean, really, is it possible for Jonathan Canlas to take a bad picture? I doubt it. (But I'm getting antsy to see.)

ANYWAY.. married life is awesome. I love waking up next to my absolutely gorgeous best friend of a wife every day. But more on that later when I have good pictures. Life in general is good, too, even if it's cold outside and I wish it were summertime again already. Last night I walked to the supermarket to buy some stuff for dinner and froze my face off. Wisconsin wind down by the lake is awfully cold.

Why was I on my way to the supermarket to make dinner? Lindsay's working full time as an attorney, and I'm only doing part-time at the ER, really, which means that it falls to me to bumble through the roll of househusband for the first few months of our marriage. It's been fun so far, and I've managed not to ruin any meals or completely destroy the house. And you know what? I even make the bed. Go me. (I never did that as a bachelor. I mean, excluding the last month, my bed has probably been made a total of about 5 times in the last year. It's just never been a priority.)

As an entertainment update, Linds and I have been reading the 'Twilight' series. We're about 2/3 of the way through book 3. It's kind of fun, because Lindsay and I are both fast readers to the point where we find it obnoxious to try to read things out loud to each other so we sit side by side for hours at a time and don't say much -- just flip pages and pause occasionally to discuss. Good fun. Currently, we're going to shoot for alternating between brain candy books (such as Twilight) and things with more substance. Since we've burned through more than 1500 pages in the last two and a half weeks alone, I imagine we'll be getting a lot of reading in together throughout our lifetime. I sure hope so -- reading is awesome. (I'm such a bookworm. Linds, obviously, is too.)

Election Day

2008-11-04T05:24:00.001-08:00

Hi all.

Well, it's been a great couple of months. Okay, that might not be entirely true: it's been an incredibly stressful couple of months, but the last two weeks have been absolutely wonderful. Getting married to the woman of your dreams is something that I highly recommend.

More on that later (I'll have much more time to update stuff this winter. Really. I swear.)

As you all know, it's election day today here in the United States. Go vote, people.

I wish I'd have had more time prior to today to muse a bit on the political atmosphere and the exchanges going on in the media and elsewhere. Being on my honeymoon in sunny Florida with my beautiful wife Lindsay, though, is a great excuse in my book.

What I will say about the political atmosphere is that it's been highly, highly charged. Since I know that's the case, there's probably a good portion of people that will disagree with me when I pass along my own opinions. Nevertheless, here are a handful:

I think that the Obama camp overall ran a better campaign. They were better funded, and had the distinct advantage of offering something amorphously 'different' as a draw.

Americans are extremely unhappy, upset, and even angry with the way things are right now. This definitely adds to the "different is good" mentality. However, I think it says much more about the attitude of the American people than it does the actual current state of affairs. Talking with foreigners who've recently immigrated to the US from places such as South Africa or Eastern Europe has made me grateful for what I have, current problems notwithstanding.

I've observed that patritotism is often muted when it's flaked by so much negative clamour. I really wish this election season were more about America as a Great Nation and less about America as a Great Problem That Needs Fixing. While I'm wishing, I wish that both sides of the political fence were less apt to point fingers and assign blame and more apt to sit down and have real, meaningful dialogue. I also wish there was less villainizing of the candidates going on.

Mostly, I wish that the media wasn't so inflammatory. Juicy headlines sell, I guess. (Which fact I've learned from going through the check-out line at the supermarket.) The whole thing makes me a little sad.

But, even with all of that, I'm personally extremely proud to be an American. I love living in a country where I can get an education, have a job, eat, have a safe living environment, and get state-of-the-art medical care when problems arise. It's a good life, frankly. I hope it keeps getting better.

And yes, I voted today. Go America.

Engagement Photos

2008-09-13T15:37:00.001-07:00

Hi all. Sorry for the delay in any sort of update. My life in a nutshell is that I work about 70 hours a week on my internal medicine sub internship, I'm trying to help with the wedding preparations as I can (stuffed envelopes this week), though admittedly I'm probably only very minorly helpful or involved (thanks, Linds, and especially thanks to the rest of the Heller clan out here and my own family back in Utah who are taking care of that end of things. Seriously, families are awesome.), trying to study for my board exams next month, finish applying to anesthesiology residencies, and still eat, sleep, and sneak in a bit of exercise. Oh, yeah: I've been writing a scientific paper on PET/CT scans and head and neck cancer.

So, while I try to keep my life from exploding into a mess of disjointed, fragmented bits of reality, I thought I'd paste a link to some of our engagement pictures for all to see and enjoy.

The wedding is October 18th, and it's coming up soon.

Father's Day

2008-06-15T20:19:00.000-07:00

Happy Father's day, everyone.

I've been blessed to have a great dad in my life. He's honest, hard working, treats his wife and children well, and is a great example of everything a dad should be. He's done a lot for me, and I wouldn't be where I am today without all of the help he's given me over the years.

Therefore, in honor of my dad (he's great) I thought I'd post a few pictures from our fishing trip to Alaska last summer.

We caught some big salmon on that trip.

And had a lot of fun. The best part about this picture is that I can't remember what we were laughing about.

Caught a northern pike as well. See how I have it behind the gills? As I put it back in the water, I noticed my fingers were bleeding. The gills were that sharp.

This is the two of us in front of the small plane we flew in out to the middle of the Alaskan tundra. Quite an adventure, that. It was cold, there were bugs, and the ground was the oddest kind of squishy.

The best part of the trip, though, was being able to spend some quality time with a great man that I look up to a lot. He's a busy man (partner in a law firm in downtown Salt Lake) but always manages to have time for me whenever I need him. He's been a great support to me in every way-- even going so far as to give me his car (which is holding up great throughthe Wisconsin weather) when I went off to medical school. Just a small example of a way my dad's made my life easier through the years.

Happy Father's Day, dad. Thanks for everything.

Eventful Weekend

2008-05-26T20:55:00.001-07:00

Happy Memorial day, everyone. I had a great weekend. Here's why:

The ring is fake, but the engagement is real. We'll be married October 18th. Isn't she cute? I haven't really blogged about Lindsay very much, but that's largely because I haven't blogged very much in the last eight months... I've been hanging out with Lindsay instead.

See? (Okay, so carving snow hearts is kind of sappy. But hey, that's okay every once in a while.)

This is the two of us hanging out on the lawn the day after we got engaged (with yet another fake engagement ring**, I might add.) You've probably noticed that Lindsay is significantly better looking than I am. Don't get me wrong-- I'm not dog meat or anything, but besides being brilliant and an incredible person, Linds is gorgeous. (Which is fine by me. I'll be the ugly one in the relationship any day.)

You can find a better (and more detailed account) of things (including a video clip or two) on Whitney's blog (Linds' sister).

**She's wearing fake engagement rings because her fingers are ridiculously tiny. The jeweler took the diamond I picked out (with help from her mother and sisters-- always a good idea to have help in such endeavors) to Vegas for the week to try to find a suitable setting in a suitable size (3.75). So, in the meanwhile, $6 hospital fake-ring-vendor specials wrapped in dental floss on the bottom (size 5 rings) so they fit.

Psychiatry

2008-05-14T15:34:00.000-07:00

Hi folks. As promised: (Okay, so it's been 10 days instead of a single, clean week. It's still progress. Be kind.)

Mid February to mid March of this year, I spent my time on the Psychiatric Crisis Service (PCS) at Milwaukee County Mental Health. As a little bit of background, PCS is basically the psychiatric emergency room, which means that the craziest people are brought there when they get out of control and end up arrested by the police. It's also the place that people come when they threaten to commit suicide or have failed suicide attempts, real or pretend. Of course, we didn't really ever care if the suicide attempts were real or not, the rationale being that it doesn't really matter if you're actually trying to kill yourself or just pretending to try to kill yourself to get attention: you're crazy, either way. But I'm getting ahead of myself.

In general, PCS was fairly manageable and not half so hectic as I thought it'd be. This was, ironically, not because there are less completely crazy people in the world than I thought there were, but because there are a lot more of them than I thought there were. About 80% of the time that I was working the psychiatric ER was on standby. No patients could be brought there by the police or transferred from other hospitals. The only patients we dealt with while on standby were those that walked in under their own power (or a close friend's/spouse/landlord's own power,) and there were still plenty of patients. I was very rarely, if ever, bored.

We were on standby because the entire Milwaukee mental health complex (MHC--several acres of purely psychiatric hospital beds and wards) was completely full. Not a single empty bed in the whole place. That meant that all of those people who were indeed crazy but not at the mental health complex got to stay wherever it was they happened to be. For some of them that meant hanging out in other hospital's ER's and taking up beds there. (Emergency room beds are ALWAYS in short supply, so this wasn't really an ideal situation. Ever had to wait five hours at an ER before? This is one of the reasons why: beds taken up by people who should, ideally, be in other places but can't go there for one reason or another.) For other people, that meant spending the night in jail for either their own protection or everybody else's. For still others, it meant taking up hospital beds on the medicine wards at major hospitals, which is also not ideal. (Hospital space is at a premium these days, at least in Milwaukee.) This, as you might imagine, becomes a social nightmare for a lot of people. the patients themselves, their families, psychiatrists, other doctors, the police, the hospital administration (most people that are crazy enough to end up needing to spend time at the MHC aren't functional enough to have health insurance and thus they're a moneysink on the hospital system) social workers, and pretty much everyone else involved in the care of these people ends up facing a very stark reality: there just aren't resources around for dealing with all of these people.

Now, I'm traditionally a conservative (let's not get into that just now), but at this point in my life I'm all about government-funded health care --especially psychiatric care-- for the mentally ill. Yes, I understand that there are a lot of logistical issues when it comes to having selectively subsidized healthcare for some people and not for others, and I also understand that it opens up potential for a LOT of abuse of the system, but I still feel it's the best way to go in this case. There are an awful lot of people who have such significant psychiatric issues that they just can't take care of themselves and really do need to spend some time in asylum. Unfortunately for those people, the asylums are quite full already, and there just isn't any room for them. And, because there's very limited funding for those facilities, it doesn't look like things are going to get better for them any time soon. Keep in mind that the people I'm talking about are so handicapped by their disorders that they really don't stand a chance at holding down a job long enough to qualify for insurance. Or, at least, not the kind of job that offers insurance.

The really tragic thing about it all is that there are also a lot of people that could possibly quite functional if they had a little more support. But they don't.

Gotta cut this one into two parts, or I'm never going to post it. It's my bedtime (Anesthesia makes for early mornings.) but there'll be more on Psychiatry next week. Specifically, I'd like to talk about some of the people I met. Until then...

My absence

2008-05-04T08:51:00.000-07:00

Hi all. I've definitely been gone far too long. So I'll give you all a quick update on my life.

I really only do three things:

1) School/Work (interchangable these days)

2) Sit at my computer and email/play video games/study

3) Hang out with Lindsay

So there aren't a lot of major life events to write about. Work's been interesting, and I'm going to refresh my goal of trying to blog weekly. This will be the third time I've tried this, and I've never pulled it off for more than a few weeks. But hey, third times' the charm.

Since February, I've seen some interesting things at work, though. These experiences were during my rotations of Psychiatry at the Milwaukee County Mental Health Complex's psychiatric crisis service (where the police bring in all the people that have psychiatric issues that they don't know where else to take-- i.e. the really crazy people), two weeks on the Froedtert hospital Neurology consult service, and a month on the Radiation Oncology service, which rotations were also very interesting. Now I'm on CPR-- which is NOT basic life support. It stands for 'clinical procedures rotation' and encompasses trauma (which I've done), ER (which I've also done), and anesthesiology (which I've never done.) And it's shaping up to be a good month so far. Tomorrow, for instance, I have class from nine to noon. Then I have the rest of the afternoon off to study. Yeehaw.

So here's the deal: I'll update this blog once a week for the rest of the month, and I'll do recaps of each of my rotations, starting with Psychiatry next week. Stay tuned.

Merry Christmas! (and the last two months.)

2007-12-26T18:10:00.000-08:00

Well, here I am writing an update to my blog for the first time in... oh, two months or so. It's been an eventful and busy two months, and I can't say that I've been bored or not had anything to write about. In fact, I've had a lot go on in the last little while.

Before I start, though, Merry Christmas everybody! For the record, I had a wonderful Christmas in Utah with my family and friends. And that's about all there is to say about it. Now, for the update:

Most obviously, I've been in school during this blogging sabbatical. Medical school these days is, as I've said before, a lot more like work than it is school. The exceptions to that rule occur at the end of the month when we sit down for our standardized, national, end of rotation examinations. This morning, for instance, I sat to take the exam for my Internal Medicine Rotation. The national test writers decided to wish me a Merry Christmas by sending me an academic karate chop to my adam's apple. That thing was absolutely wicked. I read pretty fast, but that didn't seem to help me – I finished the 100 question exam with about 90 seconds left on the two-hour and ten minute clock. And that was after working myself into a frenzy for the second half of the exam. There was no time to think, or ponder, or puzzle out the answers to this test. Either you knew the answer (after reading a two to three paragraph question, mind you) right off the top of your head, or you didn't.

The irony of the whole thing is that Internal Medicine, in practice, involves a LOT more thinking than any other rotation I've been on so far. Surgery, while not for idiots, is much more about knowing HOW to do something than it is knowing WHAT to do. By the end of my two-month surgical rotation I could examine Mr. Joe Schmoe in the ER, poke his belly a bit, and be 98% sure that the guy needed his appendix taken out. (“Does it hurt when I push... HERE?” If the man jumps off table, congratulations. You've just diagnosed acute appendicitis)It's also not rocket science to see that the guy who's been stabbed and has a good 8” of his small bowel sitting on (not in) his abdomen needs some help or he's going to have a really, really bad day. Now, can I DO anything about these problems as a junior medical student? Heck no.

Internal medicine is just the opposite. Mostly, when someone has a problem, we give them medicine to make the problem better. Any schmuck with a sufficient grasp of the English language and reasonable handwriting (and 'reasonable handwriting' has some extremely loose interpretations in the medical field) can write “Please give 40mg of Lasix three times daily” on a medical chart, and the medication is magically (thank you, nurses!) given to the patient exactly as you write. The question that lingers is whether or not the prescription you just gave this guy with congestive heart failure is going to make him better, or kill him before the end of the day. So you have to really THINK about it, and make sure you've considered everything before you put this guy on something. Then you have to watch him carefully, adjust doses as needed, and either pull the medication or put him on something else if things start to go South. So I have no idea whatsoever why testing people in such a way that they have to intellectually sprint through the exam is helpful or realistic. No patient wants a doctor who's so rushed he (or she) doesn't have the time to ponder the differences between an asthma attack and mycoplasma pneumonia when they show up in his office with a wheeze and a cough. At least, I sure don't.

But enough about school. As always, the medical students whine and complain about how hard everything is, yet the vast majority of us do just fine. If we're honest, we're mostly just bothered that for the first time in our academic lives, we just don't feel all hat smart anymore. Some of us handle that better than others. I can't help but smile whenever I see a grossly type-A classmate of mine writing a dissertation on why that last test was terrible and should be thrown out and the test writers flogged. But I digress, for I'm talking about school again. Like I said, enough of that.

Other things going on have included dating, friends, major holidays, and – of course – flying home for those major holidays. I'm writing this from my parent's house in Utah, actually. It's been a great couple of days out here with friends and family, and I even got most of the things for Christmas that I put on my Christmas list. Which, despite the fact that I'm 28, seems to make the holidays just that much brighter. Hello, rent money.

In any case, I hope everyone had a very Merry Christmas. (Whether you celebrate Christmas or not. If you celebrated something else recently, I hope you had a Merry Whateverthatwas on TOP of a Merry Christmas. I'm sure I probably had a Merry Whateverthatwas, too. Life's just been plain old good recently.)

Happy Thanksgiving

2007-11-22T10:06:00.000-08:00

Hope everyone has a wonderful holiday. I know I certainly have a great deal to be grateful for.

(I should probably wish everyone a Happy Hallowen as well. It's been a while since I've posted.)

General update

2007-10-12T13:48:00.000-07:00

Well, I've had a great couple of weeks. This month, I'm rotating in the pediatric ER, and it's been a lot of fun. I like the diversity that I see in the ER- wounds, sicknesses, asthma, wierd stuff I've never heard of, broken bones, seizures, fevers, and sickle cell disease. I also like never knowing what's going to be coming through the door next.

I learn a lot when I'm on duty and like working there. It's a bit crazy at times, but I like that too. It's kind of like trauma surgery, but with less hours, less trauma, and less (i.e. absolutely no) surgery. Surgery itself really doesn't seem to be my thing. I *did* enjoy my surgery rotation more than I expected I would, but in the end I still don't think I'll enjoy it anywhere near as much as some of my other rotations. Time will tell.

The downside: I never thought I'd say this, but I wish I worked more. I'm averaging something like 30 hours a week, and I have no idea what to do with myself for the rest of my spare time. I mean, I can study, clean my room, cook, do laundry, and generally live the life of a normal human being. But even then, there's not all that much of those things to do while I'm a bachelor. So I end up wasting a lot of that extra time I was oh-so-looking-forward-to. I'm going to be ready to be on the medicine service come November, I think. I hear the hours are crazy and there's a lot to learn there. My type of thing, at least at this point in my life. Once I learn enough for something to become routine, I quickly lose interest in it. Right now, though, I'm not anywhere near that point, at least in terms of medicine.

Other things I'm thinking about at the moment include girls (and why I can never seem to figure out what's going on. I know everyone says that, but really, it's incredible. I even have a sister I use as a consultant, and as brilliant as she is she can't seem to help me), the relative lack of interesting news in the media (even CNN.com reads something like a tabloid these days with headlines like: "Brad Pitt Transformed," "Free From Whitehouse, Former Counselor Tells Tales," and "Jury Sees dying Princess Diana Pictures," -- all up on the site at the moment of my typing this blog entry), the fact that I have to be carefull to distinguish between perpetual change (i.e. a new job every four weeks) and actual progress in my life, and what I'm going to wear for halloween this year. I've RSVP'd for a costume party on Halloween night, and I don't have access to the basket of Halloween costumes in my parent's basement this year. Any suggestions, folks? Let me know.

Other things I'm still thinking about include how to get more done with my free time, and the ever-present problems of health care costs, insurance, the underinsured and uninsured, the corporate business aspect of hospitals, and what's to be done about it all. I haven't forgotten my promise of a blog post on the subject, and I expect to have it written in the next couple of weeks.

You know you're in med school when...

2007-09-23T07:07:00.000-07:00

I was on call last night. Which means that I was at the hospital dealing with sick kids my entire day and most of my night. I don't really mind being on call, usually. After all, in order to resent the loss of a social life, one must have a social life to lose. I lost mine a long time ago, which actually helps when it comes to enjoying work. But I digress.

I got home at around 10:30pm, which isn't too late on a Saturday night. Unless, of course, you have to be up at 6:00a.m. to go back to work. My roommate and fellow medical student Jared was still awake when I got home.

As both Jared and myself were getting ready to go to bed, Jared posed a very mundane yet significant question:

"Hey, Trace-- what time is it?"

I glanced at the clock: 11:04p.m..

"Almost seven," I replied without thinking.

"Cool. Thanks."

Sensing that something about the exchange was less than normal, yet that we had communicated perfectly, Jared and I both sat quietly for a moment while we took in what had just happened.

You know you're in med school when you tell time based on how many hours of sleep you're going to get.

Jason Whitlock Wins

2007-09-21T20:56:00.000-07:00

Just thought I'd publicly agree with this article. If the link breaks (and they always do, don't they?) just add acomment at the bottom and I'll add the full text.

(Link broke. Full text appended. Credit to Jason Whitlock of Fox Sports.)

Forgive me. This column is going to ramble and stumble a bit before I get to my main point. Real Talk is like that sometimes. Good conversations don't always fit in a tight package. They wander from time to time, and the wandering provides context to the point.

My dad once explained to me that absolutely everything you accept from another human being comes with a responsibility whether stated or not. He was a bit tipsy and the conversation took place around 2 a.m. He drifted, bad-mouthed some of his best friends, bad-mouthed a couple of my friends. I was 17. I've never forgotten his message, and repeat it at least two or three times a year.

I'm already meandering. Stick with this column; you'll enjoy the journey to Jena.

We're in this age of whining and bitching about the lack of accountability among professional athletes and wannabe pro jocks when it comes to bad behavior. The message sells. I've sold it.

But America's accountability crisis extends well beyond the sports world and bad behavior. You know that. Wednesday afternoon, I surfed the 'Net and came across the video of Miss Teen South Carolina absolutely butchering a relatively easy question about why one out of five Americans can't find the USA on a map.

Lauren Caitlin Upton's response was unintentionally hysterical, a piece of comedic gold that must be viewed to be appreciated . Her fourth-place finish in the Miss Teen USA pageant and the subsequent Today Show pity party thrown in her honor say all you need to know about how we treat our "beautiful people."

They can do little wrong, little we can't excuse, and we hold them to the lowest of all standards in nearly every regard.

The 40-plus contestants who finished behind Miss Teen South Carolina should all file lawsuits. The clip is literally making millions laugh, but her rambling, incoherent soliloquy didn't really hurt her in the pageant standings. Short of calling a group of women's college basketball players "nappy-headed hos," I'm not sure how the 18-year-old could've answered the question any worse.

I clicked from the Miss Teen video to stories about Chicago linebacker Lance Briggs' one-Lamborghini, hit-abandon-n-run accident early Monday morning.

Briggs, a Pro Bowler, met with reporters Tuesday and fed them a line of (spit) that they pretty much refused to swallow. He claimed he "panicked" and ditched his $350,000 vehicle because he didn't want to create a "big scene."

Good move. By running, Briggs avoided a sobriety test, and left the police with no choice but to hit him with a few misdemeanor traffic citations. More important, Briggs handcuffed commissioner Roger Goodell, the discipline dean of the NFL. An arrest for driving under the influence could've potentially landed Briggs in the league's substance-abuse program and in Goodell's suspension crosshairs.

Instead, Bears coach Lovie Smith quickly announced that the club planned to take no action against Briggs, and Lovie grew angry when reporters asked if Briggs had been drinking.

Well, this is the organization that lost Tank Johnson to guns, pit bulls and a driving-while-sober traffic stop. I'm sure Lovie feels like his roster is owed a get-out-of-Goodell's-office free card.

Again, it's not just pro jocks who feel like they're owed something. It's not just pro jocks who have their failures rationalized and excused. It's a societal problem, brought on by the fact that our pursuit of a bigger house, a fancier car and a splashier vacation has short-circuited our commitment to parenting. At the end of the day, only your parents can truly hold you responsible for your misdeeds. Coaches can't. The media can't. A judge can't. Teachers don't stand a chance.

This belief crystallized for me over the past couple of months as I tracked and researched the case involving the "Jena Six," a group of Louisiana black boys who have been charged with a very serious crime after jumping, beating and stomping a white boy on school grounds.

The "Jena Six" are becoming a cause célébre for Al Sharpton, Jesse Jackson and the media. At least two or three times a week for the past three months, I have received an e-mail from someone asking me to support the "Jena Six."

