emerging journey

Love the one your with.

2011-08-30T06:01:00.000-07:00

I am pondering death today. Such a fragile thing. I have never really had the "I am immortal" thoughts. I have been around death for a long time and just understand that people die. I remember when I saw my first dead body. I remember the first time I picked up a dead body. I remember the first time someone died when I was watching them.

A man died today. I did not know him. I know no one who did know him. Its a sad thing to know someone in death. They are already mostly gone. There is really nothing that you can do to change that. Dead is dead. We love to think that we have this all powerful medical power that alters the course of life. The hospital and EMS are just there to make death a little cleaner. Death is a messy process.

Part of me wishes that I could know that man. The other part of me knows that if I did meet him on the street, I would just ignore him as another abuser of the cheeseburger. All I am saying is that you never know when or where. Just love the one your with.

Meat, if not properly digested, becomes poison; But poison, if used rightly, may turn medicinal.

2011-05-12T06:40:00.000-07:00

Does going through bad things change you? I suppose they have to. Profound events in our lives are bound to have a profound effect on our lives. The question is what you do with that impact.

I am home. I came home to a wife who still loves me and a dog who may remember me (but I cant tell because he is a little special). I came home with all my bits and pieces in the same place as when I left. I dont have any major defect in me.

That does not mean that I did not see and participate in things that will have an impact on my life for as long as I live. Things have changed. I had a clinical psyc explain it to me like this. Every one who goes here ends up with post traumatic stress, just not every one ends up with the D in PTSD. Is it a disorder.

As much as I ranted and raved about what I saw and did and did not do, I was deeply hit tonight when asked by a friend a simple question. We were at work, it was not a hard question, but the venom that came out of me directed at the people in mountain country was so very bitter. I spewed forth with hate and anger. It would not stop. It was hard for me to realize that those words and hate were pouring out of my mouth, but they were.

I am angry and bitter about what I saw and experienced. I dont like it. I dont like that it seems to have infected me with a level of bitter anger that burns so deeply. The worst part is that I like it. I like the hate. It feels good. So very good. I liked to just let it spew forth and watch the faces of those around me as they recoil in shock. Good, perhaps they will see what I see. Or perhaps they are just looking at a bitter old man who saw something and did not like it. I dont know that it really matters one way or the other.

And I am the lucky one who came back whole.

2011-03-02T17:59:00.000-08:00

I dont know why, but I am seeing weird stuff as of late.

Example:
A Marine is out here in the middle of the desert. He is board. He decides that he wants a penis piercing. Clearly there not being any piercing parlors around, he shaves down the handle of his toothbrush and trys to pierce his penis from R to L. Needless to say, he fails. Later that day he comes in with a massivly bleeding penis and has managed to disrupt some fairly important anatomy in the process.

This kids is why if you are going to get anything pierced, have a profesional do it. And dont do it with the handle of a tooth brush that you shaved down to a point.

2011-02-21T08:03:00.000-08:00

An Afghan man walks into the tent with abdominal pain for a few days. He is concerned because he was engaging in anal sex and the other man ejaculated in his rectum. The patient is now very very concerned because he thinks that he may be pregnant.

I explain that his anatomy is incapable of becoming pregnant.

He does not believe me.

2011-01-26T09:00:00.001-08:00

“All told, 268 U.S. troops were killed by the improvised explosive devices, or IEDs, in 2010, about as many as in the three previous years combined, according to the figures, obtained by The Washington Post. More than 3,360 troops were injured, an increase of 178 percent over the year before.”

This is a staggering figure. My mind balks at the notion that its true. I have been living it and yet it still seems so wrong. I can not express to you in words what this looks like. The loss of human life is such an ugly thing. I have lived it and I have seen the face of the victim of that loss. I have seen the face of the victim who was not killed. Part of me holds a hatred for myself and for the medical community that allows some of the people to live. Yes, they are “alive” but will never know the joy of running barefoot through a grassy field. I weep at their loss. I cry for them. Some wont cry, they just have a solid face that says “I accept this”. Perhaps I have a harder time accepting it than they do.

On the other hand, I see the people that we are here to help. I see the face of the new Afghanistan. I despise them when they sit in their compound eat food paid for by US citizens and chant about the fall of America. These are the people that my Marines gave their feet for? These men who rape their own comrades? These men who burn the toes off their own children? This is what my Marines gave their legs for?

On the other hand, I see the face of those who have killed Marines. My heart is confused with what to make of these different strings of thought. What is wrong with the world when the bad guy who got shot is more grateful for the medical care than the Afghan man we are here to actually help?

No one ever came to war and had the profound realization that it all makes sense now. I guess that for the most part, people see this and ask “Why?”.

I ask why. I don’t have a good answer for myself. It makes no sense.

M@

Oneword

2011-01-21T09:12:00.000-08:00

I had three of the most interesting cases today. Odd because I may go a month without an interesting case crossing my path, and here today, three drop by.

First is the largest Pilonidal cyst that I have ever seen in my life. I am by no means an expert in the area of pilonidal cysts, but I have seen my fair share. They smell SO VERY BAD. One of the worst smells ever in my opinion. They are an abscess or big huge zit that grows out of the ass crack.

This poor Marine had three that had grown together into a long cavity. When I pressed down in the middle of his ass cheek, puss comes squirting out of the openings. The smell was so horrible that I left and covered my lip with an alcohol pad to help block out the smell. That only lasted a minute or two. All told after I opened up the area, 20-30cc of the rankest smelling puss known to man comes pouring out. Some of it even squirts out and sprays against the wall of the exam room. I had learned my lesson long ago and had goggles and a mask on. It smelled so bad I was trying to vomit two different times, but kept it all down. Nauseating.

My second interesting patient of the day shows up with a painless ulcer on his penis. He had a single one, then it went away, now he has five smaller ones. I run a test called an RPR that checks for syphilis. Bummer, he has syphilis. Real, no shit, ugly nasty syphilis. I can’t confirm it for two to four weeks until the formal results come back, but holy dirty dick batman!

Third case of the day. A pregnant woman. Its just not something that I normally see a lot of, especially out here. I got to give good news to a woman who was quite happy about it. Probably not the best time. The odd thing is that because of general rule number 1 that states that you will not have sex out here, the normal course of events is that if you are found to be pregnant, that usually means at least one person is in trouble and probably two people. This was an error on the screeners part and she has been pregnant for a while, and just got here 4 days ago. This is different from the last one of these that was about 2 months prego and has been here for 5. THAT one got into a lot of trouble because of the above rule #1. So, it was good to give good news, and not worry that she was going to get into trouble.

Thus ends my interesting cases for the day.

When do you give up?

2011-01-10T08:37:00.000-08:00

I feel that there has to be a time and a point where you have exhausted your available means and you must simply give up. I know that there is a fascination with being the unrelenting hard charger that just never gives up. Hell, I have held out hope for years and been rewarded by the fulfillment of those desires. The wait made it all the more sweet.

I have been working on a work related goal for months now. Its silly and just busy work, but I worked hard at it and have accomplished a great deal. Late last week I found out that I would not be able to finish my project. There are two tasks left out of over 100, but those two tasks have been outlawed here. So policy prevents me from gaining my device.

I have been fighting for the last month or so because there were obstacles in the way to my goal. It seems now that two obstacles will stop me. I have accomplished all other tasks that I can. These two remain. I know that I have given up. I was angry for two days. I did not talk to people and I just sat and stewed and listened to angry music as I worked out.

Now, I am just calm. I have given up. I don’t know that this fight is worth fighting. I want it badly, but I just don’t seem to care much at this point. I wonder how often that plays out in my life. How often do I give up before attaining my goal? How often is that goal futile and I SHOULD give up? I am not opposed to hard work. Contrary to that, I quite enjoy it.

One of the tasks I checked off today was to run a Marine Corps Physical Fitness Test (PFT). I passed. I did not blow it away, but I passed and I am proud of that. I remember back when I was 18 and in high school, I was pondering what to do with my life and I did consider joining the USMC. I was so very afraid of it. It’s a scary idea. Those guys are NUTS. Besides, I was fat. Very fat. I started my senior year of high school at 276 lbs. I had a 46 inch waste. I was fat.

I weighed in at 193 when I graduated. I had accomplished a lot. It was a lot of hard work, and I obsessed and I sweated my arse off in the gym every day. But that was a goal and I worked and I achieved. I had lost a lot of weight, but I still saw myself as fat, I pondered joining the MC but was so afraid that I would never make it. I still see myself as a fat man that just hides his fat well with clothes, but I know I can do so much more now than what I had the mental strength to accomplish when I was 18. So today, when I crossed the finish line of that run, it cleaned off the chalk board.

To fight on, or to give in? That is the question of the day. There is no right answer. Or there are several answers depending on when and what the situation is. I don’t have the answer.

Reflections on Reliance

2011-01-01T07:58:00.000-08:00

"A man should learn to detect and watch that gleam of light which flashes across his mind from within, more than the lustre of the firmament of bards and sages. Yet he dismisses without notice his thought, because it is his. In every work of genius we recognize our own rejected thoughts: they come back to us with a certain alienated majesty." R.W. Emerson Self Reliance

I have been digesting slowly Emerson's work on self reliance. There are some powerful words contained in those pages.

I have had to read small sections and then walk away for a while to ponder. There is just too much to take at one sitting. Take the above. How many times have we all had those thoughts that we have dismissed because the thought originated in our mind so we choose to throw it away? It is not that we have brilliance in all our thoughts, but it is saying that all too often we have no faith in our very own mind.
Perhaps even more so, we lack the heart to follow our thoughts. Its scary out there. You have a dream, a hope, an aspiration, or even just a thought, but we get lost in the complexity of the situation, then just walk away. It is slothfulness.
We cut ourselves off at the knee before we even begin because we lack the constitution to follow our own heart. Do we lack trust in our own capabilities? Do we fear failure? Is it that it’s just too comfortable at home, on the couch, watching the TV?
I saw myself as a weak and stupid individual so clearly my thoughts were not worth having.
What keeps you from following your heart and your mind? What have you rejected?

Thoughts following Emerson

2010-12-30T19:16:00.001-08:00

“What I must do is all that concerns me, not what the people think. This rule, equally arduous in actual and in intellectual life, may serve for the whole distinction between greatness and meanness. It is the harder because you will always find those who think they know what is your duty better than you know it. It is easy in the world to live after the world’s opinion; it is easy in solitude to live after our own; but the great man is he who in the midst of the crowd keeps with perfect sweetness the independence of solitude.” ~ R.W. Emerson

How do I build my life after my own heart? It’s a scary thing to follow one’s heart and abandon reason. All too often we are pressured into following the rule of normal because its what is expected of us. We crush out the flame of our sole in exchange for the acceptance of those around us. Rare is the heart that beats without regard for those around.

I spent a very long time trying to appease the people around me. I am a pleaser; I like to see the people around me happy. Even if it may cost me something, I tend to give because I enjoy helping those around me. I like to see people succeed. I get joy from watching the success of others.

Following your heart is probably one of the best things we have as humans. Way I see it, you can fall off that path a couple different ways.

First, when your heart’s desires harm others, part of me hopes for the fundamental goodness of people, that at the core they are good, but I have met some really bad people in my life who had a black heart. Fucking the co-worker because you want her ends up hurting your wife, that’s not a good thing. You must be faithful to your commitments, guard your honor, do the right thing, but follow your heart as well. This could also be from when your pursuit of desire brings hart to others, perhaps unintentionally.

The second could be if your heart is so twisted that your desire is twisted as well. I guess this could be tossed in with the above, but there is a little difference. This is an intentional harm to another in order for you to gain pleasure from that act. Its much darker and evil.

That being said, how do we follow our heart’s good intentions? I can truly resonate with this text about finding others who love to tell you exactly what your duty is. My purpose in life seems so clear during those quite moments of peace, but enter the noise of life and all my peace seems to go out the window.

I am far to easily swayed by the opinions of others. How to find that strength to hold my own heart and my own thoughts centered. Also to do this at the same time as being open to learning and changing as I grow and encounter new people and new thoughts. Self reliance is good, but arrogance in your own self knowledge is bad.

There must be balance between following your heart and being open to what the world has to teach you. Easy to say, hard to do.

M@

Thoughts following Emerson

2010-12-30T19:16:00.000-08:00

OZ

2010-12-27T18:57:00.000-08:00

What if this is it? I am really loving on the album Instant Karma. It was a fund raiser for Amnesty International. It’s a collection of Lennon songs sung by different artists. A new spin on some of the greatest songs ever written.

Its got me to thinking about life on this rock. There is question that keeps spinning in my head. People can be so cruel especially if they can justify it via a greater power. This attitude pervades our human race. I can kill, rape, or steal from this person because they are heathen, speak a different language, look different, sound different. We love to find excuses for our actions.

It’s the rare nut-job that just admits that he likes to kill. The rest decide to blame it on some wrong done against them. Excuses. We are such great makers of excuses. Rare is the person who just nuts up and accepts individual choices. We re-enforce this in our society. Excuses are rewarded.

Shut it and do your freaking job.

I decided that one of the major problems with this place is simply that there is no reprieve. There is no place or time that you can just walk away from it all and be still. That is one of my major complaints today. The work in and of itself is truly not that difficult. The difficulty comes with constant small pressures.

Its getting about that time where nerves and emotions are a little strained. People that might not bother you much even in a normal work environment start to bother you after 4 months of daily contact.

I have the ability to empathize with people. Its not a bad thing, but you can just pick up on how someone is feeling and share in that experience. Some times it’s a bad thing if you are around someone who exudes negative emotions all day long. Those negative emotions can build and sill over into my world. Now I am stuck with the residual of those negative emotions.

Some days this helps me because I am able to share the emotion of the person that I am talking with. Comes in handy given my job, but other times like now when you are surrounded by a shit storm it sucks.

I have found the retreat of music. It’s a beautiful thing to just put my head phones on and be in my world. Granted, I still have to come back to ground eventually, but it does offer the briefest of relief from the day.

Shawshank

2010-12-17T18:55:00.001-08:00

I always thought that right and wrong were fairly solid. The more I am here, the more I see that that line is very murky. My wrong may not be your wrong. Yes, I still do believe in some very solid universal wrongs, but I also know that I am an emotional creature that can be swayed by events and circumstances.
Example: I think it’s the right thing to put everything I have into my job, to treat people regardless of who they are or what they have done. I am human, I fail at that ideal. There are some people that I do not like, that I have a hard time doing my best for because they are who they are. Its hard to have someone’s best interest at heart when they throw shit on you. I am not Christ, and I have a very hard time turning that cheek for another slap in the face. Don’t judge me till you walk that line.
Some people are bad, they will drive an 8 inch wooden shank into you for no reason other than to watch you bleed. They may even laugh at you as it happens. Part of me hates them, but part of me cries for them. That is what they find joy in? Killing and hurting. Don’t judge.
I find new things out about myself every day. I knew that this place would be a challenge, I just did not understand in what ways it would challenge me. Life is a collection of challenges and how you respond to those challenges.

Azkaban

2010-12-16T20:07:00.000-08:00

What we do in life echoes in eternity.

When I was in school, I desperately wanted to help. I felt helpless as I cried as Marines stormed Fallujah. I was saddened by the tsunami in the Indian Ocean. I was broken by the death in New Orleans. These moments shaped a lot of thoughts that I had.

I had this dream when I was in Med School, I was living in the corner of the living room on and extra mattress with a couple other students. My dream showed me that despite all my expensive learning, that what hurts people most often is their own actions. That all the medicine in the world will not stop or cure a person’s desires to eat themselves into an early grave.

More importantly, is that really the goal of medicine? Should we try to reshape someone into what the textbook says is healthy?

I came to the conclusion that perhaps its not. My goal in medicine should be to empower the individual and to help them back onto their feet when they fall. I am not here to judge, I am not here to tell you what to do with your life. I am here to put a couple sutures in a cut, I am here to tell you news that you may not like, but what you do with that is your own choice.

I reached a point in my life where I could have done a lot of different things. I had a lot of paths open in front of me. I chose the military because I wanted to plug a hole in a kid. I wanted to be able to go out there, and save a life. Ego? Perhaps. I felt that as a member of the medical community, that I own a certain amount of the risk involved in caring for the troops. Agree, disagree, it does not really matter the citizens send the troops over to risk their lives for a cause. I don’t even have to care about the cause; my cause is to see young Americans come home.

A bigger life goal for me as a practitioner of medicine is to take this knowledge that I have accumulated over the past years and give out of that knowledge. That is why I am in medicine.

I assumed that I would be able to help the local people when I came here. I assumed that I would be able to go out and serve people. Reality is never what we expect. I will not leave this camp. Part of me does not want to. I don’t know that I would stick my neck out for any of these people. Mostly because I know that, if they wanted to, they would have no problems killing me or my men. That knowledge makes me much less willing to risk anything for them.

I had a realization yesterday. That in my daily activities, I am one of the few people here that has interactions with the local population. That what I do with them is the face of what the US is viewed as. To be cheesy, I am the face of the US to these people. I don’t particularly want that burden. But on the other hand, it is what I wanted to do. It’s the primary reason I wanted to be in medicine. I want to serve those who truly have the need. Yet here I am presented with that opportunity and I shy away from it.

I struggle with that. I am not really sure what to do about it. I don’t particularly like my patients. I don’t like what they have done and I don’t like what they will do. The hopeless romantic in me wants to say that I can change this cycle. These people have been abused and killed by imperialistic outsiders for as long as any one cares to remember. Are we really that different? No, probably not. Of course we think that we are doing good things here, but for every good thing we do, we usually end up doing something bad as well. The problem is that it takes 100 good things to ease the sting of the one bad thing. In that respect, we are loosing.

We sit here out in the middle of the desert and hide in our bases and send out aircraft and drive around an awful lot. We kill and are killed. In the end, most people here don’t even have a clue where America is or why the hell we are here. All they know is that we are just another in the long line of empires that are here and don’t really belong.

Is it truly that hard to imagine that they would rise up against us? They are ignorant. They don’t have any formal education, and don’t particularly want any. What is the point of learning to read when the only thing that you have to read are books that outsiders bring in.

They are ripe for manipulation. We want to manipulate them into something more western and there are other forces that want to manipulate them into their image. That’s what this whole thing is about. The problem is that these people will never be American, they are starting from a world away and don’t have a desire to change.

Do your job.

"I want to ride my bicycle, I want to ride my bike"

2010-12-16T19:21:00.000-08:00

Every morning I get on my bike and peddle away from my tent, I make sounds as if I were riding my motorcycle. It never really gets old. I don’t even have to have a playing card in the spokes of the wheel because part of the pedal is broken and so it makes a very nice clicking sound every time it goes around.

Childish? Sure, but I don’t really care. Perhaps some day I may grow up and stop making motorcycle sounds as I ride my bike, but not today. Probably not tomorrow either.

So I was taking my bike off a cool pile of sand bags forming a bunker behind medical and got some good air. Upon landing, the impact broke apart my headlight and I had to spend the next half hour crawling around in the dirt trying to find all the little parts and putting it back together. Good news is that it worked and I got it all back together just fine.

I just finished reading It by King. Weird book. It took me quite a while to finish it just because I could only read the book for a few hundred pages and then had to put it down and go do something else for a bit. Its interesting in that it makes you think about how you keep and how you view your own childhood.