On the surface, the story sounds like a horrifying tale of Emmett Till-style justice. At a predominantly white high school in a segregated town (Jena), a black student sat under a shade tree that was traditionally used by white students. The next day three white students hung nooses from the tree, sparking racial tension and a sit-in (under the tree) by black students. The principal attempted to expel the three white students, but the school board overruled the principal and the students were given a suspension, which sparked more racial tension.

Police patrolled the school's hallways. The town's district attorney visited the school for an impromptu assembly, allegedly looked at the black students and said he could end their lives with one stroke of his pen. A little more than three months after the noose incident — and just days after two off-campus fights/heated exchanges involving a black student and white former students — the "Jena Six" punched, beat and stomped a white kid who made fun of a black kid for getting whipped in a Friday-night fight.

The white kid was knocked unconscious. After a three-hour hospital visit, he was released. The town prosecutor initially charged the "Jena Six" with attempted murder. Mychal Bell, the first of the six to stand trial and a Division-I football prospect, was convicted of aggravated second-degree battery and conspiracy by an all-white, six-person jury, a white judge and a white prosecutor. His public defender did not call a single witness in his defense. Bell could be sentenced to 22 years.

Whew! Before I go any further, let me state this: The prosecutor should've never charged these boys with attempted murder. The entire school board should be replaced for stopping the noose-hanging kids from being expelled.

OK, having said that, much of the mainstream reporting on this story has been misleading, irresponsible and inflammatory.

No one mentions that Mychal Bell's clueless public defender was black. No one mentions that there were no black jurors because of the 50 people who responded to the more than 100 summons, none were black. No one mentions that Bell was already on probation for battery relating to a Christmas day incident in 2005. No one mentions that Bell was adjudicated (convicted) of two other violent crimes in 2006 and one charge of criminal damage to property. No one mentions that Bell's father acknowledged he moved back to Louisiana in February (after seven years in Dallas) to supervise his son because of the "Jena Six" mess. No one mentions that Bell starred on the Jena High football team while constantly jeopardizing/violating his seemingly flimsy probation.

This was all talked about in open court during a bond hearing for Bell, and a newspaper in Alexandria, La., wrote about it. Just about everybody else has pretty much ignored the "other side" of the story. Including the fact that not one witness — black or white, and there were 40 statements taken — connected the jumping/beatdown of the white student (Dec. 4) to the noose incident (Sept. 1).

No one mentions that a black U.S. Attorney, Donald Washington, investigated the "Jena Six" case and held a town-hall meeting explaining that there was no evidence connecting the jumping/beatdown to the noose incident.

Only after the prosecutor overreacted (or tired of letting Bell and others skate once the successful football season was over; Bell wasn't the only football star charged) did the "Jena Six" blame the attack on the nooses and the white shade tree.

Rather than report the truth, flames have been fanned by lazy or cowardly or agenda-driven members of the media. Because the white kid regained consciousness and survived the attack with only a swollen eye, defenders of the "Jena Six" have called it a typical "schoolyard fight." Would anyone call it that if six white football and basketball players jumped one black kid?

I've mulled this topic for months, and I keep coming back to one question: Where in the hell were the parents — all of the parents, white and black?

Shame on the parents of the kids who hung the nooses for hiding behind a seemingly racist and insensitive school board when their kids were inexcusably wrong. Shame on the parents of the "Jena Six" for blaming white racism for the cowardice of a six-on-one attack.

And shame on the prosecutor, the media and Al Sharpton for not rising above the ignorance and distortions, and seeking a truth that will set everyone in Jena free, including the "Jena Six."

Why People Become Pediatricians

2007-09-17T19:16:00.000-07:00

You'll need sound.

My One-Sidedness

2007-09-15T22:30:00.000-07:00

Well, I've been chastised by some friends for my one-sided posting on obesity, which for a lot of people can be a sensitive topic these days. I suppose I should have taken time to moderate my comments prior to this as I expected it to happen eventually, and I'd like to say that I'm sorry if I offended those friends or anyone else. Never my intention. Everyone has struggles, and far be it from me to pick and choose which struggles are okay to have and which are not.

As an individual criticizing a people and a culture (which happens to be my own people and culture, I might add), it's very easy for me to say that we're gaining weight and it's becoming more and more of a problem. It's taking a toll on many different aspects of our lives, the one I'm most familiar with being health care. Hundreds of billions of dollars worth of a toll over the last decade, to be precise. It's also easy for me to say that it's almost exclusively due to our collective eating and exercise habits. Which is also true, and something I make no apology for. There are scientific studies to support that view, and in my experience it's also the general consensus in the health care community.

The problem occurs when I try and take all of that and apply it to individuals. What little of that I did in my last post wasn't done all that well. I'll be more constructive about it in the near future so stay tuned. In the meanwhile, I think I'll change topics for a bit.

Happy Sunday, everyone.

General Update

2007-09-13T15:54:00.000-07:00

In the last couple of weeks, I've had some good experiences that all started with me finishing my surgery rotation. I took my test the Friday before labor day and left a free man, with nothing but good times on the horizon for the weekend. Those good times began with a boating trip with some friends out to one of the many lakes that dot the Wisconsin countryside.

Of course, as we were coming back we ran out of gas three-quarters of a mile off shore, and so Jonny and I towed the boat in. I'm the wet one on the right hand side. Lindsay's the brunette smiling at our folly while her sister runs the camera. Good times.

Two weeks ago, I started my pediatrics rotation. It's so very different from surgery. I think I'll list some of the starker contrast points:

1) In pediatrics, everyone is nice. A surgeon's trade does not require personality or kindness-- Just a good set of hands and an attitude to get things done. That's not to say all surgeons are mean(in fact, most of them were great to work with), it's just to say that you can be mean and still be a good surgeon. You really can't be mean and still be a good pediatrician.

2) As one might imagine, medical students are strongly encouraged NOT to be innovative and motivated to proactively help during delicate surgeries. In fact, even doing something helpful before the surgeon explicitly asks you to do it can be a great way to catch some wrath. In pediatrics, however, creative research and treatment ideas are smiled upon. Even if they ignore your suggestions, you've given them something to think about.

3) In surgery, we recieved lectures on how to manage sleep deprivation. In pediatrics, we have a bedtime. (10:00 p.m.)

4) In trauma surgery, we had close to 40 patients on our service. When I showed up for pediatrics, we had five. This means that I get to learn from every patient we have. It also means when I'm on call I don't have to work for 30 hours straight.

5) It's easier to be devoted to the care of an innocent young child with a fever than a felon with a gunshot wound and an attitude.

6) I was never bored on my trauma surgery rotation.

7) I've never been sleep deprived on pediatrics.

So it's a different world. The pediatric residents are great- they're kind and helpful and motherly and they bring cookies to our meetings. The surgery residents are also kind and helpful, but they are not motherly nor do they bring cookies as a general rule.

So that's how school's going.

What I'm realizing is that -- aside from school -- my life just isn't all that interesting right now. When I'm not at school I do things like study and clean my room and do my laundry. And eat and run and sleep and all that stuff. So there's not all that much to write about. I suppose at some point in my life I should probably start dating again. If only I could find a girl that plays the tambourine then maybe... well, nevermind. I've decided I don't want to write about this after all.

What I DO want to write about is the policy of the healthcare system and the politics of it all. So stay tuned. Right now I'm going to go have dinner.

Nature vs. Nurture vs. Soda

2007-08-11T09:23:00.000-07:00

I just finished reading this article on obesity.

I have to comment on this article, because I think it sends a really distorted view of the role of biology in human behavior. Particularly human eating behavior, which is a pet topic of mine anyway. Here I go:

The Bariatric Bed

Outside of the operating room of the hospital yesterday, there stood a pair of sales reps showcasing a product I had never seen before: a bariatric hospital bed. For those of you who've never heard the term before, 'bariatric' is the word tossed around in the medical community when something is designed for use with obese people. This particular bed had extendable sides so it could accommodate people with too much girth to fit comfortably in a regular hospital bed. Also, it's inflatable mattress was compartmentalized so that different portions could inflate at different times and move the patient around to prevent bed sores, because patients that are obese enough to need a bariatric bed can't usually move well enough under their own power and bed sores become a real problem in the hospital. And the sales reps were giving out candy in order to get people to come and look at the bed. It worked. I had two pieces before the irony of the situation got to me and I had to walk away.

The reason the sales reps were showcasing the bed is rooted in good old fashioned economic supply and demand. There are more and more fat people. Therefore, they need hospital beds for fat people. But why are there more and more fat people? I'll give you a hint: genetics and biology are both wrong answers. The article, "Fat hormone sheds new light on obesity: study" says:

"It showed desire for food is driven by biology -- not greed -- which causes overeating and obesity,"

I couldn't disagree more. Biology does not cause overeating and obesity. Habits do. (Which, admittedly, is not the same thing as greed. But it's certainly not biology, either.)

The thing is, if you're paying attention, you'll also learn from the article that it's talking about a rare genetic hormone-deficiency form of obesity of which there are about a dozen known cases. Does that really extend into the general population? Definitely not. For 99.999% of us, our leptin hormone works just fine, thank-you-very-much.

If biology causes overeating and obesity, biology also causes teen pregnancy. And violent crime, while we're at it. After all, those are also driven by hormones: pregnancy by sex hormones, and violent crime by adrenaline.

The bottom line is that we-- as a human population -- are only two generations out from our grandparents. Most of whom were not even overweight, let alone obese. In fact, in 1991 obesity rates were WAY lower than they are now. And most of the people reading this blog were alive back then. There has been NO appreciable change in the genetic material we're working with here. Which means that if our grandparents would have sat around at watched television all day, eating potato chips and ice cream, they too would have become fat. I guess you can call that genetics if you want to.

The thing is, the chips are stacked against us in America unless we're paying attention. There's a soft drink isle at my local supermarket. An isle. Not a shelf, but an entire isle, both sides. I don't run the supermarket, but I can tell by the supply what the customers are demanding. At the gas station, they have 44 oz. cups, and they're not even the biggest size. A 44 oz soda has, on average, about 600 calories. Lots of them have more than that. A 64oz lemon-lime has about twice that- almost 1200 calories. A hamburger - you know, the good kind that's huge and loaded with everything - can break 1200 calories with ease. Which means that if the ONLY thing you had to eat in a day was a 64oz soda and a big juicy hamburger, and if you skipped breakfast and lunch completely, you'd never hit below 2400 calories a day. Which is 20% higher than the 'recommended daily allowance' of 2000 calories a day on average. Good morning, America: this is your lifestyle. After all, when was the last time you saw an advertisement for a hamburger that WASN'T big a juicy and came with an order of deep fried potatoes we've attributed to a European country!? We like things that are bigger and, though nobody ever says it, fattier. Mmm. Bigger burgers.

The recommended serving size for a piece of meat is 4oz. Which means that your 8 oz steak is actually two steaks, from a nutritionist's point of view. Your 16oz steak is meant for a family of four.

We're fat in this country because we eat like fat people. If you, personally, are bigger than you'd like to be, it's your job to change how you're eating and what you're doing with your body. 3500 calories=1lb of fat. If you take in more than you burn, you'll gain weight. Your biology tells you to eat. How you eat and how much you eat is up to you.

Exercise and inactivity are the other half of the equation, but I have to go make lunch so I'm not going to go there except to say that exercising for 30 minutes a day really isn't that hard. If I did it when I worked 90 hour weeks in trauma surgery (and I did miss a day or two, but I did pretty well), anyone can. Except trauma surgery residents. They're excused.

Why We Wear Helmets

2007-08-05T18:58:00.000-07:00

This is why we wear helmets. I've seen people fall less than half this far and end up with irreversible brain damage. Helmets is where it's at.

By the way, he was released from the hospital a few days later with a concussion and minor injuries.

Note: This link was broken for a while, but it's now working again. (Google Video had it after it was removed from YouTube.)

Good ol' JK Rowling

2007-07-31T20:17:00.001-07:00

I read Harry Potter and the Deathly Hallows last weekend. All I have to say is that JK Rowling wins. If you've never picked up a Harry Potter novel, you're missing out on literature that's not only highly entertaining and very well written, but is -- and is going to continue to be -- highly influential in the entertainment industry for many years to come.

Addendum to my previous post: trauma surgery was WAY cooler than general surgery could ever hope to be. I think I want to be an ER doc.

One down, 23 to go.

2007-07-30T13:16:00.001-07:00

I just finished my first rotation, and it was intense. I spent a month of 80 hour weeks (sometimes a little more) on the Trauma Surgery team at Froedtert hospital, the biggest hospital in the Milwaukee area. That's significant because it means we get all the crazy stuff. Milwaukee has an impressive crime rate (#12 in the US according to Wikipedia), so there was plenty to go around.

My work weeks consisted of twelve to fourteen hour days, plus two thirty hour overnight call shifts per week. Hitting eighty hours isn't hard under those circumstances, let me tell you. As a man dedicated to eight hours nightly, I was more than a little surprised to realize that the overnight shifts were my favorites. All of the cool stuff happens at night. (By 'cool,' I may also mean 'crazy,' 'intense,' 'violent,' or 'traumatic.' Not that violence or trauma are cool things to have happen, but from an academic standpoint, they're certainly cool things to study and learn from.)

During my time on the trauma team, I saw some pretty cool things. To name a few:

*Note: I'm in the medical field, so I'm a lot less ancy about some details that the general public probably wouldn't mention. Fair warning.

1. A man stabbed in the chest by a garden light. His story was that someone was stealing his barbeque, so he picked up the garden light (everyone know what I'm talking about here? The solar kind?) to beat the evil thief and defend his rightful claim to the cookwear. At this point, the thief took the light from him and stabbed it into his chest. The guy had to go the OR (operating room) to have the light's 2" anchor removed from his sternum. He was also high on cocaine, incidentally.

2. The man who's self-described job description was "I steal drugs from drug dealers." Unsurprisingly, he had multiple gunshot wounds. Surprisingly, he managed to get shot doing something besides stealing drugs: stealing a drug dealer's girlfriend. To escape the drug dealer, he bailed out of a second (maybe third- I'm not sure) story window and broke multiple bones when he hit the pavement below. He had at least one pellet in his heart, but survived everything and made it safely to jail.

3. A jolly drunk of a 23 year old who kept giggling and asking what was going on and what we were doing to him. The guy was wasted. He kept making brilliant comments like "Man. This is so weird. I have NO IDEA what you guys are doing!" and then giggling like a school girl. "You're at the hospital, bud. You got hit by a car." "I DID NOT! I'm fine!" Yes you did you drunk fool, and your three missing teeth and bleeding face agree with me. Eventually we convinced him he had indeed been smashed by an auto, at which point he proceeded to share with us that "Hehe. Someone is touching my penis!" followed by even more giggling. He was right- we were putting a catheter in. He giggled a lot less as we inserted it, though ("Ow! Stop! Please stop! OW!") and then immediately forgot we'd done anything to him at all. "I have to pee." I bet you do! "Can I get up and go to the bathroom?" After a few minutes of reminding him, he figured it out and voided the clearest urine I've ever seen into the cath bag.

4. A nineteen year old with multiple stab wounds to his back, neck and face. Seven of them in all. He also did fine, though I imagine he's going to have a wicked looking scar on his cheek.

5. A drunk who'd been shot in the leg. He had mold growing on him it had been so long since he showered.

I saw countless other stabbings, gunshot wounds, car accident victims, motorcycle victims, and people who had fallen off of things (20ft concrete walls) or had things fall on them (the roof of his garage.) Like I said earlier, it was pretty intense. I learned something, though:

If you live long enough to make it to the hospital, you're going to live.
UNLESS: You smashed your head up too badly.
OR: You got shot in the chest.

So, I highly recommend wearing a helmet any time there's a possibility of cracking your head on something, and strongly discourage anyone getting shot in the chest under any circumstances. If you can do those two things, odds are you'll live a long and productive life.

Summary: Don't be an idiot- wear a helmet.

There was something that all of the gunshot victims and all but one of the stabbing victims I saw had in common: they were black or hispanic. The one white guy got stabbed by his wife. (Who was hispanic, I might add.) The moral of the story: traumatic injury is a socioeconomic disease. One of the attending physicians told me that on my fourth day there. After a month of experience, I couldn't agree with him more. Culture, education, and one's habits have a near-overwhelming influence in the life of any given individual. That's a blanket statement with little applicability in individual cases, but it sure seems to hold up well generally.

As for the thirty hour shifts, I learned that my need for sleep was not so great as I once thought. I also learned that the reason doctors do it is because there's enough work to keep you busy the entire time. If there's not, you go to sleep and wake up when someone calls you. Is there a better way to do it? Not that I can think of.

As far as my personal life goes, things are pretty much the same as ever. I'm generally happy, I like what I'm doing, and I'm almost too busy do do much else besides school.

Two Month Sabbatical OVER

2007-06-27T20:21:00.000-07:00

Hi folks.

It's bee na while since I've updated this. I feel like a kid telling his teacher why he didn't do his homework, but here's why there's been such a drag in the blogging:

1) I had finals. This included the Pharmacology final, which weighed in at 32 pages of short-answer questions. I have read shorter books in my lifetime.

2) I had boards.

'Boards' in this case means Step 1 of the United States Medical Lisencing Examination, or USMLE Step 1, as we call it 'round here. I'd have rather taken another Pharmacology final. I spent roughly ten hours a day for virtually an entire month studying for that thing, and when I took it there were still questions containing vocabulary I had never seen before and may have been fabricated for purposes of smashing the confidence of would-be medical professionals. The exam was 350 questions, and eight hours long. The questions were all multiple choice, with no rhyme or reason to the number of possible choices. Some were A-E. Some ranged as high as A-N, and everything in-between.

Everyone asks me how I did. When I tell them I won't know for six weeks, they ask me how I think I did. When I tell them that I have no idea, because parts of it seemed ridiculously obvious and other parts seemed suspiciously like they were about fictional diseases that didn't actually exist (after all, I'd never heard of them before,) they usually don't have anything else to ask. Most of my classmates I've talked to felt the same way. Our consensus: the boards are hard.

I also took five days and went to Alaska to fish with my dad. It was some of the most fun I've had in a long time. I'll post Alaska pictures sometime soon. I don't feel like including them tonight.

In the near future (Monday), I'll begin my stint as a third year medical student. This is a big change for me. Instead of taking tests and studying all the time, I'm going to be taking tests and working all the time. But more working than test taking, I think. And I'm starting it off with a bang.

My first rotation is going to be in the trauma surgery department. That means that I'm going to be in an environment that's very much sink or swim, and it's going to be all that I do for the month of July. My work schedule consists of being on call every third night. That means that I'll work a 30 hour shift, come home and recover for the rest of the day, work a normal (10-14) hour shift the next day, and then the day after that I'll have another 30 hour shift.

Why? Because here in the medical community, we believe in working 30 hours a day. After I've done it, I'll let everyone know if I can come up for any sort of logical argument as to why 30 hour shifts are a good idea for someone in charge of making sure other people don't die.

Here's me on my trauma surgery rotation. I thought I'd vent some of anxiety by drawing a picture of how much I'm going to love it and how excited I'll be to be actually out applying what I've learned over the last two years. (I really am excited.)

The Media

2007-04-16T10:59:00.000-07:00

This post is a follow-up to the last one. For those of you who haven't heard, both MSNBC and CBS cut ties with Don Imus this week over his insensitive comments the other week. Before I start on my rant, I'd like to point out that I'm of the opinion that cleaning up the language and topics of discussion on radio and television is an excellent thing to do. Pulling Imus off of the air is, most likely, a step in that direction.

With that said, I think the fact that he was fired is not so much an indication of the moral fiber or progressiveness of the country as it is an indication of the herd mentality of bandwagon outrage and susceptibility to suggestion.

Don Imus wasn't fired because he said something he shouldn't have. He was fired because he said something he shouldn't have on a slow news day.

The vast, vast majority of people who were crying for Don Imus' blood were not people who'd heard his comments on the radio. They were people who'd read about his comments in the newspaper or online. His sponsors didn't care about what he said: if they had cared they'd have immediately reprimanded him. The reprimand came only after the public cry of outrage, which was a self-fueling fire. The more upset people became, the more news coverage it got. Without the news coverage of the event, it'd have been a non-issue.

As for the take on it that it was damaging to the Black community, women, or college basketball, I'll refer you to Jason Whitlock's opinion article on the subject. If you haven't read it, you should.

The simple truth is that a guy on the radio who makes tasteless comments in an attempt to be funny has little to no bearing on anyone's day-to-day life. I'd never even heard of the guy before this incident. Most of the people calling for his head hadn't either, I'd bet.

Had President Bush invaded Iran the day before Imus opened his mouth, Imus would have kept his job.

The news media has become an alternate form of entertainment for the world. We read the articles that are the most shocking and the most controversial first. Then we move on to economics or global warming. The headlines to the articles about what's going on in Washington D.C. are often not so different from the taglines for the sitcoms on television. I watched an interview where Mitt Romney, one of the political candidates for the 2008 presidential election, was asked by the reporter to comment on each of his rivals, both Democrat and Republican. Not their policies, but the people themselves.

It's almost as though the media is treating the election to the most powerful governmental office in the world as a high school popularity contest. Does that bother anyone else? It drives me nuts.

I suppose my point is that the American public as a whole could stand to take what they read in the media with a little bigger grain of salt. Even if the things that are being reported are factually true, we should take a minute to step back and ask ourselves if they really matter.

Political Correctness

2007-04-09T20:42:00.000-07:00

After watching the initial stirrings of the 2008 presidential campaign, as well as this week's fiasco with the decrying of Don Imus and his comments on the Rutger's women's basketball, I've re-realized a couple of things that I'd like to share with everyone:

1) Most of the discourse (especially politics) in the media today is a world-class, 3rd-grade-recess style yelling contest consisting of namecalling, fingerpointing, and telling on people

and

2) Being offended is stupid.

First, I'd like to talk about Don Imus in the context of point number two. I freely admit that I've never listened to his radio show, and hadn't even ever heard of the guy before he started showing up in the news this week. (Obviously) I'm not a radio guy. According to wikipedia, though, Don Imus is one of the great radio hosts of all time, famous for pranks and off-color humor. He's been on the air for approximately forty straight years, and has a significant following. He's a philanthropist as well.

He's now been suspended for two weeks following an insensitive and stupid comment about the Rutgers Women's basketball team. Political Correctness strikes again. Stupid.

So: Don Imus made a bad comment. (Yes, it was bad.) Welcome to Earth. If you've spent much time here, you know that people make stupid comments here all the time. Here's the real kicker: comedians intentionally make stupid comments all the time. People that are really good at it get paid exorbitantly well, as a matter of fact. Society is encouraging them. Society is entertained by stupidity.

Don't get me wrong- I'm not a fan of that type of humor as a general rule. I think making fun of other people is tasteless, and unentertaining to boot.

What bothers me isn't when people say stupid things, but when other people actually bother to take offense to them. Seriously, how much of our time and theirs are they really willing to waste being upset and bothered by other people's idiocy? Do they not have anything better to do? Do they really believe that their indignation and anger serves any sort of constructive purpose at all? I sure don't.

What really bothers me is when those people act like offending them is an Unpardonable Sin Against Humanity. Don Imus, after realizing that he'd gone too far (or that other people felt he'd gone too far), did the decent thing and made a good-faith effort at apologizing. He said he was sorry, that he didn't mean it and that it was said in a humorous context and wasn't intended to be taken seriously (which does make some difference), that he regretted saying it, and that it was inexcusable despite all of that. He requested to meet the ladies of the Rutger's team and apologize. He even agreed to go on the air with Rev. Al Sharpton and apologize publicly. All of that convinces that he-- like each and every one of the rest of us at one point in life or another --said something he didn't mean and would like to try and fix it. (See the "Welcome to Earth" statement above.) But the Rev. Al Sharpton, on the air with the offender who'd come to apologize, saw not an opportunity to build a bridge of forgiveness and unity ('Thanks so much for apologizing. It's good to know you didn't mean that seriously and you're trying to make it right.') but instead chose to open up the discussion with "What is any possible reason that you could feel, that this kind of statement could be just forgiven and overlooked?"

The Rev. Sharpton, apparently, was offended. Offended enough to want Imus to lose his job. And wasn't willing to let that offense go in light of something so paltry as an apology. Nevermind if Don Imus is a good person or not, and nevermind that he's obviously sincere. Someone from Time magazine agrees with Sharpton. Maybe you do too. That's your call. I certainly think we could use less stupidity and frivolity in our media as a whole, and the media sans Don Imus might be a step in that direction and it might not.

Now, I'm not black. Nor am I a collegiate basketball player, nor a woman. In fact, I'm a middle-upper class white male. What could I possibly know about being on the recieving end of discrimination and misinformation and bigotry? I'm also a Mormon. Go google Mormonism if you want to see what some people say about people like me. I'm going to Hell in at least eight different ways. Interestingly, I'm usually going to hell for things that aren't even actually true. (By the way, if you want to actually learn about Mormonism, go to the site run by the Mormon church, www.lds.org.)

Do I really care what a bunch of hateful, overzealous ignoramuses think about me and my religion? Not really, no. Do I become offended when they tell me to my face that I'm going to hell and I'm a bad person and have been decieved into following the devil? (I've actually heard all of that firsthand, by the way.) No. Frustrated, maybe, but not offended. Like I said, welcome to planet Earth. Some people here just don't get it.

It's now mainstream and even trendy to be offended by certain things, and especially to seek offense where none is intended. Racism, pro-life/pro-choice issues, Bush/antibush issues, and sexual orientation, to name some of the big ones. It doesn't even really matter what side of the issue you're on anymore. Both sides of the argument feel that they're justified in stamping their feet and pouting anytime someone says something they don't like.

Along those same, divisive, shortsighted, and unproductive lines, it's also more common than not to see artificial polarization in the way we see not only those people, but the issues themselves.

If you believe homosexuality is morally wrong, you must be a bigot. If a black person gets fired by a white boss, the boss must be racist. If you believe abortion should be safe and legal, you're an immoral baby-killer without a conscience. If you support Bush, you must be uneducated and ignorant like he is. If you're a Muslim, you must be fascist. If you're from America, you must be arrogant and thoughtless.

It's empowering to be offended. It lets people access some good old Righteous Indignation. I bet that feels good.

Unfortunately, it also effectively curtails any sort of mutually educational civilized discourse.

Perhaps the most tragic part of all of it is that it's not confined to the public forum. Through watching all of this, people are learning to take offense at things others say or do in their personal lives. Which is an even better way to guarantee that they're going to waste a lot of time angry, upset, and unhappy. But hey, at least they'll have something to be angry about and blame all that unhappiness on. Stupid.

Grow up, folks.

I've been watching (or trying to watch-- I'm in medical school at the moment) the development of the 2008 presidential race. I'm amazed at the lack of insight the media displays.

If you believed the media was reporting things properly, you'd infer that the election is about character assasination, catching candidates in supposed inconsistencies, ferreting out (or fabricating) deep dark secrets, and trying to discredit the opposition based on those things. Why? So we won't take anything they're saying seriously. It's funny to me that most of the people who are against George Bush hate him passionately, rather than simply disagreeing strongly with his ideology and views on running the country. John Kerry, a war hero, got smeared when he jumped into the presidential running in '04. A war hero. Did everyone catch that? Our president George Bush, that supposed ignorant fool, holds degrees from both Yale and Harvard.

So here's my challenge to all you readers: as you look at the people portrayed in the media, pay special attention to what those people are saying, and less to what others are saying about them. You may decide that you agree with what's being said by everyone else. But hey, you might not.

(Now if I could only convince all of the 2008 presidential candidates to discuss their own policies instead of everyone else's...)

Spring Break

2007-03-30T20:21:00.000-07:00

I had spring break two weeks ago. It was eye opening.

I went home and spent a few days doing very, very little. To my amazement, somehow during that time I developed a personality again. It was great-- I'd sure missed myself. The highlight highlight of my trip occurred the Saturday night before I came back: I cracked a joke. It was even funny.

Medical school is extremely enjoyable. It's interesting and fulfilling and challenging and mind expanding. What it ISN'T is fun. Ever. Before last week, I can't remember the last time that I'd laughed until my sides hurt, or got out of bed in the morning and decided that I'd like to begin the day by jumping on my little brother's bed to wake him up. Or done anything else 'fun.' Even the things that should have been fun were intermittent enough that they only managed to pass as relaxing. That's not the same thing. Things are relaxing when you're wound too tight to have fun.

Not that I expect things to get much better in the next couple of months. I have to take the next month and study for finals, and after that I'll take a month and study for my board exams.

Simplicity

2007-03-11T18:23:00.000-07:00

It's been an interesting month, truthfully. I've had a number of personal situations arise that have taken a good portion of my time and energy (nothing too strenuous-- just time consuming), and what was leftover was eagerly lapped up by my schooling. My second round of exams this semester ended last week, and I'm happy to report that I'm still not failing out of medical school. Which is a great sign, since I'm almost done with the coursework portion. Come July, (assuming I pass my board exams) I'll begin my hospital clerkships and have eight solid months of intense work, followed by four more months of less intense work and then another year of much of the same, but with more freedom on my part to choose where I am and what I'm doing. Med school's almost half over, and it's gone by more quickly than any other eighteen months of my life to date. It seems to be a recurring theme: the older I get, the faster time flies. I read once that by the time you're in your eighties, you feel like you're having breakfast every fifteen minutes. I believe that. I already feel like I go to bed every six hours or so.

I took some pictures on my morning jaunt the other day, and I thought I'd share a few of them.

This is the canal near my appartment. I love it. It's got about thirty yards of trees on either side of it, which means that it feels secluded even though at any given point I'm about thirty seconds from the road. It was a little warmer that day (and a LOT warmer the few days after that) and so the canal was a little higher than normal. It made for a brilliant walk, frankly. It was cold, but not bitterly so, and the temperature even passed for pleasant with me dressed in sweats and a jacket.

I ran across some ducks. Not all that noteworthy, except that it means that spring is (finally) coming. Considering it was Cold only four or five weeks ago, that's a very welcome sign. Winter gets depressing after a while. It's exciting through Christmas, and the holiday cheer keeps me going through most of January, but come February and March, I'm about ready for the weather to change. Which, fortunately, is about the time it happens.

In fact, the last couple of days have been downright balmy, as far as I'm concerned. And I feel great about that.

Now, you're probably all wondering why I've been talking about the weather for the last two blog entries. Great question. The reason is that nothing else in my life really changes all that drastically from day to day. I'm happy, but if I weren't I'd definitely be in what's known as "a rut." My days blow by, I spend them studying, working out, attending school, (the non-lecture portions of it), sleeping, and keeping in touch with family and friends. Occasionally I do something fun like go out to dinner with classmates or have friends from church over to watch a movie on the weekends, but other than that, one day is pretty much like all of the others. I like it. I'm learning amazingly interesting things in school. (Like how different drugs work.) I'm healthy. I eat well (because I cook my own food.) I get enough exercise. Overall, life's good. Simply satisfying, is the best way I can think to describe it. It's uncomplicated, and I have all of the essentials and no major problems. I can hardly ask for more.

The Cold

2007-02-07T14:45:00.000-08:00

Those of you who were paying attention to the national news last week may have noticed that the weather out here in Milwaukee made headlines. I'd just like to point out that it deserved to.

Here's a picture of the intersection outside my window, and below it is another from almost the exactly same angle, and at a comparable time of day.

See the roads in the first picture? They're gray. That's a layer of salt that's frozen to the pavement. The idea behind the salt on the road, as you know, is to make the water more difficult to freeze. This spiffy little trick works well down to about 10-15 degrees Fahrenheit in the real world (though in the lab you can technically go lower than that under certain conditions.) The road in this picture has no water on it whatsoever because you're not looking at a picture of cold weather, you're looking at Cold. This condition (Cold) is very different from normal winter weather (cold.) Ice cream is cold. Liquid nitrogen is Cold. You'll notice that there are no cars on the road during the Cold. That's because about half of the cars in Milwaukee wouldn't start (mine was fine, though. Thanks again for the Maxima, Dad.) The other half belonged to people who realized that it was Stupid to go out in the Cold, and schools across the state were cancelled. In the picture of cold (not Cold) weather, below, you'll notice plenty of cars. That's because the high school I live two blocks away from had open doors again this morning. It's only cold today, after all. Other cancelled things this weekend included church (yes, my LDS singles ward cancelled meetings), volleyball, elementary and middle schools, and work. Note that 'Superbowl Parties' are not on the list. Please also note that, in one of the great ironies of my life, I attended one on Sunday.

Milwaukee dropped to about -10 during this time period, with wind chills bringing the perceived temperature somewhere closer to -30 Fahrenheit. I'd like everyone to go through a mental exercise with me now. Imagine sitting on the beach in Florida, with a temperature of a balmy 90. Nice, yes? Now imagine being in the dead of winter, and having it be cold - just below freezing, at about 30 degrees. There's a huge difference there. You just went from warm to cold, a sixty degree jump. Now imagine taking yet another sixty degree jump, all the way down to negative thirty. Welcome to the Cold. It's as far from freezing as freezing is from Florida. Now, just to make it interesting, imagine dressing for Florida while being out in the Cold.

Every so often in life, people have a tendency to do stupid things just because they can. It happens to men a lot more often than it happens to women, I've noticed. I've also noticed that men tend to range up into the Stupid region more often than women do as well. I'm no exception, and decided that I was going to go out into the bleakness of Milwaukee winter dressed as though I was in Florida summer, just for the experience. As I was thinking about it, a small voice somewhere in my head told me that I was being stupid. It was Cold out there. Why would I ever subject myself to something like that without any sort of productive or rational reason? It was pointless. After thinking a little longer, I knew that the voice was right. I also knew that if I listened to the voice, I'd be just like everyone else-- huddled inside, staying warm, and enjoying a relaxing evening. I didn't want that. Here's a picture of me before I went out.

See how happy I look? I'm such a sucker. Here's a picture of me on my way back in (I ran about a half a block and turned around.)

Just in case you can't really 'get a feel' for the experience, I zoomed in and enhanced the image a bit.

That's the expression of a man whose every muscle is clenching simultaneously in an attempt to somehow undo his stupidity through force of will alone. My feet hurt, too. I didn't think about that before I went out there, but I thought about it a lot afterwards.

In conclusion, and by popular demand, a soup recipe:

Tracy's Dump Soup (as opposed to my mom's dump soup- dumping in canned goods is the name of the game. This makes it quick and easy, and even more importantly, almost impossible to screw up. A bachelor favorite.)

2 cans stewed tomatoes
1 can red kidney beans (drained and washed)
1 can canned corn (not creamed)
4-5 medium potatoes
2 garlic cloves
1 medium onion
1 lb lean ground beef
Oregano
Salt
Pepper
Basil (if you want)

Put the potatoes in the microwave for about five minutes. While that’s going on, chop the onion and cook it up in the bottom of the soup pan with the hamburger. (No grease required.) Drain the fat, and dump the rest of the canned goods in, as well as 2 cans of water (fill up one of the empty cans with tap water.) When the potatoes are done, chop them and add them to the soup. Smash the garlic and add it to the pot. Salt and pepper to taste, and oregano and basil to taste as well. All up to you. As always, Tracy recommends repeatedly tasting the soup as you’re making it to see if you like what you’re getting.

Serve alone, or with chips and grated cheddar cheese. Enjoy.

(Please also note that you can pretty much add whatever else you want to this soup and have it work out great. I've added green beans, spaghetti sauce, mushrooms, cheese, jalapenos, green peppers, etc.)

Student Bachelorhood

2007-01-30T10:56:00.000-08:00

Hi folks. I decided I'd share a new snack with everyone that I've enjoyed lately. I've diagrammed it for those of you who like unnecessary detail. Not the healthiest food I make (far from it) but also not as bad as it looks at first glance. Both spreads are made with nuts, and the bread is made from whole wheat. Bananas are just plain good for you.

As you may have noticed, this is "Student Bachelor" food. Most of the time I eat better than this, I swear. If you want a soup recipe I've invented (there are a couple of them worth sharing) leave a comment and I'll put one up for you.

Speaking of comments, I think I've had at least a dozen people comment on my blog in the last little while (either digitally for all to see or in person over break) that I had NO idea were reading this at all or even cared. Which was flattering, and encouraging enough for me to resolve (yet again) to update this more often than I have been.

I had an experience two weeks ago that I also thought I'd share. My old roommate Matt came into town, and prompted a gathering of the Bachelor Quartet that lived together for a good chunk of last year. Then last July, Matt went away to grad school at BYU, and we've since been a Bachelor Trio. (Matt also picked up a steady girlfriend about that time, so he might not have counted as a bachelor anymore anyway.) We decided on breakfast at IHOP. Since it's Wisconsin, however, we decided to be genuine IHOPesque customers and go in mountain man flannel shirts. I felt very much incognito, as nobody would have ever guessed from the looks of us that they were witnessing three future doctors and a future business professor have breakfast together.
From left to right, Matt, Jon, myself, and Jared.

As far as school goes, my new academic demons are going to reside in my pharmacology notes. For the first test, I was required to be familiar with basic pharmacokinetic equations (how the drug dissipates through your body, how quickly it's eliminated, etc.), be able to use and manipulate them, and have approximately seventy drugs memorized in great detail, including uses, biochemical mechanisms of action, and contraindications. Pretty rough. It was the equivalent of an undergraduate chemistry final coupled with a huge chunk of memorization. I did fine, largely because of the chemistry portions of the exam. I just didn't memorize the drugs well enough, and took some hits on those sections.

The thing that worries me a bit is that the next block has almost two hundred drugs, and little to no chemistry. This is not my type of test. Cramming for it is impossible, and so I'm faced with the challenge of brute memorization and retention. Not my strong point. To put it in perspective, I still can't remember where I left my coat a few weeks ago. (And I've been relying on my (very warm) jacket ever since.)

New Leaf

2007-01-15T21:28:00.000-08:00

My friend Lauren randomly found my blog today and shamed me by showing me that she's ALSO got a blog... and she updates it weekly. Ouch. I've been meaning to do that since I started this, and it wouldn't be that big of a deal... except that I have this horrible habit of sinking way too much time into my posts. So the new goal is to have a weekly entry, and reserve my Big Entrys for the end of the month. Or whenever I actually have time. (Probably after exams.)

Speaking of exams, my first batch is next week. My only concern is that one of them is NOT multiple choice. I always hated multiple choice examinations as an undergraduate, but after taking 18 months of classes where EVERY test has been multiple choice, I'm kind of used to them. This whole "fill in the blank" format makes me slightly edgy. Which means that this weekend is going to be a whole lot of bookwork, and almost no socializing. Too bad, really. Especially since I just got invited to go sledding on Saturday.

Christmas break was good. I'll write about it... well, after exams.

It's official: I'm old.

2006-12-10T18:44:00.000-08:00

Well folks, life rolls on. This week's been an eventful one: I turned 27 on Friday. Those of you who are mathematically inclined will realize that I'm now 90% of the way to 30. (Incidentally, I'm also older than my father was when I first met him.) Earlier in the week, one of my classmates heard it was my birthday this week and started up a conversation.

"Happy Birthday! How old are you now? Twenty-four?"

"Uh... not quite."

"Oh. That's right. I forgot: you're old."

"Yes. Thanks for remembering."

I figured it was a toss up on whether I should be bothered or pleased, and in some ways I still haven't decided. Most of my classmates didn't take two years off of their academic life and are therefore roughly twenty-four or twenty-five. (I served as an LDS missionary in Taiwan right out of high school, for those who are wondering.) Frankly, I'm still not old, or even close. Now, I *am* oldER than I've ever been, but that's not exactly news, now is it? I'll consider myself old when I start going downhill. As is, I'm still definitely on the upswing. Trust me.

Besides that one little number, nothing much has changed in the last year. I live in an apartment in Milwaukee where I study medicine for at least four or five hours a day, usually more like eight or ten, I feed myself when I get hungry, clean my room when it gets so messy I can't handle it anymore, sleep, shower, cook, buy groceries, work out, go to school, and read books. It's a good life, and I can't say that I regret spending the last year of my life as I have. There's something to be said for living life as an adventure, tromping off to new places and to see new things while you're still young enough to appreciate and enjoy it, but there's also something to be said for doing something guaranteed to be worthwhile and valuable. While the circumstances in my life are nearly identical to where they were a year ago, where I am in life has changed significantly and I can't say I'm displeased. Medical school continues to be enjoyable and engaging, even if there are occasional moments where I feel like I've been academically mulekicked. Like, say, when I failed my first pathology exam earlier this year. But hey: you get up, dust yourself off, keep going, and study harder for the next one. And it works out.

On something of a shorter time scale, it's been a crazy couple of weeks. The temperature in Milwaukee has ranged from the mid 50's to some numbers rather too close to zero for my liking. The doors on my car were frozen shut during a cold snap last week, and then a few days later we got hit with a huge snowstorm. This is what my car looked like the next morning:

It took me about fifteen minutes to get my car to the point where I could drive it to school, relying mostly on flailing my arms across my windshield to clear it. Bob, my Trusty Ice Scraper, simply wasn't up to the challenge of an actual blizzard, as you can see here.

Keep in mind, all that snow fell in an eight hour period, so it was a pretty intense storm. MCW didn't bother to cancel classes, though, unlike the Milwaukee public school system. That usually wouldn't have affected me, as I skip class 90% of the time anyway, but that day I made it a point to go to class just to prove that I could. It's a guy thing. I did fine, though I was about ten minutes late as I forgot to account for the time it took me to excavate my maxima.

This upcoming week is finals week, which means that I did very little to celebrate my birthday this last weekend (Thanks, John, for dragging my out of my house and feeding me Qdoba for my birthday celebration) and spent the time instead studying lung diseases and tumors. I'm used to it. I haven't had time for a birthday party in over half a decade: it always falls on --or just before -- finals week. Such is the life of a college student.

And it's now my bedtime. I have to be to the school by 8:30am to take my Pathology exam.

The Grind

2006-11-02T12:38:00.000-08:00

My days lately have been pretty uniform. I'm afraid I've fallen into "The Routine" of school once again, and I'm awfully glad that it's "The Routine" of school and not of work. I think that if I knew my life was going to follow this same schedule indefinitely I'd go nuts. As is, in about six months it all comes to a grinding halt as I begin studying for boards, take the boards, and then begin my clinical rotations around the hospitals of Milwaukee. At which point I'll be lucky if I get a good night's sleep. I know. Both of my roommates are at that point already.

Still, some days do indeed break up the monotony. The picture below should give you some idea of what I'm talking about. And no, that's not a Halloween costume. There's actually a purpose for putting me in a 60's spaceman movie mask.

I was getting fitted for a respirator. See the duckbill? It's to prevent me from coming down with tuberculosis when I sit in on my first real autopsy later this semester. The space suit helmet is to test the seal on my duckbill (a.k.a. the respirator.) I got a cloud of saccharin mist sprayed into the mask, and my job was to nod my head, talk, turn my neck from side to side, and let the nice tester man (background) know if I could taste the mist. I couldn't, and therefore I passed, just in case any of you were wondering. The respirator fit, so now I can go see my first autopsy.

Leaving the school that morning (respirator fitting was scheduled for 8:00a.m. sharp), I ran into this little fiasco as I was leaving the parking lot. You'll notice that most of the people are trying to get into the parking lot, in sharp contrast with my situation. That's because, while there are a great many of my classmates that still actually attend lecture, I'm not one of them. I study on my own at home most mornings.

What actually happened is the power went out. See the little electronic gateway arms? Yeah. They need juice. So the traffic backed up all the way into the intersection. The power was out for probably less than fifteen minutes before the security office showed up and removed the arms, but it just so happened to be during the fifteen minutes of the day where everyone shows up for school. Here's another shot of the lineup, just so you all understand how long that line of cars was. (Not my finest hour photographically, but you get the idea.)

See? All the way back to the road, and probably beyond.

Here's Emily. She showed up late and thought everyone was just waiting in line for kicks. Bless her heart. As a result, she drove out in front of everyone and blocked the road in the process of trying to get into the parking lot. I'm sure she meant well.

She wasn't very happy with me when I took her picture, though.

Those of you who know her will get a kick out of that shot. Most of you won't, but I'm sure you can all sympathize anyway. Who hasn't done something like that in their lifetime?

My finding something like this as amusing as I do is a testament to how little I get out and about these days. I'm just looking forward to coming home for Thanksgiving this next week.

I'm back

2006-10-10T19:11:00.000-07:00

Well folks, I'm back. I actually just typed an entire blog entry, only to have it deleted by my browser. I'm not happy about that, but have once again learned the lesson of not trusting my computer for anything I don't absolutely have to.

It's probably fine. The only thing remotely interesting in the last entry was a world-class, toaster-based waffle ejection that managed to slightly dirty my kitchen ceiling. I'll let all of you puzzle the mechanics of that one out yourselves.

Other than than, I eat, sleep, walk, study, and get dressed up for my 'Touchy-Feely-Tuesdays' which include Psychological interviewing and my ethics class, where they try to teach me to be a good person by following the appropriate checklists for any given situation. I'm sure there are savantish, insensitive clouts in my class that will benefit greatly from it, as it's the only way they could learn it. Most of the class, though, will agree with me when I say that it's a cakewalk, and only enjoyable because the mediators for the small group sessions are such nice people. My mediators are both old and nice enough to be my grandparents, and I feel suitably taken care of whenever I show up for class.

Don't get me wrong. I'd trade almost any one of my undergraduate instructors for these guys. (But not all. I had some pretty good undergraduate instructors.)

Random stuff

2006-05-07T19:44:00.000-07:00

Okay folks, my time for the next month is going to be very limited, and I have a whole lot of stuff I'd love to put in here. Therefore, I'll be sharing random photographs and thoughts from my school year every so often.

Before I do, though, I'd like to announce that I have FINALLY fixed my laptop's browser issues. At least, I think I have. Apparently, Microsoft has included a self-repair command in Windows XP that allows XP to check all of its required files and makes ure they're working right. If they're not, it fixes itself. Super cool. (sfc /scannow in the "Run" command menu, for those of you who care.) My only gripe is that I had to hunt for it through Google- I couldn't find it referenced anywhere else. Meh. Such is life.