I have been blessed by my childhood. I did not have an abusive alcoholic father; he was there for me. I had a house and a loving family who supported me through many tough times. I have been truly blessed by my youth and I continue to be blessed by those same people who loved and supported me growing up.

I recently got a bunch of packages from my community where I grew up. They love me and they sent me many packages of good stuff to take care of me as I sit here in this cold place. I did not ask them, they just did it out of love and that’s a beautiful thing.

Some of the funnier things are someone sent me a single after dinner mint from Sonic. Someone else (or perhaps the same person) sent me a whole Italian dry salami. Honestly I don’t care what they send, but I just feel loved and that’s not a bad thing at all. Oh, and nice warm socks that I am wearing right now.

एंडलेस राम्ब्लिंग.

2010-12-10T18:14:00.000-08:00

Is healthcare truly a right? I am not sure. To some people it must be. They feel that they have a right to be seen for anything. We have many civilians who do work here. Some, I am not sure what they do, but they all do jobs. Most civilians come out here with a LOA (letter of agreement) basically it says what the gov will provide for them. Mostly chowhall, laundry, space-a flights, and medical.
Every US citizen here has access to “Life, limb, or eyesite” care. Meaning that if you get blown up, we will sustain your life. Most are not authorized Primary Care or sick call stuff. Here is where it gets sticky. Their companies charge the gov so very much for the civilian “expertise” and charge the gov to provide for the individual, but then the company turns right around and sends a guy out here with no/limmited access to medical care, they pocket the money that they charge the government to provide health care for the individual, and leave the individual alone out here with only the life/limb/sight care.
So now the civilian comes in to see me because he sprained his ankle or has a headache. What am I supposed to do? I don’t want to turn a guy away, but if I see him, I keep feeding into the system that allows for continued frauding of the gov. Their companies do not pay into my clinic, they don’t pay for our pharmacy or lab supplies. They just mooch off the government.
Here is the really sneaky part. If the civilian does not like the care he gets or gets turned away because he is not in risk of loosing his life, he goes and complains to his boss who complains to his boss who complains to our boss who bitches us out that we are turning accutly sick people away. It’s a viscous cycle. The same people that authorized the civilian to be here without access to medical care are the ones in power who can force patients on the clinic.
I don’t think its right to leave a person to bleed out and die in the dirt when you can do something to try and save him or her. That seems like the human thing to do. Lets just try and help eachother. I don’t even mind providing every one with some cold medicine, but what I do mind is you stealing from my pocket and every one else’s pocket when you fraud The Man and take our tax dollars. If you want into the system then pay up like every one else.
I am bothered by the idea that health care should be free and given to everyone. If you want it, then pay for it, work for it, earn it, do something. The other side of that coin is that free care does not mean that you get what you want. It means that you get what you “need”. That will be a major adjustment for the American people. We are so spoiled and selfish. People have gotten so used to the idea that they will get a million dollar work up for everything that is wrong. They may not need that. Just like the contractor here may not need medicines for their ear ache.

"A man cannot be comfortable without his own approval."~ M. Twain

2010-12-07T18:06:00.000-08:00

I am so very blessed. Mine is a life of ease compared to most. Even here where I live under “austure” conditions. Well, it does suck quite a bit in the evening. The heater for the tent broke about 5 days ago. Not normally a big deal, but when the temp outside drops to 0 every night and there is nothing but a tent wall between you and the outside, it gets nippy. The fantastic part is that I don’t really mind at night once I get into bed. I am so very warm. Snug as a bug in a rug if you will. I just burrow down under a massive stack of blankets and am fine. I learned my lession early that having blankets on the top of you is fine, but when sleeping on a cot, you need some bottom insulation as well.
The hardest part is before you go to bed, when its cold and you just want to climb into bed to be warm, but its 6 at night and you don’t really want to go to sleep that early. Enter the “happy suit”; imagine if you will a tall brown stay-puff masrshmellow man. I was fortunate enough to rate a cold weather suit and I broke it out last night and fully understand why its common name is the happy suit. I was damn happy to have it on. Puffy jacket = very nice.
I had a guy come in the other day, local guy, and well, he has a rash on his dick. There are a few nasty things that come to mind when thinking of penis rashes, so I try a few treatments, but nothing seems to be working. Its just not a normal rash that one would see on the penis, not that I am a penis rash expert, but I have seen my fair share of diseased penises.
I was stuck for a while and not sure what was happening with the guy’s penis. Then his brother shows up with the exact same rash on HIS penis. Now I am intrigued. Clearly both brothers are putting their respective penises somewhere they should not, and it’s the same place. Interesting. So I ask them about what they may have been sharing. It’s a goat. Who knew that you could get some horrific penial rash from fucking a goat, but evidentally you can. Now you know, and knowing is half the battle.

The first rule of Zombieland: Cardio. When the zombie outbreak first hit, the first to go, for obvious reasons... were the fatties.

2010-12-03T07:27:00.000-08:00

Life and death. It all happens here. The world keeps moving despite my loud protests. Some days I wish I could pause this thing, but others I am so happy that no matter what I do, the time I have here is a set amount. I have hope and future fun to look forward to.

My boss was a dick yesterday. If you are every in charge of something, don’t delegate the responsibility for handing out bad news to someone else. That’s why you are the boss, you are the person in charge and good or bad, the essence of leadership is to exude an attitude of leadership that people will follow.

There was bad news to hand out. It sucks. Not the you are going to die bad news, but bad news none the less. My boss knows about it, but does not want to hand it out to girl doc. So, he just leaves it to the Commander to make the news known. When the CO comes by to drop the news to the recipient, she happens to be out to lunch. CO being busy has to leave so leaves the news with me to pass out.

I had an idea that this particularly bad ness was going to happen, but still, it’s a cowardly move to not present bad news to your own people and just leave it to someone else. Now I have to deliver said news to my superior. Its not a task that I relish.

I am reminded of an episode of The Office. Where Michael the boss cant seem to fire people, so just makes fun of it. But this is real life, and you should man up and do your freaking job even if that’s to hand out bad news. In the words of Woody Harrelson “Time to nut up or shut up”.

Marines are pack animals. They will gladly accept you into them, but they keep an eye on you. If you fail to meet their expectations, they will cut you out like a little squamous cell carcinoma.

One of the docs here has failed their body composition test. Its probably the biggest thing that an individual can do to loose the respect of the Marine. Once you fail that test. You are dead to them. They may keep you around if they cant find a replacement, but they no longer want you. Its interesting.

The Marine does not want this doc around any more. Hence the bad news that must be given. I don’t think that the two are directly related, but I have a feeling that if the Marines wanted this individual around they would fight to keep them where they are.

The more interesting thing is to see the reaction of the individual. That this failure breaks the person a little. They are weak, they blame every one and every thing other than just taking some measure of responsibility for their own body and action. I hate that.

One of my biggest problems with the medical community is that we are built around deflecting blame. No one wants to get blamed and sued for something, so we always pad our answers. It may be this, it may or may not be that. Honestly, when was the last time you got a straight answer from a medical provider? Again, Nut Up or Shut UP.

“The proper function of man is to live, not to exist. I shall not waste my days in trying to prolong them. I shall use my time.” ~ Jack London

2010-11-26T07:42:00.000-08:00

What is justice? I know it’s a big word that gets tossed around much. I have read and reread that quote from MLK the last few days. I wrote it on the plywood door to the wardroom. It says that justice is the ultimate expression of love. Justice corrects everything that stands against love. I want that kind of justice.

I lost my love for the world, I let the hate of my situation cloud my perception. I have not found love again, I do NOT love these people, but I don’t hate them. It may return, I hope it does not. I hope that I can continue to learn from this experience. I hope that the shit of this place will wash off. I long to return to my blissful life of ignorance. Its so much easier to not think of the great cost of this continued endeavor.

I try so very hard to not squander precious resources. Everything here costs so very much. Every drop of water that I drink during the day comes from a plastic bottle. Not a lot of choice in the matter, there is no safe source of water to pull from here. Every drop for cooking, drinking everything. I average about 8 bottles a day, 4L of water, not counting what goes into the food at the chow hall.

The Navy shower. Every time I shower, it’s a ritual. You turn the water on, jump under the stream and get wet. You turn the water off, soap up and then rise off. Whole process takes about 2 min with only 30 seconds of water used.

Everything I do costs money. Its expensive to keep humans alive out here. Much more expensive to keep us fat dumb and happy. Perhaps part of me feels that I don’t suffer enough. Its such a shitty place, but I have it so much better than so many of my brothers. Every day the planes bring in fresh meat and take away the dead. I don’t watch any more. I don’t want to know.

This place is such a waste of human life. I hate it. I hate the injustice of it. I cant seem to balance those two things. My extreme dislike of this place and the death it brings VS the good of freeing a people from an oppressive group of bastards. But my perspective is skewed, I hate them more than I do the injustice of this place. I wish they would go away. I wish that my guys did not have to die for this stinking shit hole. I have no love for this place. I have no love for these people. I don’t hurt for them, I don’t feel for them. I just want my people to stop coming in with no legs and no hands.

I hate, but I don’t think it’s a wrong kind of hate. Perhaps that is justice? I don’t hate people, I hate the situation, I hate the end result of young men returning to their wives without a dick. I hate that I sit here and just watch it all happen. I am so absolutely helpless to make the insanity stop.

Make it stop.

2010-11-23T07:18:00.000-08:00

“Well that’s what they get for going to bars with gay people”~ Chaplin

I am fairly critical of the professional pastoral staff. Hurts from past run-ins. I don’t like the Chaplin. I think I started to dislike him the first time I met him, but really started to dislike him when he mocked my marriage. Sure, I am with a bunch of dudes and my skin is not that soft, but damn it, you don’t make fun of someone’s marriage. Poor form.

Was having dinner with Head doc and Chaps and somehow Head doc was crude as normal and talking about ass raping. Chaps brings up that its not so funny when the Marine comes to you crying because he got ass raped.

What bothered me the most in the whole situation was this statement from Chaps: “Well, that’s what he gets for going to bars with gays”.

What the fuck? Really? This dude is a grade 1 jerk. I think I am just going to dislike him more now. No one deserves an ass rape. I don’t care who you are or what situation you are in. No one deserves any kind of rape. That’s how it starts. Its acceptance of something evil because you don’t like the victim.

I have a responsibility to combat the evil I see in life. However that presents its self. Life is a balancing act. One must be careful. One man’s evil is another’s good. I hate these people because they kill and maim my Marines. They hate me because I am an outsider that is oppressing them. The world is full of hate and you have to hate carefully.

Perhaps we would all be a bit better off if we tempered our anger and hate. It does not lead to good things. It hurts. But it feels so good. It feels good to hate the things that hurt .

Who is the first to drop their fists? No one wants to drop their guard and let the other punch them in the nose. I need to think on this. I have wrapped myself in dislike and hatred. Its easy to do when you are surrounded by it. Too easy.

I need to find the center again. The center that says that love is the way. I hate them. I don’t know that I could love them.

Thought of the moment:

“Like an unchecked cancer, hate corrodes the personality and eats away its vital unity. Hate destroys a man's sense of values and his objectivity. It causes him to describe the beautiful as ugly and the ugly as beautiful, and to confuse the true with the false and the false with the true. Power at its best is love implementing the demands of justice. Justice at its best is love correcting everything that stands against love.” ~ MLK Jr.

“sometimes you just need to look reality in the eye, and deny it” - Garrison Keillor

2010-11-21T00:55:00.000-08:00

I have been blessed with an abundance of time as of late. I work every day, but I have time because there is nothing else to do other than eat, work and workout. It changes your perspective on life to just simplify things.

I guess we are mostly all hoarders by nature, forced simplification hurts too much to not be forced upon you. Not many would voluntarily take the simplification.

I used to live in my car. I used to pride myself on the fact that I was independent. During my wondering years, I would travel from place to place and it was a constant comfort to know that I had my camp stove and coffee pot in the back and could survive in my car for weeks just off what I had in there.

I did not need for space, the car was just for sleeping. I worked out and showered at work, I would spend a bit of time in the evening at one of the local coffee shops eating or drinking and just living life. No one really knew that I was living in my car and that was the point. What we “need” for survival is much different than what we “want” for survival.

Here it’s a bit different, but similar. I live out of a small bag. Take my clothes to the laundry every other day and just survive with the same things every day. I am nothing if not a creature of habit. Once something becomes habit, it becomes deeply ingrained in me. This place is a constant habit. Same thing every day.

Perhaps a little like prison. In Shawshank Redemption, the author tells of how prison life is built around routine. I have built myself a routine here. I eat the same things most days. I even shower in the same shower stall. The other night, I changed it up and showered in the stall across the way, it was really freaking me out that everything was backwards. I build in stability to my day, and when things change, it upsets the balance.

I am calm today. Perhaps I need the stability of routine to comfort me. I seek it out and it calms me to find the same thing every day, even if it’s a small thing, its comforting. It’s a bit like doing a long steady state piece of workout on the erg, you just pull and pull and you don’t have to think about the numbers. I can get lost in the numbers and that’s not a bad thing.

I think too much. Some days my mind will not unwind enough to just see what is in front of me. I have to fight that and just stop and see what is staring me in the face. I seek peace.

I dont particularly like this reality. I dont think I will accept it.

"they know enough, they that know to learn"~ inscription on one of my undergrad buildings

2010-11-17T20:25:00.000-08:00

Days have ceased to mean anything. Whats the difference if you are working the next day or not, really I just make sure I am to work when the day/time approaches that I am supposed to be there. Other than that, I wonder.

I have taken up the sport of wondering. I put my body armor and back pack on and I walk. I walk down to “the wire” and I look out over the desolate waste and ponder why in the world people would want to fight and die for this shit hole of a place. I walk and I practice the art of looking at my feet to make sure I don’t fall over one of the odd shaped rocks. Ever read The Long Walk by King? Interesting book, I read it on the way over here and I think about it every so often as I walk.

I read I am Legend yesterday. It was quite possibly one of the most frustrating moments. I was reading and reading and loved the story and it was at the climax but I was only half way through the book, so I knew that there was much more to come. Then the shock of discovering that it was not just that one story, the book was a collection of short stories, so no, my story that I was interested in ended and I was so very upset and disappointed. Perhaps I will have to watch Omega Man today to make it a wash. Charlton Hesston is The Man.

I am learning new things and am refining who I am as a practitioner of medicine. It is scary, but I have devoured multiple medical books on a range of topics. The odd thing is that I am getting so very much out of them. I would read a book in school and ponder its meaning, try to retain whatever tidbit might be on the test, but this is different.

Take nausea for example. I read new and interesting ways to decrease the symptom of nausea. Just read about them, then this morning at 0300, I had a nauseous person come in. I tried a new combination of medicine that I had never given for that specific reason. It worked.

Medicine is scary, and I think that I tend to find one medicine that I know, that I feel comfortable with, safe. Then I use that medicine, I know its dosing, I know its effects and side effects, it becomes known to me. Branching out is scary. Especially if it comes from a book, for some reason, its easier to trust when some doc you know and trust says “use this at this dose”. But that may not be the best science, how do they know, what info are they basing it off of? I don’t really have a choice here. Its not like I can go to lecture and ask the professor for a new witches brew. This may be even better, I have a written down formula that is widely accepted by experts in the field. I have to trust them, my patients trust me. I am learning. I am growing.

Why we fight.

2010-11-13T01:54:00.000-08:00

We fight every day. Perhaps not the fighting as in shooting or stabbing or kicking in the nuts/ovaries, but each of us faces battles every day of our lives.

I am loosing, have been the last few days. Every day may be a winner or a looser depending on what happens, but some losses are worse than others.

Its not a loss against age or time or our own body, but a loss against the soul. I have lost a part of my soul in this place. I don’t think it will come back. I have crossed a line that I never truly thought I would, yet here I stand clearly on the other side of that line wondering how I managed to get where I am.

I don’t want to talk about “IT” I hate myself the more because of “IT”. Part of me wants to say that I am able to be honest with myself and that’s why I am here. But I see things in me that I can truly hate. Not hate, but part of myself that is disgusted with my own soul. But I don’t hate “IT”, I like “IT”, that is the part that scares me. I don’t hate it on an inner level.

I have discovered something about my soul that some spend a life seeking. I have looked into the mirror of life and seen ugly and beautiful things about myself. I hope that this is a glimpse. I am clearly not bound by anything. I make my path. I make my choices.

“Fear is the path to the dark side. Fear leads to anger. Anger Leads to hate. Hate leads to suffering.”~ Yoda

"Mos Eisley spaceport: You will never find a more wretched hive of scum and villainy. We must be cautious."~ Obi-Wan

2010-11-05T02:13:00.001-07:00

Do the right thing. Its important to do the right thing. It used to be a simple rule. Good guys wear the white hats and don’t kill the bad guy even though they have been nearly killed by said bad guy. Perhaps even having the bad guy hanging off a cliff, wall, building, tower, something. The good guy still nearly falls off trying to save the bad guy, he reaches out to keep him from falling.

I am thinking back to the games of boyhood. There are rules. The good guy stands on the side of right, the law. He fights for those who cant fight, he defends the weak and the poor. He brings the fight to those who would oppress the helpless. He certainly never cheats at cards and always wears a white hat.

Bad guys are easy to see, they are sneaky, they will cross you given the chance. They lie cheat and steal. They sneak in the back door, steal the girl and run off into the night. They will hold up the white flag to draw you in and then stab you when you get close. They do not follow the rules.

No boy ever had to sit down and read the rules, they just are THE rules.

Life is more complex as an adult. The bad guys may be bad, may be good, may be both at the same time. No one wears hats much at all any more. We still have rules. Somewhere along the line, we as humans decided to make war humane.

It never occurred to the 6-year-old boy that there were humane ways to shoot people. That one kind of bullet is more civil to use rather than another. You just shoot the bad guy and he grabs his chest and falls over and there is never ever any blood.

Agree or disagree, there are rules and you follow them. You follow them or there are consequences for your choices. The prison system is no exception. Once a bad guy gives up, he stops being a bad guy and you have to help him. It’s a rule. You certainly do not get to hurt him at will. My stomach turns at the shit you see here. Some countries do not play by the rules, the skim along close to the rules but then drastically deviate from them when they think no one is looking or will care. I care. Wrong is wrong, we are the good guys and you play by the rules.

I don’t know where this deep need to follow the rules comes from. It is so deeply ingrained in me that I dare not disobey it. Its not a fear of the consequences. It’s a fear of no longer being the “good guy”.

The dark side of the force is strong, and it tempts. It offers power, it will give you much, but in the end it will take your soul in exchange for its power. Power corrupts, and absolute power corrupts absolutely. Resist the dark side in every way, do not condone it, do not accept it, do not ignore it. Fight it.

Burr

2010-11-05T01:38:00.000-07:00

There are certain things that really bug me. Bug me more than the next person. My friend Sal used to say that I would get a burr under my saddle and just could not let it go.

One of the things that truly bothers me is my perception of the oppression of women inside western religions. It really bugs me to say that a woman has a pre-ordained roll that was given her by god.