My random moment of today is my spring break Karate lesson from Donna (one of my M2 friends). Here I am practicing breaking a board. My hand hurt after a couple of failed attempts, but I kept at it. (Male pride prevented me from giving up on the challenge issued by the 2x4 before at least one of us was broken. I figure that gave me 50/50 odds of coming out on top.) Suprisingly, I got through the ordeal without any real damage to my hand, though Jonny's face (or maybe my own) almost wasn't so lucky.

This is me successfully breaking a 2x4 with my bear hands- you can see half of it sailing over Jon's forearm. I felt super cool despite the throbbing in my palm, which only dissipated after about two days. Those of you who've taken martial arts can see that my form is pretty crappy. I'm banking that those who haven't, though, can't tell the difference and will instead just think it's pretty cool. :)

And I'm back to studying. I've got an exam slated for tomorrow morning at 9:00a.m. -- Medical Neuroscience. The grand concepts I've learned in the class have been amazing (I didn't realize how automated my body was before. Even things that I THOUGHT I was controlling conciously, I'm not. Without physically trying it, can you point to the muscles in your leg that flex when you start to fall sideways and catch yourself? I'd bet not. Your brain keeps track of all that stuff so you don't have to. Sweet system.) but the minor details are pretty obnoxious sometimes (have YOU ever wondered what cGMP phosphodiesterase does in the visual pathway? I haven't- I don't really care enough.) . I suppose that most of what I'm learning is important to be familiar with, but it's hard to feel that way sometimes when I talk to third or fourth year students, ask them for help with my Neuro studies, and get a "Oh- I have no idea what that does. I forgot that a long time ago [and haven't ever needed it in a clinic.]" Such is medical school. I still love it anyway.

Spring Break II

2006-04-26T16:19:00.000-07:00

This morning I attended a breakfast for those who went on the Habitat for Humanity Spring Break trip. It was an opportunity to thank and meet our generous sponsors, Harry Franke and Paul Roller, who put up about $2500 through the Greater Milwaukee Foundation for us to go.

The biggest and most significant journey of the trip occurred Thursday night. We went to New Orleans to see the destruction. All I have to say about the experience is that destruction is destruction, and looks pretty much the same whether it's an earthquake or a flood. (For those of you who don't know, I went through a 7.6 earthquake when I was in Taiwan and spent six weeks of my missionary service doing disaster cleanup.)

I hadn't realized the power of the floods until I saw this car.

As you can see from the pictures, the damage is severe. Yet, the single most difficult thing for me to convey about the destruction isn't the severity, but rather the sheer scope of it. Miles upon square miles of total waste. The McDonald's, I think, expresses some of the sense of hopelessness and loss of the area. There's a multi-billion dollar corporation behind that restaurant that has decided to simply abandon it and let it rot. They can affort to rebuild it -- there's just not a point to doing so. Nobody's there. Nobody's come back.

This is a shot of a standard street. You can see that a lot of the houses on the street are totally gutted. You may have a tendency to think that those whose front yards aren't strewn with garbage lucked out and somehow avoided the disaster, or have somehow cleaned up already. Neither is the case. Those front yards that are clear are clear only because nobody's bothered to pull all of the refuse and furniture/posession leftovers out of the houses. Down at the end of the street you can see a trailer home. What that tells you is that that guy had flood insurance. Most people didn't, and their lives were therefore a total loss.

This is an entryway of one of the homes. It's (obviously) in pretty poor shape. We came across a local who talked to us a little about the difficulties of rebuilding (there are now new flood regulations going into efect- except the government can't decide exactly what they should be just yet, so the residents wait,) and why so few had flood insurance when the hurricane hit. Apparently, the flood insurance had to be paid in one big lump sum at the beginning of the year, and many of the people in the neighborhood couldn't afford it. They lived paycheck-to-paycheck, and forking out thousands of dollars at the beginning of the year (just after Christmas, I might add) simply wasn't an option for them. They lost everything, most likely. My friends, remember to be properly insured in life, and never gamble more than you can afford to lose. It's just not worth it.

And this next shot is the picture that, for me, really hit home exactly how personal all this destruction was. It was kind of beyond the scope of personal comprehension to see all of the acres and acres of junk and debris. It finally hit me that it was all people's stuff. Things they'd owned, things they'd valued, and things that had held worth and value.

You see that? It's a stethoscope. I have one of those. Mine's the exact same model, except forest green instead of blue. Whoever's this was didn't even bother to come back for it. I don't know if they didn't survive, didn't have means to return for their stuff, or (most likely) just gave up on their old lives and moved on. There were other things in those houses that could have still been salvaged, but nobody had bothered to try. Sad.

More than anything, seeing New Orleans made me suddenly grateful for everything that I've had in my life. Honestly, my life's a cakewalk. Sure, it's a lot of work sometimes. Yes, there are most definitely bad days. And there are times, even, when I wish things were completely different than they are. Still, though, I'm by and large very happy with where I'm at and what I'm doing in life. More importantly, I have absolutely, unarguably, nothing to complain about. My stethoscope is sitting neatly in a box in my closet, right where I left it. And while it's not the absolute highest quality stethoscope in the world, it works just fine for me. It's all I need. I have everything I need. And if I'm fortunate enough to have my life so for the remainder of it I'll have lived an excellent life, no matter the details or might have beens.

Spring Break, Part I

2006-04-15T13:01:00.000-07:00

I’m back, finally. It’s been a long road, and I fear that my poor half-decade old laptop my be starting to suffer from old age. Nevertheless, all’s up and running now and I hope to keep it that way.

Well, as you all know I spent my Spring break in Thibodaux, LA. MCW put a trip together for twenty of us to pack ourselves into minivans, drive for sixteen hours straight, and arrive in a place we’d never been before to devote ourselves to full-time manual labor for people that we’d never met. When you throw in the fact that we were all medical students and that this is the only significant break time that we’re going to see all semester, it becomes even more impressive that there was no shortage of volunteers, and every one of the twenty available slots was filled.

With all of that out of the way, I have to say that I had an absolutely fantastic experience, and loved almost every minute of it. Below, I’ve documented what went on during the break on a rough day-by-day basis.

Saturday

Not much to be said here. We all showed up in a dark, cold, Wisconsin parking lot and loaded up our gear into a pair of vans. Originally, the plan was to have two fifteen person vans for the trip down, and arrangements were made to pick them up at 1:00p.m. Saturday afternoon. Upon showing up, the van-fetch crew came to the horrible realization that the van rental spot closed at noon. None-too-happy with the administration’s scheduling techniques, a scramble was made. The result of the scramble was one full-sized fifteen person van and one minivan. For those of you trying to do the calculations in your head, the seating arrangements weren’t looking pretty at that point. So, in classic good form, our fearless leader Louis volunteered to drive his own car down and free up some seating for the rest of us. It worked out well as Luis, Mary, and Donna all had plans to stay in New Orleans for an extra 36 hours or so after everyone else wanted to head home. Here’s a picture of us loading up the van. The building in the background is the medical school:

And here's a picture of Todd standing in front of the other van. He's obviously thrilled to have been caught on film.

At approximately 8:45p.m., the journey began as the vans (and car) took to the roads for our sixteen hour drive south.

Sunday

Again, those of you who are mathematically inclined have most likely already deduced that we spent most of Sunday in the vans. We stopped every few hours for gas and/or food, and it was pretty much like every other road trip that I’ve ever taken in my life. There were a lot of uncomfortable people in a small, enclosed space trying to sleep through the night while plowing down the highway at freeway (and sometimes faster) speeds. I was in the MegaVan, a.k.a. “Twinkie”, and the trip was pretty good as roadtrips go. At least, everyone had a decent attitude about the cramped conditions, which was nice. Here are some pics. You'll notice that everyone is generally in a good mood- which was a good thing, and lasted pretty much the entire week.

I drove the final leg of the journey on about three hours of sleep with the aid of a Rock Star energy drink, and felt great. Incidentally, while I’m normally not a caffeine guy, I highly recommend drinking stimulant at times when falling asleep inappropriately could cause you and ten other people their lives. Just my two cents. We always drove in pairs, and so I've included a picture of my copilot, Dave: For whatever reason, the guy had about 1/4 the need for sleep that the rest of us did, and ended up staying up the whole night without a problem. Good man for a copilot on a long trip.

While driving, we passed the 1000 mile marker on our trip. Here’s a picture of the rollover.

Not thrilling, I know, but it seemed significant at the time. It’s amazing how twelve hours in a van will skew one’s perspective. On that note, here's the Graceland exit:

We arrived without incident, had a quick orientation, and unpacked (I roomed with Jonny, Jared, Todd, and Aaron- all friends from school as well as church). Here's home sweet home for the week- made by those volunteers who went before us, and not a bad place to live with nineteen other people for a few days. We were all pretty tired after our trip, and went to bed pretty early.

Monday

This was the first day of actual work. When Jonny’s alarm went off for the third time in as many five minute periods right around 7:15a.m., I admit that I had serious doubts as to my judgement regarding my Spring Break choice. We were sleeping things resembling beds only in the loosest of definitions, and while I wasn’t necessarily comfortable in mine it seemed a great deal more desirable than dragging my lazy self out of bed and getting ready for a day of backbreaking work in the sun. I got up anyway, and made the morning circle meeting where we had a short devotional (Habitat for Humanity is a Christian-based organization) and I was assigned to be part of the framing crew.

We spent the first part of the morning trying to figure our tools out.

And here’s a picture of what the jobsite looked like before we got there and started getting things done.

We spent the day pounding nails, moving walls, sweating, and doing a whole lot of whatever else John, our foreman, decided we needed to do. John used to work construction for a living, and now instead runs a construction company in Maine. He's a nice guy, and knows how to give orders, which means that we got a whole lot done in the week. Here he is:

That night, we fired up the grill and had hamburgers. Nothing special, but a great end to a day of hard work. Everything tasted great, but I have a feeling that had a lot more to do with the fact that we'd worked hard and were hungry rather than anything special on the part of the cooks. It's the same way with camping, hiking, soccer, or just about anything else outdoors. I think there's something in the nature of mankind that makes life more enjoyable if there's the proper amount of work in it.

Tuesday

Tuesday I was sore when I woke up. My body wasn't used to eight hours of hard labor in the sun all in one go. Still, it wasn't as bad as I thought it'd be. Mostly, I think, I was dehydrated. It took me until Thursday or so to realize I wasn't drinking enough water, and after I fixed that and turned into a fish my perpetu-headache that I'd been dealing with for most of the wek miraculously vanished. Moral of the story: headaches are often caused by dehydration. Drink water if you have one, and THEN reach for the painkiller if that doesn't fix it. Anyway, moving on...

Here are some pictures of us on the job, just so you can get an idea of the type of home we were building from the construction perspective. They were all very modest, but very livable, and (of course) brand new.

This is Aaron...doing something. Not sure what he had in mind here.

Here are the unfinished walls. These things got pretty heavy sometimes, and really tedious to move almost all of the time.

This is me holding up a wall. Apparently, sometimes it's actually a useful thing to be doing.

The day passed without incident, and we handled the exhaustion from work a lot better on day two. Inspired by the extra energy, we decided that this would be a good night to visit New Orleans proper and see what it had to offer. There were only two things I wanted to see in N.O.: the French Quarter, and the hurricane destruction. Turns out I got to see both by the end of the week, but Tuesday was dedicated to playing tourist, so the French Quarter it was.

The district had a lot of personality to it, and only about half of it good. Some of the stuff being sold in the streets was of most dubious moral charachter, and a lot of it involved nudity, profanity, or both. I made an effort to avoid that stuff as much as possible, and I'm sure nobody's suprised that there's no photo record of it to be found here in this blog. Here are some things that you might find interesting, though:

Michelle and me in front of a Voodoo shop.

A sign I got a kick out of.

A fountain in one of the clubs we visited. For some reason I was fascinated by this thing- I loved the way that the firelight played off of the water and the cool colors it generated. Artificial beauty lacks something that natural beauty has, but is still beauty, nonetheless. It was a small thing, but it was something that I enjoyed and so I'm going to include it.

And here are a few of my classmates at that same club. From left to right, meet Kevin, Kim, Marisa, Amanda, and Tom. Good people, every one of them. Kevin had a great deal of construction experience under his belt, and was actually the foreman of the roofing team. That was handy, because if we wouldn't have had him we'd have had to disband the whole crew and not had anyone to roof. (Leadership was the limiting reagent on the job- there were plenty of bodies.) And yes, many of you are probably starting to notice by now that there are a lot of cute girls in my medical school class. While the odds of me ever dating any of them are virtually nil, there's something nice about having beautiful, intelligent, attractive women around that makes school (or spring break, in this case) that much more enjoyable. It's an unexpected perk.)

We spent the rest of the night wandering through the streets and seeing what we could find. Eventually, we ended up in a (relatively clean) Karaoke bar where we spent an hour or two dancing. Well, most of the class danced. I sat in the back and watched while I pondered all kinds of random stuff- but that's about par for the course for me whenever dancing's concerned. I can do it, I'm just not usually thrilled about looking like a complete fool. I freely admit that there's something oddly healthy about looking like a complete fool every so often, and I'm getting better about dancing. Really, though, it's not all that important to me. I do enough spontaneous, strange things around my apartment to give me plenty of time looking like a fool. Still, here are a few shots of others. Note Jonny in the blue shirt. Somehow, in every single shot I've got of him dancing he's contorting his body in ways that one doesn't usually see on a dance floor. The DJ was sure he was extremely drunk, which was amusing. (For those of you who don't know Jon was one of the six LDS guys there, and none of us (of course) touched a drink the entire evening.) Unique dance style, that one. You'll just have to use your imagination, though, because I'm only posting one shot of him dancing. And no, that's not his real hair.

Here's a picture of a street corner on bourbon street. Classic French Quarter, complete with the feel of old Europe.

After dancing and karaoke, we predictably returned home (about an hour drive.) Upon arrival, we were faced with a most unexpected turn of events: Mary and Donna, who had abstained from the trip to the city, had decided that the boys' bathroom could use a little bit of stylish, feminine love. Here's the result:

The candles were a nice touch.

Jared, as you all can see, was particularly interested in the kissprints on the bathroom mirror.

We, the men, lived in the feminized bathroom (much more pink than the girls bathroom) for the rest of the week without complaint or incident. There were no injuries sustained from the lipstick or graffitti on the mirror, and so everyone went home with fond memories of the vandalism.

Now, I'm going to quit and post this. I apologize for any and all spelling errors, but I don't dare run the spell checker on this. I've had Blogspot eat posts before, and I'm not about to lose my hours I've spent on this. I'll get to it manually soon enough. As for the rest of it, I'm well aware I'm only covered halfway through spring break with this blog and haven't even gotten to the coolest pictures (hurricane destruction), so you're all just going to have to keep watching for it. Typing these monster-sized blogs takes more time than I think it will every single time, so while I'm going to try to have the second half up in the next two days, you never know. And now, back to your regularly scheduled program. I'm going to bed. Stay tuned.

-Tracy

Technical Difficulties

2006-04-13T12:49:00.000-07:00

Hi everyone.

I apologize for failing on my Spring Break blog promise. Technical difficulties are the culprit. I thought it was Blogger's problem, but it looks as though it's actually something to do with my laptop. I'm going to try to fix it ASAP so I can post a real blog, so everyone wish me luck.

I've tried logging in with Mozilla firefox as well, and still no dice. www.blogger.com is the only site I've found that I can't load, which is why it took me so long to figure out the problem was on my end. I love computers, but sometimes I wish they weren't so fickle.

Anyway, moving right along. Quick update includes the fact that I just took another round of medical school exams. Two more of those left this year, and them I"m home for the summer. Good times.

Almost Forgot: Spring Break Humanitarian Aid

2006-03-13T21:21:00.000-08:00

Myself and twenty-two other medical students will be taking or spring break in Thibadeaux, LA to build houses for hurricane victims.

If anyone would like to contribute funds to the expedition please contact me by email or phone in the next few days. We leave Saturday night at 8:00pm. Currently, we're paying about $45 out of our own pockets plus food for the week (which we'd pay anyway, since we'd eat no matter what we did with our spring breaks, right?). I publicise it not because we're desperate, but because it's a worthy cause and would help some medical students survive a semester a bit more easily while on a tight budget. If you'd like to say that you helped with the expedition, by all means donate what you can. You can donate either anonymously or publicly. (I'll mention you in the blog and to the rest of the students.)

Pictures will be posted the week that I return (Mar. 27th or so.)

I'm back.

2006-03-13T20:40:00.000-08:00

Sorry for the delay in updating this, folks, but it's been a hectic couple of weeks. (Not to mention technical difficulties. I tried to update this yesterday and failed due to problems with blogspot.)My last weekend in February was spent moving all my gear across town so Matt and I could move in with Jared and Jonny, effectively placing me in an apartment with three of my best friends out here. It was a lot of work to tackle the week before exams, but I pulled it off, and my exam scores didn't suffer too terribly for it. (But they did take a slight hit compared to last round. That's okay. My current goals in school are to learn and enjoy, and my test scores are only roughly reflective of the first goal and completely transparent to the other, so I'm not twisting my knickers over it.)

Here's a shot of Matt and I getting ready to move out of our apartment. He's got a hatchet and I'm wielding a genuine African tiki spear my sis brought home from Zambia. Matt had a couch that was on its last leg as a piece of furniture and about to make the graduational transition into tinder and fluff, so we thought we'd help it along by breaking it into splinters. As every man knows, there's nothing that makes you feel stronger than breaking something into itty bitty pieces. Especially if you have to put some effort into it. I think it simplifies down into some sort of male primalcompetitivee urge rooted deep in our genetic structure. There's something oddly satisfying about realizing that "I can break this couch and there's nothing that it can do about it" that then progresses into "I'm way stronger than this couch (or jar of pickles, or whatever else. Insert noun here.)" and then finally to "Dang I'm cool." As any woman knows, it makes no sense whatsoever. And as any guy knows, it's really satisfying anyway.

Here are some pictures of the hapless couch falling victim to the mighty hunters.

And just for kicks, here's a picture of the most random thing I found while packing to leave. I have no idea what it is or where it's from.

I love it here at the new appartment. To anyone with the opportunity, I highly recommend living with two highly talented musicians. On a good night, Jon rocks out on his guitar and sings while Jared jams on his keyboard and joins in with the vocals. Good stuff. Here's Jon in the living room singing to the wall.

Besides the musical perks, the new place is cleaner and better kept than the old place, my room is bigger, the kitchen is bigger, I'm now living with three of my best friends out here instead of one of my best friends, I have a yard, and I have stairs. For those of you who've never lived with me, I tend to bound up stairs as many as I can take at a time, which is currently right around six, sometimes seven if I have enough room for a running start.

More soon. I've had an interesting couple of weeks and have a lot to talk about.

Ice, and other cold things

2006-02-19T20:50:00.000-08:00

By 'other cold things,' I mean, essentially, everything in Milwaukee right now. This last week I had the priviledge of experiencing my very first ice storm. It's a different animal from a snowstorm, a hailstorm, a thunderstorm, or a blizzard, and has elements of each. Overall, not a pleasant experience. For those of you who've never experienced one, I'll go into further detail:

As the name implies, an icestorm consists of ice falling from the sky. It's neither snow nor hail, but ice. In this particular icestorm, it first started coming down in sharp little granules, and felt very much like an unholy cold sandstorm. It blew up in your face and stung anything that was exposed. Had the ice flecks been any more massive I think they'd have had the potential to cut flesh- as it was, the only thing that kept them from doing so was that they didn't have enough weight to penetrate.

Walking from the parking lot to the school felt a whole lot like I was striding across a beach. (Minus, of course, the fact that it was so bitterly cold. Had the weather not been attempting to shave my face off, I'm pretty sure the sheer frigidity of the wind alone would have been sufficient to cause me physical pain.) The ice shifted and moved under my feet almost exactly like sand does on a beachfront, a very cool effect. I'd have had some fun with it had I not been in such a hurry to get inside.

After a day of class, I walked back to my car only to find that my doors were frozen shut. I could only get into my car by using some real force to pop them open. After that, I got a handle on my ice scraper and went to town on my windows, and I was on my way. Cleaned up great.

Driving home, I came across yet another hazard: the beachy ice that had been around at the beginning of the day had solidified into a hard, slick sheet that covered the road. Not fun to drive on, I assure you. Snowplows and salt made the road navigable, but only barely. I'm grateful that I have great snowtires on my car, designed for taking snow-covered Utah hills in the wintertime. I made it home without a problem. (Once this winter I drove across town and picked up a friend of mine whose car had devolved into a toboggan when a snowstorm hit. I was grateful for my snowtires then, and my respect has not lessened since.)

The final hazard of the storm has been the ice that's piled up in my driveway. It's extremely persistent, and I cringe every time I take my care out of my garage and hear it scrape the undercarriage. It's not bad, and I'm sure it's not damaging anything (the ice isn't all that dense), but it's still unpleasant. I wish the temperature would creep up above freezing for a few hours tomorrow and help me out, but it's not looking good.

And that's about enough talk about the weather. There's a reason that 'talking about the weather' is synonymous with 'smalltalk': it's just not that interesting.

The problem I have is that the rest of my life isn't all that interesting either. I cook, I eat, I sleep, I got to class, I play on my computer, I write emails, I work out, and I go have fun on the weekends. That's it. Since the rest of everything is pretty mundane, I'll talk about the weekend.

Friday I went to my friend Matt's house for a get together with my classmates. It's a little bit of a different social scene than I'm used to, coming from ultra-LDS North Salt Lake to ultra-Beery Milwaukee, but I had fun. I don't drink, of course, but that doesn't seem to matter to anyone. Without exception, my classmates have been respectful and accepting of my beliefs and I'm grateful for that. (Thanks to any of them who happen to be reading this.) Coupled with the fact that they're intelligent, good-hearted, interesting and fun people, I have a lot of fun hanging out with them. Friday was no exception, and I had some really good conversations throughout the night. We talked about religion, politics, religion and politics, school, personal life, and China. I may have had conversations about other things at some point, but over 90% of my chat fell into those categories. One of the most interesting came in the form of Josh and I discussing Christianity and capitol punishment.

There was a decent amount of alcohol there, but that's normal for everywhere in the world except my hometown. It's new for me, but I'm getting used to it. Besides, my classmates are past the 'get totally trashed at every possible opportunity' stage of life, and had I not known better, I don't think I'd have been able to easily tell that any one of them had been drinking. Well, almost. My buddy, we'll just call him 'Andy,' was pretty far gone. He gave me a big hug as I was leaving and told me that he loved me. He also assured me that he wouldn't remember our conversation the next day. Again, something new for me.

Ah, well, I lead a good life. I'm lucky enough to be surrounded by great people, be attending a great school, have great friends, a great ward (an LDS congregation, for those of you unfamiliar with Mormon terminology. (LDS is fairly synonymous with Mormon, for those of you REALLY unfamiliar with the terminology, and both are nicknames for 'The Church of Jesus Christ of Latter-Day Saints.')) a great roommate, two more soon-to-be great roommates, and a warm bed to sleep in a night.