The converse has got me into some trouble even recently, that by definition, then a man has a pre-ordained roll. My friend and I were out to lunch with her mother who was visiting. Everything was happy and we were all the best of friends till we got to the lunch place and sat down to eat and my friend’s mom insisted that I pray because I was the man. I was a bit offended. It was not an offer, it was a demand, that I pray because its my job, my roll as a man. You are saying then that my friend is not capable of praying because she has no Y chromosome. It was a silly little scuffle that got blown way out of proportion and I responded poorly to a simple statement.

Yet, the over reaching thought I came up with was simply that I don’t like it when people try and push me or anyone else into a pre-manufactured box. You don’t even bother to ask me who I am, just what name I use when I describe my eating, voting, drinking, sexual habits. That you have somehow boiled me down into a five-word title offends me. I am more than that, other people are more than that. Ask, seek, and get to know a person before you decide to judge them and put them into a pile and assign value to them.

Two rapes on deck. The violence inside our human nature rears its ugly head even in this the most ugly of places. Humans are sick fucking creatures. I am more angry at the lack of response rather than at the act in and of itself. I see the vic, I see the result, the tears, the snot, the guilt, the anger, I get to share in that all. We get daily updates about speeding tickets and parking violations, but on this subject “they” are silent. I bring it up, in email, in person. I express my deep concerns for the safety of our sisters and urge a response, anything, an email, a statement condemning it, something. Silence is worse. Silence says you don’t care one way or another. A parking ticket is of more concern.

It’s a bur under my saddle, I speak, I scream, I type, but “they” don’t want to hear. I can not make them act. Now I sit and stew. A slow bubbling anger that simmers just under the surface. I ponder what next. My answer, I do my job.

His name is Robert Paulson.

2010-10-31T02:09:00.000-07:00

What is hard? Some days I do not understand myself. I am drawn to do hard things. Mostly physical, but a lot of just difficult things. They suck, they hurt, they inflict pain on not just myself, but those around me, yet I want more. I can not really say if it is a self destructive bent or if I draw some dysfunctional pleasure out of my own pain.

Sounds sick, but I used to think that I deserved pain; that I did not deserve good. Perhaps part of it comes out of the idea that people are hurt on a daily basis. Suffering through a mile of shit smelling foulness that I don’t want to imagine. The idea that I could take pleasure in something makes me sick to my stomach.

Example: One night a week they have surf and turf night. Chowhall has steak and shrip/seafood for dinner. Tonight actually. I hate it. I do not partake. There is part of me that balks at the idea of eating steak when my boys are out there eating pouches of food and crapping in a bag. Perhaps I don’t feel that I deserve it. Perhaps I feel guilty that I would draw any sort of pleasure from life in such a place of shit. Perhaps I want to sit here and remember the last steak that I ate because that was such a happy memory and I don’t want to pollute it.

Any way you boil it down, I refuse to eat it. I eat a powerbar and call it life.

Some days you must choose the harder path because it is were your heart is leading you. I do not fear that. I trust my heart, I have faith in it. Its more than just trust. I know that perhaps I will one day make a choice and follow my heart and it will be wrong, it will hurt, I will suffer, I will inflict pain on someone else, but my faith says that I am better off following my heart rather than living a life of silent slumber.

I detest the life I see lived around me of silent people making motions to go through life. Good or bad, I live by the heart, it has steered me well, I do not fear to follow it.

Kite Runner

2010-10-31T01:49:00.001-07:00

This is an R rated post. Fair warning.

I remember from some dusty part of my mind a quote something to the effect that Travel is counter to prejudice. I took it to mean that travel will open your mind, perhaps even cure a few racial prejudices that you may have been harboring.

This travel to this place has done quite the opposite. I had no real high opinion of the local population, not a disapproval either, just a feeling that it sucks to be them, that they have been hurt much. It’s a hard life and I feel bad about it.

I was talking with our interpreter the other night, we somehow got onto a very random subject, but it really lit me up and made me think. We were discussing children and I learned that in this culture, its socially acceptable to rape a child as a form of punishment. I understand that people are fairly fucked up. People as a whole are a deprived bunch of animals. I understand that people’s idea of rising children differ from parent to parent. Some may think spanking is abuse, others use it as teaching for a child, depends on your own perspective.

I used to think it was a global idea that fucking an 8 year old in the ass is wrong. Turns out I was incorrect.

Here, a good ole ass rape is a step more sever than a spanking. It is a socially acceptable form of punishment. Perhaps I am just ignorant. I know that it happens to children the world around, but usually is met with social outcry when it is put under the light. It’s criminal. It is “wrong”.

I hate this place. I am starting to hate the people. I know its general, broad, a sweeping statement. There is not a lot of good in this place. I fear that there is not a lot of good in the people. I would not trade one of my Marines for any number of them. Yes I am making a judgment call. I am placing a value on a whole people group a dangerous thing for a mortal man to do. I never said I was anything but an ignorant human. But this place is wrong.

I can not bring my heart to love these people.

Hawkeye.

2010-10-29T02:10:00.000-07:00

The hardest times for people here are the second month after you get here, the first few days after coming back off of R&R in the middle of the long deployment, and the month right before you go home.

My friend left yesterday. Its sad, it has really taken the wind out of my sails. Its not like she was a daily dinner friend that I saw all the time, but there was something nice about knowing a friend here who was not associated with here.

I find myself not wanting to be friends with people here. I know that there is so much talk about how you form these amazing bonds of brotherhood with those you go through combat with, but I don’t. I am not really in “combat”. I sit here at the base camp and just see the aftermath of that combat. I don’t enjoy the company of those I work with. I don’t know if I am in part just not letting myself, or if I am just not under the same stressors that create that bond.

I feel unused, underemployed, lazy. The hospital across the road accepts the injured in from the field. I don’t work there. I work across the street at the aid station. I see the sick call, cough, cold, ankle sprains, foot fungus, the unglamorous side of medicine. My friend worked in the ICU at the hospital and worked her arse off. I feel so weak in what I do here in comparison to what they do.

Sure part of me wants the ego boost of saying that I saved lives and that’s a good thing, but its more than that, I want to feel like I am making a difference in the lives of our boys. I track my specific patients so I get the hourly updates as far as who is in there and when new patients arrive.

I think of the old MASH episodes, Radar would get on the loud speaker and announce that incoming wounded and to get to the OR. Now, you just get email blasted out to you, it lets you know who is inbound, and you get the play by play update on what is happening to them.

Its harder to just watch the text scroll across the screen. I am absolutely helpless to do anything. I just sit here and watch the names and numbers roll across my computer screen and know that I cant do shit to help them.

I was struck heavily yesterday by one of the wounded passing through the hospital. He was a guy the same age and same rank. He lost most of his left leg, half his right and destroyed about everything below the belt buckle. I cant imagine what his life will look like when he returns home. Is he married? Was he planning on having kids? How much your life can change in the instant hot flash.

I hurt for him. I don’t know him, but I cried for him.

It makes me so very mad. I immediately want to rush out into the heat of where he came from and throw my weight into keeping more hurt from happening. But I cant, I am here, safe and sound inside my tent here at base camp. I feel useless.

Batman

2010-10-29T02:06:00.000-07:00

One of the joys of medicine is that you get to work at being a detective. Problems present themselves, solutions some times present, but some times you have to dig.

In my normal life, I do rapid damage control. I try and make sure that people don’t die. I had a Doc explain it to me that medicine is the art of slowing the dieing process, that only fools think that they cure. I do not agree 100%, but I do agree quite a bit. I think he just said it to make you stop and think.

As of late, I have had to hold onto more of my patients. I have gotten to work harder on more specific, dig a little deeper. Try and nail down an elusive diagnosis. Despite my best efforts, I failed to find a specific problem. Some times things happen, the body hurts and we don’t have a specific answer. Its frustrating to both the patient and the provider.

The human body is not quite a helicopter that has a specific A+B=C algorithm. Not everything fits into a nice clean mold. Some days, you just put your hands up and say “I don’t know”. Never the answer that someone wants to hear, especially when they feel that something critical is going on.

I had a problem that I could not patch up with my insta fix methods that normally work, I had to dig a little. I read the full chapters on belly pain in two different and big books. Always a good thing, I studied for the whole night pondering and came up with an answer that was inspired by CMDT 2010.

Nortriptyline. Ever hear of it? Probably not, but perhaps yes. It’s a second line treatment and I tried it and it worked like a champ. Solved the whole belly pain issue over night. It was a small victory and I felt like a winner the whole day, well actually this is a week later and I still feel fairly good about it. It was not an easy answer, I had to work for it, I found it, I tried it, and it worked.

"carry on my wayward son, there will be peace when you are done"

2010-10-15T22:43:00.001-07:00

I seek peace. Not a world without war kind of peace, but my own personal piece of peace.

I am taking care of a very old local man, this place is hard on the body. A twenty year old looks more like he is 35, so a man who is “70 or 80 something” looks absolutely ancient. It gives me a moment of happiness to provide for a few small comforts to an old man in this harsh place. I go out of my way to take care of him. I know I should have all my patients in my top position and do my absolute best for each one, but this old man struck me and I love him and just want to help him.

He is not a good guy. He is not a bad guy, just not a really good guy either. He said something profound to me the other night. He said “God bless you for your kindness and respect. We (locals) are a stupid people, God held out his hand with food in it through you people, and we hit his hand away”.

I have been pondering this much as of late. I don’t know that I have a really good answer to what it all means. It could just be pink smoke that he is blowing up my arse because well, people do that, but it could just be the true thoughts of this old man.

I find many moments of quite thought here. I don’t know that my mind has been challenged in this way in a while. For the last few years I have been focused on learning a trade. I have worked hard at sharpening my mind and memorizing facts. This is different. The world is outside and it just does not mean the same thing it did just a few months ago.

What is real now is breakfast, gym, lunch, dinner, sleep, do it all over again. Some work tossed in there for good measure, but that’s the reality of my day in a nutshell.

I ponder my own mortality as I am surrounded by the death and dismemberment of so many people. I do not draw a great deal of job satisfaction out of my current situation.

The morals of the majority.

2010-08-04T21:10:00.000-07:00

I had some interesting training today. Its "cultural sensitivity training". It is designed around allowing troops heading to Afghanistan to understand the culture of the Afghan people.

I tried to keep an open mind about such things, yet something really bothers me. In one brief the instructor talked about how the women are held as a symbol of honor for the family. The problem comes in how much sugar is coated upon this lie. The culture of the Afghan people is built around the marginalization of women. Women are not human-beings, they are slabs of meat with a use, but certainly not the symbol of honor to the men of the culture. I am no expert in culture, but when men leave women to bleed to death in the street and refuse to seek medical help, there is something wrong. How can you stand there and watch another human bleed slowly to death? To watch the life blood drain out onto the ground and think it better that they die?

There is so much concern over honoring the local culture. We have to dance around this shit pile. We are not allowed to touch the dyeing woman. We are not allowed to provide medical care. We are forbid to render aid. We are required by the Geneva Convention to render aid to wounded enemy soldiers. But the life of a woman we will hold back on to maintain the status quo. Thats sad. I think its wrong.

Some days your own personal morals are in conflict with the majority around you. Some days you fight it, others you cave to the pressure. I hope I have the courage to follow my heart when the shit really hits the fan.

This picture is for OG

2010-08-03T20:48:00.000-07:00

My patience has been tested as of late. It should not have been, but it has. I used to think that I had a lot of patience. I could love on people despite themselves.

Today the simple things seem to bother me. I am cranky. I get to listen to people's problems. Its my job. I sit and listen to people and what bothers them. I used to care. I loved to hear a problem and take that and try and solve the problem. I would get a great deal of joy out of solving the problems of a stranger. I am having a hard time finding that joy now.

A great deal has changed in my life. I no longer have an endless supply of people with different and interesting problems to solve. Now I sit behind a desk and write paperwork. Suck. The complaints are no longer a problem that I can fix in a 5 minute visit. They have morphed into vague non-solid problems.

Its times like this that I start to really see how much the public idea of medicine is unrealistic. People expect solutions. Example: "my knee hurts when I run", well ya, everyone's knees hurt. "My back hurts" every human has back pain, it comes with being bipedal. Some days I want to scream "We have no answers". How rare and happy I am when I find a problem and a cause all in the same visit. It seems that most days I just rule out any kind of bad issues, and let nature take its course.

I am dissatisfied with my job today. I feel that I have prostituted myself into a system that really does not care that much. That is built around harnessing and using humans. I am a cog in that machine. I am just here to patch up the leaky dam and get it back in the game.

I do not like working for the man.

Humm. As I type this, I feel that I have had an insight. I have never liked "the man". Yet now, my job is more as an advocate for the system. I used to be an advocate for the patient, but now I work for the man. I have to justify everything. I have a set system to work in. Its veterinary medicine. I am working on someone's prize thoroughbred horse. They care about the body, but only in so much as it is a slab of meat to be put back into the grinder.

I have sold out part of my soul. I have betrayed the trust.

I have lost my way. I need to seek the center. The balance.

"Citizenship is an attitude, a state of mind, an emotional conviction that the whole is greater than the part"

2010-06-04T07:01:00.000-07:00

I have been pondering lately what it means to have true social responsibility. What am I as a citizen of this world responsible for? What do I owe my fellow man? What do I owe the "system" that currently owns us?

I just finished reading the book starship troopers. Its really interesting in comparison to the Hollywood movie. The book is so much more centered around the idea that our current political system is flawed. One thing that I really jive with is that they place a value on citizenship. Some days I feel that modern humans have come to the point of feeling that everything is a right, that it should be given to them. I think this is wrong. I think that you must earn something to appreciate it. I think that citizenship should be earned by those who put into the system. Give something of your life/time to help the whole community. A citizen should care about the greater good, should care about making the whole system better by their actions.

Yes, I am speaking in generalities, I know dear friends who had their undergrad paid for, and they truly seem to appreciate it.
My undergrad cost me quite a bit, I spent 4 years working for my country, I paid for my undergrad in sweat and tears of hard work. I wrote the check to the school every month, I knew how much each hour of lecture cost me.

Gifts are valued less than something that is earned. If something costs you years of your life to accomplish, you remember that, you value that.

Value is an interesting thing, many things have a value because we place an artificial value on that thing. A diamond is valuable right? But that value is fake, the amount of diamonds that are in the world is artificially controlled by a group of bankers that sit in a bank and decide how much of the diamond overstock to release into the market in order to maintain an appropriate value on the diamonds, but the individual diamond that you may buy in the jewelry store has only a real value a fraction of what you would pay for it, but we pay because we feel that its valuable.

Value is arbitrary, but if something costs you a great deal to earn it, even if its true value is small, you treasure it greatly. That diamond is no less valuable because its true value is small, what you think is of the hours of work that you had to accomplish before it could be attained.

The right to be a citizen of the world should cost you something. You should value it, not throw it into the corner and step on it.

What have you done to better the human race? What will you do?

M@

"We improve ourselves by victories over ourself. There must be contests, and you must win." ~ Gibbon

2010-06-01T04:25:00.000-07:00

There is balance in life. I find it difficult to accept that balance some days. I would rather bend the universe around my will, but thats probably why I fear I could become an evil emperor. I am a mix of very different and strong emotions. I hate and despise "the Man" and all that is represented by big corporate/government. I immediate reaction is to push against it. I guess I am just a rebel at heart.

I am a rebel that has to find a cause. I pick my causes because I need the fight. I need combat in my life, I need to do battle with something. I had a very interesting case the other day. Very sick and had a lot of different pathologies going on inside their body. I had to spend days with my nose in the books trying to understand what I was being presented with, I had a fundamental understanding, but I wanted more. I nerded out on that experience. I needed that challenge. I needed to be pushed. There is so much more that I need to know, but every step of the journey takes me one step closer.

Its unfortunate sometimes when someone tells me that I can't do something, it makes me try all the harder to make it happen. Sounds like a small problem right? The problem comes when you try and live your life in community with others and you cant just do something for the sole purpose of proving someone else wrong. There needs to be compromise. It has taken me a very long time to come to grips with that small word "compromise".

I used to rail against compromise, I would follow my heart or die, simple. There are very few things in this world that can make me compromise. Perhaps I would even go so far as to say that there is NOTHING that can make me compromise. I can choose to compromise in exchange for living in community/relationship with other people.

I have strength, some days its not harnessed into a useful strength, its wild and untamed power. I can get myself into trouble with that, focus is the key. I can do anything, I just have to focus the strength and will the completion. I have a tendency to put myself into difficult situations. Its out of some deep need to feel the pain of the situation. I desire great things of myself.

I choose this battle. I will overcome.

M@

rambling thoughts.

2010-05-24T03:09:00.000-07:00

I have always had this idealized notion of medicine. I chose the profession because it was hard and it allowed me to make a profound impact on people's life. In much the same way that I want to engage with people in their life. Some days life sucks. I wanted to make it suck a little less.

I have been scared for a long time because I dont want to impose upon people. I dont want to force my will upon others. Some days its hard to balance my love of medicine with my love of people, some days they are opposed. I have to tell people that they cant continue to eat the way that they have been unless they want to continue to destroy their body. Its really hard for me to watch someone step into the room who has made choices and now is crying over those choices.

Yes, I want to help, but part of me is angry as well. I am angry that they have killed their liver with alcohol, or lungs with smoke, and now want me to pick up the shattered pieces of their body and try to stitch them together. I have been an organ donor for as long as I could remember because in my mind, I am obviously not using them any more so why should I care what happens to my body when I die? But, a bitter part of me wants to be the judge of who is worthy of my liver. I have taken care of it, I dont want it to go to a person who chose to destroy what they had to begin with.

I still dont want to force people to change. True change only happens when you have an internal compass change. Yes I can put a bit in your mouth and force a change, but you will return when the pressure is off. A true fundamental change in your life is possible, but it takes great internal fortitude to withstand the pressure that it takes to make that change. Pain and pleasure, they will pierce your heart and wake you to a change.

I fear that the world is built around keeping the masses asleep at the wheel. Just living life in the hopes of passing another day of mundane life. Life is bigger, it is people and love and hate and passion, its dirty and shitty. WAKE UP! Just find a reason to live today! I am not saying that you have to have a passion of life, but pick something today and fight for it. Pick anything. Pick it up today and just live life with that in your mind. Pick a friend, a stranger, a coworker, a pet something.

I am tired of sleeping people. I wish that they would wake up. I cant make them wake up. I wish that they had just a spark of life inside them. I hope for them.

"You may say I am a dreamer, but I am not the only one"

Two bucks.

2010-05-12T06:04:00.001-07:00

I got home this afternoon and was going to take the dingo for a walk, then meet up with Katie. Well, a little nap sounded good so I slept for two hours. I woke up and I realized that I was in the middle of this really crazy dream.

I think I was in Alaska. I think I was in a school of sorts. And there was a big huge bear outside that was trying to eat a kid and threw the kid into the building via a small window. Well, then the big huge grizzly bear was coming through the small window, and there were several people standing with me at the front desk, so I ran down the hall and threw 8 quarters at the bear because clearly if you make enough noise it will scare the bear away. That did not work and the bear was trying to bite the kid, so I grabbed him by his backpack and pulled him down the hall to safety.

I realized that I had to make more noise to scare the bear off, and so I went back and walked past the door to the room with the huge bear in the small window making sounds like a chicken and flapping my arms like in the chicken dance.

That did not seem to work, so I went back by pretending that I was a cat and hissed at the bear. That did not work.

So, I went by again, this time making slow up and down flapping arms and caww-ing like a crow. Clearly this worked, and then I woke up.

M@

What do you trust?

2010-05-05T04:38:00.000-07:00

Our money says that we trust god. I honestly dont know what I truly trust in absolutely. Its a scale, I trust some people with my heart and everything that I am, others, I choose to keep at an arm's length out of fear. I trust that my breaks will work when I get into my car, I dont trust the rest of the drivers out on the road.

We are forced into trusting different people at different times. We trust the mechanic when he says that our car needs a new flux capacitor, we trust the doctor when she says we have a disease and need a pill to make it all better. All of us are relied upon at different times and for different things it does not matter who you are or what you do, someone is seeking for something from you and trusting your judgement in the answer.

We are all human and when we fail in that trust given to us, we hurt others. It may be for very valid reasons, but the hurt is done and can not be un-done. We need grace for those who fail our trust and we need to be diligent in the trust given to us.

I wish that we as a species could focus on the love of life. I know that I tend to focus way more on those things that have hurt me. I try and justify my feelings but the real reason is that I felt hurt and need revenge. I fear that hurt. I dont want to be hurt. But I also know that we dont feel the true love of another person till you have trusted, opened and loved. The hardest thing in life is to be loved. Is to accept that love that you know you dont deserve, and just accept it. Not deserve it, but accept it.

M@

Where is your strength?

2010-05-01T04:07:00.000-07:00

Ever just really surprise yourself? More than just letting out a really loud fart when you thought it was just going to be a little squeaker. But truly surprised yourself with your own capabilities. I used to really be stuck in the mode of thinking that being good at something was being prideful, that was a sin and you should not be prideful. Humility was the goal.

I had to put that down at some point, I had to embrace who I am and that I have the capability to do great good or great evil, the choice is mine and I can do whatever I want with it.

But, as a new guy in a new job, I am still scarred shitless most days. I wake in the night scarred that I made a bad choice the day before. I worry that I blow off something as minor and that it was truly something horrible.

Had a person come in and they had drowned out at sea, not a good case to start with, but the whole code went really smoothly. I intubated and placed a central line, two procedures that can be tricky and nailed them both. It was a moment of need and I rose to meet the challenge.

Some days I feel that I have an unlimited potential. I just need the challenge to push me forward. I need the motivation to move me. Don’t take it to mean that I don’t give up. I have done my share of giving up and quitting, but there is also strength there, the question is how to tap into that strength.

Where in the world is M@?

2010-04-29T02:50:00.000-07:00

Good lord, I know some of you have heard it before, but I am really honestly heading to another country in a few short weeks. Well, in a few weeks I will leave my little island to head back to the mainland and join up with a Marine unit that needs a few good men.

I will be providing medical support to several hundred Marines as well as evacuating wounded casualties. It brings up a knot in my throat to just think about it. I am filled with the anticipation of something great and dangerous so very near in my future. Yes, I have been preparing for this for months now, I knew it would happen, but its formal now. There is relief in the formality of it, the stupid paperwork, getting things signed and stamped, getting shots and stabs from half the hospital. Saying good byes and trying to find places to store things. Not buying more food because of the need to eat up everything in the fridge.

I am not the first to undertake this task, nor will I be the last. I enter it with my eyes open and my heart full. I hope to do my duty and serve the men that I have been assigned to with every ounce of my strength. I hope to bring them all home.

Moon

2010-04-28T06:08:00.000-07:00

Some nights I come home and I find the most amazing back yard ever. I know I know, that’s a bold statement, but I stand by it.

Its an amazing view that I don’t even want to take a picture of. I fear that the picture will not do the view justice, so I don’t even dare to take the picture. I will try and relay in words because that seems to be the only way to truly relay the beauty of the moment.

As I walked into my yard, my one eyed rescue dog was there to great me with a joy so great that he had to pee on the ground. Its not every night a guy gets to come home to something so happy to see him that it urinates on the floor.

But the view once I got into my yard just made me sit on the ground and absorb the beauty. The moon was rising over the pacific ocean, the waves were crashing out on the coral reef and the lagoon bay behind my house was full of a reflected moon light that was so bright that I felt like I was looking out into a solid pool of diamonds. The light reflected off the small waves of the lagoon and each one seemed to reflect the moon a little more than the next one over. On-top of this, the clouds were pulling back and the sky was light up by thousands of stars. The stars were so bright that I could see reflections of them on the water. I sat on the cliff overlooking the bay and just absorbed the moment.

I have often dreamed of being a cast-away on an island in the middle of the ocean. Not for the island but because once you are a cast away, adventure is certain to follow. I am reminded of the movie Joe VS the Volcano. There was a scene in the movie that had Tom Hanks floating on a raft of luggage as the moon rises over the ocean. I know its fake movie stuff, but I felt like I was living that moment. Sure my island is a little more stable than a raft of luggage, but the beauty of that moment pierced my heart. Its not every day that you get to just feel that power of something so big and beautiful.

M@

Its the little things

2010-04-23T05:56:00.000-07:00

Today I learned some valuable lessons. I am quite sure that I have learned valuable lessons the past week or month, but have just not really shared them here. Today, I feel the need to share, so here goes. In no particular order.

Its hard to stick a needle into the vein of a person when they are having CPR done to them. Friends are a valuable thing. When you have been surrounded by them, you can take them for advantage. If you live far from the auto repair shop, and need a ride to pick up your car, and all of a sudden, your friend population went from high to low very quickly, it becomes hard to just find a ride. A vein may have a pulse if you press the hart hard enough. A car without a catalytic converter makes more noise than one with one. My dog likes to lick my feet after I get out of the shower. Dyeing is never pretty.

What does that all boil down to? That our time on this rock is limited by many factors, most of which are out of our control. Enjoy your life, enjoy your friends, enjoy the cold beer in the shower. Seek the small things that make life worth living because we are all going to die. Was today worth living?

Thats the question. Was today worth living? What happened today that made it worth living? I got to help some people today. Some people I hurt, but others I helped, perhaps its a wash. I have been blessed/cursed with an overly active optimistic perception of life. My glass is not half full, its brimming at the top with nothing but water tension holding the little bits of water from flowing over the side. (like when you pour a drink in a glass and its actually over the top of the glass, but makes a little bump that is actually taller than the glass, thank god for the hydrogen bond). I love life, I love the stupid little things that I see every day and the crappy things that happen, well, sometimes I love them as well.

Its not that I see life as a bouquet of roses. I see life as a box of everything beans from Harry Potter. There are a lot of flavors in the world, and some should not be made into jelly beans, but thats life, its full of shitty things right next to beautiful things and they may even look a lot alike, but the end taste is vastly different.

It was not always so. I used to be quite convinced that life was a boiling cesspool and you just had to survive one day at a time. Dont think about it too much, just try and survive one day at a time, one week. I just have to survive till my next hair cut, thats all. Dont try and think beyond that.

Life took a very interesting change for me in 2003. I met the most amazing woman in the world, I fell passionately in-love with her and all of a sudden life started to mean something wholly different. It was no longer a matter of survival to the next haircut, it was that life was a big thing, and that you can engage with it. I felt passion, fire, love. Those things moved me. They pierced my heart like nothing else ever had.

The sleeper had awoken.

It was not till we broke up that I truly started to taste this life. I found that I had passion for this woman, and that that passion could be tapped into, that I could become passionate about feeding the homeless, righting wrong, saving a life. Its not hard when you find that key that can unlock your potential. We humans are such amazing creatures, our potential is damn near unlimited. Yet the shit of this life seems to lock us into mediocrity.

Live life with passion. Find your joy and pursue it. Never give up. Follow your heart.

just another monday on tuesday

2010-03-01T14:37:00.001-08:00

I have returned to my little island in the middle of the ocean. Interesting enough, some friends are going out to the movie and I tag along. We watch shutter island.

I will preface this by saying that it is perhaps not the best film to watch when suffering from an 18-hour jet lag, separation from loved ones, and drastic climate change. I really got lost in the madness of the whole situation. I felt more than a little trapped in my current situation.

Overall a good movie, but it just freaked me out. I was already in a funk because of feeling more than a little isolated. Its odd, here is a smaller community than the one that I normally have lived in. Its its own ecosystem. There are only 180 thousand people on the whole island, you cant help but start seeing the same people. But my heart is not in it, my heart is not here. I am holding out and not engaging.

I desire so strongly as a life goal to be able to find a community and to engage with the people there. I am jealous of my friend Erin who has planted into a community. My life here is of a transient nature. As is everyone else’s , it’s the nature of the beast inside this system. I don’t have to like it.

I think that I will leave this system at the end of this obligation. I will endeavor to find a community that I can engage with, one that I can plant into. Its not settling down, heaven forbid that, but it’s the idea of being part of the whole process, to have an impact on the community as a whole that you live in. I want to go to the highschool football game, I want to be more than “that tall guy with the glasses”.

The question is if you can find that community anywhere. I suppose that I could find it here, but I want to be able to know people for years and years, to become deeply intertwined with their life. I did not get into this to be the guy that you go to to get your pill fix.

I want to be part of a community organism.

Almost done.

2010-02-10T17:44:00.001-08:00

I near the end of my training here. I am happy to see the end near. I miss my little ER, my job, my life, my dog. It has been a fantastic learning experience. I feel better and more confident and more able to deal with trauma when it will happen to me in the future. I am better in my job because of this.

All that said, I do not have to enjoy all the experiences that I have had here. Seeing this ugly side of humanity day in and day out for years would hurt me. I do not enjoy seeing the blood and guts of a person spilled out onto the floor. I do not enjoy watching blood dry into little lumps of red jello pudding. I do not enjoy seeing the depths to which humanity will descend into to hurt others. Yes, my vision is skewed because what I see is the funnel of bad, I am sitting at the bottom of that funnel as the hurt and pain of this place showers down upon me. It is what I will think of when I think of this city from now on.

A good friend and I had a conversation about violence just the other day. She chooses to live in this situation because it is what it is. I choose to flee this place because it is what it is. I detest the violence that I see presented to me on an hourly basis. This is a monument to the pain and suffering that we humans deliver upon ourselves. As much as this place is a result of the suffering of humanity, I still feel that there is a place for violence. I can not even after seeing everything that I have, that there is not a place for violence. Part of me wishes that I could say that, that I could see this shit and turn that into non-violent thoughts. There are still things that I would defend with my life, and that I would use deadly force to defend. Yes there are things in this life that I value more than another human's life. Yes, I am making a judgement call and saying that my loved ones are worth more than a 16 year old kid on crack who just wants his next fix. If he were holding a gun at those I love, I would drop him dead, two to the chest, one to the head.

Because that leads to the other valuable lesson that I have learned here. That is that to some people, the life of another human is worth less than an i-phone, a pair of shoes or 25$ in cash. Life has less meaning in this place. That is sad.

M@

"she could tell right away that I was bad to the bone"

2010-02-05T13:18:00.000-08:00

Had a very unfortunate person come in to see me last night. Just working the cash register at the mini mart and got shot in the head for his trouble. Lucky or not, the bullet was either not big enough or fast enough to punch through the skull, so it grazed off and just took off a bunch of the back of the skin. It also ended up with a big huge bleed in the middle of his brain. Bummer because there is no hole and the brain was swelling to beat the band.

The brain was starting to be pushed out through the spine, never a good thing. So we have neurosurgery come eval. They decide to put a little hole in the skull to relieve some of the pressure. Not a bad idea. But the guy running the show had the worst way with words.

First: activly drilling into the skull and he turns to his partner and says "Bob, is this normal for it to get hard like this?". Not comforting words to hear from the man with a drill in your skull. Just saying.

Second: As he finally makes it through the skull and sinks the drill bit to the shaft. "Ops" Again, not something you want to hear from anybody doing work on your car, your tv, or your brain.

Caution given, dont use those words. Noted.

Holding pattern.

2010-02-04T10:49:00.000-08:00

I dont know what I am doing, nor where I am going, nor when I will get there. In short, I dont know much of anything.

I am currently living and working in LA. I get to work at general hospital, yes the same one from the soap opera. Yesterday for example, I saw 4 different men who got shot in different places. As a highlight, one of the other Docs that I work with found a cool section of our x-ray reading program that was titled "Interesting Cases". So it being some time in the early morning, we proceed to spend the next hour not looking after patients, but looking at interesting xrays and ct scans. Some of my favorite are the mobile bullet that shows a small caliber bullet in the RU quadrant of the abdomen, then 4 hours later, in the mid-left, then back to the right. So, we are feeling that it is most likely in the intestines and that it is traveling around the GI system. So clearly a job for the med students, they get to collect and examen all of his poo for the next few days to see if he passes a 9mm bullet. Interesting.

The man with the object in the rectum that he "fell" on. That was a good xray (it was starting to make the turn around third base going the wrong way).

Sorted random collection of different head CTs. Had a patient that came in with altered mental stat and well, when I got to look at the CT, the midline was shifted so far that it had filled one ventricle with blood and the other was damn near closed. Huge bleed. Died. Seems to happen to a lot of people here.

Last night some of the corpsmen were making a coffee run down to the 24 hour doughnut shop, and they saw a guy get hit by a van, so they got to make a little field work. Good on them.

After here, I dont know where I am going, or when I will be back. I have a plane ticket back to island, and they have not told me yet to go somewhere else, so I guess I am heading back to my island. That will be nice. I miss my puppy, my hammock, and my coconut trees.

I have put on several pounds due to the fabulous mexican food here. One of the things that I miss about Hillsborito. OK, back to more hours of class, then more ER tonight. Starting trauma call day after. That should be fun.

Peace out.

Every day is a holiday, every meal a feast.

2010-01-16T03:35:00.000-08:00

"You've got orders". Short words, but big meaning. I have been tasked to go. I dont know where, or when, or how long, or with who. I was notified on the 15th of Jan, and the orders start the 19th of Jan. Nothing like the military to keep you on your toes.

It looks like I will be going to LA to work in a trauma center for 4 weeks to brush up on my skills before I go into the wild. For some reason, LA scares me more than another country. I have a good friend who has lived there for years, but it still scares me. At least in Iraq you have body armor.

I stand on the cusp of a great adventure and am more than a little scared of the whole thing. I dont know what the end will be, but I look forward to the ride.

Deep breath.

“We are all in the gutter, but some of us are looking at the stars.”

2009-12-20T05:16:00.000-08:00

What is hope? I have had three big HUGE conversations with three separate friends about this very topic in the last week. It seems to be a theme right now. But more than just a theme, its a root nerve that runs through life.

I can live with a lot of things, I can survive a lot of things, but having no hope is not one of them. Hope keeps me alive. It makes the sun rise and makes each day a new fight that is worth fighting. There are volumes of stories that speak of hope, lord of the rings, Shawshank, the list goes on and on. But what is this thing of hope?

I think it is this. It is the spark of life. It is what keeps us going when life sucks and the shit of the world around us threatens to drown us. People tend to insulate themselves from the pain of life by whatever means they can find. TV, food, drugs, sex, religion, whatever fires them up for a few moments in time. But they are hiding because they fear to hope. Hope can hurt you so much, it can kill you. Hope is a drug that can bring you bliss, or crush you in one fell swoop.

I am no expert on hope. But I do hope. I hope for things that I have no right to hope for. My life is burning with hope for not just myself, but for my friends. Beyond my friends I have hope for mankind. Granted, its hard to see it some days when I get buried in the foul smelling cesspool that is normal life. But I still hope. I will always hope. I will hope for love, life, and peace. I hope for my friends to be touched by the fire of hope and pick it up and run with this thing. I hope for people to taste life.

I hope.

All I have to say about that is "asphinctersayswhat". ~ Wayne

2009-12-06T03:26:00.000-08:00

"Peanut butter cups here I come"

This from the man who until 4 days ago was on insulin and dialysis. Now he has someone else's kidney and pancreas. This frees him up to eat peanut buttercups. Weird. I would think that being forced into mechanical means of prolonging your life would make you think something along the line of "Perhaps I should care for this gift that just a few hours ago was someone else's body". No, first thought is about peanut buttercups.

I am in a place to observe free healthcare. I see what happens on a daily basis in my ecosystem. When I was a student, I saw people who didn't check their blood sugar because they didn't have the money to buy enough strips. Thats not a "barrier" to care where I work. You want strips, BAM, done, pick them up at the pharmacy. Oh, your meter is not accurate, hell, let me put that in and BAM, you get a brand new one. No co-pay, nothing other than the inconvenience of having to wait in a line.

So in a system where you get free medical care, free medical supplies, and a nice air conditioned room to wait in. Your diabetes should be in top shape right?

Incorrect sir.

Why am I pleading with you to take your insulin? Why am I pleading with you to check your sugar? I refuse to get lost in your self destructive behavior. Go home, eat your spam, smoke your "couple packs a day", dont check your blood sugar because it hurt your finger, its your life.

No, I am not bitter already. Just frustrated. Frustrated that I can spend so much time on this and it wont make a difference a few weeks from now.

Lidocaine acts on the NA channel after the cell is fired.

2009-11-28T05:57:00.000-08:00

I have not hated the holidays for a few years now. But I am feeling the start of hating this one. I may just become a bit bah-humbug this year. I don’t feel happy about it. I feel insulated from the world.

I feel bad. I remember when I had a good friend end her years of college and become very sad about her leaving that time behind. I did not openly mock her, but the tone was one of mocking.I did not understand.

There is a newfound drive in life, but it scares me. I get up every morning and I run through all my ACLS cards. I see them in my head. I see the patients that we have coded at work in my mind. Its no shit time. Its 1147 at night and I am studying from The Schnob’s text book. I want to know the mechanism of how lidocaine stops arrhythmias. I am sure that was taught to me, and I even remember drawing out the diagrams of it back on a white board somewhere. I even have notes and highlighter marks in my text book proving that at some point in my past I even looked at this page.

Perhaps a little gin will make it all better. One can only hope.

Fiction is obliged to stick to possibilities. Truth isn't. ~ Twain

2009-11-24T02:55:00.001-08:00

There was a disturbance in the force last night. I was at work and had a person comes in wearing a hoodie with the hood up. Sick person. Anyone wearing a hood here is defiantly sick. We get them all plugged in, they are in a wheel chair, cant use their legs from a MVA a couple years ago. They have a home health who comes to visit them. My first gut reaction is that this person is really really no kidding sick.

I take a history and find that they were in the hospital a few months ago for a wound check. So we roll them over to look at the wounds. I a very infected stage 3 DU on the L hip. There is also a dressing on the sacrum, so I take that down. It’s the worst DU that I have ever seen in my life. 11CM by 12 CM that tunnels another 8 CM around the R side. The sacrum is completely exposed as well as L1, and a good part of the pelvis.

Both heals are eaten down completely to the bone and smell gangrenous. I would not be surprised if the R foot has to come off.

The next person to arrive via EMS is another young person about the same age, who was playing football and ran into another player. But now cant feel anything from mid shin down, and can no longer move the ankle, or foot, or toes. The loss of sensation crosses 4 dermatomes and 3 levels of spinal inervation. Anatomically I don’t believe that there is a way to make this happen. I check the reflexes and at first I note that there are no reflexes on the affected side. But when I go back and check again a little closer I note that the muscle is activated for the reflex, but he is tensing the rest of his foot to hold down his foot. My spidy sense says malingering.