And food. I eat well, though I'm poor. It's amazing what you can make with hamburger, canned veggies, an onion, some spices and a big pot. Mmmm... dump soup. Good stuff.

More later. As usual, my blogging is butting up against my bedtime.

Happy Valentine's, World

2006-02-13T21:43:00.000-08:00

Well, it's hard to believe that it's been so long since I've updated this thing. So here goes:

Happy Valentine's Day, everyone. I'll be spending the day curled up with my physiology textbook, and just in case any of you were interested in the latest juicy gossip in Tracy's love life, I'll say it explicitly: I don't really have one out here. As a matter of fact, I'm officially postponing my Valentine's day until after this semester. All single people wishing to join me in my postponement are welcome to sign up under the 'comments' section of this Blog.

The closest things that I had to a Valentine this year came out to visit last weekend. I was graced with the presence of a trio of beautiful girls that I adore. One blonde, one brunette, one redhead. Can't beat that. Here they are in the mall, their natural habitat.

The redheads my mom, the brunette my younger sister Becca, and the blonde is Nicole. The three of them are road-trip buddies and decided to come visit me for a weekend. The fact that I live an hour away from the second biggest outlet mall in America probably helped sweeten the deal a bit. Still, I flatter myself that they came for me. :) No matter why they came, it was great to spend a weekend with them. They're stellar company- all three of them.

Other than that, my life's pretty bland. Not much to report, nothing much changing. Lately with my spare time, I've done things like make new candles out of old, unburned candle wax, play intramural volleyball (first loss tonight- bummer), and gotten ready to move. For those of you who don't know, I'll be packing up my stuff and moving across town by the end of the month. I'm excited. Matt (my roommate) and I will be joining Jonny and Jared at their place, and I fully expect it to be some of the most fun I've had in a long time. Between the hours of 9:00pm to 10:30pm, of course. The rest of the time nobody will be at the house besides me, is what I'm guessing. For those of you curious about my two new roommates, they're featured in an earlier post, so scroll down until you find it.

And now it's time for me to wrap up, because I've got an exam tomorrow. Not a big one, but an exam nonetheless. (Medical Neuroscience lab. I have to know what a brain looks like and what goes where. Third time we've covered it since August, and it's just a little different every time. Must be important.)

This makes me mad...

2006-01-31T19:45:00.000-08:00

Well, I've come this far without involving politics in this blog, but I'm breaking my own rules and throwing in a commentary about an article that I read online today. Here's the article that made me so mad. (As soon as the link breaks, someone let me know so that I can include the full text of it.)

Plainly and simply, this article is both disrespectful and ignorant in its portrayal of these people. It pokes fun at Bush supporters, Utah, simple people, and makes the whole lot of everyone who supports the president out to be backward country folk. It's horribly one-sided journalism. Such writing has its place, but it's in the opinion columns and not the news. Do we hear questions from Mr. Finkel? No, we don't. Do we get to gear these people explain why they feel the way they do? Not really, no. Does the fact that they support Bush have anything to do at all with what, in Mr. Finkel's eyes, is wrong with this small town? Maybe. Maybe not.

I'd wager that the examples cited in this article were an elite few, chosen specifically to make these people look bad.

I've got news for Mr. Finkel: I'm from Utah, I'm of the Mormon faith, I have family in Utah who live in small towns that are basically indistinguishable from Randolph, I spent time on a dairy farm as a kid (though not as much as my father did, and he less than his father, but my great-grandfather owned the farm, and his children and grandchildren -my cousins- still run it.), and I support Bush. I am not, however, ignorant about the world I live in. I'm fluent in Mandarin Chinese, hold a bachelor's degree in chemistry, and I'm on my way to a medical degree. I also, incidentally, happen to know what Dijon mustard is, though I may not have when I was fifteen.

My relatives on the dairy farm aren't ignorant, either. Nor are most of their neighbors. Two summers ago I attended the Oakley rodeo- the biggest rodeo in Utah. It was an old-fashioned cowboy extravaganza complete with bull riding and bucking bronco's. I spent the evening with the England family, who live across the way from the rodeo stadium in Oakley - a small town filled with horses, cattle, and simple people that would be right at home in Randolph. The social niceties of the area consist of phrases like "Any new babies?" (referring to farm animals, not human infants) mixed in with the everyday "How are you?" Guess what? Mr. England, the head of the home, was both intelligent and articulate, and held a law degree if my memory serves. And, since he lives in Utah, statistics say he's likely to have been a Bush supporter. I didn't talk politics with him that night, so I don't know for sure. I do, however, personally know a great many educated Utahns who do support Bush - and there's no ignorance involved. I can't speak for all, but I personally admire Bush's straightforwardness and willingness to risk for what he believes is right. That goes a long way in my book, though the cynic might call me naieve.

That's not to say that we, as Bush supporters, feel that everything he does as president is necessarily a good idea. Mistakes have most definitely been made. Recall, though, that judgement is limited by foresight. One month into the war in Iraq the approval ratings for President Bush were at 76% (Gallup's poll of 4/16/2003)- i.e. most of America initially thought the war was a good idea. Many of those who now oppose the president's handling of the war supported it initially, and have simply changed their opinion. That's the nice part about having a civillian's opinion: it's an opinion without any real responsibility attached to it and you can therefore change it whenever you want, free of consequence. There's nothing wrong with that, but it's important to remember that the president has no such luxury. Regardless of how he feels now or what, if anything, he would change if he had it to do over again, he is stuck with his choice of action and has to see it through. With such a large percentage of the country initially in favor of the war, it's very possible that someone else would have made the same decision to go.

Of course, all this is from the standpoint of assuming the war was a bad idea to begin with. I don't presume to know that just yet. It'll be interesting to see where the pieces fall in the history books.

But I digress. I don't really want to argue the pro/against Bush stuff in this blog. I support him, yet aknowledge that he's definitely got his problems. You may be of the opinion that someone else may have had fewer. I don't claim to know the answer to that either.

Back to the defense of my own people and homeland, I'd argue that Utah's "sense of loyalty and patriotism that kind of overcomes the tendency toward cynicism that is evident in the rest of the country right now" isn't rooted in ignorance either. Loyalty and patriotism will always accomplish more than cynicism. It's true that they can be exploited and misused, but go watch "Band of Brothers" to gain something of an appreciation of what they can be worth. Then go out and show me a single instance where cynicism accomplished anything worthwhile or significant. Cynics and negativists may occasionally be right, but that doesn't mean that they're not uselessly failing to contribute to a viable solution.

I don't know where Mr. Finkel was raised or what his life was like growing up, but I find it incredibly presumptuous of him to judge the people of this town, implicitly or otherwise. They lead a simple life, it's true. They have their own beliefs (which I may or may not agree with) about president Bush, politics, lawyers, doctors, and everything else. And apparently these views differ from Mr. Finkel's. I'd wager that he has more education under his belt than they do. I'd bet he knows more about politics than many of them. Yet, when all's said and done, he certainly gave the impression that the people from this "place that seems less a part of the modern United States than insulated from it" had the common courtesy to treat him respectfully and kindly, a favor he did not return. Right or wrong, ignorant or informed, they are, as the article attests, simply good people. I'm of the opinion that the world would be a better place if more people like them existed in it - no matter who they chose to vote for.

Another 'Be Healthy" Rant, by Tracy

2006-01-29T19:05:00.000-08:00

Pre-blog note*: I've updated the page code to include a simple counter so I can track how many people have visited my site. The code seems to be extremely simple, and therefore unlikely to cause anyone any problems. If, however, anyone experiences ANY advertisements of any kind or any other unwanted computer behavior while visiting my webpage please let me know so I can get rid of it and try again. Thanks.

Hello everyone. After a significant break from my regular monologue on being healthy, I've decided to post about some things that I found interesting while I was reading Guyton and Hall's Medical Physiology textbook. (Which, again, I love. It's a great book.)

Mostly, I've been reading and studying about muscle. Skeletal muscle (what people normally think of when you say 'muscle'- it's the stuff in your arms, legs, abs, etc.), smooth muscle (blood vessels, guts, the muscles in your skin that make your hair stand on end, and pretty much every other muscle you can't consciously control minus your heart), and cardiac (heart) muscle. They're all different, and react differently to different hormones (e.g. adrenaline) that may be in your system at any given time. But I digress. My intention isn't to give a lecture on muscle.

While reading about muscle, I came across the following diagram that I liked. Sorry about the lighting quality. I didn't have a scanner, so I had to employ the good old digital camera and do my best. Without further adieu, here's the a diagram from the abovementioned text, p.1083. The horizontal portion of the graph displays time, while the vertical portions of the graph show the percent of fat/carbohydrates burned during exercise:
(Note that the X axis (horizontal) is on a logarithmic scale. For those of you who are unfamiliar with such scales, it basically just means that each unit of distance is worth more time as you go to the right. That is, a half inch on the far left is worth 20 seconds, while the half inch on the far right is worth a full hour. Just look at it carefully and you'll figure it out.)

The points I want to make from this diagram are threefold. 1) The longer the duration of your exercise, the more fat you'll burn. 2) The more carbohydrates you eat, the more endurance you'll have, and 3) You burn fat earlier in your workout if you have a high-fat diet, and it'll take longer to burn fat if you eat a lot of carbohydrates.

Now I want to immediately say that I do NOT recommend a high fat diet to anyone, ever. You may burn fat earlier in your workout, but note that you'll have less than 1/3 the stamina of someone who eats lots of carbohydrates. Not also that the fat you'll be burning isn't the stuff that's been making your pants tight, it's the stuff that's still in your blood and on its way to make your pants tighter.

The way to burn the MOST fat in a day, assuming that you've dedicated your entire life to it and aren't doing anything else that normal people do (work, school, etc.) is to eat virtually no fat and exercise intensely for four hours a day or more. You may burn less fat initially in the workout, but you're able to go four almost three hours longer than the guy on Atkins (who passes out on the trail after an hour and a bit), and end up burning a LOT more fat than he does by the end. For those of you who have the time and drive to lose intense amounts of weight fast, I recommend this course. I also recommend looking for a job, since you probably don't have one. Maybe you could run around the city and collect application forms on foot.

To the rest of anyone reading this who wants to lose weight, I have developed the

Tracy Zundel Miracle Diet of Absolute CertaintyÂ®

and I'd like to present it as follows (if you decide to take this seriously, follow all the links and all the instructions, then going through this whole thing might take a little while, probably 10 minutes or so):

Fact: A pound of human fat stores approximately 3500 calories.
Fact: The only way human beings take in calories is through food consumption. No mammals are photosynthetic.

Here are the rules of the diet:

1) Calculate your daily caloric intake (a rough value of how many calories you currently eat in a day) using the Caloric IntakeCalculatorr found at the bottom of this page.

2) Limit your (average) daily caloric intake to 10% less than what the calculator gives you as your current intake.

3) Limit the amount of fatty foods that you eat, remembering that a little fat is okay. (Also remembering that eating out is a great way to break this rule.)

4) Exercise for one full hour five days a week. Take one of the remaining two days off, and take a small (~10-15 minute) exercise session on the other day.

Tracy's promise to you is that if you follow these four steps, you will lose significant and lasting amounts of weight, feel healthier, live longer, and be in all around better shape. Guaranteed.

How can I make such a startling guarantee, you ask? Because I know Newtonian Physics. And they work.

The only tricky part to this whole thing is calculating your daily calories. Yes, to all you men out there, I'm turning you into calorie counters. I'd apologize for that if I thought there was a better way to do it.

Here is a list of common foods and their caloric values. I recommend everyone take a peek at it. If you live in America, I'd wager a good amount of money that you're eating more calories than you think you are. You can search for the food you're looking for by using your browser's 'search' function. (Ctrl+F, for those of you with Microsoft Internet Explorer.) Here's an example:

HAMBURGER, 4OZ PATTY 1SANDWICHH 21g of fat 445 calories

Okay, people, a four ounce hamburger has 445 calories in it BY ITSELF. That's not fries, drinks, or anything else. When was the last time you ordered a four ounce hamburger plain? That's a single quarter pounder, no cheese, ketchup, mustard or mayo. A double-quarter pounder pushes almost 900 calories fully loaded. And that's all I'll say. Be aware. (And if this example intrigues you and you haven't already done so, I highlyrecommendd watching "Super Size Me." That's a documentary that'll wake you right up.)

Being a naturally skinny person, I simply never understood why obesity was such a big problem. I had my first pseudo-experience with it when I moved to Milwaukee and rapidly gained twenty pounds over the course of a few weeks. My 'abs,' which were something very close to a six-pack while I was in Utah, became my 'ab' almost overnight. Wow. After two weeks of the above diet plan, I now have 3.7 abs, and I'm on my way back to 5.7. (I have to stress that probably 75% of the 20lbs of weight I gained was muscle, so I'm not trying to lose 20lbs again. I'd settle with 3-5. After all, I like the muscle part of things.)

As a medical student living on my own, through both school and the above mentioned personal experience, I'm rapidly learning that obesity has a lot to do with personal culture. More to do with personal culture than genetics, I'd say, though genetics do play a role in shaping personal culture. Had I not cared about what I weighed, or simply decided that I was going to keep eating like I was eating and doing what I was doing, I could very easily have become fat.

We talked to a dietician in class the other day who said that she once had a client family who just weren't losingweightt, and shecouldn't figuree out why. After going through their diet with a fine-toothed comb, she discovered the issue. To a normal person, 1 garlic bread with spaghetti is a normal thing. To this particular family, 1 garlic bread with spaghetti meant 1 loaf of garlic bread. Yes, that's per person. Yikes. Personal (or in this case family) culture, pure and simple.

Anyway, I'm off to get ready for bed soon, here. To close this off, though, I'd like to offer some positive information I've gained from my textbook while studying muscles. The paragraph reads, in part "When the total mass of a muscle increases, this is called muscle hypertrophy... Only a few strong [i.e. with significant added weight] contractions each day are required to cause significant hypertrophy in 6 to 10 weeks." Cool, eh? It's very possible for the human body to reshape its muscle mass in that time frame, and I find that absolutely amazing. Personal health is a matter, largely, of personal culture. And that ends my rant for the week. My next post will most likely be of a more personal nature instead of a preachy dissertation, but I hope you got something out of this anyway. Have a great week, everyone. I know I will- my mom and sister are coming out to visit this weekend, and I'm excited to see them.

No photos this time

2006-01-27T22:48:00.000-08:00

Well folks, this time ther ewon't be any photos to post. It's not that I haven't taken any, it's just that it's 1:00a.m. on the eve of the last day I've got to study for my major round of examinations that begin Monday. I'll be getting up in the morning and hitting a review session at the school for my phsiology exam, and then spending the next seven hours straight (well, lunch will probably find its way in there somewhere) studying. Physiology on Monday, Medial Neuroscience on Tuesday. It's going to be a crazy weekend with too much to do.

Not much changes in my life these days. I've kind of fallen into a routine. That routine consists of school, eating, sleeping, studying, the occasional social event, and hanging out with my laptop computer online when I have no more brain power left to study. I've picked up programming again in my spare time, and I enjoy that too. (I haven't programmed anything significant since high school, so it's been an uphill climb to get anything accomplished. But hey, what are hobbies for?)

Medical school is a lot less exciting than it was last semester. Mostly because I'm used to it now, I think. I still very much enjoy it, but it's lost the novelty. I still love what I'm learning, though, and I'm still planning on updating this with some pointers from my physio text. As stated in a previous post, it's hands down the best textbook I've ever come across in my life. Great stuff.

I've noticed some significant differences in living on my own since I've been back from Christmas break. (Actually, I more noticed them on break, but the contrast has been enforced since I've returned.) The first is that I don't lose very much in my little apartment out here. In fact, I can't think of the last time I lost something. I live in my room, and go into the kitchen when I need something that's not immediately at my fingertips. There's nowhere to lose anything. While I was at home, I repeatedly lost my keys, my wallet, my celly phone, and any number of other things that aren't coming to mind right now. It was at least a daily event. It's nice to have stuff where I can find it again.

The downside to my localized domestic lifestyle is that I don't get enough exercise by just being at home. (I work at it, which is also good- today I lifted weights for an hour. Felt great.) While at home, I functionally degenerate into a fifteen year old again and sprint down hallways and bound up stairs. At one point I could take seven steps all in one go, but I'm down to six after moving to Wisconsin. I just don't have the access to staircases that I did at home. (Well, I do, but only at school. It's a professional school, though, and I can't help but be aware that bounding up stairs seven at a time would probably be considered by most to be un-professional.)

The weather's been nice out here lately, and I think I'll end on that note. As soon as I start talking about the weather, I know I'm out of things to say.

The Pileup Begins.

2006-01-23T21:00:00.000-08:00

Well folks, I'm officially behind in my schoolwork. I love school, love going to school, love my classmates, love the material, and hate taking time out of my day to study. I also hate getting up at 8:00a.m., but hey, whadda ya do? This semester, the hard class is physiology instead of biochemistry, and I love it. The physiology textbook (Guyton and Hall) is THE best textbook I've ever read in my life. I plan on blogging some stuff out of it in the near future, even, so you'll all get a chance to see wht I'm talking about.

(Actually, on a random tangent, I've started setting my alarm. My problem isn't so much waking up in the morning, though, it's going to bed at a decent hour, so I've got one alarm set for 7:00a.m., and another set for midnight so that I'll go to bed. It'll be interesting to see how it works out.)

Today I spend a few hours of my afternoon pouring through old neuroscience exams to try and organize something resembling a set of practice test questions to use. It was productive, and gratuitously used the school's scanner and their text recognition software. Worked great, as son as I figured out all the little tricks to it. I was impressed- technology just keeps coming along. Science fiction is becoming science reality at an ever-increasing rate, and I like it, though I can see how it might get daunting as I get older and have less time/inclination to keep up on current tech trivia. Oh well. Life's a journey.

Today my blog will be short, as alluded to in the title, my tests are coming up and I need to study, but there are a few random shots that I'll throw in here for good measure before I check out for another few days.

Today's topic: A Select Few Bachelor Med Students at MCW (Just for fun. Hope none of you mind being put on display.)

Meet Bolaji. Bolaji's one of my classmates, and I thought I'd feature yet another Nigerian and keep the trend going. The guy's great- happy and easy-going, and extremely social. He'll make a great doc someday, and has a super-cool Nigerian accent that I thoroughly enjoy. (So take note all you single African girls reading this, because the guy's single.) He's giving the camera the "tough-guy" pose, but in real life the guy's all smiles.

This is Jared. Jared and Jonny (featured below) are two of the people that I spend the most time with out here. They're both a year ahead of me in school, which means that I don't see them as much as I'd like. As Matt and I will be moving in with them in a few weeks, though, that will all soon change. Jared's a musical genius, and I don't use the term lightly. He composes, sings, plays the piano, and does it all apparently effortlessly. He is, hands down, the most gifted pianist I have ever come across in my lifetime and it's a whole lot of fun to watch him play. (He seems to get a kick out of having things the other way around, though. I think he likes studying my fledgling piano style and analyzing it in his head. Every so often I can get him to give me pointers. I hope it happens more often once I live down the hall from him.) Jared's also one of the nicest people I've ever met, and loves to smile and keep happy. Above, he's apparently a little too happy about something, but trust me when I say that he's actually quite stable despite the pic. (Yes, he was posing for the camera.) As implied above, he's currently single.

This is Jonny. He's really enjoying his PBJ in this shot, and I can't help but wonder where in daydreamland it's gooey goodness has whisked him off too. (I actually don't think that Jon was posing in this one, I think I caught him off guard.) Jonny's also hyper-talented, plays a mean guitar, and sings with the best of them. He's the current catch of the singles ward, and attracts the lion's share of attention from the ladies. (He'll be unhappy with me saying so, but it's true.) I can't really be bothered by that at all, because I love the kid, and it's obviously well-deserved. Like the other two, he's has a heart of gold. Jon and I share a strange and as yet imperfectly defined nerdy streak that makes it a lot of fun to sit and chat with him. It's fun to have other socially capable nerds in my life.

Anyway, I'll go now. It's my bedtime. More later.

A Day of Class in the Life of a Medical Student

2006-01-15T19:09:00.000-08:00

The post today is going to consist of a few random highlights from a day at school this week. Most of the time, medical school is just about how everyone expects it to be. There's a lot of sciency stuff up on the wall for everyone to look at during lecture with hopes that we learn enough of it to be good doctors someday. Here's a snapshot of some of that sciency stuff for you to enjoy. This particular slide deals with preventable death, though the meat of the lecture was rooted in medical information management, a topic that can be successfully navigated with a little bit of statistical know-how and a whole lot of common sense. (If you can't read the slide and would like to, left-click on it for a version big enough to read.)

The take home message, for me at least, is that if everyone in the US suddenly quit smoking and started exercising and eating right then 80% of all these people dying due to 'risk-factor' (a.k.a. stupid) behavior would live through to old age. Another effect of this hypothetical scenario would be that all of the tobacco companies, McDonald's, Burger King, and probably Ben&Jerry's and Haagen-Dazs would all go out of business, while the now-jobless employees would be forced to relocate and find jobs in health spas and tofu factories. In all seriousness, though, 80% is a statistic that's worth thinking about. (Or maybe getting up off of your couch for, hmm?) My friend John, pictured below, found the lecture fascinating.

In most classes, we get a ten minute break every hour or so, which is nice. It means that you can take some time and go fill up your water bottle, head to the bathroom, grab a bagel (which rhymes with 'haggle' if you're in Wisconsin) from the cafeteria, or just chat. During this particular lecture break, I had John, freshly vivified, snap a picture of myself and my classmate Ogugua (Oh-goo-gwa, Ogee (Oh-Gee) for short). She's from Nigeria, and one of the nicest and most genuine people I have ever met. She's also at least three times as smart as I am, which is good because she's going for the M.D./Ph.D dual degree route and is considering neurosurgery afterwards. Translation: If she sticks to her current plans, she'll receive her first significant paycheck in the year 2020. Go Ogee. I admire her for having so much academic stamina.

I can't blame my half-chipmunked teethy grin on someone sticking the camera too close ot my face this time. I may just have to face the fact that I'm not all that photogenic. Ogee on the other hand, doesn't seem to have that problem.

As you might imagine, it's sometimes hard not to feel cooped up in our classroom after spending so many hours there in a week. Oftimes, this results in pent-up creative energy among the medical students. To relieve it, I doodle in class and blog sometimes. Other people find other outlets. During the Physiology class, I was passed a rather random note, authored by Mark and passed down the rows. It's important to always be up-to-date on current policies and procedures.

Schroeder, of course, was thrilled to see that the management was not ignorant of the state of possession of the pantalones. He was also a good enough sport to keep passing the note down the row.