I am sitting out in my area looking at these two rooms with two very different people. One who will never walk again, one who wont walk. I feel like there is something that the force is trying to tell me, I just don’t understand it.

What to say?

2009-11-23T05:47:00.000-08:00

I dont know what to say. I found this when I was in the shower and realized that I was not alone, that there was a HUGE F-ING spider that wanted to eat my face.

"Education is what survives when what has been learned has been forgotten." ~ Skinner

2009-11-20T01:18:00.000-08:00

I realize that I have been delinquent in updating this. I apologize.

Anyhoo. I finished up the wonderful joy that is officer development school in Rhode Island, which by the way turned out to be a lot harder than I had planed on it being. I think mostly because I was really unprepared to deal with a bunch of just baby snobs. So, my thought process went something like this: It was the first week and they were asking for volunteers for the jobs, now my first plan had been to do the safe thing that I did when I went through basic training and that is just hide in the middle and never volunteer for anything ever. But this was different this time, I chose to take it all on head on. Grab it by the horns if you will. So why not vol for the student leader guy right? I mean whats the worst thing that could happen? This is not really that tough compared to what I have been doing lately. So I was the only guy who volunteered for it, so I will be damned if I did not actually get it.

It was not that bad at all as far as just the job, but dealing with all the other students was the biggest problem for me. There were about 10 prior enlisted and its not really all that hard, but the senior chiefs screwed with us a lot in stupid little ways, all the normal fun and games. I think the weirdest thing that I can remember is that the first three times I pissed one of my classmates off the very first FIRST reason out of their mouth why I should respect them was that they have a PHD. Its odd, here are a bunch of the smartest people in the world and asking them to clean the floor or take out the trash is so far below them. Its sad almost. They are 30 something and have never been outside the bubble of education. Smartest dumb people ever. But I got fired after the first week so that was fine with me. Then I could just hide for the rest of the time, I had done my duty.

So, step forward to arriving at my first Navy duty station. Naval Hospital Guam. I get here late night and my sponsor meets me at the airport and he happens to look like an extra from Miami Vice. Purple silk shirt with a couple too many buttons unbuttoned and his chest hair and gold bling popping out. But he takes me to lodging in his Jag so thats nice of him. He is a nurse from the ward so does not know much of anything about where or what, so I get plugged into fam med the next day and wonder around in my dress blues sweating my ass off. I get about two days into the check in and someone stops the check in because my bilit number that is on my orders is not in fam med, but in the ER, so I have to go talk to the CO (commanding officer) and XO (executive officer) and DFA (Director for Administration) and a bunch of other three letter people. But the bottom line is that I ended up working in the ER, not fam med.

Its FANTASTIC! The ER has been PA-less for 6 months so they are super happy to have me there. The ER is booked for two PAs and one GMO (general medical officer aka an intern) but have had none of the above for the last year and change. So, I am doing my best to not suck it up too much, but damn, its been a while since I was in a real good clinic setting. That was my biggest fear about going to the ER, I told them outright that I am new, I suck, you have to be patient and hold my hand and pull me along. But the docs here are so freaking good about that. The department head doc is a really awesome guy and was talking with me last night and he was really excited about something because I had asked him a question. He said: Oh, its great, we have not had anyone here in a long time to teach so its nice to be able to have someone to teach that wants to learn.

God, its fun. I love this stuff.

So, now that I am an old salt and have a dozen shifts in the ER under my belt as a naval PA and am getting ready for another shift today I decided that I should at least update you as far as what I have been doing and where the adventure has taken me so far.

"hope is a dangerous thing" Shawshank

2009-11-19T03:55:00.000-08:00

I feel an unfortunately large amount of alone tonight. I have been “alone” for a month or so now. At first it was such a change from being in officer school where I was packed in very small space for 5 weeks and ate, slept, shit and shared about everything with a group of people. Its different here. Here, there is a big insulation layer between me and others.

I sit on my porch and drink my gin and watch, I watch as the world spins by me. But part of me does not want to be here. It’s the first time since arriving that I have really felt it. It’s a geographic isolation. I feel alone.

Perhaps I have just been running at full speed and not noticing much else. I am sure that it will pass, that I will sleep tonight and that it will all be better in the morning. That’s the beauty of me. I have been in some crappy places, but life just seems better in the morning.

Perhaps it is the tease of making contact with people, yet not really connecting with them. I guard my “electronic” connections because it feels like that is such an important thing, but in truth perhaps that is a cause. It gives me a false sense of being near people. I crave the contact of my herd that I left back in the states. It just hit me today that I don’t get to see them. That this is truly a level of isolation. It’s a lot of talk, but I wont be back in the states for a very long time. None of them are coming here. I kept thinking that I would see them again and soon. But not so. Its dangerous to hope too much. But how do you balance the hopes of daily life with living life with hope of greater things? I don’t want to just sit here and “hope” that I get a good breakfast tomorrow. I want to hope big, but the big hope hurts when you don’t get it. How do I hope big, but hope realistic? There must be a balance in the mix.

Life is just one day at a time.

Just another thought.

2009-10-04T09:12:00.000-07:00

A sniff of freedom. Not a big gulp, but a sniff non the less. When I was in basic training back in the late 90s, I remember getting a day of base liberty, and being able to go to the rec center where they had a big TV and games and what not. I sat and watched 24 hours of a Christmas Story, not all 24 hours, but I did watch it back to back to back. I ate a whole pizza all to myself and just sat and watched. It was AWESOME!

I went to the O-club last night with my crew, it was a good time to just get out of the building. I am itching with a great desire to just leave here. I am ready to see something else in this world. I dont even really want to leave base, I just want this time to be done.

Its getting very hard now to remember what happened during the first two weeks of training. Its a bit fuzzy now. I remember thinking that it would never end, I remember thinking that it was quite the mistake to come out here. I remember thinking that I could just freak out and DOR (Drop on Request) in the pool and just pretend to freak and say that I cant be here anymore. I guess all of my big talk about really wanting to be here to "serve" is just that, talk. When it comes down to the push and shove, and I dislike being forced into the system, I want to run.

Its not even that hard, I just dont like it. Perhaps my brain/personality has changed over the last few years. Perhaps.

M@

on the island of roads

2009-09-26T07:26:00.000-07:00

So, I am now two weeks into this adventure of Navy life. It’s a bit different than I had thought it was going to be. It became really hard; I had this picture in my mind of it being super easy. But alas, it was actually quite difficult for the first two weeks. The breaks have been taken off quite a bit now.

It has become very hard for a number of reasons, part of the issue is simply that I am currently locked up with a bunch of very selfish people. They are very privileged and have not known the suffering of being a grunt worker bee.

It makes me sick to be here. I don’t like it. I have forgotten how oppressive the atmosphere is at training commands. Training bases are just ugly. There is so much pain and hurt being inflicted on people.

I am not even in the “bad” class. There is a whole separate group of classes that are for “line officers” I am not, I am just a guy with a degree and so therefore get to look like an officer, but in all the real ways, I am still just me. The people that go through OCS are brutalized. They are broken down in so many different ways. It breaks my heart to see the crap that they have to go through. But it makes me so angry that my f’d up class that complains about going outside and getting dirty is somehow privileged and able to avoid most of the really ugly things that happen to the poor schmucks over in the OCS class.

I don’t want to be here now. I want to leave.

Where to go now?

2009-08-17T11:12:00.000-07:00

Here I am sitting in school, on the floor that I came to back in November of 2006. I came here then to interview for a seat in the class of 2009. I came here bright eyed and bushy tailed. I remember that I was listening to Blue October’s new CD Foiled on the way up here. I remember that Al called me and said some really super encouraging things as I was walking into the school.

I remember that I was wearing my nice new navy blue suit, light blue textured shirt and a tie with some subtle purple accents. I was quite proud of my get up. I had pondered for hours what kind of shirt and tie to wear. I wanted it to be subtle, yet powerful. I did not want to wear a white shirt and red tie. I wanted color; I wanted to be almost edgy, but not crazy.

I remember showing up so early that there was no one else around at all. I remember having to walk and walk and walk because I could not stand still. I came inside and met several other people all nervous and anxious to start this thing off. We met on the second floor and were all having juice and some sort of bread things. I remember going to the bathroom on the second floor and using the urinal.

Here at school, the person who designed the men’s bathroom was evil and sneaky. This evil genius made all the urinals at such an angle that no matter how you pee in the thing it splashes out towards you. Well, I did not know about this mastermind’s evil plot so of course now there was pee all over my nice new dress shoes. I was mortified. I was scared that someone saw me cleaning off my shoes in the restroom.

Despite my poor performance in the men’s room I made it into school. Now I sit here all graduated and working on getting ready to take the board exam. I had to use the bathroom on the second floor and to my own shock and horror, I managed to splash some pee on my feet yet again.

So, two plus years of school, 100 thousand plus spent. I am not that much smarter and I still get pis on my feet.

“The function of muscle is to pull and not to push, except in the case of the genitals and the tongue.” da Vinci

2009-07-10T15:49:00.000-07:00

You would think that after cramming as much writing in as I could the last few days that writing would be the last thing that I would do when I had a free moment, but no. I have been cramming on my paper the last few days because I knew that I had the earliest appointment with the writing lady. I was supposed to have my rough draft done even before our outline is due online.

I got to school all early and stuff today so that I could push out a couple more pages, well, somehow there was a mix up and my appointment turned out to not be at 1 this afternoon, but at 9 AM. Well, that makes for a crappy paper when you are trying to read a rough draft and the paper is full of half thoughts and broken ideas. Ugh. That was a bit embarrassing.

Perhaps this is freeing because its something that I want to just blabber on about and I am really not concerned what any of you think of my spelling or comma use. There is freedom for me in the abuse of words and the written language. I even decided somewhere along the line that I am not going to indent my paragraphs. I just add an extra line break, for some reason I like it. I did not see it somewhere and think “ok, that looks nice” it just sorta happened. I know when I am writing a “real” paper because I have to go back and take out the extra line and tab in all the paragraphs before I turn it in.

The ability to transfer an emotion via words on a page is a powerful thing. It did not take long for the writing woman to pick up on a fairly negative vib in my paper that is more than a little critical of the current medical treatment that is offered in the ICUs today. For the faithful EJ readers, you know of the fun that I had in the ICU and my feelings about it. Its good to blurt those emotions out again. They are less raw now, a bit more refined, they have marinated in my brain for several months now.

I may bilge some more thoughts on the evil that is the ICU in a bit, but not for now. I just got back from a good ole 6 mile run from base camp and my mind is sharp. I need to focus that and use it to push more on this paper. It too will soon be history and I will take another step in the direction of graduation and life after that.

"If we were logical, the future would be bleak indeed. But we are more than logical. We are human beings, and we have faith, and we have hope." ~ J

2009-06-25T22:39:00.000-07:00

Done, just fucking done. I do not have to pretend to like people I work with, I can tell them if I think they are full of crap, I don’t have to play the game any longer.

I am getting ready to hop on the red-eye tonight bound for the mainland. They did not have an upgrade option online, but I will ask the ticket lady and if its under 100$ I will pay for the upgrade. Free beer all the way back to the mainland. Free and or cost 100$ depends on how you look at it. I have found this new joy of drinking beer on the plane. I don’t know where it started, but they had Heineken for 5$ and I was like “Engh, might as well try it out” well, let me tell you, its fantastic to drink a beer and know that you are flying around at 518 miles per hour. Its like you are being carried somewhere, but more perhaps because I have such a strong aversion to drinking and driving, this touches that and it is scandalous.

Overall, I have not enjoyed this last rotation, but looking back over the year+ that I have been out wondering the desert of life, this experience has been AMAZING! I met some of the most amazing and loving people that I ever have, I got to see places that I never dreamed of going to. I have seen and engaged people in their pain and in the struggle of living life. This little stretch of time this summer will be the longest block of time that I have continually been at one place for more then a matter of weeks.

I found out today that I ship out for the Navy on 11 September. I will take the board exam on the 28th of Aug two weeks after that I will be in Rhode Island for 5 weeks, then off to Guam.

It is coming at me fast and strong now. Life. Can you taste it? It smells of freedom and adventure. Of being on an island in the south pacific, of being a plane ride away from Fiji, Wake island, Palau, New Zealand, Australia, and Thailand. The world is in front of me. It is unwrapping itself like an orange. Not one of those with the thin skin, but the ones that have a good ¼ inch of peel that you can just rip away. I am a kid in a candy store and am very excited to see where the wind will take me.

Fair winds and following seas my friends. I will see many of you soon.

M@

"It happen'd one Day about Noon going towards my Boat, I was exceedingly surpriz'd with the Print of a Man's naked Foot on the Shore." - Daniel Defoe

2009-06-20T15:35:00.000-07:00

Last weekend on this island for the now. I might end up on a different island again, but for the near future, I am quite excited to head back to the mainland. I am afraid that I will be cold. It’s a little odd now, I put pants on and my legs get all sweaty. I take my shoes and socks off at lunch because I don’t really want to be wearing shoes. I have tan lines on my feet.

This morning I woke up and picked a papaya off the tree in the front of my house. My breakfast consisted of a papaya, a bowel of lucky charms and a powerbar. I found the lucky charms on the road last week, it had fallen out of someone’s grocery bag on the way up the big hill by my house and rolled all the way down to the bottom. I rescued it from the edge of the road.

I have become a bit of a scavenger as of late. I found a red bungee cord on the beach in ka’ena point state park, that was cool because I could attach the body board that I found behind my house to my bike and ride downtown to play in the waves in Waikiki. The world is full of interesting things, you never know what you will find. I am reminded of the line from Cast Away where he talks about never giving up because you never know what the next tide will bring in. Perhaps there is a bigger life lesson here.

Some days I want to be like the guy in Cast Away. When I was a kid I was always extremely jealous of Swiss Family Robinson and Robinson Crusoe. When I went to Disney land for the fist time and went in the tree house, it was bitter sweet. It was amazing, but sad. I loved it, but it was fake, all fake. It was like learning that santa was not real, or that your parents are really the tooth fairy.

Perhaps some day I will be able to live on an island and make my own tree house. One can only hope. It will be much cooler than the stupid one in California.

M@

"They get a little nauseous, a little radioactive, but they tolerate it well, they don’t glow in the dark." Prof LaB.

2009-06-18T21:43:00.000-07:00

I think I had the best day that I have had on the island so far today. I did not have to work with the preceptor. I got to work with an active duty PA. He knows his shit and will actually tell me things. I listened to a set of lungs that had actual pathology in them. I never thought I would be so excited to listen to someone tell me about how they have had a fever and headache for two days. Ahhhh. I LOVE family medicine.

This is “community medicine” for me. This system is a failure of everything that is community medicine. I struggle for hours and hours trying to understand how I am benefiting my community by doing what I am doing. I still don’t understand.

Much of the rest of this job has been to do occupational medicine. What that means is to do return to work notes, annual physicals to check on lung cancer. Its odd because if you order a CBC and Lights on 500 guys, how many abnormal results do you think you will find? I love waiting to find out what my preceptor will use as an explanation. My personal favorite so far is “You have 125 sugar in your urine because you drank two regular cokes two days before the urine was tested.” We did not have a blood sugar on him, but I remember from some lecture about there needing to be more than 300+ glucose in the blood before it will start to spill into the urine. Uh, I don’t think that it is good to have sugar in your urine. Just say’n.

Today was very different. The PA that I was working with was fantastic and knowledgeable and no shit was even willing to talk about pathology and why he thought what he thought. Imagine that, explaining your thought process and perhaps even offering tips on how to improve your exam to be more precise.

Often at the end of the day, many preceptors will ask you if you have any questions about what happened that day. Vast majority of the time I say no. Granted, I sit there and look like I am thinking about it, and nod my head like I am running through every person that we saw that day and thinking about them. But its all a show. I don’t ask questions.

Today, I asked questions. I asked questions about life as a PA in the Navy. I asked about job ideas, about recertification, about the roll of the combat PA, about career progression, about life. It was good, I had to stop myself after a couple questions and check to make sure that he was still really OK with answering questions.

It was good. It re-affirmed my desires to do what I am doing. I want to be a PA in the military not for a specific goal, but for a life goal. I feel that we as citizens of the US have asked our men and women in the military to fight our wars. I feel that we as the medical community have a responsibility to share some of the risk of that fight. To take the risk so that someone can come home who may not have been before my interaction with him/her. THAT is a noble cause and I will pursue it.

M@

Pursue life, now.

2009-06-14T16:57:00.000-07:00

My friend asked me if my 30’s are less full of angst than my 20’s. I don’t know that I am in any kind of place to comment on what my thirties will/are. But in the 4 months of being in my thirties I have found a few things, so here we go.

My answer to her was that I don’t know that they are less full of angst, but they seem to be filled more with hope and a drive to accomplish. For much of my 20’s something would fire me up on a sole level and engage me, but I would get worked up over a lot of things. I have not been doing that the last few years. I blame school. This whole PA thing has taken some of my fire. I hate them for that.

Perhaps its life? You get a bit more tame as life progresses? I don’t think that is how I will go out. I don’t think that I will fade away, I fully plan on going out in a blaze. I fight against anything that would pull me away from the fire of life, but I am also a sell out. I sell out my ideals and my passions in the pursuit of this bigger thing of life. I say “sell out” but its life, you have to compromise to make any kind of forward progression. Perhaps that is the curse of getting old, you become complacent and start to make compromises that you don’t have to because it is easier to do so than it is to fight the system.

The answer to my friend’s question of angst seems to be this. That I still have my angst, I still get fired up about life and about the failures of our system, about the oppression of people, about the abuse and mistreatment of others, but I am starting to see that the way forward is to also identify ways that I can alter the course. It’s the big question that always comes up when I think of the crap of the world that happens around me. “What can I do?” The answer is SOMETHING. Find a way to fight against the wrong, find a way that you can do your part to fight the system of oppression. If enough of us push a little that becomes a BIG push, a big enough push to make a change, to change the world.

I have been so conflicted as of late, I am conflicted because I am surrounded by conflict. Not overt conflict. Its not that people are fighting in the streets with pipe bombs and tire irons, but conflict is here. Its just below the surface. There is such an effort here to keep the ugly side of life polished up. I guess it is a testament to advertising. This place is billed as a paradise that you can come to and its all beauty and aloha. But the ugly side is that its also a magnate of human misery. The homeless about and are carefully herded into specific camps and locations where they are away from the roads that the tourists travel on. I see them.

Now the question, I have built up enough angst in me to get fired up and pissed at the people that oppress and abuse, but I also have no small share of piss to toss at the people that are just sitting in this situation and accepting it. Get up! Do something! Its hard. How do you live life and provide for the basic needs in a system that is set up to profit the people who have on the backs of those who do not.

I think that is what I am upset about. There are solid options that are open for people to dig out and “survive”. But also it is important to know that “survival” does not include the Cadillac or 5-room house with in ground sprinklers.
It is important to also understand what is happening and not force our “solutions” upon people who are fine and dandy staying in the situation that they are. One of the most important things that I learned from Darby is that “The enemy of good is better”. Don’t force a solution upon something that is good, you may very well break up the whole thing.

It’s a balance between empowering people and rewarding hard work. I guess it’s the basic right of “pursuit of happiness” you are not owed happiness, it’s a right to be able to pursue it. The rights of life, liberty, and the pursuit of happiness.