After school, I go home to my apartment that I share with the above yellow-clad gentleman. Meet Matt, my roommate. (My immediate family members will note that the semi-ratty couch he's sitting on is identical to the ones we had for upwards of ten years and only relatively recently replaced.) He's good company. Astute observers will note that there is absolutely no sunlight coming through the blinds. Admittedly, judging from Matt's sport shorts and tee this picture was probably taken later at night. Because this is Wisconsin, though, this same shot could have probably been taken at 4:45p.m. and there wouldn't be any more sunlight than you see here. It's starting to get to me, though it's not as bad as I thought it would be. Yesterday was sunny for a bit, and I basked in it for an hour or so while I wrote a letter. Not half bad, as far as life goes.

Anyway, I've got to get ready for bed. I have class in the morning.

New Record for Milwaukee: 15 Days of No Sunshine

2006-01-07T23:21:00.000-08:00

That's right folks, it's official: a new record for total lack of sunshine. I was impressed. Honestly, my days and sleep schedule are all whacked out after coming back. I was going to blame it on playing X-box in my parents basement until two in the morning almost every day that I was home for break, but I'm now convinced that the weather here in Wisconsin has something to do with it as well. I'm also attributing the insomnia to it, but that may or may not be accurate.

Of course, my case for the weather is weakened when you take into account that I've only been here for six of those fifteen days.

Anyway, for your amusement I've included a picture of my insomniac self. Note the double chin.

The double chin is not a byproduct of poor diet and lack of exercise, but rather an unconscious and largely reflexive attempt to pull my face as far away from the object I've stuck in front of it (my camera) as I can manage. I know it's unconscious, because consciously I'd do the intelligent thing and move the camera instead. After viewing my pseudo-chub in the picture, I retook it with my neck in proper position and got the following:

Much better, no? The quirky smile is a result of amusement at my earlier folly.

You've all noticed, I'm sure, that I take a lot of self portraits with my camera. That's not out of vanity, but rather out of a sense that I should be using my camera to further my blog and thus my friends' and family's access to my life out here at school. The problem is that I usually only think of that during those moments when my mind is free to wander. In other words, when absolutely nothing is going on. During those moments, it always seems like a really good idea to take a picture of myself because I'm the only person around. Alternatively, I could take pictures of my desk. Here's one of those.

I'll leave it up to you to decide which you personally prefer.

And now for something mildly interesting. The next few pictures are of the M1 (first year medical student) reception held at the University Club in downtown Milwaukee this past Friday night. Good times. Mostly, the party consisted of classmates and faculty becoming (sometimes inappropriately) drunk and talking. My date Jessica and I abstained from the booze on religious grounds and still managed to have a grand old time.

Jessica's the lady on my right in the red dress (though it looks pink in the picture for some reason- when it's not under a camera's flash it actually matches the shirt I was wearing rather closely) and black sweater/jacket thingy. (I'm sure there's a proper name for that article of clothing. I simply don't know it or can't think of it. Since it's 1:30 in the morning, I don't really care which it is.) Jess is a first year dental student at Marquette and is great company. Lest the lot of you get your hopes up that something could happen there and start making smart comments about us dating, I state up-front that she and I are simply good friends, as evidenced by her boyfriend back in Salt Lake. I'm more than okay with that, and was simply glad to have some good company for the evening. The other couple consists of my good friend and classmate Aaron, and his girlfriend Erin, (Aaron and Erin. Gotta love it.) who's a math major at Concordia university in Detroit, and a great girl. Aaron and I study together for examinations, and complement each other well. He's focused and disciplined, and I feed off of that while I help him with some of the material I'm a little more familiar with (biochemistry, nuclear pores/nuclear transport, molecular biology) and he helps me with some of the more clinical material and other things he's familiar with (embryology, pathology, general clinical experience, etc.). It's a great combination, though I can't help but feel that I've got the better end of the deal. No matter who actually comes out ahead at the end of the night, though, we have a lot of fun in the process.

Anyway, the insomnia's worn off, and I have meetings at 10:30a.m. definitely bedtime.

Back to the Real World

2006-01-04T16:09:00.000-08:00

Well folks, true to prediction I scored a wonderful digital camera for the great holiday of Christmas, and I've put it to decently good use since. As a reward for your patience, all of you will now get to enjoy some pictures as a part of this blog, and not just my shapeless ramblings. For starters:

This is me pre-haircut.

My little sister Becca gave me a haircut as part of her Christmas present to me (the other part consisted of cologne), and took me to see her friend Chantelle, a hairdresser by trade. I'm not one for complicated haircuts, and I'm always a little leery about going to see someone and paying them $12 (which was apparently a special price for my sister, no less) to do to my hair what I could do myself given an hour and a set of clippers. Chantelle, though, was as-skilled-as-advertised by my sister, and I left with one of the best haircuts I've ever had in my life. What that means is that when I left, it wasn't apparent to Joe Everyman on the street that I'd just had a haircut. It had the look of a head of hair that had been cut perhaps a week ago and already had time to grow out of the awkward phase. At least, in my opinion it did. Now that I've got my camera, you can judge for yourselves:

This is me post haircut. Don't mind the curlyque calick there. It always does that if I'm not careful enough.

As far as life goes, I'm glad to be back in Milwaukee going to school. I love med school, there's just no other way to say it. Yes, it's a lot of work, and sometimes it's downright stressful, but I love it just the same. My life in Salt Lake was a lot of fun, and I can't ever complain of being out of things to do, but I was definitely ready for a change when I moved out here to start medical school. There wasn't anything wrong with my life in Salt Lake, I'd simply outgrown it. On a grand scale, I was bored and needed to start something with more purpose to it. That's yet another reason that I love medical school: it's given me a meaningful challenge in my life.

While I was home over the break, I took a few shots of my home to show my Wisconsinite buddies who've never been there (Utah.)

This is a shot from my parent's deck overlooking the Salt Lake Valley to the West. In the distance you can see the Great Salt Lake beyond the swamps, and beyond that on the right hand side of the picture you can see Antelope Island. I'm sure that there are a handful of astute observers that will notice the lack of snow on the ground. It was 53 degrees that day, and there was no snow to be found. While I was in town, Utah went through a freak warm streak and all hope of a white Christmas was lost.

This is a North-facing shot from the same spot on the deck. Geez I miss the mountains out there. Those of you from Wisconsin who are convinced that the U.P. (Upper Peninsula) has mountains to ski on are sorely mistaken. It has hills, and this shot is what I'm using as proof that they are NOT mountains.

Anyway, there's a decent warm-up for my picture posting skills. Right now I'm going to get around to unpacking my suitcases. One of my new years resolutions, though, is to update this thing twice a week so stay tuned.

Coming soon...

2005-12-22T11:18:00.000-08:00

Well folks, I've been holding off writing a new entry because Christmas is coming and I've got a digital camera under the tree. That little dealio will be used mostly for making this blog photographically literate. Words are great, but don't exactly hold people's attention quite the way pictures do. So check back for an update after Christmas to see some holiday pictures.

Merry Christmas

Second post of the day: Cooking tip

2005-12-13T21:46:00.000-08:00

If you happen to add too much vinegar to your improv spaghetti sauce recipe and it tastes funky, you can throw in some baking soda to neutralize the acid and tone it down.

It will, however, still taste funky- just in a whole new way.

Biochemistry Ends

2005-12-13T10:31:00.000-08:00

The end of my biochemistry class might not be all that important to the rest of the world, but it's making all the difference in my own little life.

Today, for instance, I have enough time to update my blog. Yesterday, I only had enough time to study for ten hours straight and give myself a headache. I then took a break, and put in one more hour before I went to bed (at one in the morning.)

This morning I got up at 6:30, studied for twenty minutes, and then fell back asleep until 7:50 when I had to get up and head off for my test, which began at 8:20 and ends at 1:00. I say 'ends' because it's now only 12:34 my time, which means that I still have classmates that are beating their head over 120 questions of ridiculous minutia. I love the material I learned in the class- really, I do. I just thought it was stupid to test the class on ridiculously minute details that aren't going to effect our clinical skills. Does anyone really care if I remember that the name of the enyzme amidophosphororibosyltransferase? (No joke- real name of a real enzyme.) I don't. It's enough for me to know that the body's process of making DNA building blocks is self-regulated.

In my mind, it's too easy to lose the point of what I'm learning in all the jargony garbage that gets thrown around. It's worse than Chinese. Trust me.

Medical Biochemistry:

"Amidophosphororibosyltransferase? What the crap does that do?"
"Uh... I dunno. Let's see what the notes say: 'amidophosphororibosyltransferase (ATase), is the first committed (and also the rate-limiting) step in the de novo synthesis of purine nucleotides and is also subject to allosteric control by end products of the pathway, i.e. IMP, AMP, and GMP. NOTE: The amide N of glutamione becomes the N-9 of the completed purine ring.'"
"...so what's that mean?"
"I have no idea. Something about nucleotides. Let me read it again..."

In contrast:

Chinese:

"Wo bu yao chi naga ji jiao."
"Huh? what does that mean?"
"I don't want to eat that chicken foot."
"Oh. Right. Neither do I. Let's hit up Taco Bell."
"Cool."

See? What'd I tell you?

Anyway, I've got to go study for the rest of my exams. I think I'm going to make myself lunch first, though, which will be a nice break. I've only taken one final exam out of four, but I'm easily through 70% of the hard stuff. It's a nice realization.

Hopefully I'll update this again soon, but no promises. It IS finals week, after all. Check back later in the week and see. In case I don't, I'll be home for the holidays starting this weekend, and I'll have time then.

Sunset: 4:18pm

2005-12-01T14:06:00.000-08:00

I'm sitting here in my room absolutely amazed that it's not even December yet and I'm down to nine hours of daylight a day. Egads. In three weeks, it'll be closer to eight hours a day and I'll be even more hermitish and antisocial. Lack of daylight does that to me. Of course, it may instead be the 100 pages of biochemistry that I'm supposed to study every day.

When it comes down to it, if I'm honest with myself, I have to admit that I haven't ever come close to studying that much in a day. I keep hoping for a miracle to occur so that my brain will be able to focus on a topic longer than about three minutes at a go but I'm still waiting for it to happen. Don't get me wrong, I love my ADD. It has the wonderful effect of ensuring that I'm never bored (for longer than three minutes...), but sometimes when I'm trying to apply myself to something scholastically relevant it becomes a real pain in the rear.
Despite that negative introduction to this email, life really is great. Tomorrow morning my class is going to be doing a blood glucose lab. After 8:00p.m. this evening, I'm not allowed to eat anything. That's so that I have a fasting glucose level at 8:00a.m. tomorrow morning when I show up for breakfast. I'll prick my finger, go eat, and then check it again in 30minutes. I'll be checking it periodically up through high noon.

Now, those of you who know me understand that I have insane metabolism. I weigh about 170 lbs, and regularly consume 3500+ calories per day. I should count my calories on a hungry day sometime and see what I get up to. It bet it'd be pretty sick how much I eat, and it wouldn't suprise me if I was pushing 5,000 kcals.

On a regular day, here's how it goes: I get up in the morning, have a huge bowl of frosted mini-wheats with whole milk and a handful of raisins. (Yeah, I have the same thing almost every morning. It's great.) Because I have that stuff handy, I'll calculate the total calories on that. Hang on... 1/2 cup raisins at 260 calories + 50 frosted mini-wheats at 400 calories + one and a half cups of whole milk at 225 calories = 885 calories for breakfast. And that's low fat when everything's said and done, even with the whole milk.

Next, I go to school where I eat two peanut butter sandwiches with honey on them, one yogurt, and probably some peaches with cottage cheese. And, of course, my daily fruitsnack rations. Hang on while I calculate that out, too. 650 calories in PBH sandwiches + 120 calories worth of peaches + 170 calories worth of yogurt + 350 calories of cottage cheese + 180 calories worth of fruitsnacks (usually gushers. I love gushers) =1470 calories. So, at that point, I'm at right around 2350 calories. Before lunch. Granted, most days I don't have all of that, but some days I definately do. On those days, though, I usually skip lunch and snack on everything through the afternoon and then take an early dinner. And then I almost always have dinner at least twice, and usually another snack on top of that before I go to bed.

What I'm trying to say is that I eat an awful lot. In fact, I'm almost always eating something.

Tomorrow morning, though, I get a 500 calorie breakfast, and that's it until noon. I'm going to be one miserable little bugger, I tell you. What it'll let me do though, is get a read out on my blood sugar. I imagine that it'll be pretty low, and maybe low enough to diagnose myself with hypoglycemia.

Of course, it might not. More tomorrow.

Opportunity is missed by most people because it is dressed in overalls and looks like work. - Thomas Edison

2005-11-16T20:56:00.000-08:00

Well my friends, I'm taking this advice to heart. It's time that I buckled down and had a nice, long, study session with my biochemistry book. I've got exactly two weeks until the exam, and about 700 pages of material to cover. That means, assuming I want to cover all of the material at least twice before the exam, that I've got to study 100 pages of material per day for the next two weeks. And that's not including anatomy or human development so this is going to be a short blog.

Heck, maybe I'll start a trend of blogging a few times a week instead of once every few weeks. That'd make the prospect of sitting down to write a blog a lot less daunting, as I wouldn't feel obligated to put pages and pages of material in it.

I suppose the noteworthy event of the last few weeks was my trip home over the Thanksgiving break. It was most relaxing, and I realized that I've grown to appreciate my family a lot more since I've been away. I had a chance to see most of my cousins, minus a few who were out of state, and have two back-to-back Thanksgiving dinners. We went to my dad's side of the family for Thanksgiving lunch, and then my mom's for Thanksgiving dinner. I don't know how it seems to work out so very well every year, but I've been able to see both sides of my family every Thanksgiving for as far back as I can remember. It's a good life.

I also had a chance to visit with a few of my friends back home, and it was good to see them too.

I think it's safe to say that while I don't miss my life back in Utah (well, maybe a few parts of it just a little), I definitely miss my friends and family. I'm far from lonely here in Milwaukee, but everybody's different, and one group of friends just doesn't take the place of another. They take a completely unique place, and that's the way it should be.

My random tip of the week comes from the kitchen: if you're going to make fried rice for just one or two people, remember that a whole clove of garlic is too much. I ate dinner, brushed my teeth, gargled with scope, went to bed, and I still woke up with garlic on my breath a full eight hours later.

Google Earth

2005-11-09T21:53:00.000-08:00

Well folks, this is officially the coolest thing I have ever had the priviledge to come across on the internet: Google Earth. It's cool enough that it gets its own post. (Note that I also did a regular post on my week today. It's below. I freely admit Google Earth is probably cooler.)

This is a program that's basically a huge compilation of satellite photos of the entire world. Yes, the entire world. Using your mouse cursor, you can view ANYTHING on earth- though, admittedly, sometimes the resolution isn't as high as we'd like. Specifically, I'm dissapointed with Milwaukee. But, life goes on.

So far I've been able to find:

My appartment (blurry, but there.)
My house in Salt Lake.
Some of my friend's houses
The MCW complex (again, resolution's not great)
My old workplace, the Huntsman Cancer Institute
An appartment I used to live in in Taiwan
The Forbidden City
The Grand Canyon

It blows my mind what's out there these days. I've included a link to download Google Earth on my links list (which has warped to the bottom of the page for some reason). In case it doesn't work, here's another one:
http://earth.google.com/download-earth.html

Tests, cousins, and more health stuff

2005-11-02T09:26:00.000-08:00

This week's going to be notus. In fact, it's already been nuts. It's test week, and I really need a good break so I've decided to blog for a while.

To give everyone an idea of what it's like to have tests your first year of medical school, my week went something like this:

Monday: Studied for tests. Attended an anatomy lab review session. Came home, studied more. Slept.

Tuesday: Crammed for last minute anatomy lab test. Took test. Came home. Studied for my written anatomy exam and my human development exam (it's embryology, basically.) Went shopping. Forgot to buy cereal. Nearly out of frosted mini-spooners.

Wednesday: Got up, went to school an hour early to cram for my devo test, and then took my written anatomy and human development tests. Came home. Went out into the backyard to run around and do backflips to get some energy out. Came in. Am now typing blog. After this, I'll study.

Tomorrow, I'll study.

Friday morning, I'll take my biochemistry test. Friday afternoon, I'll do laundry, clean my room, finish my shopping, and do everything else that I'll need to do to catch the rest of my life up to where it's supposed to be. I'll also be very, very happy, because I'll have a full month until my next round of exams.

With all that said, I need to re-emphasize that I really do love medical school. It's been a long time since I've got this much enjoyment out of my academics. Probably not since kindergarten when we had scheduled cookie breaks and naptime, in fact. I love it that much.

I'm looking forward to being back home for Thanksgiving. Last time I went home, I had a chance to help my little sister Becca babysit my three adorably blonde cousins, who are some of my favorite people in the world despite the fact that two of the three of them still have single-digit ages. They're cute. Very, very cute.

McKayla, Matteline, and Melise are their names. For whatever reason, they seem to like me and we have a lot of fun together. Mostly, that consists of them dogpiling on me and fighting about who gets to sit in my lap. Occasionally, though, we play games or go places. That's usually when things get interesting.

Last round, Becca and I had the opportunity to take them to dinner with their grandpa. Becca took McKayla, and I put Matty and Melise in the back of my mom's car for the trek down to the restaurant. Before we left, all three girls had insisted that they were thirsty and needed a drink. They chose to each take an 8oz plastic bottle of sprite with them into the car. (The three of them usually act as a trio. What one does, the other two do. Not always, but usually. It's a very different dynamic than what you get with three boys of that age.) On the way, I idly listened to the two girls conversations while I zoned out and worried about the road, and in this state failed to notice that Matteline and Melise had discovered that if they closed the caps on their bottles and waited a bit before opening, the bottles would hiss at them as the gas released. Being seven and five, this was incredibly interesting. Then, still in my semi-catatonic state, I heard Matty say something along the lines of "Shake it up. It's cool," to her little sister.

Any experienced parent or babysitter would have had all sorts of bells and alarms go off in their head at that statement. I was neither.

It wasn't until Melise had already given her beverage a fierce little joggle and unscrewed the top halfway that it occurred to me that somewhere between this stop sign and the last, something had gone terribly wrong. Sprite started spraying out of the bottle in a torrent that got the back of my neck sticky, and Melise began to half squeal and half scream. Still, though, I give the little gal credit for having the presence of mind to hang onto the bottle and try to keep everything together.

"Put the top back on!" I called back to her. I was more amused than angry, because I really should have seen this coming. I think I chuckled from that point until we got to the restaurant.

"I can't!"
"Okay! Give it to me!" I reached my hand around the back of my seat as best I could while I kept my eyes on the road. By the time she got it to me, of course, the pressure was spent and the bottle was merely dripping. I still felt better having in my hand than hers, though. She was sniffling a little, obviously a little traumatized by the incident. Matteline then chirped in another piece of helpful advice that must have seemed sound philosophy to her seven year old mind.

"It's okay as long as you don't cry, Melise," she said matter-of-factly.
"Okay." Melise, on the verge of tears, sucked her emotion back in and didn't cry at all. I was impressed. (Of course, I shouldn't have been surprised. A few months ago I'd tried to chase the girls around grandma's house by growling and snarling and making a scary face. The other two girls had squealed and hid behind the couch. Melise, the smallest, had put on her own scary face and snarled back. Loud. She was totally nonplussed. The kid is tough by any standard, let alone for a five year old little blonde girl. I love her for it.)

I opened a wetnap and tossed it back to her, instructing her to use it to clean up the mess. After a minute, I got a high-pitched "okay!" and she tossed the wetnap back up to me, still folded into a little square. I'd neglected to tell her to unfold it before she cleaned up the mess. Gotta love kids.

Anyway, that was a tangent. I love my family. I'll just leave it at that.

I had a chance to shadow my anatomy professor, Dr. Karim Bakhtiar, in his general practice clinic the other day. The guy is incredibly bright, and an excellent physician. On top of all that, he speaks eight languages. (Arabic, English, Persian, Italian, German, Spanish, Russian, and another language I'd never heard of but he grew up with. In fact, there may have been two obscure languages that he grew up with, which would take the number up to nine.)

Anyway, his clinic is in downtown Milwaukee, and most of his patients are minorities or have low income. It was a great experience to see someone as educated and talented as he was practicing medicine in a setting that's a lot less financially rewarding than a lot of other things he could have been doing. But I digress.

My point in bringing it up is that a full 80% of his patients had diabetes. That's not an exaggeration, either. The appropriate response to that factoid should be something along the lines of "Holy, holy crap," in case you were wondering.

Granted, that's in a minority/low-income population where there are generally more health problems than mainstream middle-class America, (which is a different problem and a topic for another day) but that's a huge percent. If 80% of the people in the world caught the bird flu, (and half of them died) that'd be a pandemic. Guess what? Diabetes kills people, too. (But admittedly, not like the bird flu does.) Of course, nationally, only about 7% of the population has diabetes. That can be misleading, though. A more useful fact is that one-third of all Americans will develop diabetes at some point in their lifetime. With that said, I'm going to cite some statistics from one of the US government's pages on diabetes:

*Diabetes was the sixth leading cause of death listed on U.S.
death certificates in 2002. This ranking is based on the 73,249 death
certificates in which diabetes was listed as the underlying cause of death.
According to death certificate reports, diabetes contributed to a total of
224,092 deaths.

*Diabetes is likely to be underreported as a cause of
death. Studies have found that only about 35 to 40 percent of decedents with
diabetes have diabetes listed anywhere on the death certificate and only about
10 to15 percent had it listed as the underlying cause of death.
Overall, the risk for death among people with diabetes is about twice that of people without
diabetes of similar age.

People, those are bad statistics. Moral of the story? Exercise. Especially if you're already at risk for diabetes, an hour of exercise five or six days out of the week will drastically lower your chance of getting diabetes. You don't have to kill yourself- go walking. Just do it. Walking is nice, right? Oh yeah- eat healthy, too. It's not uncommon for people who are borerline diabetic to reverse the condition by altering their lifestlye... the catch is that you have to actually alter your lifestlye. And there's my health rant for this blog. More on diet next time.

My buddy Ryan Jensen (jonryan.blogspot.com) sent me this article:

http://www.hardnewscafe.usu.edu/artlife/features/110705_fatmedia.html

And yes, this is the flipside of my argument of being health and weight concious. There's something to this article, and it's a real issue. It is, however, a different issue than what I'm usually talking about in this blog. The people I'm pointing my 'get healthy' comments at are mostly older adults, though they apply to everyone.

And I have to stress that my get healthy rants are NOT about eating less food to starve yourself. They're about eating healthy food and getting enough exercise. Eating significantly less food as a weight loss strategy is almost always unhealthy.

Of course, I can't help but pull this line out of the article to comment on: "...Those who watch television at least three nights a week are 50 percent more likely than non-viewers to feel overweight or fat..."

Two comments: First, if you're watching a lot of TV, stop. It's just not good for you at all. Second,
I'd wager that those people probably aren't getting enough exercise (after all, they're spending quite a bit of time in front of the TV.) People who exercise regularly usually have higher self esteem than those who don't. All types of health are connected, and if you're physically healthy, you're more likely to be emotionally healthy, and vice versa.

I don't have hardcore statistics on those last few comments, though. Sorry guys.

And I'm going to go study now. Personally, my life's great. The weather is still incredible- I didn't even wear a jacket today. Cold wind and sunshine in the forecast for this afternoon. Too bad I'm going to be buried in books...

Colored Trees and Unhealthy America

2005-11-02T08:42:00.000-08:00

Well, I love Wisconsin. The place is beautiful. Today is November 2, and the temperature outside is probably right around 65 degrees. Love it. Across the street, the leaves on the trees are yellow and orange. As in flaming orange- there's not a trace of brown in them. We just don't have leaves that color in the Salt Lake valley. There's too much pollution, and nowhere for it to go. It builds up in the air, stuck in the bowl created by the mountains, until a storm comes and washes it all out so the cycle can start over.

Of course, the tradeoff is that Wisconsin has no mountains. Win some, lose some.

School's been good. Next week is test week, which means that this week I'm studying like it's test week. At least, I'm supposed to be. To be honest with myself, I have to admit that I probably haven't put the time or effort into studying for this round of examinations that I should have. It's a common theme in the class, though, because I'm not the only one. Most of us are burnt out scholastically after block II, and there's just not a whole lot of motivation to stay focused through block III. Such is life sometimes, I suppose. In all fairness, this block's materials don't seem to be so bad. Last time I was freaking out the week before exams, during exams, and even a day or so afterwards. It was just a huge load of material to take in at once, and while I know that that's something that comes with the territory of being a medical student, that doesn't mean that I enjoy it a whole lot.

There hasn't been much by way of noteworthy material in the last little while. I've hit that portion of the school year where everything's become routine- I study, I go to class, I go home, I sleep, I wake up and do it again. I'm okay with that. The fact that I've been sleeping with my window open at night in November without any problems at all keeps me so happy that not a whole lot else can get to me. And like I said, the trees are beautiful.

Of course, I'm well aware that this is a temporary situation. In a few more weeks, maybe even a few more days, the weather will snap back to what it's supposed to be this time of year. And then it will be very, very cold. All the leaves will finally fall off of the trees, and my happy little colorful world will degenerate into a frosted grey wasteland. I've been me long enough to know that the weather effects my mood, and I'm guessing I'll be noticably less perky when that time rolls around. So I guess I'd better live it up while it lasts.

As far as interesting stuff we're learning in school goes, it's hard to pinpoint something particularly noteworthy or worth putting in this blog. We've studied a great deal on metabolism, cholesterol, fats, carbohydrates, proteins, and what your body does with them. If you're curious, you can go to my 'Science in the News' blog and get a partial rundown on why everyone in America is fat and unhealthy. (Okay, not everyone, but it's more common than not, and that's a sad truth.) America's lifestyle is just plain old unhealthy, and that's what it comes down to. It's part diet, but mostly (in my opinion) lack of exercise. We drive cars everywhere- our cities are usually too spread out not to, and we take elevators instead of stairs. We're so busy trying to pack everything into our lives that we never take time to exercise, and it's killing us. The moral of the story: exercise. A lot. Don't go crazy and kill yourself with sore muscles and exhaustion, just take time everyday to keep yourself in shape. I'm not talking about Arnold the governator style healthy, just average joe healthy. (Which has become rare. Average Joe now subsists on hamburgers and frenchfries, which is killing him. But I've said that already.) Walk, run, lift weights, do yoga, rock climb (if you live in Utah or somewhere else with rocks tall enough to climb, that is), or do whatever else gets your blood flowing. Just do something. You'll live longer, and enjoy life more.

Did you know that 70% of disease in America is preventable? Yeah. Crazy, isn't it? So get off of your couch and go do some situps. (And for pete's sake, don't 'reward' yourself with a huge bowl of ice cream afterwards. Eat a carrot.)

Oh yeah, and stop smoking. That's even worse for you.

All that said, though, back in the day it was considered healthy to smoke, and nobody worried about what they ate. Anyone jealous? They also chopped their own wood and hunted their own food, not to mention built their own homes and plowed farmland by hand. And a lot of them were healthier than our good friend Average Joe 21st Century American. Moral of the story? Again, go exercise. Really, it's good for you and there aren't any substitutes.

And now I'll get off of my soapbox. Get healthier, America. Pretty please with a cherry on top.

Well, I'd love to rant some more (I STILL have stories I want to tell that I never seem to get to) but I've got to go. Yes, I have to actually study. Go figure.

Illegitimis nil carborundum.

2005-10-15T10:42:00.000-07:00

Well, I just made it through a wicked week of medical school testing. I had five examinations in as many days, and it was pretty grueling. Nonetheless, I survived. Now I've got a full month to burn before I have to mess with exams again. What a great system. The human mind can only comprehend so much stress at a time, and therefore, it's not significantly more stressful to have five tests in one week than it would be to have two or three. You're kind of maxed out at that point, and anything more just gets jumbled together as an amorphous ball of mental numbness that you can't really comprehend. The practical advantage of going with all five at once is that I have huge chunks of relative downtime in-between exams. I think if I had to test weekly I'd go insane.

Now it's time for my movie plug. If any of you are mormon, know mormons, live in Utah, or have ever lived in Utah, go rent and watch "Sons of Provo." It's akin to "The Singles Ward" in its blatant mockery of Utah/LDS culture- particularly Utah County, only it raises the bar to a whole new level. I'm almost hesitant to compare it to "Singles Ward," though, because it really is SO much better than any other LDS cinema I've ever seen. And it's horribly funny. It's ad-libbed, like "Best of Show" and "Waiting for Guffman," and therefore the outtakes and deleted scenes are also very worthwhile. Let it be known that I don't often plug movies, much less LDS ones. (It's also perfectly clean, so if any of you have small children you can watch it without worry.) Trust me on this one.

As a little bit of a personal update, the hardest part about med school is simply dragging myself out of bed in time to make it to my 8:20 biochemistry class. Really, that's it. It's a whole lot of work, but MCW's administration is really good to us and does what they can to keep us happy and well taken care of. To any aspiring doctors caught in the pre-med hubbub: it gets better. Way better. Don't decide to switch career paths because medical school seems like it'll be too hard- it's not. It's challenging and difficult, but it feels a lot more like navigating a ski slope than shoveling garbage. I'm tired by the end of the day, but I feel really good and I've had a lot of fun. (On days that I have anatomy lab, though, I smell like I've been shoveling garbage...) To name a few things that have made me really happy in the past few weeks:

1) Dr. "Carvin'" Marvin Wagner arbitrarily decided to bombard the lecture hall with obscene amounts of candy one afternoon. He began by flinging it randomly into the masses of students who showed up for class (almost all of them) and then got a little more organized and had it passed down the rows. Providing candy for 200+ med students is no small amount of trick-or-treat loot, either- this guy went out of his way. It's not like you wake up one morning and find ten pounds of candy lying around.

2) I lost my anatomy notes (purchased from the school during the first week of class,) and had to get new ones. I asked Dr. Kolesari where I should go to pick up a new set because mine had gone missing, and he proceeded to not only tell me where to go to get them but also write me a note informing his secretary to hand me a copy free of charge. ("You've already paid for them once?" he asked. "Yes." "Then that's good enough. Here.") I've been at MCW eight weeks. I was at the U of U for twenty times that long and never had any slack cut my way when money was involved. Don't believe me? Go get a parking ticket at Utah and try to appeal it. I dare you.

3) That brings me to my next topic: parking. While the student lot isn't exactly close to the school, it's WAY better than what I'm used to. And when the lot gets full and students start inventing their own parking spaces, nobody cares. Hallelujah. The first time I didn't have a space and parked up against the curb, I was sure I was going to pay for it. I was pleasantly surprised. (At the U you check your car everyday after class. You're relieved if there's not a ticket on it even if there's no conceivable way you could have warranted one.)

4) While MCW has nothing to do with this in and of itself, I'm really happy that I live five minutes from school. The other morning I woke up for my 8:20 class to find that I had a full nine minutes before it started. To top it off, it was small-group discussion day and that meant that if I was late I'd be marked down for it. I skipped the shower, grabbed my notes, ran to my car, drove to school, ran from my car to class, and was there before they started.

5) Dr. Michael McBride, my psychiatry professor. The guy went out of his way to make our psych class as enjoyable and low-stress as was in his power. This included an explicit promise to the students that nobody would fail his class, and if someone did he'd find a way to get them out of it. It also included offering to buy a bike helmet for anyone who rode a bike to school and couldn't afford one. After all, "wearing a helmet is important- kids look up to you." (Only one student took him up on the offer.) He also had students with kids bring them to class one week, had grandparents come the next week, and brought his pop-up book of phobias to show us another week. His final lecture, he shared his personal family history with us, including stories about his sister who'd committed suicide and his parents who had also passed away. Brave guy. The title of this blog is a saying of his he uses to encourage us on a regular basis.

So yeah, school's great. I'm sure there'll be more on that later.

The random fact of the day is that I've learned how to perform a traecheotomy. Of course, my patient was my anatomy lab cadaver, but in theory it should be the same. For those of you who aren't sure what a treacheotomy is, it's essentially re-routing your breathing through a hole in your neck so you don't choke to death. For those of you who are interested in learning how it works, here're the basics: First, place two fingers on your Adam's apple. Your Adam's apple is a part of your voicebox, and it's made out of hard cartilage. Slide your finger's down the cartilage until you feel a divot, a soft spot. Below the divot should be another hard piece of cartilage. You should be able to press on that lower piece of cartilage without cutting off your airway at all (don't overdo it, though.) Between the two cartilages, just where the divot is, is where you would make the incision to open up the airway. My anatomy professor told us a story about how he ended up in an elevator with a choking man while he was in his residency. They couldn't get his airway cleared, and so he and the other residents there performed an emergency traecheotomy on the guy with a ball point pen. Yes, that's right, they stuck a pen into his neck while they were in an elevator and saved his life. I don't reccomend trying it, but I thought some of you might find it interesting.

I'd like to add a disclaimer that I'm throwing this in as random trivia- not as a practical tutorial. In other words, please don't practice on friends or relatives. Thanks.

And that's all I've got for the week. Hope you're all well.

I'm not dead. I swear.

2005-10-07T10:20:00.000-07:00

Well, it seems as though I've gone from updating this weekly to updating this bimonthly. I'd like to say that I can see that changing in the near future, but it might have already become a permanent trend. You see, life here in Milwaukee has become busy. Very busy. School's a big part of that, as is feeding and taking care of myself. I've gained fifteen pounds since I came out here (good weight) and I just can't bring myself to start eating junk food because it saves me time. At least, not very often. I'm the first to admit that the taco bell two blocks from the medical college has become my good friend, and receives biweekly visits from me. Most of the time, though, I cook. And I'm proud of that.

Anyway, I found a copy of the poem that's on the wall of my anatomy lab at the college. Here it is:

To Remember Me

by Robert Test

At a certain moment a doctor will determine

that my brain has ceased to function and that,

for all intents and purposes, my life has stopped.

When that happens, do not attempt to instill

artificial life into my body by the use of a machine.

And don't call this my "deathbed".

Call it my "bed of life", and let my body be taken

from it to help others lead fuller lives.

Give my sight to a man who has never seen a sunrise,

a babyÂs face or love in the eyes of a woman.

Give my heart to a person whose own heart

has caused nothing but endless days of pain.

Give my blood to the teenager who has been

pulled from the wreckage of his car, so that he

might live to see his grandchildren play.

Give my kidneys to one who depends on

a machine to exist from week to week.

Take my bones, every muscle, every fiber and

nerve in my body, and find a way to make a

crippled child walk.

Explore every corner of my brain. Take my cells,

if necessary, and let them grow so that someday

a speechless boy will shout at the crack of a bat

and a deaf girl will hear the sound of rain against her windows.

Burn what is left of me and scatter the ashes

to the winds to help the flowers grow. If you must

bury something, let it be my faults, my weaknesses

and all my prejudice against my fellow man.

Give my sins to the devil.

Give my soul to God.

If, by chance, you wish to remember me, do it

with a kind deed or word to someone who needs you.

If you do all I have asked, I will live forever.

I hope you all enjoy it and get as much out of it as I do. It's something that gives me a lot of desire to become a good doctor.

Some of you may have read my dad's comment on the last blog I put out. He had some good points in it. I'd took some time this week to talk with a few of my Muslim classmates to get their take on the whole suicide bomber/ Islamic extremist thing, and they gave me some pretty good information.

First, it's stated very clearly in the Koran that suicide is forbidden. It's also stated in there that women are equal to men, and that women have all the social priviledges that men do. That is, they can own property, become educated, work, and do whatever else they want to- as far as I can tell, there aren't any provisions for sexism at all. This then begs the question of "If that's true, why are there so many suicide bombers and so much abuse of women in the middle east?"

Ignorance. The Islamic extremists are usually uneducated, poor, and generally have very low standards of living. The leaders of the movement spread propaganda and lies which perpetuate things like suicide bombers. They use Islam as a tool to control the masses and incite them to military action. The condescending and often abusive treatment of women is also rooted in the culture. And that's where the distinction has to be made- it's the middle eastern culture, not the religion of Islam itself that's spawning the problems.

As far as decrying the actions of the terrorists go,the Muslimss in the US do just that.The Muslimm leaders in the middle east do to- at least, some of them do. Those that don't are usually the ones doing the inciting in the first place.Mainstream Muslimss are hard working, virtuous, down-to-earth good people. At least, the ones that I know are. There are probably a dozen or so of them in my med school class, and they're great. About half of them are women. (On a side note, you might consider what people think about us Mormons when they look at the medical school class. There are almost 30 LDS students just in my class, but only one woman. Anyone going just by those numbers would assume automatically that the LDS culture is bigoted and unenlightened when it comes to women- but we're not. Go read some of the LDS literature on women. Go find an LDS woman and talk to her about heroppressionn." I'd imagine that most of them won't have any idea what you're talking about.)

Well, there's my political rant for the month. The fun science trick included in this blog is that lots of cereals have a TON of iron added to them. That's generally a very good thing, as almost 20% of women in the US are at least slightly anemic. (i.e. they need more iron.) If you want an indication of how MUCH iron is in there, take a bowl of high-iron cereal like Kellogg'ss product 19- you can read the iron content on the box. Compare a few and take the one with the highest iron.) and place a few flakes of it in a bowl of water so they float lightly on the surface. Now take a magnet and drag them around. Yup- it works. Pretty cool, eh?

I've still got stories to tell, but I have to go to my anatomy lab. I've got tests next week. I'll work on blogging more often, I promise.

-Tracy

Thunder, Party Tricks, and Al-Jazeera

2005-09-22T20:28:00.000-07:00

Well, recently I've attempted to have some sort of organization to my posts here. Tonight that will not be the case, so if you're offended by structureless rambling you may want to skip this round. That said, here I go.

Recently life's been good. Aside from the thunderstorm last night, I really don't have anything at all to complain about. But what a storm. At about three a.m. I woke up to my walls rumbling. No joke, the lightning was close enough and the thunder potent enough to shake my entire apartment. Pretty tough to sleep when it sounds like someone's firing a shotgun outside your window every thirty seconds or so. I'd never had anything like that before, and had I been awake enough to enjoy it I'm sure it would have been a spectacular light show. As is, the only noteworthy consequence of the storm was that I missed my Biochemistry class to make up for lost sleep.

I've made some good friends in my med school class and in the ward. There's a good crew out here in Milwaukee and I'm happy here. I wasn't expecting to be as happy as I am.

And school's great. We're studying metabolism, cranial nerves, and more embryonic development. Today on the side we had a lecture on Muslim culture. The doctor giving the lecture was an American citizen whose parents had immigrated from the Middle East in the 60's. He talked a lot about the religious culture, and what we should be sensitive to as we treat patients. Mostly, it came down to being open about the culture, not making any assumptions (for instance, about women being oppressed - it doesn't happen any more often than it does in White-American-Christian culture), and respecting the culture and religion. Modesty's a big thing, as are formal religious obligations. He said some things that were interesting politically, too. Most notably, he said that he'd overheard another doctor talking about how Al-Jazeera was nothing more than a terrorist mouthpiece. His response was that Al-Jazeera was as appropriate as CNN- they just target different audiences. CNN knows and reports what people in America are interested in and what they want to hear. Al-Jazeera does the same for those in the Middle East. It was a very interesting viewpoint, frankly. I went and read some of the articles on aljazeera.com and I can't help but feel like both sides are failing to communicate effectively. Just my two cents, and I don't mean to excuse anyone's actions. Blowing people up isn't a great communication tool in my book, though I don't think that the communication situation will get much better with America always taking the hardball approach. (Of course, I don't have any better ideas.)

Is the media slanted? Most certainly. It always will be. Tonight, I heard from a soldier recently returned from a brief tour of duty in New Orleans helping with the relief effort. He said that the media is making it out to be a whole lot worse than it actually is down there, and that a whole lot of progress has been made that the news stations don't show anything about. That's the second account of that tone that I've heard about the relief effort, albeit the first one that I've heard first hand. Good to know that it's not so doomsday as some would make it out to be. We'll see what the media reports by way of Rita's aftermath.

That reminds me of another time the media seemed really slanted, this time a little more local. When I was a sophomore in college I attended a party at the governor's mansion thrown by his two sons. It was a great party, and fairly low key. There was music and dancing, and parts of the mansion were open for people to go and tour, though most of it was roped off. The cops came to bust up the party at about one in the morning and it made the news as an incident of scandalous collegiate reveling that tainted the governors mansion. The party was nothing of the sort. There was no drinking, no drugs, no unruly behavior (i.e. brawls or the like) and people were highly respectful of the property. To my knowledge, there was no property damage. Heck, nobody even crossed the ropes set up in the mansion to go explore off-limits areas, though it would have been extremely easy to do. The music was a little loud and the cops got called. The media came out to feed and made everyone look bad. And most people bought it, because drunken revelry is a lot more interesting than what was actually going on. It was an eye-opening experience for a kid just home from his mission. People feed off of gossip at all levels. (Those of you who know me well know that I wouldn't have shown up at the kind of party the media reported that one to be.)

And that's my rant on the media. A necessary evil, but always remember that it's never fair or balanced.

Bah. That's about all I've got for today. And heck, I'll pass on a party trick secret: eating chocolate triggers some sort of central nervous system response that causes temporary weakness. I'm perfectly serious. To test this, have a friend hold his arms horizontally so he or she looks like a cross and briefly test to see how far out along their arms you have to go before you can't push them back down to their side. Obviously, do this quickly so you don't make them tired. That'd give you an excuse not to believe what I'm about to tell you will happen. Remember where your hands were- usually it's roughly around the elbow, though the stronger you are compared to the person with your arms out the higher up along their arm it'll be. It gives them an advantage with leverage.

Got it? Good. Now give your subject a small piece of milk chocolate to eat. (I don't know if it works with white or dark chocolate. Never tried.) While it's in their mouth, have them put their arms up again. Put your hands back on their arms, and push them down to their side. You'll be surprised at how much effort they can't muster to resist. Sounds too dramatic to be true, but go try it. I dare you.

(And before anyone asks, I have no idea why this works, nor did I learn it in med school.)

We only wash those about once a month.

2005-09-13T21:51:00.000-07:00

Well my friends, it's been an insanely busy couple of weeks. Hopefully this'll be the only time that I miss a blog, and I apologize for giving any of my loyal readers a scare that I'd vanished from the face of the earth. I had a batch of tests last week, and spent Tuesday night studying for them. Wednesday I flew out to Utah for the weekend and couldn't justify sitting down to blog with only a few days to spend back in the homeland. That said, much has transpired in the last two weeks. In fact, there's way more to write about than I'm going to get to tonight, so this week will quite possible have more blog posts than one.

As it's freshest on my mind, I think I'll talk about the flight home first. I know that I'm skipping talking about everything that happened while I was home, but I'll get to that later.

I left Salt Lake at 4:45pm and headed to Denver via Frontier Airlines. The flight was noteworthy for two reasons:

1) I learned that it hurts to sit for long periods of time when you've given yourself a nice orange-sized but raspberry-colored skidmark right about where your rear end and leg become indistinguishable. That pain is amplified when your room to move is limited by portly gentlemen seated on either side of you. (Skidmark due to weekend soccer game.)

2) I learned that the days of airplane turbulence are not over. Most of the flights I've taken in the last few years have been smooth and comfortable. (Heck, I flew to and from China earlier this summer without a hitch.) The flight to Denver was less so, and I arrived more than slightly motion sick.

I still felt queasy when I landed, and decided to feed myself dinner at the airport. I was worried at first about spending money on the Sabbath, but then I remembered that airports have all kinds of weird rules and guessed that there was probably a stipulation somewhere that it was never actually Sunday in an airport. Hello Panda Express, bye-bye motions sickness. I ordered a huge dinner with three different entrees, fried noodles, and some classic Chinese hot-and-sour soup. For some unknown reason, hot-and-sour soup smells almost exactly like live cattle- there's definitely something in it akin to digested grass. Also for some unknown reason, I don't mind one bit. I love the stuff, but I can never figure out why after I smell it. After eating I felt a lot better, and I attribute it mostly to the soup.

My carry on for the trip was my pillow. I'd stuffed the pillowcase with some necessities for traveling by plane (comic book, notepad, pen, tupperware filled with homemade peach pie, etc.) and (of course) carried it around everywhere I went. I always get weird looks when I do that. It's unusual, to be sure, but highly practical. I can sleep on it whenever and wherever I want to, and it's much more portable than a suitcase. I sling it over my shoulder like Santa's bag of toys and go on my merry way without having to drag or carry a bulky squarish suitcase around. I hate those things and avoid them whenever possible. The only catch is that my pillowcase gets pretty dirty after a trip. Airport floors are not the cleanest.

When my second flight landed in Chicago, the pilot managed a less-than-optimal landing as evidenced by his slamming on the brakes of the plane about halfway down the runway. Those things can pump out some serious friction, because the deceleration of that huge chunk of metal was most impressive. I felt the tension of an airplane seatbelt for the first time. When landing, the co-pilot informed us that the rough landing wasn't his or the captain's fault, "it was the asphalt." Coupled with a polite deplaning comment of "It's been a pleasure serving most of you this evening, and the rest of you know who you are," I was convinced that the co-pilot had finished his shift and was more than a little giddy about being set free. I heard at least one passenger wonder out loud about what must have been added to his coffee. After the airplane stopped moving, I hopped out of my seat (first row) and ended up at the front of the line to get out of there. The stewardess, while waiting patiently for the captain's signal to open the door, noticed my pillowcase.

"Oh, that's a GREAT idea," she said. Then she leaned over and gave me a look over the top of her glasses, adding "We only wash the airplane pillows once a month, you know." Fact is, I didn't know, but I do now. It gave me one more reason to keep carrying my pillow as a carry on, and I strongly endorse all of you to do the same if you're taking a flight where you might want a nap. I'm no doctor yet, but I'm pretty sure that sleeping on a pillow that fifty people drooled on before you got to it is a great way to get sick.

On that note, it's my bedtime. Like I said, I'm going to try to update this again a little later this week. I still have my stories from my weekend home.

Blog material's sparse the week before exams...