How do I empower people to pursue happiness? I give opportunities, I don’t have to pull them along kicking and screaming. Just offer a hand if they want it.

M@

STUDY NOW!

2009-06-06T13:08:00.000-07:00

I got to hang out with one of the PAs that worked at a clinic that I was student-ing at a year ago. He and his wife are out on the island for a bit of a vacation. It was cool to just chat with him and catch up. Its different to talk with a guy who is the same age as I am, but is a few years ahead in the whole PA game.

I am starting to feel tired of being here. Perhaps its tired of what this place represents, I have to fight myself to keep my mind focused on this being work, that there will be time enough to play, but that is not today. Today is for the brain. Today is for the future. I am motivated to study, I need to harnes that and sharpen myself for the future. I dont know where this motivation came from but I need to use it up before I loose it and become a zombie again.

M@

Why I hate the man

2009-06-04T18:29:00.000-07:00

I got SUPER pissed at The Man today. I was at the NCO club on base here and just chill'n using the free internet computers. Some lady comes in and tells me that I have to move my bicycle. The base commander drove by and did not like that there was a bike locked up to the light pole out front of the club.

The stupid thing is that there is NOWHERE else to lock up the bike, its not like there was a bike rack and I was just being a dick and parking my bike wherever I want to. So I ask "where would you like me to move it to?" Answer: "I dont know, there are not any bike racks here, you just cant park it there." Stupid ass. I hate them all now. Grrrrrrrr.

Some days I hate the system. Ok, MOST days I hate it. But I also hate that I give into it so easaly. Sure I bitched and moaned about it, but what did I do in the end? Move my bike with my fat ass on it right away from there. They are holding all the keys and they know it. So what if I dont want to go there and get their stupid 1.60$ beer which is the greatest joy in my day. Who looses??? For sure not them. Its one of the biggest things about fighting the system. I usually dont want to do what they want me to do, but if I dont do it, what do I do insted??? They have a courner on the market of things to do, it IS a military base and they sorta own everything.

I am such an odd mix. I love the conformity of the military. But in the same way, I HATE it and have to fight it. Its like being in prision. I have to fight in little ways that are just bairly outside the "correct" way of doing things. If they say that your hair has to be less than 1" long. I will go through a lot of effort to make sure that my hair is 1.25" long. Just so that it is a wee bit long, but close. Its almost as if I need the system so that I can fight against it.

I dont know what that means.

M@

Just one foot infront of the other.

2009-06-04T17:00:00.000-07:00

I went on a little bit of a hike this last weekend. It was FANTASTIC!!! Just to get out and to see the world more then 10 miles away from base camp. But I did rent a car for the adventures. I even got to swing on a vine across a ravine when I was running away from the five-OH. Ahh, good times on the island.

I have been wondering a lot today about what it means to work in America. I am deeply troubled by conflicting emotions and thoughts. I work in "Occupational Medicine" for this 6 weeks.

Let me get on my box for a moment, but this could be one of the most frustrating rotations EVER! My preceptor types at 12-14 words per minute. Well, I dont know that for sure, but he hits the space bar about 12-14 times per minute so I am going by that. The thing is that at that rate, it takes an awfully long time to try and type up a note. Grrr.

Well, my time is cut short by the CO of the base who evedently does not like where my bike is locked up, so I am going to leave now. Humm. Stupid rules.

2009-05-28T18:02:00.000-07:00

I have this love hate relationship with Golf. I just started to really enjoy the sport. I LOVE walking around a nice little park and sorta pretending to play a game at the same time. It fills two of my needs. A need to be outside and a need to play some sort of game. What better I thought. It really saved my bacon last rotation when I was freaking out in the ICU and hating life. I could get out of work and be on the golf course in less then an hour. It was so calming to be able to just put around a nice grassy area and not care about life or work for a moment.

I was pondering something different this past week. I am now in an area where space is at a premium. Land is so hard to find here. People just keep building and building and building trying to just make space for someone to live. But now we have all this space dedicated to a game that only a few people play. How does that work???

As soon as I say that, I see a flaw in my thoughts. If I say that green space should just be used for homes. What happens to parks and anything else nice and non-developed? It gets mashed into a homogeneous subdivision. Ugly to the max.

There is an ugly side to this island. The more I am here the more I see it for what it is. Ugly mixed with beauty. Guess thats the way it is with a lot of things in life.

M@

Whats in a name?

2009-05-26T21:05:00.000-07:00

I decided this weekend that I want to change my title. One of the things that the military is great about is that everyone gets a cool title. When I was a mechanic. I was not a "mechanic" I was an areospace ground maintenance craftsman. I mean thats a cool title. But what does it really mean? It means that I was a mechanic.

I want to be a Community Health Care Activist. We all have some responsability to the community that we find ourselves in. I want to advocate for people to be healthy. I want to stop the polution of our people with poisons and junk. Not all of it, but like anything it just takes some moderation. I want to advocate for people to be healthy, to live healthy/happy lives, and then to die a good death.

It takes more than just working in an office a few hours a day and making a buck. I want to take this crap that I am hauling around in my brain and take it out to people who dont come in for health care.

Where did the idea that the sick must travel to us come from? When did this happen? Jeasus? Guess he did a little bit of going out and waiting for people to come in. But the idea is that we need to enguage with people in the home, talk to them about the food that they have. ADVOCATE for their health FROM THEMSELVES! We are killing our bodies. Somewhere along the line our food stopped being food and started becoming something else, a consumable. It can be eaten, but should it?

My new approach to telling people about food is this "Eat food, if you can dig it out of the ground or pick it off a tree, than its probably good to eat" Seems simple enough, but try it. Its harder than you would think.

I will take medicine to the people.
I will not make the people come to me.

M@

2009-05-25T16:36:00.000-07:00

What to say about all this fun in the sun out here in Hawaii? Part of me loves it. But another part of me does not enjoy living the island life when I am constantly made aware of my "otherness". Its just odd to think about being the only white guy in my house, or block for that matter. I have been pondering what it means to me. I was asked if it bothered me. Being the only white guy. I dont know that it bothered me. Its just not my normal state, I am normally surrounded by many people who look quite a bit like me. I dont look very Hawaiian. I dont speak hawaiian.

The difference was made very real to me yesterday when I was crusing on the bus to go down to a different side of the island and go snorkeling there. I was back among the whit/burned red people as soon as I made it downtown. There is a line. I cant see it, but I can feel it. There is such a difference between the "tourist" area, and the "local" area. I happen to live in the local area and am quite happy with that. But I am starting to feel the strain of living in a place where everyone is scraping by and looking for money.

The industry here is tourisum. Like it or not, I am a tourist. But I hate that I become a commodity. I become a mark to make a buck off of. I dont feel anger towards anyone particular, more anger against the system that sets these people up to have to survive leaching a living off the visitors to their home.

There are so many homeless people here. I got to chat with one a bit. He was saying that for most of the people, they choose to live on the beach and have a car. Others choose to have a home but no car. Both are so expensive here that it becomes a choice between the two.

I chose the room and bike option. Its great to be able to ride the island on my beach cruser. Good times.

Salud!

MS

2009-05-07T16:21:00.000-07:00

I have been pondering the impending trip out west. Pondering is the wrong word, excitedly anticipating the return out west. I got my covered wagon all tuned up and have an extra wagon wheel just incase. I got my ox checked out and packed up enough food for a “strenuous” pace. Needless to say I packed up my sling shot to hunt for extra deer or bear along the way. I love the bear because they are slow and you get a lot of pounds of meat out of them. If something bad happens, I plan on hunting a lot and trying to trade up to purchase an extra axel or wagon tongue. But in reality, I think I have enough power-bars to last the duration.

It makes me a bit sad. I have made some FANTASTIC friends out here on the east coast. I never thought I would. Its actually making me a bit sad to think that I wont have parties to go to every week and friends to cook dinner for. I dream of the day that I can unpack the wagon and actually have more than 5 tee shirts. But how petty is that? How many people live in a state of not OWNING 5 shirts, but I gripe and complain about having to recycle my shirts every week. Some days I feel guilty over life.

The last few weeks here in the ICU have not sucked to the point that I have hated life. I still am not a fan of this type of medicine. But I am surviving.

I feel that I have found a hole in my education. When I work in primary care or Fam Med, I feel that I am competitive. Not totally competent, but competitive. I can answer questions that people ask me, I can usually come up with good answers and even have reasons why I think what I think.

In the ICU, I do not have that comfort of competition. I suck, rarely do I have good answer, much less anything more than a total guess. But all that changed this week. This place rotates on a 4 week schedule. What does that mean to me? We got a new crop of interns Monday. The cool thing is that the staff docs only have 4 weeks worth of questions. So now they are just repeating themselves. ITS GREAT!!!! I know answers! I wonder what it would be like to be able to do all your hard rotations twice? I don’t want to because there is a chance that it would just suck for 12 weeks as opposed to sucking for 6. Humm. Tough call.

I feel the strain of this mental marathon starting to weigh on me. Senioritis? Perhaps. It funny to hear the docs talk about hating clinic. The thing that I continually think is “OH how I wish that I could get back to seeing clinic?”

I may very well miss this place. I will miss the people, not the roads or the drive into work, but the volleyball, the food and fun that I was not expecting to have out here. But the itch of travel is once again upon me. I wonder some days if I will ever just “settle down” and live a normal life, but that seems so darn boring to me.

Part of me does not really even care where I go, just that I go. Perhaps I am part salmon? I just feel this undeniable primal urge to migrate. But unlike the fish, I don’t have a real specific goal in mind. I am so very excited to go home, to see my family to be bugged by their funny quarks. I miss Portland and the max. I miss coffee shops that are not starbucks, (nothing against SB) there are just TONS of mom&pop shops out in the Oregon territory. I miss my Jim & Pattie’s coffee shop in NE Portland, I miss the habanera mocha, the coffee cake. I miss it all. But I will miss this place as well.

Hopefully I will not die of dysentery

See you on the trail.

M@

almost got em.

2009-04-16T15:26:00.000-07:00

So, what has happened? Things were different today. It’s a bit as if the sun has risen on the battle field in the Lord of the Rings. It was dark and dreary; I had no hope. I was afraid. All I saw was the darkness and stench of death that I was wallowing in. I was afraid that all that I had worked for was for not. That I would fall in the last hours of the fight.

Overly dramatic? Perhaps. That experience brought me to tears. I had to call friends and beg of them to listen to my sorrow. To be told that I am not a horrible person. That it was not a good situation. Then I had to eat some fudge, drink a few beers and eat some hot wings. Once I had slept on it, it did not look so black this morning. I still dreaded the drive to work, it made my stomach turn to walk back into the ICU and smell the same smells. BUT. Today was not bad, today I feel like perhaps I even got a chance to help someone. I helped two people leave the ICU today. One of them even knew who I was. Its odd that of all the people that I help, most have no clue who I am. Most are delirious or have some stages of dementia. I don’t blame them. This place literally drives me crazy and I get to leave after 10 or so hours. I get to go home and sleep some without the incessant beeping, binging, bleeping, winging, blinging, and not to mention some random person coming in to wake you up and check to see if you are sleeping OK. This place is a nut house. No as in a place that you would want to buy some hazelnuts, or almonds or pecans. But the other kind.

People walked (sorta) out of the icu today. Despite our best efforts, we did not kill them. It looks like two people may make it out alive. I will be sure to try and update you if I can.

The good death.

2009-04-15T15:49:00.000-07:00

Its hard to describe how I feel right now. I want to try, forgive me if this gets a little discombobulated.

We extubated the old gomer. Dr. Kill feels that we “got so far down wiggie lane that we don’t know our arse from a hole in the ground”. Which I promise sounds much funnier when its said with an Irish accent. But I still don’t know what that actually means. I know that we were in a bad way, “we” had intubated a guy who did not want to be. Now what do we do with him? Well, we took the tube out.

I have seen people die in a wide range of ways. I have seen people that have burned to death, been shot, been stabbed, been in a car wreck, air plane crash, perhaps others that I cant think of right now, but those are the ones that stick in my head. Actually only a few are stuck in my head, the others are fuzzy memories. None of them ever bothered me. I remember thinking that it was odd to not be bothered by my first one; by the sight of a burned and mangled body that was a person at one time. I remember his face and eyes when he actually died. But it seemed good in some messed up way. He was horribly hurt, he should have died. It was “right” that he died. Even though he died a violent death, it seemed like the right thing.

The gomer’s death is not right. There is nothing right about it. It was violent and un-natural. I watched him dieing. I left the hospital and went home. I went for a run and was pondering on the run about what this was, about what I was feeling. The thing that makes me stop and just never want go back is that what I really wanted to do was to go back and take a big dose of morphine or epi and just put the guy out. I wanted to kill him. I wanted for him to die, to just slip into a nice peaceful sleep and not wake up. A movie death. Anything except what was really happening to him.

Part of me is really in turmoil over this. What do my desires say about me as a person? I feel HUGLY guilty over my thoughts, yet they are what they are. It was a huge and primal thought process.

No, I am not cracking up in a bad way but this experience has changed me. I don’t like the ICU. I feel somewhat like the garbage man of a hospital. Send me your trash and I will make sure that they leave in a nice neat bag.

Humm, no, I am not bitter at all.

How would you describe yourself? Tell me.

2009-04-14T18:15:00.001-07:00

We got a new attending doc today on the service. Lets for the sake of HIPPA call him oh, I dont know.... Dr. Kill.

Let me set the scene. I went in silly early in the morning because unlike the Turns/Rez. I dont work the 30 hour shifts. So I come in at about 0530. Get in early and I see the old gommer who I thought for sure would be dead by now still up and on the vent. I am getting the X-rays up on the screen and ready for the rounds to start. A nice old guy comes up and it turns out that he is the new attending. First question that he asks of me is "How would you describe yourself? 1. A healer 2. A palliator 3. A benevolent executioner"

I said that I was not a healer. The more I work in this whole “medicine” thing, the more I realize that I really can not “heal” anyone. I think that it is wrong to think that I cure anything. I don’t. I don’t think that the medical community offers a cure. We can aid the body in defense or make you feel better when you are sick, but cure, I don’t think we do that much.

I don’t think that I am a benevolent executioner. I would hope to avoid that if I can.

I do think that I am somewhat of a palliator. I try and alleviate pain when I can, try and not inflict any extra for no gain. Really, I feel that the profession of medicine is about palliative care. Perhaps this idea that “we” in medicine NEED to cure, we need to heal the person’s illness. There is a constant pressure to perform to the ER standard. To do chest compressions and shock the person and they will cough a couple times and then get up and walk out the door. That is not reality. Real life is that people all die, it just depends on what that death looks like.

It makes me sad that the guy is still on the vent. Last week when he came into the hospital there was a horrible thing that happened. Its messed up beyond my explanation how a man can come into the hospital with a valid DNR/DNI. Fill out ANOTHER one in-house so that we have a full copy of his wish to NOT be intubated right in the front of the chart and now he is “living” on the vent. It makes me sick.

Damn.

2009-04-11T06:31:00.001-07:00

I am stuck in a place of being very uncomfortable with my current situation. Its not that I don’t “like” the people that I work with. I just don’t like working in the ICU (intensive care unit) during part of the intro I learned that 20% of deaths in America happen in the ICU. I may vent and say that I don’t like it, but it’s the whole situation. Perhaps it is just right to say that I don’t like it. Grrr. I don’t want to say that I do not like it, but I don’t.

A few days ago I got to meet an old guy who came in because he could not breathe. Classic COPD, old military vet, big chest, no lung space. Looks super bad on chest x-ray, all full of fluff and fluid, his heart is big (not a good thing). He has a DNR/DNI its an order to not do chest compressions or intubate him. Its fairly common, lots of people do not want to live life hooked up to 20 machines with a big tube stuck down their throat. Well, during morning rounds, he was crashing, he was at the end, he had had a HUGE heart attack and his lungs were filling up with fluid because his heart could not keep up any more. We all knew that he was a DNR, we had spoken with him many times during the night and he was very adamant that he did not want tubes and mechanical ventilations, he did not want chest compressions, he did not want to be shocked.

The head doc who had just come on shift comes in and tells him that “You have had a big heart attack, the only thing that we can do to help you is to put a tube down your throat to help you breathe. Is that what you want?” The man agrees and we intubate him.

He is now “living” with a tube down his throat, one in his nose, two lines in his arms, an arterial line in his wrist, and a central line in his femoral vein. We have 8 different drips set on him. His lungs are shot, his heart is not working, his kidneys are shutting down, and he has a massive infection.

The more I think on this, the more it bothers me. Sure we “saved” his life. But is that a good thing? The man was drowning in his own lung fluid and could not breathe! What did we offer him? The only thing to do is to put a tube down your throat. What the FUCK!? Of course he would take that. I will never forget what it looks like to watch a man drown in his own lung fluid. NEVER. Its not a good thing.

The thing that has been bothering me is that we did not offer an alternative. All the interns and residents KNEW he was DNR. He was 86 years old and was OK dieing. He did not WANT to be tubed and have a billion lines run into him. I wish that we could just do it over again. What if we offered him some morphine to make him comfortable and just let him go??? But NO, we have to push and push and push and sell him a fucking tube. Who would be strong enough to say no to that?

I would not be.

I did not think that I would be this angry over “saving” a life, but I AM! I hate myself for being part of this system. I feel dirty.

2009-04-05T08:45:00.000-07:00

I am using the free wi-fi in PDX and happy that it is such a beaUtiful day outside. Sad that I get to spend the day in a metal can. I got to have some really good conversation with Frank as well as Rick&Sal. It was all too brief and that makes me sad.

I keep pondering how/what I will do when I grow up. I have this dream to be able to take all this crazy knowledge and skills to people who really need it. But what does that look like? Battery dead. ....

RIP orange hat

2009-04-04T18:59:00.000-07:00

I ran that whole rotation with one entry here. Sorry. It was a LOT of fun! I had some of the best experiences in Cardiology. I truly love it.

I have been back in Oregon for the past week attending a professional seminar. It was actually much better then I thought it was going to be. I am actually not even upset about the huge waste of time and money to fly back here. I did get really sick the first part of the week and have actually lost 10 pounds over the week which is scary that I could get down that quickly. I feel that I might even classify that as an "unexpected recent weight change" on my review of systems. I want to thank those who got me some ginger ale and generally took good care of me. I apologize to those whom I may have infected with whatever plague this is.

I am struck by how quickly this bug took me down. The thing that struck me more then how badly it hit me was how badly this might impact someone who did not have an extra ten pounds to loose. There are just so many people who live life on the fragile edge of health where the drastic loss of a weeks worth of food might really hurt someone. Again, I am stuck in a constant struggle with living my life, yet living life in the world. How do I engage the world?

Perhaps it is that I feel the end of this phase of formal school drawing to a close. Soon I will be called on to apply this vast sum of knowledge that I have been accumulating. I will be heading out to a small island in the south pacific to work for three years. I am excited to see what there is to see and I feel that in a way it is my journey. I will head off into the unknown. The adventure is around the corner. It is so near I can almost taste it.

Health.
M@

2009-02-18T14:30:00.000-08:00

My computer battery is quite dead, I get about 43 min off a full charge. Bummer.

I am working in cardiology now-a-days. Its quite a change from working in fam med or most any other place that I have rotated through so far. But I absolutely love it! I think that they get cool titles like “interventionist”. Granted that took them a heck of a long time to earn that title so I guess you should get a cool title after working so hard for it.

I got to poke a line into a guys femoral artery today. Cool. There was blood everywhere. I lost cool points for sure but the job got done. I think one of my favorite things is when someone asks you a question, you don’t know the answer so they explain it to you. Half an hour later your preceptor walks into the room and asks the very same question and you get to answer like you know what you are really doing. Ahhh, I love that feeling. I don’t even feel bad about it. Granted I give the appropriate wink to the CV tech who spilled the beans and actually told me the answer. Its our little secret.

I was passed out sick yesterday. Not really sure how that happened, but I blame the 72 year old guy with bronchitis that I saw last week. Ever walk into a room and just KNOW that whatever they have is going to attack your immune system? I was standing in the corner trying to breath through my coat just to try and keep his germs at bay. Bad form I know, but I just KNEW that he was going to get me sick. I am not sure which is worse. Old people germs or kido germs. They both seem to be big Petri dishes for interesting bugs.

I got home yesterday and went straight to bed wrapped up in a blanket and did not really wake up till 630 this morning. Ugh. I think its much better now. I probably was spewing virus all over the poor guy in the cath lab but hey, at least he has good arteries now. Or at least better then they were.

6 months. 6 Months.

M@

Odd things to hear on your rotations in PA school.

2009-01-27T18:21:00.000-08:00

1. "You might ask how an MD can get two confirmed kills, well, welcome to the new war in Afganistan" ~ER doc

2. I went on a little run today, and the Marines were out storming the beaches of NC. So, there was mortar practice today. Nothing quite like the sound of an M252 with mini charges when your out for a post-work stroll around the block.

3. Yesterday was an M-60 day.

4. They fly the silly little bastard child ospreys. They are not really helicopters, they are not really planes, they are sorta some of both. Honnestly they look goofy. I just dont like it. They have no tail rotor. But I did my Forest Gump run today, I ran from the hospital to the O club, and they have a dock that runs out 100 yards or so into the bay, so I run out to the end of the dock, stop and turn around. Today a flock of the V-22 went flying past me out on the dock. They make a different sound, its not a helo sound.

“It's high time you were shown/That you really don't know all there is to be known.” ~Dr. Seuss

2009-01-16T20:26:00.000-08:00

Somehow it has become OK to dump your problems off onto someone else. Perhaps it has always happened and I just am ignorant. I admit that about every day I learn something that I just need to know more about, not that I know something or even that I am close to knowing something. Often I feel as though any sort of smarts I might have accumulated during academic school somehow leaked out of my head in a hard night of drinking and that I just dont remember that party.

But I got to deal with something else very new to me today. I wanted to be sad about it, but it really made me angry. A person left her mom in the hospital. Checked her in, she got admitted and then would not come pick her up. Unfortunately it does happen to people more often then not, I have seen the reports on how mentally ill people are given a taxi ride to the local shelter. It made me so mad at the time, but I felt the pain in a different way these last few days.

What do you do with a pleasant but demented woman who had a stroke and does not remember much except that the black man who drove her in the taxi really scared her. In fact all black people scare her, but in her words: "Its not that I have anything against black people... But..." Funny how that usually comes before an insult. Geeze. I dont even know where I was going with that rant.

But really, now this woman is admited to the floor because of masive diarrhia and UTI and a laundry list of other isues. But when we call her daughter to come pick her up when she is all better, the daughter says that she is not coming back, that she cant take care of her mom. I am reminded of the song line : "You dont have to go home, but you cant stay here". Thats really what I felt like. I was supposed to find a way to get rid of her. But where do I put her, she has no fam, her daughter wont take her back because she does not want to get shit on her nice white carpets! RRRRREALY? Thats why you dont want your own mother in the house? Because of your white carpet? Humm.

It took two days of calls to convince this woman to take back her own mother. If I ever do that to my parrents, someone shoot me.

M@

"Jesus, Joseph and Mary. These Hmong broads are like badgers. " Grand Torino

2009-01-11T17:17:00.000-08:00

I walked up and down the beach a bit, the odd things are that the shells are very different on this side of the continant. I guess I am just firmilure with the ones that you would find on the West side of our island. The East side has odd things like horse shoe crabs and VERY thick shells. Could have been a bivalve of sorts, but the shell was a good 2-3 cm thick! Very odd, and I found the top part of conch-like shell, but again was a good 2 cm thick. I found an old washed up tire a mile or so from where I started my walk, so I decided that on the way back, I would take it with me and do my good turn for the day. So on the way back, I took the tire with me, and rolled it along the beach all the way back to where I started and there were some trash cans there, so I left it leaning against one of them. YEA for me!

I went to the local aquarium today. It was really stinking cool! I got to chat with the girl at the front desk who is a huge turtle fan (go figure she DOES work at an aquarium). But found out about joining a cool group of people that all work to help save the turtles during hatching season. I am going to join up and stand guard over a turtle nest!! How exciting!

FUBAR

2009-01-09T18:02:00.001-08:00

SHIT SHIT SHIT SHIT! Not good, really not good, really bad. Getting worse. The only thing that saved me was that I was ignorant of much. I think I would have freaked out a bit more if I had known right away what I know now. But I guess that’s learning right?

I have often wondered about how we talk to each other. I noticed something today, made a bit of a connection if you will. When we have to give bad news to people, its so much easier to use the “we” term. Perhaps I always thought that was a bit arrogant, but no, I don’t think its arrogance, I think its because its such a hard thing to try and tell someone “bad news”. There are different levels of Bad News to give to people, I have done the “Your dad may well die”, “This does not look good”, “this is a bad kind of cancer”. Today’s bad news was a bit different. Luckily I did not have to do much talking. Lucky because I don’t think I could have made it through without breaking down and balling like a baby.

All started off as my first solo approach to abdominal US for the first OB check. I was happy as a clam when I found the uterus, and even found the little peanut in there. But then the rez sorta took over and we measured it out, it’s a couple weeks smaller then where it should be. But the big problem was the heart was not beating. Sad.

Clinically I know that it happens, I can distance myself from it, but trying to tell a mom that her fetus is not “alive” sucks. I don’t care where you fall on that whole abortion thing, but telling a mom that she is not pregnant when she really wants to be is about a shitty experience.

M@

"its funny what a young man recollects"

2009-01-05T17:49:00.000-08:00

So, another new place, I thought I had gotten over being worried about new places/faces. But nope, got all the butterflies and everything on the way to work this morning. REALLY REALLY morning. I love early AM more then the next guy, but something about working on a Marine Camp makes you get up even earlier then normal. But the cool thing is that there are running trails and pull up bars EVERYWHERE. No kidding its actually really cool, perhaps I will get all buff this rotation (although I keep saying that EVERY rotation). I already lost a good 5 pounds of sideburns and hair to get back to some sorta “clean cut” look. It feels good to get back to high-speed-low-drag.

Marines are interesting critters, they spawn interesting things such as a store where you can get a tattoo, a haircut, and buy porn in the same store 24 hours a day. Who knew that you might really need to get a hair cut at 0430? Or get some ink done at 0513?

Marines seem to be herd animals, they travel in packs. They go get hair cuts together. Like an outing to get a burger and fries, but they just cut their short hair to super short hair. They are sorta like girls, except for going to the bathroom, they are going to the 24 hour barber shop.

M@

Maritime Strategy

2009-01-05T16:52:00.000-08:00

Good news!!! So, I learned something new today (not surprising) but what I learned was very interesting. I learned about a new strategy that the military is working on. Its actually “old news” came out in late 2007, but I just learned about it now and that’s because its starting to actually trickle down to the normal people. This was a big pow-wow with the head generals/admirals of the coast guard, navy and marines. What they came up with was this fantastic idea. We need to work harder on winning the peace.

It’s a simple idea. What came out of this meeting of really important people is that just winning the war is not good enough. That it needs to be at least as important to win the peace. The big goal of this strategy is to within the next few years be spending at least as much money on peaceful goodwill missions as we spend on bullets and bombs. Dollar for dollar. 50/50. What an amazing concept!

This is not a politically motivated change, its not being pushed by a politician in DC. This came out of these great navel strategists who found out that its not enough to be able to project force and beat someone else into submission. We also have to be able to project good will and help when that is needed. I know its an odd thing for military people to be contemplating but its one of the key reasons that I am still involved with the military. I want to be able to help people when push comes to shove.

This radical change in strategy is from lessons learned from the tsunami in 2004. The US Navy and Marine Corps were some of the first people to roll into town and we worked really hard to bring in TONS and TONS of goods and supplies and went to work right away building, clearing and cleaning. We activated a whole MEU (Marine Expeditionary Unit). These units are normally stationed around the world and are a whole group of really supper motivated people who can float into town, build a whole base and fully support it within hours of being activated. We change their mission quite a bit and had them helping people as opposed to forcefully kicking down doors and clearing landing strips but they did an absolutely AMAZING job.

We floated in hospital ships and set up a better level of care then many of the people in the country were used to prior to the tsunami. It gives me warm fuzzy feelings just thinking about it. We also noticed something from that encounter. That country liked us about 14% prior to this, after its at about 86% and its staying there. In other words. We made a friend. Someone got punched in the nose and shoved in a mud puddle. We put a band-aid on them, brushed them off and set them on their feet again. And now we are buddies.

So perhaps we can make more friends, perhaps instead of being a bully that pushes our will on others we can also become a powerful force of good. Granted this is a military strategy so its somewhat simplistic in that it’s a vague idea of a direction to move in. But it gets me excited just because its real. Its turning into more then just talk.

The closing words from my Captain. (BTW, Captain in the Navy is not the same thing as a Captain in the Army/Air Corps, took me a min to figure out why it was a big deal that “THE Captain” was coming by) He pulled me aside and we chatted for a bit and he really does feel that there will be a HUGE place for PAs in the future of this strategy. We will see what happens.

What do you think?

2008-11-23T04:43:00.001-08:00

So, I found this house out in the middle of the bay near the last island wildlife reserve. I was wondering down the "trail less used" and it ended at this place. I was COMPLETELY infatuated with it. Its a real honest to goodness house, but its 1/4 mile out into the bay. I should have found out more about it, but it was clearly not on the hand out map, and I dont think that I was near the normal trail that people tromp along in the park.

But my questions are this:
1. How much property tax do you think this guy had to pay?
2. HOW stinking cool is it to be able to live above the water in a nice little house?
3. There is a boat doc at the bottom, but what if your boat gets a leak? There is not really a path to the shore. Perhaps the old piers were a board walk of sorts at some time.

M@

Soup and Shoes

2008-11-22T16:40:00.000-08:00

YEA!!! I got to get out of the area today! I went to a little island today, I hiked all around this cool little island that has wild ponies on it and a big light house and MILLIONS of birds! It was awesome! The odd thing is that if you are wondering around out here on the east coast, you find these little old piles of house/foundation things that are really really old, it got me thinking about how old our civilization is out on this side of the continent. Perhaps only in comparison to the west coast where we are still on our first generation of most buildings. This whole area is steeped in history, its quite remarkable that we have made it this far without killing off ourselves.

I also got to work in a soup kitchen this last friday, I worked extra hours earlier in the week to get the time off and go in on my own. I say "worked" but really, I walked around and filled up people's cups with milk. Actually, I loved it just because I got to wonder around and talk with people. Probably one of my favorite things, I got to meet people with broken bones and people who had wounds and heart surgeries. Its sorta funny, when the people find out that I am working at the hospital, I guess its natural for them to want to talk about medical issues. Everyone knows someone who was hurt, or had some surgery of sorts. So, bottom line is that it was just cool to feel really connected with some people that I had never met before. I also got to hang out with some of host fam's friends, who have now become my friends and we went to a cool little pub called the Salty Dog. LOVE THE NAME!!!

M@

I do love the beach.

2008-11-16T15:22:00.000-08:00

This is almost like working in a free health care system. I have spent the first week in the ER out here on the east coast. I am working in fast track, which is sorta ER light as one of the (former) professors would say. I get to see all the people who show up in the ER with a cold, or an ear ache, or back pain for the last three months.

Its hard, it makes me a little upset, I want to say to them: "Why are you in the ER? Do you realize that you are making really hurt/sick people wait much longer as I try and take care of you?" Who wants to come into the ER for back pain that has been sorta bugging you for three months? Well, I met him. This is an odd mix of ER medicine, but also odd family practice complaints.

BUT, on a great note, I get to go help in a soup kitchen this friday!!! I am so excited, two of my favorite things, helping people, and cooking all rolled into one. Does it get better then that?!

On a sad note, I am really not a fan of people acting like the election is still going on. Give up, its over. Lets just get back to life as normal, take down the signs, stop being mean to people.

The next step in the journey

2008-11-10T18:12:00.001-08:00

So, I made it, but google maps did not account for hurricane force winds and several feet of snow in southern Wyoming and Nebraska that wrecked havoc on the road travelers. I had to divert down through Colorado to i-70 and then travel across the ENTIRE length of Kansas. Its a lot longer then I thought. And it is flat. Very flat. 3253mi. 66 hours start to finish. Average speed of 49.9 mi/hour. I smelled really bad by the end of the of it all. Some of the highlights. Its cold in Wyoming. Really cold. That first night the condensation froze to the inside of the windows and surfaces of the car. Good thing for 0 degree sleeping bags!! I was nice and tosty warm. I started my car from inside my sleeping bag to let it warm up before getting out of the bag. I stopped at the "Bobber Cafe" in Missouri, that was cool. And by cool I mean that was the first non-powerbar meal that I ate. So breakfast was good. I did not get the chicken fried steak. But there was a fine layer of cigarete dust on all the surfaces. I felt like I was in a bowling ally as a kid, where you see that permenent haze that covers everything.

The last day was a bit rough. I drove through West Virginia in the dark, that was sad, it looked like it was really pretty going though the appalachian mountains. But alas I wasted all the good sun light on Kansas. Why could I not have figgured that out better to not waste precous daylight on the flat state? Next time.

But I am here now. I am working in the ER and LOVING IT!!! Great group of guys that I work with and they really beleave in throughing me in the deep end. I said more then one silent thanks to Dr Bob and Baker for teaching me the basics so well.

Well, I get up at 0430 tomorrow to make the treck from the fabulous house of Rowan to the hospital. Much love to all you.

M@

I hope

2008-11-04T08:18:00.000-08:00

"I find I'm so excited, I can barely sit still or hold a thought in my head. I think it's the excitement only a free man can feel, a free man at the start of a long journey whose conclusion is uncertain. I hope I can make it across the border. I hope to see my friend, and shake his hand. I hope the Pacific is as blue as it has been in my dreams. I hope."~ Red

Last day of work in Peds/Med today. I have absolutely loved working here, loved working with the doc, the Pts, the staff. Really, I have not worked that much. But I feel that it evens out working way too much last rotation, and probably way to little this rotation. But it all evens out. I love that my doc would let me run at lunch, that he would offer more time if I wanted it so that I could run further or longer. I loved going out on the town with the docs from the clinic and just being normal humans. They are such good people.

But the joy of the current situation is also giving way to the idea and the dream of what is to come. I long for the adventure of tomorrow. I leave on an epic road trip. I have chosen to roll solo. I feel that it will be harder, but something profound by accomplishing it alone. Not all alone, I have several new songs to geek out on. The ipod will get quite a work out this trip.

I feel free from the obligations of life, it is me vs the open road, and I do not know what the end of this journey will be, but it should be fun. 3,002 miles, aprox 45 hours of drive time. I need to get some new window whipers before I leave...

M@

What time is it?

2008-11-02T11:03:00.001-08:00

So, I went back in time this morning. For real, I traveled back in time one hour!!! I have heard of such sillyness of people staying awake for the official “fall back” time of two AM. Well, I did it, so then 2 AM became 1 AM. Its all very odd. Somehow the law says that the time changed, so it did, so I got to go back in time. I got an extra hour of time.

Sorry for all you people who missed out on your chance to time travel, but perhaps you can next year.

Muhahahahahahhahahaha!!!

Laying down Layers

2008-11-01T09:27:00.001-07:00

So something happened since the last time that I was at OSU. Everyone got really young. REALLY young. I have not really been here in two or three years. But WOW! All the students got SUPER young. Scary. I know its not that I am a wee bit older. Its not that I have a good 10 years on them. No, clearly the people that they are letting into college are much younger then they were back in my day. But they are using the same O-Chem models that they used for me so that’s something at least.

An odd thing happened to me on the drive down here today. Something that might even be worth the effort of writing about. I realized today that I have had a bit of a shift in my fundamental thinking. For the last five years, I have been fairly destructive. What I mean is that I saw who I was, I was not really happy with that, and I started to peel away little pieces of myself. I felt like I had to pick them off much like a scab. I had to get rid of this false self that I had built around myself. I built it up for the first 23 years of my life and this place offered an opportunity to rip down those little pieces of my false self.

It was not destructive in a negative way that destroyed who I am at core. It allowed me to find out a lot of things about myself that I needed to know. It broke down things that I had just grown up with and did not know why I thought that way.

I hated much of the way that I grew up, I hated being pushed to live life in a set way. Perhaps its just a normal rebellion that all people go through in undergrad. None the less, it was a profound. I pictured myself as an onion. Pealing away a little bit at a time trying to find out who I was at a core.

The thing that happened to me on my drive today is that I reached a point of clarity. I decided that perhaps I have been destructive enough. Perhaps I have finished what I needed to in the super critical phase of my life. Perhaps I am ready to start to build around myself. Not to rebuild a false self, but to surround myself with layers of community that will be with me, help me be who I am as a person.

I really want a puppy. I NEED a puppy. That will be the first layer. Something to add to my personal little world community. Perhaps a fish, but no, I really think it needs to be a puppy.

But the idea is that I am OK with the idea of being very intentional about the people around me. It bends into also this dream I have to live a life that is open to being influenced by those around me. I want to be able to have people around me that will help shape me more and more in a better way. I want to live life open enough to those around me so that I can influence them in healthy ways, but they can also influence me. It has to be give and take. But there will be layers, some people will clearly be some people who will have a profound impact on me. Others will be a peripheral influence. Its dynamic, it can shift and change, the layers are not set. They change as people change and move and change locations. But there is beauty in it.

What does this all mean? I don’t really know. Its just a feeling at the current. Something small delicate, but there is power in the idea and it wakes me up at night because of the truth that is in it. I hope and dream continually for what the next step is. I can almost see the path opening in front of me. I guess I just keep moving. One step at a time, make the best choices that I can when they come up. Then see where it all leads me. I have faith that it will take me somewhere amazing.

M@

Why?

2008-10-15T06:32:00.000-07:00

So, the more I work in "Peds" the more I realize that old people (old is anyone over the age of 21) just are funny talking. So, one of the old patients that I got to work with yesterday had a list of complaints, it was one page, single spaced, 12 point font, numbered, the FULL PAGE. Complaint number 18 was in-fact that she could no longer use her L arm at the drive in. This one caught my eye mostly because well, she probably should not be doing much of anything at a drive up window. I hate hate hate hate hate drive up windows. I make a point that if and when I go to a place, I will park and walk the 25 feet into the store and make my purchase. It makes me feel better to have burned off the 5 cals that it took to walk into the store.