2005-08-31T22:20:00.000-07:00

Classes have indeed picked up as predicted. I find myself running out of time in the day to study. It's not a negative thing, though. Frankly, I've enjoyed studying a great deal so far. My goal is simply to pass all of my classes and become a doctor while making the best use of my time that I can. Sometimes, that included updating my blog. I'll try to keep it to once a week, guys. The week before my tests, though (a.k.a. presently) it's going to be a little tricky.

My anatomy professor, Dr. Marvin Wagner, is a small man, probably no taller than five and a half feet. He's got stark white hair that covers his head in thick waves and (no joke) a purple nose. Not purple-tinted skin tone, but really, truly purple. I'm sure it's perfectly healthy since...well, since he's a physician and so are all of his coworkers at the school. Nonetheless, it's impressive. I don't expect everyone who reads this to believe me, but I state again: his nose is purple. He wears thick glasses and talks slowly and deliberately in a moderately high-pitched voice, but with enough life in it that he's never boring to listen to. His voice sounds kind of what I'd expect to come out of a leprechaun, actually. Some of the students in my class started calling him "Willow," but then we found out his long-time nickname from our psychiatry professor: "Carvin' Marvin." Fitting, for an anatomist at a medical school. He wanders around the anatomy lab with his white coat and white hair, shiny glasses atop purple nose and answers any questions that we have about what we've found on our cadavers. It's great. Apparently he used to have a habit of failing to modify such behavior during laboratory examinations, and has since been reprimanded by the department for undermining exams. He's very popular with the students, and I get the feeling that he's much more concerned with teaching us anatomy than what the department or anyone else thinks of him. "Remember This Until You Die" he'll intone at us with his trademark voice whenever something's important. Then he'll pause for a second and let it sink in. I love it.

I've made some good friends out here. Some in my classes, some in the ward. I think it's safe to say that I'm not going to be lonely out here at all, and that's nice.

One of my friends told a story I got a kick out of about her family at the dinner table one night. With no apparent warning, her mother had turned to her older brother and very directly asked "Adam, are you gay?" With no idea where the query had come from or what had provoked it, Adam responded with a question of his own"...If I was, could I have girls in my room?" (Brilliant.) His mother paused to blink before answering with a brief but decisive"No." "Then no, I'm not," was Adams final verdict on the subject. I admired the kid for his quick thinking. His mother went on to explain that she just wanted her son to know that he'd be loved anyway even if he was. I'm sure he was thrilled.

I've got biochemistry and anatomy exams coming up in less than a week, and after that I have a hunch that most of my class will be taking some time out of their day to go get ridiculously drunk. In fact, I'm sure of it because I've heard some of my classmates say as much. One of these days I'm planning on following them into the bar just to enjoy the spectacle. Not next week, though. I've got other plans.

Well, that's all you get for now. I'm out of brainpower, and my writing suffers whenever I can't seem to string together complete sentences. Go figure. I'll have a better update next week. Until then.

Anatomy Lab et al.

2005-08-23T20:10:00.000-07:00

We've started the actual anatomy lab dissection. Our cadaver is a man roughly in his seventies, and we've named him Bob. Bob's in pretty good shape. So far we've been unable to figure out exactly how he died.

The nuts and bolts of the anatomy lab are that we get to take a scalpel to this human body that was so generously provided us. Our job is to figure out what goes where and how everything's put together. Fascinating. So far we've dissected nerves, arteries, veins, muscles, and today we did our first piece of bone work. I'm always enthralled by what we're doing. Anatomy lab is scheduled at the end of the day, and we're sometimes there until five or even later. I don't mind at all. It never seems that late until I actually leave the lab.

The catch to the whole deal is that I stink. Often, and unpleasantly. Every time I leave the lab, I reek of formalin and other preservative chemicals. The bodies don't smell like bodies- they smell like ... well, anatomy lab. The other day as I was walking to my car I passed a bus stop with a half dozen people waiting at it. Two or three of them were smoking. As I walked past, I got a big whiff of nicotine-laced grey fumes that made my eyes water a little bit. Loved it. My body was thrilled to get something up my nose besides ethanol and formalin. Change can be a beautiful thing. I almost stopped and took another big whiff, but decided I'd look pretty stupid doing so. 'Lab fume' is some potent strong stuff, and it's like nothing else I've ever come in contact with. If you want to have the experience but aren't a medical student, I reccomend the following: Take a steak. Leave it out on your counter for a few days or until it starts to get 'the funk,' and then put it in a jar. Fill the jar with rubbing alcohol and allow the steak to sit for three weeks, stirring occasionally. Remove the steak, douse it with bleach or beer, and then let it sun-dry on your roof for several hours. Take the steak off the roof, pour more alcohol on it, and stick it right up in your face. Breathe the fumes for fifteen minutes or so- you'll get used to it after about two and will hardly smell them. Then rub the steak over all of your clothing and see what your family thinks when they get home. Great stuff. It's inspired me to shower both before and after school.

On another note, I also met Bill the Kinko's guy. That was an experience. I went downstairs to the med school's basement Kinko's to talk to him and see if I could send and recieve fax messages from his store. ("I can? Great. I'll make a phone call and wait for my fax to come through.") Bill proceeded to ask me where I was from, how I was enjoying medical school so far, and what my name was. Apparently that was all the information he needed for us to become fast friends. He told me about how faxes were $0.45 a page, how color copying was WAY better than black and white, how the school had cut his hours from fifty to fourty a week, and that the new guy that was going to work those leftover Fridays didn't know ANYTHING. That was all fine and good. Then he leaned over and got that I'm-about-to-let-you-in-on-a-deep-dark-secret look in his eye and asked "You wanna see my new stapler?" After a two-blink pause, it occurred to me that the new stapler, obviously, was very important. Of course I want to see it, Bill. Let's see what you've got. The new stapler was grey and, as promised, very new. I got a demonstration of it's capabilites for no extra charge. It took normal staples and could do twenty full sheets every spring-loaded punch. (Bill then informed me that normal staplers can only handle about eight.) I was thrilled. Modern marvels. About this time, my fax came in. I filled out the papers and re-faxed them to the car insurance people, and Bill handled everything flawlessly. The right man for the job, in my opinion- he obviously knows his stuff despite his quirkiness. In the man's defense, though, I'm not sure how normal I'd be after fifty hours a week for several years in a 15x20 cement room with no windows and sparse company.

Class is starting to wind up, and the pace of my life will likely change very drastically in the next few weeks or so. For now, I'm content to just sit back and enjoy the ride. Med school, unexpectedly, can be pretty fun.

Let the Schoolwork Begin

2005-08-16T19:03:00.000-07:00

Classes started this week in medical school. I've arrived to school the last two mornings with a schedule replete with biological chemistry, human anatomy, human development, and even some small talks with patients and doctors. Good stuff.

A lot of what's going on is pretty similar to what I've been doing for the last four years of my life in my undergraduate degree. (In fact, most of the material that we've studied so far I've been exposed to on a much deeper level at the U.) The twist, though, is that everything has been applied to a medical clinical setting. That is, we study why what we're studying is important so far as playing doctor is concerned. Fascinating.

We had a patient with sickle cell anemia come and talk to the class about his disease. His doctor came with him to answer the more technical questions we might ask. Good stuff. For those of you who aren't familiar with sickle cell anemia who would like to be, read the numbered paragraphs that follow this one. For those of you who have no desire to learn about biology because biology bores you to tears, go ahead and skip them. You won't hurt my feelings at all.

Basics: Sickle cell anemia is caused by a mutation in hemoglobin, the substance your red blood cells use to carry oxygen to your body. The mutant hemoglobin still works for carrying oxygen, but it has a tendency to stack on top of itself in long chains. That's bad because the chains get so long that they stretch and distort the red blood cells and make them sickle shaped (they look like crescent moons, roughly) so they get caught in small blood vessels. The jams cause the nearby tissue to start to die (it has no oxygen- the road's blocked) and it hurts like a bugger. Bad jams can cause more severe problems like strokes, arthritis, and all sorts of other nasty stuff.

1) Sickle cell anemia is a genetic disease. Therefore, it's not contagious and has everything to do with who your parents are. Human genes come in pairs You get one set from mom and one from dad. Sickle cell anemia is a recessive gene, which means that if you're unlucky enough to end up with two copies of it (again, one from mom and the other from dad) you get sick. If you only have one copy of it and your other gene is normal, you're fine.

2) Sickle cell anemia is found in those of African, Indian, and sometimes Middle Eastern descent. Here's why (this is cool): Having two copies of the sickle cell gene makes you sick. Two normal genes makes you normal. (And the punchline:) Having only ONE sickle cell gene gives you resistance to malaria. Therefore, if you happen to live where there's malaria floating around that one gene comes in pretty handy. As a consequence, populations that deal with malaria (like Africans) tend to have sickle cell anemia to deal with as well. Why? Because carrying the gene gives you an edge when it comes to living long enough to have kids. The downside is that those kids might have TWO copies of the gene (assuming your spouse has one and you have one) and be sick. A one-in-four chance, to be exact.

3) The newest and most effective treatment for malaria is the substance hydroxyurea. The drug essentially tricks some of your cells into thinking you're still a fetus so they make fetal hemoglobin instead. (Which is different from adult hemoglobin.) The fetal hemoglobin breaks up the stacking of the sickle cell version and gives you something a lot closer to normal blood. Cool stuff.

And now back to non-science stuff. The short version is that I learned a lot from the patient/doctor duo and enjoyed it thoroughly.

The part of the week that I'll remember most clearly will be the presentation we had to prepare us for our anatomy lab. For those of you who don't know, first year medical students are enrolled in an anatomy lab that consists mostly of dissecting human tissue. The topic of where the bodies come from that we'll be dissecting was discussed at length.

The human bodies in our anatomy lab were generously donated by their owners. These were people who willingly gave their bodies to science to be used as educational tools to train us as future physicians. They knew what would become of them, yet decided that such a sacrifice was worthwhile. In a very real way, their last act on earth was to give what piece of their lives they could (their body) as a gift to those who would use it to learn the skills they needed to help save the lives of others. The physicians who keep us healthy, sometimes who keep us alive, all learned the basics of the human body from someone who no longer had use for one. It's a reverent thought, when taken from that perspective. Someone gave their body to science so that my doctor knew how to fix my face when I broke it wakeboarding. Another gave their body to train the physician who operated on my little brother's chest to keep his heart from being crushed by his ribcage. In a very real way, the dead help save the living.

The presentation made me realize exactly how great of a priviledge it is to have the opportunity to be in such an anatomy lab. I made the decision then to take it seriously and learn everything that I could from the experience.

I'll try to keep these things about me instead of my classes in future posts, but I thought I'd give you all a taste of my experience so far. Good stuff. I'm looking forward to the next four years.

On a less sombre note, my mother and sister were in town for the weeked. Under the direction of my fashionable young sister, we ended up at the largest mall I have ever seen in my life. Gurnee Mills, of Gurnee, Illinois, is absolutely insane. It's a Babylonian shrine to capitalism that took us ten minutes to circle completely in a car. To top it off, it's an outlet mall so everything's cheap. Cheap enough to keep the two female units of my family shopping for five hours straight, as a matter of fact. They had to buy an empty dufflebag at the Nike outlet just so they could get their spoils home on the plane. My sister afterwords suggested that I to play "depressed med student" just before finals (three weeks before Christmas) and tell my parents that it'd really help me out if she could fly down and keep me company for the next few weeks... Yeah, well, we'll see how that goes.

First Impressions

2005-08-10T10:37:00.000-07:00

I'm sitting here at my desk in my apartment eating a bowl of Malt-o-Meal frosted mini spooners for lunch. (Spooners. I love it. I'd be tempted to buy them over frosted mini-wheats for the name alone.) One perk of buying my own groceries is that I get to choose my own milk. A small thing, to be sure, but raisins and whole milk are making this lunch a lot better than most of the bowls of cereal I've had in my life. Granted, I haven't paid a cent for most of the bowls of cereal I've eaten in my life (thanks, parents), but skim milk just doesn't do a good bowl of cereal justice.

I've now been in Milwaukee for just under a week. Nice place. I'm still impressed with the people and the scenery. There are no mountains, so if you get a little bit of altitude (like, say, from the third floor of the medical school) and look out to the horizon it looks like you're living in the middle of a forest. The trees here are taller than most of the buildings (residential area) and they cover the signs of civilization very thoroughly. It's a pleasant illusion.

Since my last post, I've had several significant experiences: I attended my ward here for the first time, I showed up at orientation and met my medical school class, and I met my roommate. I'll just go in order.

The ward is about like any other singles ward that I've ever attended. Good people, good leadership, and fewer cute girls than I hoped there'd be. It's definitely guy-heavy. The problem arises because the ward can basically be divided into two different groups. The first group is the natives, which are basically 50/50 as far as gender goes. The second group is the non-natives, which consists of medical students, dental students, and working professionals from out of state- mostly BYU graduates in town to work for one of the many corporate HQ's based in Milwaukee. The second group is about 90% guys, which then throws the balance in the ward way off. In other words, if there are any girls out there reading this who think their life could use a huge influx of Mormon medical and dental students who don't have all that many girls to date (read: there ARE cute girls in the ward. Most of them are taken.) I recommend a move to Milwaukee. The bishop, Ron Becker, seems like an incredible guy, and he's very in-touch with his ward members. Somehow it got around that I know how to play the piano and can do some improvisation. When he heard that, he immediately invited me over to the Wednesday night jam session he was throwing. Rumor has it he's an incredible musician and used to play with one of the guys in REO speedwagon. I don't know how much I'll be able to contribute, but it sounds like a lot of fun. I'm looking forward to it.

On a side note, we had a ward potluck Sunday night. I showed up in my standard shorts, flip flops, and a polo shirt only to find everyone in Sunday dress. Oops. I somehow failed to note that there was a fireside directly following the potluck. Such is life sometimes. The bishop didn't seem to mind at all, as I still got invited to the jam session.

The next morning, I showed up for the first day of orientation at the medical college. My class seems to have a number of very interesting individuals in it. There's no curve, so we're not competing against each other, and that's a perk. Combined with the notorious difficulty of some of the medical school classes, I think there'll be a spirit of community created as we all band together to survive the tests. Silver lining of the stormcloud of stressful schoolwork, I suppose.

I've had some good conversations with some of the kids. (Yes, we're kids. You should see us as we mill around and stand in lines and stare with blank looks on our faces while the staff tries to 'orient' us to the school. Definitely kids. It feels much more like high school than it does college.) I'd love to paint a rosy picture of my medical school class and how dedicated they are to curing mankind's diseases, but I wonder about some of them. Most of them are great, and seem like great people. After talking with one of my classmates over our lunch, though, he leaned over and said to me "I don't know about you, but I'm going into medicine for the money and the women." He seemed perfectly serious, and I had no idea how to respond. (In all fairness, I don't really know the guy and he may have been joking.) I ended up dodging the comment by neither agreeing with him nor offending him. As cynical as it sounds, those two motivations are forces that have molded and shaped history and actually brought about a great deal of progress in the world. Unfortunately they've never had all that stellar of a reputation, and for good reason. It's going to be interesting to watch my classmates become physicians. If those with money as their motivation survive the first year I'm pretty sure they'll go all the way through. After all, dropping out of medical school is a bad way to go if you've got money as a goal. My first year will put me roughly $45,000 in the red. Multiply that by four and then figure out how much earning capacity I'll need to pay that off in a decent amount of time. Yeah. No fun.

On the note of finances, I got a kick out of the way the financial aid presentation went. They put us all in a room, told us how much money we were going to be borrowing, then terrified us by showing exactly how much money it was going to cost us to pay it back over the next ten to thirty years with interest accruing. Then, in true Faustian fashion, they had the military come in and offer to pay our tuition for us if we would just sign along the dotted line.... I have nothing against the military or serving in it. I just don't like the idea of not having any say about where I live for eight years instead of four.

As for the roommate, we're going to get along just fine. He's talkative, friendly, and easy to get along with. Rumor has it that he's uptight sometimes, but I haven't really seen that side of him. He has the apartmental quote of the week, even. We were talking about putting a foosball table in the middle of the apartment, and how it would have to go in the middle of the floor near the door to our deck.

"I guess something can't really be 'in the way' in a bachelor pad, but we'd have to go around it a lot," was his take on the whole thing. (The table was a theoretical scenario. We're not really going to get one.) So true.

Well, here I am

2005-08-06T14:53:00.000-07:00

I moved into my apartment here in Wauwatosa, Wisconsin on Thursday night. My dad was kind enough to drive the 1800+ mile trek across the country with me and then leave me his car with no strings attached. Nice guy, to say the least. I counted my blessings and included my incredible and generous parents who've always taken great care of me. Even though I now live halfway across the country from them, I'm convinced that my mom'll find some way mother me despite the distance. I'm not complaining. My mom impressed more than one of my missionary companions with her constant stream of care packages while I was in Taiwan, and I've outgrown my Jr. High aversion to letting anyone know that my mom has been a big part of my life and she and I are great friends. Having a killer mom can be one of life's great perks.

My apartment's a nice place. It's clean and in good condition, and it's got a nice feel to it. No funny smells or tricks to operating the toilet or things like that to deal with. At least, not so far. My roommate seems to be clean and tidy, and while I've never met the guy in person I think we'll be pretty good friends. The bonus of finding roommates through the ward is that they're much less likely to have huge conflicts of lifestyle. I already know that I'm not going to have problems with his girlfriend spending the night or getting drunken phone calls at 3:00am when he needs a ride home from the bar. I'm sure it'll be give and take sometimes- but if where you stack your dishes and how you hang the toilet paper are the largest problems you have in an apartment you're doing pretty well. Like I said, I've never met the kid and It's possible he'll be super-cool. I'm sure I'll blog that experience later.

Last night I went to the Wisconsin state fair. Interesting experience. Just from my preliminary observations of the culture, I've come up with the following:

1) Wisconsonites love their dairy products. Cheese, whipped cream, cheesecake, ice cream, cheese curds, and plain old milk were everywhere. Probably a full ninety percent of the stands selling food had some sort of dairy product on the menu. Three quarters of them specialized in that dairy product.

2) Wisconsinites love deep-fried foods. Combined with number one, this made deep-fried cheese on a stick and breaded cheesecurds the most abundant food at the fair. There were also deep fried veggies, deep fried sauerkraut (better than I thought it'd be), and even rumors of deep-fried twinkies and candy bars. I couldn't find them, though, so it may have been a myth. The closest thing I found was deep-fried oreo cookies. By that point, though, I was thoroughly overloaded on heavy foods and had no desire to pay $4.00 for something that would bring me one step closer to meeting my maker on the far side of a heart attack.

3) Wisconsinites love beer. There were beer stands all over the fair, and beer paraphanelia all over the people attending the fair. Now, in all fairness I just moved from Utah, so my perception may be a little skewed, but I'm pretty sure that there was a whopping Beer presence at the fair. Positive, in fact.

4) If you read the first three, this should be a no brainer: Wisconsinites are HUGE. Not all of them, mind you, but a fair percentage of the population is significantly overweight. I thought Utah was bad (and it is) but Wisconsin is noticeably worse. Apparently fatty foods, fried foods, and alcohol consumption really are contributors to the weight problem in America. Go figure.

Anyway, I don't want to be too negative, here, because I really think I'm going to love it in Wisconsin. The people are the most friendly bunch of folks that I've ever met in my life. If you ask for directions, they'll not only give you great directions, they'll walk a block or so with you down the street so that they can point your destination out to you. I asked one lady if it was possible to get to the beach (Lake Michigan) by going down a nearby walkway. She said yes. She then proceeded to go out of her way to give me directions to a better place to see the beach, ask if I was from the area, and then welcome me to Milwaukee when she found out I was from Utah. A guy on the freeway gave me the peace sign after slowing down to let me in so I could make my exit. I waved to him t thank him. A Utah driver would have given me a crusty had they let me in at all. Nice people here. Way, way nice people.

I actually went to the fair with a group of people from the ward. I was a little reserved at first, because one can never be too careful when interacting with people one isn't familiar with. After a bit, though, I realized I was going to get along with these people just fine. By the end of the night I'd actually become pretty good friends with a few of the guys, one of which is a med student who's a year ahead of me in school. Nice to have someone ahead of you to show you the ropes, I'd guess. In any case, it's now abundantly clear to me that I won't ever be short a crowd of guys to run with while I'm out here. That's worth a lot, to be honest. Before I joined my fraternity last fall, I'd have said that it was much more important to have a group of cute girls floating around than cool guys. Now I'm not so sure. The problem with cute girls (sorry, ladies- nothing personal. You could probably say the same things about cute guys if you wanted to) is that they're usually stressful to try and date and almost always more trouble than they're worth. It's when you find those rare people that are worth much more to you than the trouble they put you through that things get good. And, of course, a really good girl is worth ditching the guys for. At least, my horde of married friends that I never see anymore seems to think so.

Besides, I had a lot of fun dating over the summer before I moved out here. And I met a lot of really cool people and had some good times. You never know what's in store for you in the future- especially with dating -so it's best not to worry about it too much. I hope I can live by that while I'm out here. Life's too short to waste it worrying, and now my schooling's going to be interesting and important enough that I don't know how much time or energy I'll have to spend on it anyway.

I've had a lot of random experiences since I've moved out here. Just for kicks, I think I'm going to share them in list form instead of narrating them into some sort of comprehensive story:

1) One of the med students at the fair with us last night commented on how large of a muscle mass the clydesdale horses we were looking at had. He then wondered out loud about the biochemical and anatomical efficiency problems presented with so much muscle. While normal people would have probably ignored him if they understood what he was saying at all, I found myself mildly amused by the whole thing. It was something I was thinking to myself before he'd mentioned it, and gave me one more reason to be confident that I'm not going to have any problems making friends out here.

2) I found that a sweater that I'd brought out with me smelled kind of funny. It had no stains or food on it, it just seemed to have a funk. I hung it out on my porch to air-out in true Man Style. (An self-respecting woman would have washed it. At least, my mom would have.) I also learned why men do that: it works. Pure and simple. My sweater now smells as good as new- and I saved myself the trouble of washing it.

3) I got a new bed. I can roll over on it without putting my arm to sleep. I'm a big fan. (For those of you who don't know, I have a bad habit of starting the night off on my back, then rolling over onto my front in the middle of the night without bothering to pull my arm out from under me. To have an idea of how uncomfortable that really is, try it. If you do it right you should have both arms poking out from under you on the same side of your body. Yes, it should hurt a bit. I have no idea why I do that, but I do know that if you lay there long enough your fingers will start to tingle.)

I'll try to get on this thing to write more about stuff tomorrow. As is, I'm probably going to go watch a movie with the ward crew in an hour or so. Before then, I've got to feed myself. I think I may actually try to cook something, because I'm really, really hungry. I bought everything I need to cook a meal today at the grocery store. Now it's time to start back up again. There's no way I'll survive as a med student without good home-cooked food. (And my mom isn't around to cook for me. To give you guys an idea of how dedicated she really is, once in the MTC she shipped me and my roommates a five-gallon bucket of homemade chicken soup using the same-day delivery system. It ruled. She's so great.) Anyway, that's that. Hope you enjoyed my introductory rant. My best to all of you.

-Tracy