The thing that broke my heart is the very next patient was a 13 year old who weighed 186 lb, with a BMI of 34.4. I was so mad at her mom who was also morbidly obease. I was shaking by about 5 minuets into the conversation. It was a good thing that my preceptor was in the room because he provided quite a good sounding board to keep me calm and gentle. I wanted to scream at the mom "DO YOU NOT SEE WHAT YOU ARE DOING TO YOUR CHILD???!!!" You are killing her, poisoning her body and she is ONLY 13 YEARS OLD! But I also got to share my story with the young girl, I was not mad at her. I told her how I was so fat in High School, how I lost almost 84 pounds in a school year, how I remembered doing my first pull up, how I changed in the military and then at undergrad. How I was able to become a D-1 athlete, how I competed against other athletes. I hope that she can hear me, I hope she can see how she can change. I hope.

This brings up another thing on the other end of the scale. This story from local news. I dont know that you would want to read it, I dont want to, I want to hide my head from the people who would do this. People who would lock a kid up in a room and only give them half a dixie cup of water per day. How? Why? Why do people do such bad things? I just dont get it, it fills me with a mix of emotions, hate is in there, pity, sorrow, disgust. There is no happy, only sad.

http://www.katu.com/news/local/30891284.html

We kill our children, we are doing it on a daily basis, does it really matter if its by starving them and locking them in a closet or putting deadly food into their mouths? What the fuck happened to us?

"Garg'n Uair Dhuisgear" which is Gaelic for "Fierce when Roused"

2008-10-01T09:46:00.001-07:00

Justice is such an inconvenience. Sure people talk the talk, but when it gets ugly, or tough, it becomes OK to ditch on the people that need a bit of help. Recently I found out that my school is no longer supporting the free clinic that I got to work at last year.

Let me qualify the word “justice” I feel that by neglecting those around us, we neglect our duty to our teammates. I have pondered this in extent, honestly its one of my favorite things to ponder on a med-long distance run. What it means to be here on earth surrounded by many other different people. I can relate it a little to sports, I realized after my first year of playing college sports that I would never make it beyond that level of sports. As well as lacking any form of actual gift at the sports, I lacked the cut-throat nature that would have pushed to make me harder/faster/stronger. But there is team.

Team is oh so much bigger then me, THAT is what I see when I see justice, that we are all part of the same team, I have a responsibility to my teammates, a responsibility to help them when they need it, to defend them if they need it, to just listen if they need it, perhaps even to tell them that they are full of shit if they need that. Justice is seeking to find that balance of caring, yet not enabling. Not leaving a teammate behind. Its not OK with me to let my teammate die because of something silly and small that can be fixed.

Sorry but I am going to get on my soap box for a moment. I did not get into this whole medical thing to pander to the wishes of the well-fed and rich people of the world. I did it to care for someone who might not get the care they need other wise. Its stupid and lofty, but really its what fires me up and my choices about my education are built to follow that dream. I don’t know what exactly it looks like or who that “person” is, but I felt that part of the solution was this free clinic that provides some level of care for people who cant/wont go to another source, or just plain don’t have another source.

It was pushed so hard last year to keep that in mind, for a moment there I actually believed that there were people around me that truly felt the same way, that it was a core value of the program, I should have known better then to trust any organization to have morals. There are morals in the individual, but ANY organization looses its individual morals and starts to compromise. This is no different. The people who were extremely active in the care at the free clinic have left the school. Once the people who guilt-ed the others into working a little extra left, the idea falls when the center does not hold.

My hopelessly optimistic side wants to say that it was not a failure because it had an impact on me, and perhaps even some others.

Right now I am just bitter and angry that this group of people have decided to abandon part of the team. It pissed me off enough that I started looking around at the nightmare of trying to transfer to another school. But that is where my wrath fails me. In the end, I will cave and just accept that they have abandoned people that I care about. I know it, they know it. Would I give up on my education to prove a point? Cant say that I would. But perhaps I can also make myself enough of a burr under their saddle for the next 11 months to satisfy myself. I am actually quite good at annoying people when I put my mind to it. Because turnabout is fair play, they know that I wont quit over this, but I know that they wont fire me over this. Perhaps it’s a bit like playing Global Thermonuclear War from “War Games”. We used to have this thing called MOD or Mutually Assured Destruction. Its what kept us from nuking the Russians, and them from nuking us, the mutual threat. Both sides know where the ultimate line is, so we can both flex a little and satisfy our selves.

Ok, now the war has begun. They drew first blood.

"The thrill of the fall is part of the dance. I believe in the power of love."~ Cowboy Mouth

2008-09-29T17:50:00.000-07:00

Ok, I can love medicine again. I remember now why I really wanted to do this whole PA thing. I got to see REAL LIVE PEOPLE TODAY!!! Even better then that, I got to see kids! So much fun! Even the poor 13 year old girl who looked like Violet off The Increadables. She had the one eye looking out from the crazy black hair. Its sorta EMO, but we got to chat about her taking rum on the buss and why she got suspended for that and why that might not be a good idea. Ahh, the drama of teen life. So glad I am not in that right now.

But for real, I forgot half the stuff that I learned in Baker, I was trying to write out a nice soap note and I realized that that chunk of my brain is a little dusty. It was actually really hard to remember how to get all that great stuff organized again into something like I thought it was when I left fam med. I realized that I had gotten all the way done with my EMO girl and forgotten to do a physical exam. Ahh, ups. That’s frustrating.

I feel a really cool connection with my new preceptor. Granted I got to work with him like a year ago and knew that I absolutely was JAZZED after working with him at the free clinic, but this hit on a lot of the same ideas. That I really do just “click” with him. AND he is WICKED smart and takes a lot of time to explain things to me in OG speed. Fires me up to WANT to go home and learn more about something cool that I got to see today. So that’s all good stuff.

"The core of mans' spirit comes from new experiences." ~McCandless

2008-09-28T09:00:00.000-07:00

I realized something about myself yesterday. I have a fierce drive to be independent. I was driving across the east side of the state, I stopped by the clinic in baker, got to say howdy to all the staff and doc and everyone. Plan was to stay and perhaps have dinner with PA and his fam and then jet out across the east side to find a nice place to camp out. I know the wild over there enough to know a lot of really nice places to lay my head.

Here is the thing. I thought about staying at PA’s house, but to be honest, I really wanted to go find my own little piece of dirt to sleep on. Its part Boy Scout to be prepared and have a whole life survival kit in the back of the subi just incase there is a zombie apocalypse or something like that. There is something inside me that makes me want to be completely independent or non-dependant on other people. Its totally reasonable to want to sleep on a couch as opposed to the ground. But I had to make myself accept the offer of a bed as opposed to just saying “no thanks, I would rather sleep outside”. But there is more to it then just a nice place to sleep. I wanted to be free from everything, free from any sort of confine that would close in on me. Its all very vague and into the wild-ish, but its not crazy, I don’t think it is.

This need to be free is in a lot of different areas of my life. I need to be free from anything that would seek to confine me to a place or time or space. Anything that would seek to control me must be met with resistance. But does it also block out part of my life FROM other people? Perhaps. I have noticed that it does keep other people out at least on some level. I seem to cycle between wanting to be near other people and wanting to run away from everything. Guess it just depends on what day you catch me on.

The end.

2008-09-25T17:12:00.000-07:00

Makes an interesting start to an entry, but ya its an end. The end of my surgery rotation was today. Cant say I am going to loose any sleep by not being in surgery. In fact, I may even get MORE sleep now. So that will make me happy. I left today from the hospital, got in my car, did not stop for gas, had everything already packed up and ready to roll out. Did not stop till I crossed the state line. Even then I did not feel like stopping, so I did not till I really had to stop to use the bathroom and go figure, where did that happen but baker, so I stopped by and said howdy to the clinic people from last sight and it was amazing saw a few patients that had seen me and they said HI and that they missed me. Does that say something about a patient that realizes that the student is gone for 6 weeks and automatically recognizes them when they roll back into town? I am sure it does and I think that I can spin it two different ways. Either I made a good impression on them, or they are frequent enough fliers that they know any change in the staffing.

So its nice to be back into baker pace. I got a super tasty milk shake and am going to go have dinner with baker PA and fam. Really nothing changed. I feel that I could show up for work tomorrow and fit right back in. Old shoe sorta comfortable.

Overall things that I learned from my last rotation:
1. I can do a lot of different “kinds” of PA job but its MUCH more important to find good people to work with rather then a specific kind of job.
2. Joint injections are actually really easy and do a lot of good for some people.
3. I don’t like being in the OR for 8 hours
4. Abuse has a lot of its effect from the person being abused. It draws its power from what you give it. You have the power to take away some of the power of abuse by denying your “victim” status.
5. Politics can make even nice people into jerks, and it can make mean people into something worse.
6. I really do like to sleep 6 or 8 hours a night, and if I can just sleep for 8 hours I can work the other 16, but I really don’t like 22 hour shifts, they make me grumpy.
7. I like the band Cowboy Mouth
8. I LOVE hotsprings...

The start

Whats a week?

2008-09-19T03:14:00.000-07:00

So, I guess weeks go away when days go away. Its 414 in the AM on Friday, but I think I started this day on thursday, but am not really sure because wednesday sorta went into overtime and became thusday, but then I did get to sleep some before real thursday, but now is it still thursday? I just dont know. Perhaps if I go home and go to sleep, when I wake up it will really be friday. BUT I think that leagally it IS friday now...

I am very confused right now. But I know that my pathetic grip on anatomy goes to shit at 3 AM.

“Change is inevitable growth is optional”. ~Rick

2008-09-17T23:30:00.000-07:00

Ever just hit "the zone"? I may have this week. I managed to dodge my normal doc for 9 (NINE!!!!) days last week, saw her once in passing, but did not have to work with her or get yelled at by her.

I think that something changed in me during that week, or perhaps it was this weekend. I dont know for sure. What I do know is that I reached a new level of not caring about her at all. But the cool thing is that there is such freedom in that. Freedom in a good way. I did not think that I was trying to show her that I was a good student, that I was not a slacker that does not know anything, but perhaps I was. The change is that I just dont care now, but its such a freaking cool thing. I was walking down the hall of the hospital this week and I had a scrubs moment, I saw spine doc walking down the hall, he saw me and we did the walk by high five. Not really sure why we would do that, but hey it happened . I got to do a late trauma pelvic fracture tonight and just got out of it a moment ago. I got a "Wow Matt, that was the funniest thing you have said during your whole rotation with us" from normal surgeon. What did I say you might ask?:

Surgeon: "No, the report says that there is a foreign body in the medial thigh, but they are stupid, its just bone."
PA-S: "Well, cant bone be a foreign body?"
Surgeon: "NO, NO, NO. Bone is NEVER a foreign body."
PA-S: "Well, what if the guy is from France?"

So I guess I am just loosening up and being much more myself, I just like being me and dont like being put in situations that dont let me be me. I dont know why I was hiding it so much but I was. Probably because I was trying so hard to remember all the anatomy of whatever I was working on. Ya, perhaps. But that does not mean I like working for 18 hours a day.

Surgery can still suck it.

Its good to laugh right?

2008-09-16T19:05:00.000-07:00

So, I got to work on a guy early monday morning who happens to look a WHOLE lot like Farva from Super Troopers. In fact this guy was a cop from the local smoky not the highway, but I will still cling to my thin allusion. (is that the correct word?) Perhaps not.

So, I got the txt that we were going to be doing a big case on mon AM so I even studied up early that morning, went to pre-round on the patient read the whole chart so I knew what had been worked up on him already. Felt sorta prepaired for the ineveatable questions that I would get pimped on. But It was a different feeling day, perhaps just because I had such a great weekend and got OUT of Potato town for a bit, got out into the wilderness and soaked in a hot springs, AND then got to peddle around a lake in a paddle boat. FUN!!! So I was feeling happy about the missery of being locked up in a little room for 8 hours doing a big case.

I am getting to know the scrubs and circulators now, at least by the scrub hats that they wear if only because the hat and the eyes are really the only thing that you can see that are even sorta different. I have a feeling that they feel sorry for me, they NEVER give me crap about anything, I guess that they see all the crap that MD gives me and decided that its not worth it to do anything else to me. Or perhaps its cool because it has now become an "US vs HER" deal. We all get yelled at a lot by surgeon so we sorta are in a support group for each other. God help you if you forget to pack her 8 holmans in the hip kit.

So we get big boy all placed in the room this is NOT a small cop, couple too many doughnuts me thinks. Surgeon starts shaving up the L side of the pelvic region. Asks me if I got a chance to look at the films for this guy and being a good student I had, so I asked her a question about what we were going to do to his R pelvis if his break was on the L. Silly. Honnestly I thought that she was going to do something on that side, its a ring after all and break one side perhaps you have to do someething to the other side, I dont know. Well, it turns out that she was working on the wrong side of the pelvis and was just really angry now because she was 15 min behind because of preping the wrong side. Silly me, now she was in a bad mood and was really angry the whole surgery. I tried my alternitive tactic and asked questions about what we were doing, mistake 2, she just ignores my questions and it makes her more grumpy. Sigh.

But the funny part was the guy kept farting the whole surgery. we would be working and he would just let a HUGE one rip. I kept blaming it on the scrub tech. That but it also kept giving me flashbacks to last weeks code brown on the OR table. Shudder... I hate shit.

Post Script

2008-09-15T05:03:00.001-07:00

FYI the picture below is of a "one man band" that I saw at Art In The Park, a cool thing put on by the Boise Art Museum. Artsy-Fartsy people are great I love them. But I have also had a HUGE desire to be a one man band ever since I was 5 or 6 and read a book about one. Its been a life long fascination. I almost quit school to go be one, but could not swing tuition....

“Be who you are and say what you feel, because those who mind don't matter and those who matter don't mind.”

2008-09-13T08:11:00.000-07:00

What if we are a reflection of those around us? I realized this morning that the Surgeon that I have been working with the last few days has a REALLY different view of me then my normal surgeon.

On a side rant, I have decided to call them surgeons, not doctors. Perhaps its like being a POW, you can change the term of address to mean something to you personally, but still have it sound correct on the outside. They are a bunch of monkeys with hammers and chisels, their motivation for caring for their Pt is that they don’t want to get sued. It is not a desire to help people, to help the person walk or live a better life. God help you if you come in as a Medicare patient, you become a “worthless sack of shit” to these people.

Back to the main rant, for the last week, I have managed to avoid working with my normal surgeon for the past 7 days!!! Joy, pure joy. So I have been a good PA tramp and spending time with many different surgeons and learning many different skills and tidbits of knowledge. I have gotten several comments the last week that I did not fully appreciate till this morning. Yesterday I got told that I was MUCH smarter/better at life then the medical resident that they were working with as the last student. Odd because they offered the guy a residency and a job when he was a med student, but he ended up going somewhere else for residency. So yea for that right?

But how can two different MDs from the same clinic have such different views of me? Normal surgeon thinks that I am a box of rocks and that she is really concerned about my level of education. Different MD thinks that I am a super star after working with me for a week and feels that I performed better then a medical resident that they wanted to hire.

The thing that I realized this morning was this: I am partly a reflection of those around me. There is a core part of me that is me, but there is also part of me that responds to my outside environment. So, normal surgeon thinks I am stupid and takes the time to tell me that every day, I just don’t say anything to her and avoid her. It makes me look worse. But there is more to it then that. The back surgeon that I have been working with was the same guy who had the temper tantrum and went ape on me, but also that’s part of the thing that amazes him is that he can completely loose control and yell like he has never yelled at students in his life (really he is actually a really calm and great guy) and the next day I can joke with him and laugh it off, then spend 8 hours in an OR with him.

I have the potential to rise to a challenge, to overcome adversities. But there is also a time when I just hide from that and go back into my shell. Different people elicit a different response out of me. Those that bring out good things in me, I tend to want to be around; those that do not bring out those good things, I don’t want to be around.

Can I shift it? Can I force myself to bring out good parts of me in the face of a negative person? I wish it were that easy.

"We are the music makers and we are the dreamers of dreams."

2008-09-06T22:09:00.000-07:00

I really hope that I am not becoming bitter. I know people who have worked in the medical system and have become bitter. It makes me sad. I think that I would have a long way to go because I started out a long way from being bitter. But I think that it could happen. I think that it just takes a little bit of effort to keep the bitterness out of your heart. I feel it creeping into my sole, I think it could eat me if I do fight it.

I got to do a total hip replacement on a very nice 60something-year-old man who is a refugee from Burma. He had broken his hip three years ago and had just not been using his leg. After the recent flooding in his country, he was let into the US as a refugee. We were able to place the new hip and I really hope that he will be able to get back up and even walk around. It would be amazing! To have a hand in helping him with regaining his mobility and freedom is such a powerful thing.

The thing that struck me was this: Two weeks ago I had to help in a below the knee amputation. Gangrene wound in the foot of a diabetic. There was no joy in that for me. I was holding her leg in my hand and knew that it would never be used again for walking. That this person would most likely never walk again. They would live in a wheel chair and would probably be dead within two years. They would have eaten themselves into a grave.

We are poisoning our own bodies. We are killing our bodies as the rest of the world starves. Is this god’s idea of a sick joke? I feel no justice in this. It makes my heart ache.

Temper Tantrum

2008-09-03T19:14:00.000-07:00

Wow, had a great experience today. I was doing my normal less then good job of being a student. Or perhaps I am just the greatest student EVER and do such a great job of being a student? (students in the medical world are not the sharpest tools in the shed)...

So, we were doing a hip replacement this morning and being the good student that I am, I wake up 3 hours before the surgery to get some extra time in at my "office" AKA the coffee shop downtown to read up on stuff that I should know. Goes great and I am feeling not so stupid, but I get to the OR and set the patent up in the room get sent out to scrub up and get back in. So off get the Darth Vador helmet thing and do the insta clean hand sani. Get back into the room and I made such a good impression on the doc from the next room that he came into our room and pulled me out of the room yelling the whole way that I was contaminating the whole room.

http://www.youtube.com/watch?v=KpSfThUv_pc

Ya, the bottom line is even if you do everything right according to the people that you are currently working for, there is someone somewhere that thinks that you are wrong. And some of those people will tell you that you are wrong and will punctuate sentences with face masks and scrub packs.

I never want to have surgery.

I am learning amazing things. But also really dont think that I am "enjoying" this rotation as much as the last one. I really do like to be able to talk to my patents, well some of them. Others I wish were asleep then I could just run away and not worry about them.

But I also found a new kind of patent today. I guess I have known about this kind of person but this is really different. Someone who really likes having surgery, they like having surgery done on them. I just dont know what to make of that. Met a woman who has had 27 surgeries done on her, really she did not even need the one we were doing on her today, but we did it non-the-less. Some parts of me thinks that this side of medicine is really far away from actually caring for the person. Granted, we need to rotate the tires and change the oil once in a while, but there is just such an un-human element to this aspect of medicine. I guess its the same thing that surgeons call the touchy feeling hippy love of Famly Medicine? Yes, I miss the touchy feely.

And what does this picture have to do with anything? nothing. I made it, it tasted good. I dont do anything fun now a days that I could take a picture of and put on here. That makes me sad, but the pizza tasted really good.

Soup?

2008-08-28T17:49:00.000-07:00

So, I just made some of the BEST soup that I have ever made in my life. And i have made a lot of soups, but this one is AMAZING!!! If you are near, or even not near, you should really stop by and try some.